Rockland County Health Commissioner, Patricia Schnabel Ruppert, gives an update on the measles in Rockland County Wednesday, October 17, 2018
Peter Carr, [email protected]

Proceeding at the weekend, health officials confirmed 74 cases of measles in Rockland, another 24 in Brooklyn and 14 in Lakewood, New Jersey.

The current outbreak was found in Israel, which has more than 1,500 cases of measles and a child fatal to complications from the virus.

Israeli outbreak can be traced to people who have traveled to other areas that have spawned, especially in Ukraine, where the World Health Organization has reported that more than 23,000 people have been affected. Many Orthodox Jews traveled to Ukraine for Jewish high holidays in September.

New York health officials add that in addition to the outbreak in Israel, there are major outbreaks in Europe, with more than 41,000 cases of measles and 40 deaths reported this year.

The European Center for Disease Prevention and Control stated that vaccination rates are below 95% in most countries in the region. The World Health Organization sets 95 percent as the number when the so-called herd immunity is effective, which prevents the spread of the cases.

Since the end of September, when travelers have brought the first cases of measles in the area, health officials have worked to limit the outbreak. This includes vaccination, public and medical education, and school management.

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Rockland was exposed to measles in early October, when five visitors, mostly natives, arrived from Israel, two were traveling alone and the other three traveled together. Most of the exhibition sites were in New Square, Monsey and Spring Valley, but since Rockland is a small county, health officials have said that anyone not vaccinated in the province is in danger of capturing measles.

Measles are extremely contagious, with a 90% chance that a vulnerable person will catch the virus, which diffuses from airborne particles, from breathing, coughing and sneezing, and can stay in the air for up to two hours after exposure.

The first visitor from Israel came during Sukkot's Jewish holidays and visited a synagogue, an outside residence next to a school and the Refuah Health Center. The others who visited Israel and were affected by measles visited synagogues, a gym and a reflexology center and shopping centers in early October. Subsequent affairs had been contracted by original visitors or exposure to websites they visited.

The sick are children, adolescents and adults, and there have been hospitalizations, including a child in the pediatric intensive care unit, according to health officials in the county.

Rockland County has a total vaccination rate of 94% and the state of New York is 98%.

In order to increase vaccination rates, especially in the Orthodox Jewish community where a large part of the outbreak occurred, prefectures and health officials have kept vaccination clinics for the free vaccination of measles, mumps and rubella (MMR).

Together with the Refuah Health Center in Spring Valley and private doctors, healthcare providers have provided more than 6,100 MMR vaccines since the onset of the epidemic.

The Health Commissioner of Rockland, Dr. Patricia Schnabel Ruppert, also ordered non-immunized children to stay home from New Square schools and from schools with a vaccination rate of less than 80%. This affects 34 private schools in the county. Health officials carry out day-to-day school checks to ensure compliance.

Students will be able to return 21 days after the last case of measles has been documented.


The outbreak has mainly affected children in Orthodox Jewish communities in Borough Park and Williamsburg. The first report occurred when 3 unvaccinated children returned from their trip to Israel. Other reports came from visitors from Lakewood and Rockland, according to health officials.

All patients are between 7 months and 4 years, according to health care officials. Ministry of Health and Mental Health of New York Assistant Commissioner for the Immunization Office Dr. Jane R. Zucker said the age factor may contribute to the reason why there are so many more cases in Rockland than other areas of the epidemic.

"We have good compliance with immunization in school age children," said Zucker. "What he sees (Rockland) is different from what we see."

There have also been hospitalizations associated with this outbreak, officials said.

Health officials work with local health service providers and hospitals to raise awareness of measles and review how to treat and reduce the disease. Strategies include the provision of vaccines to doctors and clinics, the sending of alerts to religious schools, the placement of advertisements in newspapers and the distribution of health care and literature posters.

The New York Ministry of Health and Mental Health recommends that all six months of age or older get or complete their MMR vaccinations before they make an international trip.

Health care workers recommend that non-immunized students stay at home from school during a measles event They require all non-vaccinated children to stay at home when a student at school is confirmed to have measles – regardless of medical or religious exclusion . Students can return to school 21 days after the last known report.

Immunization rates have risen since the event, with more than 600 vaccines being given to Williamsburg in October, according to data from the health department.

Employees also encourage parents to adhere to the vaccination program. Zuker said what they see is "vaccine hesitancy," where parents delay vaccination until their children start school, but this is problematic and can contribute to events.

"This epidemic would not have happened if the children were vaccinated in time," he told the children who were the first to get sick.


The recent exposure to measles at Lakewood occurred in early November when an infected person visited a doctor's office, according to the health department of the county.

