When the girl had arrived in the emergency room, she had been placed in an area where children with earaches or broken arms were usually seated. Nobody suspected measles because, thanks to the routine vaccination of children, the disease has been declared eliminated in the United States in 2000. Although there have been localized outbreaks since then, among the Amish in Ohio, visitors to Disneyland California and the American Somali community of Minnesota – neither Arroyo nor the most of his associates had seen a first-hand case. Suspecting measles was like thinking "maybe it's a unicorn," Arroyo says. "It does not really cross your mind because measles should not exist anymore."
Several cases of measles have been reported in another part of Brooklyn. And after a few hours, the Arroyo team began to fear that the child they were guarding might be another. They put a mask on her face and took her to an isolation room with two doors and air flowing under negative pressure to prevent airborne particles. to escape.
However, by that time, "the bomb had exploded," Arroyo said. Measles is considered one of the most contagious diseases in existence. If a person with measles crosses a room with a hundred people who will not be immunized, up to 90 of them will contract the disease. The virus spreads by coughing and sneezing and stays in the air for two hours. Each year, some 122,000 people pass through the Maimonides emergency room. The hospital, located in Borough Park, serves one of the country's most diverse patient populations, from ultra-Orthodox Jews to people whose mother tongue is Mandarin, Russian, Hindi , Punjabi, Arabic or Uzbek. Many are taxi drivers, manual workers, and working-class restorers who take their children to the ER at night once their work is done.
Arroyo thought of the dozens of patients who could have been exposed in the waiting room, the hall, the examination rooms – in the street where Halloween was, from the moment the girl entered the room. Hospital until its isolation. He looked at his daughter in a carriage, disguised as a clownfish, and said to himself, "She is not vaccinated." She was still too young, because it was about other babies who could have been in the emergency room. He knew that his team should immediately determine exactly who was breathing the same air as the infected girl. I made a sign to his wife, who was walking down the street with their toddler, to ask him to take the pram. Then I went home to make phone calls. "I saw my life fall into a measles gulf," he says.
Arroyo is an amateur kickboxer, skinny and sporty. I rushed to the street, talking on the phone with the hospital nurse for infection control and planning. At home, he left the octopus costume and consulted the hospital 's electronic medical records to check the exact time when the girl with measles had entered the emergency. I called other doctors who were on duty to find out if they remembered pregnant women or immunocompromised children who would have been particularly at risk.
He also called the hospital's IT department to go back in medical records. His team generated the names of 55 children who had been exposed to the disease, then asked the New York City Department of Health to compare it with the vaccination records. For the MMR vaccine (against measles, mumps and rubella) to be effective, the immune system must be mature enough to produce anti-virus antibodies. The immune system of young babies is not sufficiently developed, they usually receive a MMR vaccine at the age of 1 year and another at 4 or 5 years. those who had gone to the hospital but had not completed both doses were considered at risk.
The list of Maimonides included babies aged 12 months, 10 months and three less than 6 months old, including one just 17 days old. All were vulnerable and Arroyo realized that he was already running out of time. To prevent infection, children had to receive MMR vaccines within 72 hours, and young babies would have received immunoglobulin, a form of temporary protection, within six days. The nurse in charge of infection control started calling the parents of these babies.
When the MMR combination vaccine was introduced for the first time in 1971, it was considered a triumph of science and public health. In 1998, however, doctor Andrew Wakefield published an article now infamous in the medical journal The lancet who claimed to show a connection between MMR and the symptoms of autism. Although the results were firmly refuted and the paper retracted, Wakefield lost his license to practice medicine. His claims were deeply buried in small clusters: celebrities and others with autistic children and suspects of traditional medicine and pharmaceutical companies. Some of these anti-theft activists have sunk into the plot, claiming that vaccines contained contaminants and that the Centers for Disease Control and Prevention was engaged in a grim camouflage. When technology platforms such as Facebook and YouTube appeared, they magnified the antivirus message. in all its forms. The notion that vaccines could also be dangerous from these sources for the ultra-Orthodox Jewish communities in Brooklyn, where ideas have spread mainly in analog form of emergency phone lines and pamphlets. By 2018, when the vast majority of parents in these communities were still vaccinating their children, they were frightened enough that misinformation could blow up New York hospitals like Maimonides.
