Of course, with the emergency order in Brooklyn, the focus is now shifting.
So what do we now about the Brooklyn measles outbreak?
the outbreak began in October 2018 and was started by a traveler returning from Israel, where there is a large outbreak
as of early April, there have been 285 cases (we rarely see that many cases in an entire year, even when combining all of the cases in the whole country!)
most cases are in the Orthodox Jewish community, even though this is not a religious issue, except that this community has been targeted by an antivaccine group
429 cases have been in children
85 have been infants
only 24 have been fully vaccinated
the youngest case was an infant who was only 4 weeks old!
21 people have been hospitalized
5 have been admitted to the ICU!
What else do we know?
Although the outbreak is in its 7th month, which is very long for a measles outbreak in the post-vaccine era, there have been over 200 new cases in just the past few months!
So at a time when cases should have already stopped (most outbreaks only last a few months), or at least be decreasing, the Brooklyn outbreak continues to grow!
There is no sign of it stopping either, with new reports of more than 20 to 40 cases each week.
And that’s what brought on the April 9 declaration of an emergency order.
“IT IS HEREBY ORDERED that any person who lives, works or resides within the 11205, 11206, 11221 and/or 11237 zip codes and who has not received the MMR vaccine within forty eight (48) hours of this Order being signed by me shall be vaccinated against measles unless such person can demonstrate immunity to the disease or document to the satisfaction of the Department that he or she should be medically exempt from this requirement. “
ORDER OF THE COMMISSIONER to All persons who reside, work or attend school in the neighborhood of Williamsburg, Brooklyn, New York and to the parents and/or guardians of any child who resides, works or attends school in the neighborhood of Williamsburg, Brooklyn, New York
Does this mean that they will be forcing everyone in Williamsburg to get vaccinated? And arresting those that don’t?
“I want to do the common sense point. We are trying to get people vaccinated. Our goal is not to find anyone. Our goal is not to shut down schools. Our goal is to get people vaccinated.”
Mayor Bill De Blasio
It should be clear that they are just trying to end the outbreak.
“People in violation of the order will be identified through identification of exposures. Disease detectives will check for immunization status or immunity when tracing the contacts of a person who has developed the illness. “
Oxiris Barbot, M.D. Commissioner of Health
And no one will be forced to get a vaccine. You might be fined if you insist on not getting vaccinated and you have been exposed to someone with measles, but you still won’t be forced to get the vaccine.
Why did it come to this?
Couldn’t they just quarantine folks who are exposed?
Well, they have been trying that…
And it hasn’t been working.
In addition to schools continuing to let in unvaccinated students, the health department is concerned that people in the community might actually be having measles parties!
“So we have not used a public health emergency to mandate vaccine in recent history. The circumstance of the combination of a large anti-vax movement in combination with a large outbreak has not happened in the way that it has happened right now.”
Dr. Herminia Palacio, NYC Deputy Mayor of Health and Human Services
The case count jumped again on May 24, to 535 cases.
“The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April… Twelve individuals have received summonses for being non-compliant with the Emergency Order since the City began issuing summonses last week. “
If you are upset that this is happening in Brooklyn, the outbreaks and the response to the outbreaks, just remember that it is the anti-vaccine groups working in the community are to blame.
It’s a common anti-vaccine myth that we rename diseases to make them go away. It helps them explain the control, elimination, and eradication of diseases, since many of them don’t believe that vaccines actually work.
Now imagine that “they” actually found evidence that we did rename vaccine-preventable diseases!
That would be something, wouldn’t it…
Did CNN Rename Mumps?
Of course, they haven’t.
The original CNN story about the USS Fort McHenry stated that the sailors and Marines had parotitis, which was “due to an outbreak of a viral infection similar to mumps.”
Why didn’t they just say that they had mumps?
Because that’s not what they were told by the US Navy’s Fifth Fleet.
“… a military medical team specializing in preventative medical care is expected to deploy in the coming days to make an assessment if further steps may be needed, according to the official.”
US warship quarantined at sea due to virus outbreak
It may come as a surprise to some people, but many viruses and bacteria can cause parotitis. And until the outbreak was further investigated, they didn’t know if it really was mumps or another condition.
Since then, the Navy’s Bureau of Medicine and Surgery (BUMED) has stated that “based on clinical presentation and laboratory testing, these cases are currently classified as probable cases of mumps.”
Still, a very small percentage of the sailors and Marines on board have gotten mumps. That’s because vaccines work, even when they don’t work perfectly well.
“Beginning in 1991, the military services implemented universal recruit immunization with a single dose of MMR vaccine, regardless of prior vaccination history. Shortly thereafter, and informed by the results of population serosurveys, the Air Force transitioned to a policy of targeted MMR vaccination, limiting the administration of MMR vaccine to recruits lacking serologic evidence of immunity to measles or rubella. With recent outbreaks of mumps, concerns have arisen that the practice of not specifically screening for mumps immunity in determining the need for MMR vaccine could lead to a relative increase in mumps risk among military recruits subject to screening. “
Eick et al on Incidence of mumps and immunity to measles, mumps and rubella among US military recruits, 2000–2004
Unlike measles, the MMR vaccine provides good, but not great protection against mumps.
And although military recruits are screened to see if they have low titers for measles and rubella, they still aren’t screened for mumps. The theory is that if their measles and rubella titers are low, then their mumps titer will be low too and they will get an MMR vaccine. Of course, this misses some who just have a low mumps titer, possibly an effect of waning immunity.
Mumps on the USS Fort McHenry
And that’s why we have been seeing mumps outbreaks on college campuses and most recently, on a Navy ship, although that isn’t a reason for everyone to go out and check their titers.
In the pre-vaccine era, although mumps was supposed to be a common childhood illness, about 1/3 to 1/2 of military recruits had never had mumps.
That meant big outbreaks of mumps that were hard to control, unlike what we see today.
“This article reports a recent public health response to 3 imported mumps cases occurring at Fort Campbell, Kentucky, that resulted in a contact investigation for 109 close contacts across varied settings. No secondary mumps cases were identified.”
Public Health Response to Imported Mumps Cases – Fort Campbell, Kentucky, 2018
Instead, not only do fewer people get sick during mumps outbreaks these days, but fortunately, they have fewer complications.
In addition to a swollen jaw, mumps is known to cause orchitis, aseptic meningitis, oophoritis, pancreatitis, and encephalitis.
“Risk was reduced for hospitalization, mumps orchitis and mumps meningitis when patient had received 1 dose of measles, mumps, and rubella vaccine. The protective effect of vaccination on disease severity is critical in assessing the total effects of current and future mumps control strategies.”
Young et al on Mumps Complications and Effects of Mumps Vaccination, England and Wales, 2002–2006
Fortunately, those complications are reduced when you get vaccinated. And so are your risks of actually getting mumps in the first place!
“This study demonstrates a significant preventive effect of two-dose vaccination against mumps complications (orchitis, meningitis, or encephalitis) and hospitalization for mumps.”
Orlíkováet al on Protective effect of vaccination against mumps complications, Czech Republic, 2007-2012.