This outburst is linked to those in Rockland and Brooklyn and also comes from an adult traveler coming from abroad. Ocean County Health Officers reported exhibition venues as a synagogue, kosher restaurants, grocery store and medical centers from mid-October to early November.

Several businesses, including a restaurant and a gym that has separate hours for men and women, have asked for non-immunized people not to come to their premises, and Jewish pediatricians in Lexicus have come together to sign a letter that supports vaccinations.

Some schools have been unable to attend non-immunized children since the event began. Health clinics and non-profit institutions have also given thousands of vaccines in November. Brian E. Rumpf, director of program management and development for the county's ministry of health, said 12,400 doses of MMR vaccines were dispatched to the county since the onset of the epidemic on 24 October.

Ocean County has about 93 percent overall vaccination rate for school-age children, according to New Jersey State Department of Health.

Monsey and Lakewood had some boost from the vaccine from a small minority of communities. An Orthodox Jewish telephone line addressed to women called Akeres HaBayes had a record that called on parents to send their non-immunized children to school regardless of the event and received a long and detailed letter from a proxy who supported their cause.

Also published information on the vaccine that is being circulated by an organization called PEACH (Parents Educating and Supporting Children's Health).

Other groups present a study after studying that failure claims that there is a link between vaccinations and autism. The American Academy of Pediatrics stated in a statement that "claims that vaccines are associated with autism or are not safe when given according to the recommended program have been denied by a strong body of medical literature."

The Orthodox Union and the Rabbi Council of America published a joint statement on vaccination support and stated that the Jewish law stipulates that a person is required to take care of his or her health and to take measures to prevent harm to others including vaccination .


Although Israel has high rates of vaccination, there are "pockets" of unvaccinated communities that have very low rates of incidence, according to the Israeli Ministry of Health.

"The primary site of the disease is in Jerusalem, where 60% of the patients are, and we have also identified" pockets "in which the inhabitants have not been vaccinated," said Moshe Bar Siman Tov, General Manager of the Ministry of Health, in a published statement. "We have managed to increase the coverage rate for vaccination in the Jerusalem neighborhoods in very large numbers. We have been able to bring Jerusalem very close to the national coverage rate for vaccination. "

The ministry has made funds available to address the outbreak and said the percentage of vaccinations in these communities has increased from 55 percent to over 80 percent.

She has also kept family care centers open in the evenings, sending mobile units to cope with the event and vaccinating, hiring more medical staff, and restricting access to unvaccinated people in hospitals and schools.

Approximately 650 of the confirmed cases of measles have affected children under the age of 4 years. Another 500 children and adolescents. the rest are in adults.

About measles:

  • Measles can be very risky. About one in four people taking measles will be hospitalized, one in 1,000 cases may cause swelling in the brain and one or two out of 1,000 people may die, according to the Centers for Disease Control and Prevention.
  • It is particularly dangerous for infants and young children as well as for pregnant women who are not immune to those who are immunosuppressive or immunosuppressed, such as cancer patients.
  • The symptoms of measles include fever, cough, nasal runny nose, red eyes and rash. Symptoms usually occur 10 to 12 days after exposure, but may already be seen for seven days. The full incubation period is 21 days. People are infectious four days before and after the onset of rash.
  • Frequent complications of measles that affect about 1 in 10 include ear infections that could cause permanent hearing loss and diarrhea. The most serious complications include pneumonia and encephalitis or brain edema, which can cause convulsions or mental disabilities.
  • It is recommended that residents check the immunization status. If you have measles symptoms, call your health care provider or local emergency care before you go to minimize exposure. Residents who have symptoms are called to stay at home and not go public.
  • Doctors and health care providers assure that the measles vaccine is safe and effective. It has a 97% protection rate with two MMR shots. One dose provides 93% measles protection.
  • The first dose is usually given to children aged 12 to 15 months, and the second dose is given at four to six years of age or before starting school. During an outbreak, a child may take the first dose for six months but will still need two other doses as normally scheduled. If the children had only one dose, they would have to take the second dose as soon as possible, as long as it is 28 days after receiving the first dose. The second installment will be counted for entrance into the school.
  • People are considered protected or immune to measles if they were born before 1957, have taken two doses of MMR vaccine, have taken measles virus with a doctor or provider, or have a laboratory test that confirms immunity. If someone is vaccinated and gets measles, it is often a much milder case and is less likely to spread to others.

Asbury Park Press reporter Stacey Barchenger contributed to this report.

To read more about Rockland Measles and other stories from this reporter, visit

Twitter: @ReporterRox

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