The Arroyo team has been successful in reaching and preventively treating just about every vulnerable child exposed to measles that day in late October. But he had barely recovered his breath when, in mid-November, another child with fever and a rash arrived by ambulance to Maimonides. Another child with a suspected case of measles – this one a young child – arrived a few moments later with another entry. At that time, the baby was sequestered in the negative pressure chamber. The infant was then tested negative for measles, while the toddler tested positive. It was an unfortunate moment and many patients were exposed to the infected air.
The hospital team resumed calling. The children returned to be shot and their parents were asked to keep them at home for 28 days. The nurse who greeted the patients at the registry office looked after those who had fever and rashes and who needed immediate isolation. She rushed to the admission area to examine the disturbing rashes.
As the fall fell, cases continued to arrive.
Chany has passed She spent most of her life in Borough Park, not far from Maimonides. She has a young face, with bright green eyes and a shy smile. When we met at her home near her home, she wore a wig, she was a married woman from her ultra-Orthodox community and she was modestly dressed in a black skirt and sleeves, with a black striped duster. and white top It had been more than a month since we spoke on the phone of the journey that his life had followed, patient patient to militant. She greeted me with a hug, but seemed to become suspicious.
When Chany married and started having children in the 1990s, she took them to a pediatric practice and saw no reason to question the doctors' recommendations. His first three children received their vaccines on time. "I was open to doctors, like a nice little girl," she said. "Whatever they said, I did it."
As soon as her children grew up, Chany noticed problems that she said "should have been a red flag". The first child had recurrent ear infections. When the third child was about a year and a half old, Chany's father said to him, "I do not think he's hearing it." The boy was later diagnosed as being in the autism spectrum.
Chany, whose WIRED family name had agreed not to publish, had heard that the vaccines could cause injury, but she had not thought much about it. Now a glimmer of doubt entered his mind. When her fourth child was old enough to receive MMR, she expressed her nervousness about the vaccines to the doctor. She says that I swept it, saying only that the shooting was safe and effective. Chany felt dismissed and disappointed at having allowed the child to be vaccinated. "Why can not I tell him I do not want that now?" Thought she. "Why can not I defend myself?"
Chany had hoped to go to college and become a speech therapist. By the time her husband graduated, however, she was absorbed by the demands of a growing family. Now she has turned the time and the energy she had to read about the vaccination. While searching for books online, she found one from Sherri Tenpenny, an Ohio doctor who claimed that vaccines were linked to autism. An anti-theft source led to another. Chany began printing lists of CDC vaccine ingredients, browsing the Internet and watching videos. Andrew Moulden, a Canadian neuroscientist, drew his attention to the videos and claimed that vaccines cause autism by causing oxygen deprivation or "mini-shots" in the brain. "His information has really opened things up," says Chany.
She now felt certain that the speech and hearing of her third child had been aggravated after she began receiving vaccines. She contacted a well-known skeptic of the vaccine, Mayer Eisenstein. Unlike his pediatrician, Eisenstein listened sympathetically to his concerns and even gave him his cell phone number. By the time Chany's fifth child was shot, she was firm in her convictions. She believed that the vaccination had caused the disability of her children. "I realized it was my fault," she says. "And if I make a mistake, I'll have to fix it."
Chany decided to create a forum for women in her community. "Nobody likes to be alone," she says. "If your child has just been vaccinated and is no longer talking, your doctor will not respond." Some Hassidic cults worry about the use of the Internet, ultra-Orthodox women often receive community news, inspiring discussions and other information. through the phone. Chany has worked with other people who have set up a hotline called Akeres Habayis, or Housewife, so that she can use it to share information. "Mothers can feel that something is wrong with a child," she said, "and you should listen to their feelings and not disrespect them."
In 2000, the United States declared that measles was defeated! – Within its borders. Except that not quite. Cases have once again broken out sporadically. The country is currently experiencing the worst epidemic in more than 20 years. Between 1 January and 13 June this year, 1,044 people, mostly children, in 28 states were treated with the disease. So how was measles eliminated and is the current epidemic a sign that she has come back for good? The answer is more complicated than you think.
What does elimination mean?
Word elimination This seems absolute. But when it comes to measles, that does not mean that the United States has no cases. This means that no current strains are native to the United States. But the virus can still be imported from another country.
Elimination, a story
In March 2000, a group of experts convened by the US Centers for Disease Control and Prevention met to review the status of measles. They agreed that the few hundred cases of the last three years could be mainly administered to people carrying strains from other countries. But they did not agree on the opportunity to use the e word. Many feared that such a statement instils a false sense of security and cancels a three-decade long vaccination campaign. In the end, they have taken the plunge, hoping to give the example. Sixteen years later, the World Health Organization declared triumphantly that the Americas – 35 countries and 12 territories – were the first region to eliminate measles. The rest of the world is committed to achieving the same goal by 2020. But in an interconnected world, the elimination of the disease is a fragile concept.
The first to fall
A country loses its WHO elimination status if a single strain of measles virus persists for 12 months or more inside its borders. For Venezuela, plagued by terrible political and economic turmoil, this Rubicon was crossed in July 2017. The following year, as the health system collapsed, the measles epidemic has sickened 5,475 people and killed 74.
Will the United States be the next?
The CDC tracks all strains of the measles virus that enter the United States. Currently, the longest-distributed strain is the D8, the one that triggered ongoing outbreaks in Brooklyn and Rockland County, New York. It has been spreading since September 2018, meaning that health authorities have only a few months to stop transmissions before measles is officially reestablished. If the United States loses its elimination status, it will not be due to economic chaos or lack of resources; it will be because viral disinformation has proven to be more difficult to contain than the virus itself.
This feeling of disrespect and dismissal by doctors has fueled Chany's mistrust of vaccines, but his suspicion of medical authorities may have taken root. Two of his grandparents were survivors of Auschwitz. The other two lived in Romania under the communist regime, where they were subjected to physical violence, before settling in Brooklyn in the 1960s. Torture, medical experiments and death by decree of the government seemed an element inescapable of Chany's legacy, and this was shared with members of his community. According to her, the efforts of the lay health services to impose vaccination as a threatening invasion of privacy.
Chany began organizing conference calls, later posted on Akeres Habayis. She began to invite speakers, including well-known skeptics about vaccines. One of his first guests was Mayer Eisenstein and 47 people attended. Some of the most popular calls brought several hundred women to live conversations, and a thousand or more of them later went on to listen to the recordings. Chany got to know a wide range of antiviruses that made themselves known on the Internet but had not yet found their place among the ultra-Orthodox. The hotline has made it a powerful vector of misinformation in a world that has often fled foreigners.
While Chany was building relationships with other like-minded people in her community, she proposed an informal name for the network: Peach (Parent Education and Child Health Promotion). "It was only a name," she says. "It was a way to identify people who were in the same situation." Around 2012 or 2013, a man named Moishe Kahan told him to collaborate. Kahan lived in Williamsburg, another Brooklyn neighborhood with a large, ultra-Orthodox community. Kahan had grown up in London and had not been vaccinated as a child. Over time, I became fiercely resistant to the very idea of them. Kahan has developed a presence on Facebook, promoting conspiracy theories from sources like Infowars. He has also become an independent distributor of a company called Immunotec, which sells dietary supplements and has funded research on the use of its products for autistic children. (Kahan did not respond to emails requesting a comment.)
Chany and Kahan have joined forces. In 2014, Peach published a booklet entitled "The Guide to Vaccine Safety: An Informed Parent's Guide", in which Kahan was listed as a researcher. It was paid for by local business ads and contained such vaccines ostensibly linked to autism, SIDS, allergies, asthma and cancer. A series of illustrations shows mothers who have trouble communicating with arrogant doctors. "Doctor, my child has become autistic / epileptic / anaphylactic after his vaccinations," says a woman holding a baby in her arms. "Obviously, your child was defective.Vaccines are perfect," says the doctor. "How many" defective "children would have remained perfectly healthy without the vaccines?", Asks the caption.
In another illustration, a woman holds her arm around a little boy. "I am regressed in autism after his MMR vaccine, now he is in his own world and can not communicate," she says. "But at least we had no problem enrolling him in school."
The tone of bitterness and regret from the textbook reflected Chany's feelings. Similarly, the call for mothers to feel empowered. There was an email address that people could write to and Chany would answer. The booklet also provided the number of a "Peach Hotline", which connected the callers to the Akeres Habayis. Through the telephone service, they asked for volunteers and Chany explained to those who contacted her how to distribute the flyer in their neighborhoods. "It's a grassroots movement," she says. "It's literally from person to person."
Early 2014, an ultra-orthodox woman named Zahava, who lives in Williamsburg, found a copy of the fishing pamphlet on her doorstep. For more than 70 years, Williamsburg has been home to Hasidic Jews, including many descendants of Eastern Europeans who settled after surviving the Holocaust. The Hasidim tend to live in close communities, according to the principles laid down in the Jewish texts. Zahava, who has agreed to speak as long as her full name, is pious and lives in a large apartment building, where children play together and where extended families gather for meals. Other people in his building also received the brochure on fishing, and friends and neighbors were interested in these sensational statements, especially those relating to autism.
Approximately 40,000 copies of the booklet were published in kosher grocery stores and apartments in Williamsburg and Borough Park, as well as in the ultra-Orthodox communities of northern New York State and New Jersey. Zahava, who has delicate features, pale skin and clear eyes, reads the pamphlet only a few months after the birth of her first child. She felt terrified. The pamphlet exacerbated the concern that he and other new parents often felt about bringing babies into a world of pesticides, plastics and pollutants, and seemed to offer a simple explanation for almost all physical abnormalities or development. "It does not take much to scare a mother," says Zahava. "And once the fear is there, it's very difficult to get out of it and move on to logic."
Zahava did her shopping in a premium kosher market and had the groceries delivered to her home. One day, in his order was another copy of the booklet. He returned with subsequent deliveries of food, worrying about vaccinating his young son. Whenever she took her son for a medical examination or a sickness visit, she bombed Dov Landa, the medical assistant who was treating her child, with questions. She felt reassured by her informed answers and her concern for her son, but self-doubt would come back.
One day, at the grocery store, Zahava saw a pile of pamphlets and felt her distress grow again. After asking the cashier if she could get them, she went out with the pile and threw it in the nearest bin. Eventually, Zahava took her to Landa for her vaccinations.
In 2015, Zahava had another child, a boy who had an easy temper, but who continued to have high fever and ear infections. "Every time we went to the doctor, something happened," she says. His recurrent illnesses meant that his vaccinations had to be delayed. Just before his second birthday, in 2017, he was diagnosed with a rare form of cancer. After nine months of chemotherapy, Zahava is in remission. But with a compromised immune system that would not respond to vaccines, I could not receive his vaccines.
In October 2018, just one month after receiving the green light to start preschool, Zahava 's husband was informed of a measles outbreak on a direct line of information in Yiddish. A traveler who had contracted the disease in Israel during the Jewish Sukkot holiday had brought it back to Brooklyn. The couple called Landa, who suggested they keep their home for a while.
Vaccines protect individuals, but they also protect the most vulnerable people in communities through a process called herd immunity. If enough people are immunized, there are simply not enough susceptible individuals for the virus to spread easily throughout the group. The virus is out of breath by forcing the doors of impenetrable fortresses before it can reach those who are too young to be vaccinated or whose immune system is weak. Communities are spread across entire countries, but also in groups of people close to each other or with a strong group identity. To achieve collective immunity against measles, about 95% of communities must be immunized. And so its success depends on a high degree of cooperation; Even a small number of holdouts can precipitate a crisis.
That's what happened in Brooklyn, slowly, then all at once. Five years ago, the average vaccination rate in Jewish schools in Williamsburg, Borough Park and Bushwick was 97.8%. Today, it is 96.2. About 9% of private schools in Brooklyn have vaccination rates below 90%. At a yeshiva in the Borough Park neighborhood, nearly 97% of students were vaccinated against measles in 2012; today, the rate in this same school has dropped to 72.7%.
The loss of herd immunity has made the rapid spread of measles once introduced to Williamsburg and Borough Park almost inevitable, as extended families live nearby and congregate frequently in synagogues and community halls. Measles cases were increasing worldwide, with more than 170,000 reported in 2017. In October 2018, measles arrived in Brooklyn not once but at least six times. At least one child carrying the disease arrived from Israel and other travelers brought it back from Ukraine to the United States, where the border war with Russia had disrupted the efforts in public health. In Indonesia, Madagascar and the Philippines, poverty and lack of access to health care in the event of a measles epidemic. In the United Kingdom and several other European countries, misinformation was largely responsible for increased vulnerability.
Disinformation has been spreading for years on technological platforms, thriving in what researchers call networks of "small worlds": clusters of highly interconnected individuals that tend to reinforce each other. Instagram, Facebook and YouTube had done little to limit propaganda, but as measles spread throughout the country and lawmakers and journalists came under increasing pressure, they succumbed and took modest action. Facebook, for example, announced that it stop promoting anti-vaccine information through announcements or recommendations, although many well known agitators remain active. On Amazon, skeptical of vaccines always dominates the search results.
In the ultra-Orthodox communities of Brooklyn, the name Peach has been adopted by other groups of skeptical parents facing vaccination. In 2018, while the disease was going through yeshivas and gaming groups, Chany's forum continued to receive phone calls. Women with sick children phoned Akeres Habayis and exchanged remedies that they had used to take care of at home. Some were reluctant to consult pediatricians and report to the health department, says Chany. "Measles is not polio," she adds, "and it's not smallpox, nor is bubonic plague."
But measles can have serious long-term consequences, such as suppression of the immune system and cognitive impairment, even for healthy children. And for someone like Zahava, with a vulnerable child, it was just as scary as the plague. When another Peach pamphlet appeared at Zahava's doorstep in 2018, her frustration increased. She heard that a child in her son's class, affected with measles. Zahava called the mother, explaining that if the virus was contracted, it could result in pneumonia, swelling of the brain and even death. She needed to know if the woman's child had the disease before returning it to school. "I told him I had to protect my child," Zahava said. And she said, "So maybe you give vitamins to strengthen your immune system. "I told her that it was not going to help at this point … She talked about vaccines that cause cancer, autism and all the rest." is not at all where I want the conversation to go in. Can we do it again, does your child have measles or not? "
Zahava savait que la grande majorité des parents de Williamsburg immunisaient encore leurs enfants. Mais la minorité semblait la plus forte. À un petit ami de son neveu, une femme "se parlait en bleu de la mauvaise qualité des vaccins". Zahava remarqua trois autres femmes – une avec un bébé, une enceinte et une nouvellement mariée à l'écoute, ravie. Plus tard, elle a regretté de ne pas avoir parlé. Lorsque sa belle-sœur lui a parlé d'une infirmière orthodoxe nommée Blima Marcus qui dirigeait des ateliers sur les vaccins, Zahava a décidé de l'inviter à Williamsburg.
En décembre, environ 10 femmes hassidiques, principalement âgées de 20 à 30 ans, étaient assises dans de minuscules chaises orange dans une classe de jardin d'enfants d'une école locale. Marcus, qui se tenait devant la salle, est une infirmière en oncologie qui consacre une partie de son temps à conseiller les familles religieuses sur les soins de fin de vie. Lorsqu'elle a pris conscience de la quantité d'informations fausses qui circulaient dans sa communauté, elle s'est donnée un cours intensif en science des vaccins. Elle passe des heures par semaine à parler avec les mères et à prendre soin de leurs préoccupations.
Ce jour-là, l'une des premières questions qu'elle a posées aux femmes de la classe était de savoir si elle devait se soucier de savoir si les vaccins causent l'autisme. Étant donné la science bien établie, elle ne voulait pas perdre de temps inutilement. À sa grande surprise, elle dit: "Les femmes ont dit:" Bien sûr, nous devons discuter de l'autisme! "
Marcus a expliqué comment l'étude d'Andrew Wakefield avait insufflé de la vie au mouvement antivax. Mais l'étude était minuscule et profondément imparfaite. "En plus de 20 ans de recherche, cette étude n'a jamais été reproduite", a déclaré Marcus aux femmes. Entre-temps, de nombreux documents examinant les dossiers médicaux de centaines de milliers d’enfants n’ont trouvé aucune association entre le vaccin RRO et les symptômes de l’autisme. Elle a expliqué que l'utilisation des vaccins ROR était une source de préoccupation pour la portion du vaccin contre les oreillons qui était alors utilisée dans ce pays. Mais pendant la période d'utilisation du vaccin tombant à zéro, les taux d'autisme ont continué d'augmenter. Lorsque Marcus a montré aux femmes un graphique des deux tendances qui évoluaient dans des directions opposées, plusieurs d'entre elles avaient le souffle coupé. "C'était le cas pour la plupart des gens dans la pièce", dit Marcus.
Marcus a réfuté d'autres mythes sur la vaccination. Certaines femmes ont entendu dire que les vaccins contiennent de l'aluminium pouvant nuire aux enfants; Marcus a expliqué que l'aluminium est utilisé pour stimuler la réponse du corps à la vaccination et que la majeure partie de celui-ci est éliminée du système en quelques jours. Des quantités minuscules de substances, même effrayantes, sont peu susceptibles de causer des dommages, a-t-elle déclaré, invoquant le vieil adage "La dose rend le poison."
La belle-soeur de Zahava était là et a ressenti un soulagement. Entendre de la désinformation jour après jour, explique-t-elle, vous permet de deviner facilement et de penser: «Une seconde, suis-je le fou?». L'infirmière avait des réponses à toutes ces absurdités.
Fin mars, Des tracts sont apparus sur les lampadaires autour de Williamsburg et de Borough Park: "Une fois pour toutes, Clarity!" Le dépliant présentait l'image d'une seringue massive dans la main d'un médecin, avec les mots "Les vaccins sauvent des vies!" le canon d'une arme à feu, contrant "Les vaccins sont dangereux!" Des annonces similaires ont été publiées, en yiddish et en anglais, dans des journaux locaux gratuits.
Le texte du dépliant indiquait les numéros de téléphone pour une discussion téléphonique avec des médecins, des avocats, des rabbins et des politiciens le 31 mars à 20h30. À Williamsburg, des appels automatisés ont exhorté les familles à écouter. Zahava dit qu'elle a reçu cinq rappels sur son téléphone fixe dans les jours précédant l'événement. Personne ne semblait savoir qui organisait l'appel. Dov Landa, qui traite les enfants de Zahava et environ 10 000 autres à New York, avait vu les annonces sur le groupe de discussion WhatsApp et avait spéculé tout au long de la journée avec des collègues.
Landa estime que seulement 1% de ses patients sont farouchement opposés aux vaccins, alors que peut-être 20% sont sincèrement confus et submergés par de fausses informations. "Ils ont entendu le message tant de fois, même les modérés commencent à croire qu'il y a peut-être quelque chose à faire", dit-il. Son approche consiste à parler aux parents de la sécurité des vaccins, un à un, encore et encore. Il quitte rarement le bureau avant 22 heures et se retrouve souvent à répondre par SMS à des questions sur le vaccin ROR au milieu de la nuit. Il se levait à 2 heures du matin et a récemment convaincu un père réticent d'amener sa fille pour un deuxième coup que la famille avait retardé pendant des années. Landa, membre de la secte orthodoxe de Lubavitch, distribue une brochure que Blima Marcus a écrite à un groupe d’autres infirmières orthodoxes sur les vertus des vaccins. J'ai rappelé aux parents que de nombreux rabbins ont fortement soutenu les injections systématiques. Cette forme de persuasion est "extrêmement lente", dit-il, mais il pense qu'à long terme, c'est le moyen le plus efficace de changer les mentalités.
Aucun de ces messages n'a été diffusé lors de l'événement du 31 mars. Au lieu de présenter des informations scientifiques, l’appel a présenté des sceptiques au sujet des vaccins ou des critiques absolues. Il a été organisé par un groupe appelé PACT-Parents Advocating for Children Together. Chany says Peach isn’t connected to PACT but told me “it’s the same idea.” In the past few years, among the ultra-Orthodox, the antivax movement has become a larger, loosely organized confederation: “If someone wants to do an event, they just do it,” she says. “There’s no central organization.” Chany supported PACT by donating through the group’s GoFundMe page and called in to listen. “It was good,” she says. “It woke people up.”
During the call, Del Bigtree, who produced the movie Vaxxed with Andrew Wakefield and others, conducted an interview with Lawrence Palevsky, who describes himself as a holistic pediatrician. In sober cadence, Palevsky said “medical scientists are even using measles virus as a way to cure cancer. So of course people want to know the next question: If the measles virus is being used to help people resolve their cancer, is it possible that having the measles is a protector against getting cancer later on in life?”
Zahava, who had tuned in almost as a test of resolve, felt stricken. At 11:30 that night she texted Blima Marcus: “Do you inject people with measles to cure cancer?”
Marcus replied, “Inject measles to cure cancer? What?” Marcus told Zahava that measles actually weakens the immune system for two to three years.
“And if so, measles prevents cancer,” Zahava replied, still with a glimmer of doubt.
“No,” Marcus assured her. “It doesn’t.”
For several days, Landa’s patients also inundated him with questions about the call. One mother unfolded the insert to the MMR vaccine in front of patients in the hallway and worried aloud about its contents. By that time, the New York City Department of Health was reporting a total of 317 measles cases in the city since the start of the outbreak. But Landa estimated that the true number was many times higher because some patients were avoiding doctors. Measles is “literally all over the street,” he told me. (By mid-June the official tally had risen to 596.)
That same week, a 4-month-old baby with a fever and hacking cough came into Landa’s office. The boy didn’t have the characteristic measles rash, but he was breathing rapidly, struggling for air. When Landa sent him to a hospital emergency room, he tested positive for measles. The boy’s breathing continued to decline, and he was put on life support with a mask clamped over his face and pressurized oxygen pumped into his lungs. He had developed pneumonia and had to get intravenous antibiotics. Within a few days, a fierce red rash covered his body. After almost a week in intensive care, the boy was discharged to recuperate at home, the long-term effects of the disease still uncertain.
Before the advent of vaccines, nearly every child contracted measles before the age of 15. The disease reached epidemic proportions every two to three years, sweeping through communities in the late winter and spring. School absences rose, with feverish, coughing kids sequestered at home for weeks. With each wave, thousands of children were hospitalized with pneumonia or brain swelling, which could cause permanent brain damage, seizures, and even death. Because measles depletes the immune system, once children recovered they were more susceptible to ear infections, bronchitis, and pneumonia. One study, published in the journal Science, found that before vaccines, measles was indirectly responsible for as many as half of all deaths caused by childhood infectious disease.
After the measles vaccine was licensed in 1963, the number of cases plummeted and the epidemic cycles ceased. Not only did vaccination represent a feat of medical science, it reflected a widespread understanding that self-protection and social protection are inevitably intertwined. The ultra-Orthodox live by this communal commandment. Landa points out that they come together to provide food for the elderly, organize visits to the sick, staff volunteer ambulance services, and make sure even those who can’t afford it get access to high-quality care. Getting vaccinated, he says, fits this duty to protect others in the community who cannot protect themselves. Yet fear of vaccines has challenged that group solidarity.
When I asked Chany about the benefits of herd immunity, she would not acknowledge that communities as a whole gain protection from vaccines. The plight of children with compromised immune systems, like Zahava’s son, did give her pause. “That’s a tough one. I was in touch with somebody whose child had cancer and is on chemo, and her other son got measles,” she said. But she didn’t linger on the discomfort. “I don’t know what ended up happening, but I didn’t hear of anybody dying … There are a lot of viruses out there that are worse than measles, so just focusing on measles as the thing that’s going to kill someone who is immunocompromised doesn’t make sense.” (So far no deaths have been confirmed in the current US outbreak.)
In early May, Zahava and I met in front of her apartment building, where a few neighbors chatted by the curb. By that time, New York City had declared a public health emergency, requiring that anyone over 6 months old living or working in Williamsburg be vaccinated with the MMR within 48 hours unless they could document a medical exemption or immunity to the disease. She wore a loose blue cap over her hair and pushed her younger son in a stroller. A few blond curls were visible around his face as Zahava adjusted the sunshade, speaking to him gently in Yiddish.
As we walked to the corner, three or four school buses jockeyed for position, turning onto the main thoroughfare. Zahava’s son, still unimmunized because of his cancer, was required to remain at home, while students who came down with measles and recovered could return to school. “That’s the cutest part of the joke,” she said with a flash of sarcasm.
Zahava was tired of keeping her son cooped up and away from other children. There are only so many craft projects she can come up with. He needed to be fit for new shoes, but she worried someone with measles might be in the store, so she went without him. “I do what I can, and the rest is all in God’s hands,” she said.
Alexander Arroyo, the Maimonides doctor, also lives in one of the zip codes defined as a measles hot zone. His daughter turns 1 year old in August, and he has worried from the beginning of the outbreak that she’ll catch the disease before her scheduled MMR. “Yesterday alone I had four babies come in who were exposed in a pediatrician’s office and needed immunoglobulin,” he told me.
Arroyo’s wife, who is also a physician, suggested that they give their daughter the MMR early, and he agreed. He brought a dose home from the hospital and put it in the refrigerator, “right by the margarine.” For days, however, work was so hectic that he didn’t have a moment to sit her down. Then one Saturday night in May, another infant, around the same age as his own child, came into the ER, dehydrated and feverish with measles. “OK,” he thought. “I’m done.”
As soon as his shift was over, he hurried home and gave his daughter the vaccine.
Measles Hot Spots
Public health officials aspire to have 95 percent of people immunized against measles. At that level, you achieve herd immunity—that is, even those who can’t get shots will be protected by a wall of immunized neighbors. But in more than half of US states, student vaccination rates are lower than that. Some aren’t immunized for medical reasons, and nearly all states permit skipping shots for personal or religious beliefs. The result is that adults who aren’t fully protected and babies who are too young for their vaccines are vulnerable. A recent paper in The Lancet Infectious Diseases identified 25 US counties most at risk for a measles resurgence, as seen on this map. The researchers based their conclusions not only on immunization rates and exemptions but also population size and—critically—proximity to an international airport. Last year, 82 infected people brought measles into the country, according to the CDC. The Lancet study’s takeaway: Even well-protected states like California and Texas could suffer outbreaks. —Joanna Pearlstein
Measles cases in 2019*: 81
(Personal-belief exemption rate: 3.7%)
The year’s first outbreak started in January, triggered by a child who traveled from Ukraine to Clark County, Washington, which has an abysmal 84.5 percent vaccination rate. In May the governor signed a bill eliminating the personal-belief exemption for the MMR (measles, mumps, and rubella) vaccine.
Measles cases in 2019: 9
(Personal-belief exemption rate: 0.9%)
In May, a week after scientists named Cook County, Illinois, as the region most at risk of a measles outbreak, a traveler proved the point: A person with measles left a trail of possible exposures through O’Hare International (the sixth-busiest airport in the world), on public transit, and at a university campus.
Measles cases in 2019: 53
(Personal-belief exemption rate: 0%)
Six months after a measles outbreak in Disneyland in 2014, California eliminated the exemption that let parents opt out for personal beliefs; it had accounted for 2.5 percent of kindergartners. Medical exemptions, however, have been on the rise.
Measles cases in 2019: 897
(Personal-belief exemption rate: 0.8%)
New York has one of the country’s highest vaccination rates, but you wouldn’t know it based on the number of measles cases. That’s because in some communities, rates are dramatically lower. In six Brooklyn zip codes, immunization rates are under 92.5 percent.
*As of June 21
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