L.A. Orthodox community hit by measles outbreak

measles outbreak in the Los Angeles Orthodox Jewish community has prompted measures to contain the serious but preventable disease.

The Los Angeles County Department of Public Health confirmed 18 people in the county had measles, none of whom could provide a record of vaccination. Among them, “16 of these cases are linked to unvaccinated people in the same social group,” a health department spokesperson told the Journal in an email.

Rabbi Hershy Z. Ten, president of the Jewish health organization Bikur Cholim, said a health department official notified him on Dec. 25 that there was a measles outbreak in the Orthodox community.

Measles is a highly contagious virus that can be prevented in most people by childhood vaccination. The disease spreads through interpersonal contact and can linger in an area for up to two hours after an infected person has left. In serious cases, it can lead to brain damage or death.

Ten called the outbreak a serious threat that should be addressed by ensuring every member of the community is vaccinated.

“Our leadership, both in schools and in synagogues, need to educate their parent body and need to create policies that create greater protection for students and their families,” he said.

Some organizations are already taking steps in that direction.

LINK, a synagogue and community center on Robertson Boulevard, sent an email to members noting the outbreak.

“If your child is not immunized for measles, we kindly but firmly request that you do not bring him/her to LINK,” synagogue leadership stated in the email.

Yavneh Hebrew Academy, an Orthodox elementary school in Hancock Park, wrote to parents that, although Yavneh was not affected, the school had been notified of “a small number of private schools in the Los Angeles area where a few cases of measles have been reported.”

In a Dec. 28 email, Yavneh’s school nurse, Lisette Ohana, said the school follows a new state law, passed in 2015, that requires all students to receive vaccinations before being admitted to schools and daycare centers.

“Here at Yavneh we enforce this immunization law and require that all our students be up-to-date on all required vaccines,” Ohana said. “This law is meant to protect our students and staff, school and Jewish communities, and the larger Los Angeles community.”

Ten, the Bikur Cholim president, said schools that don’t currently go “above and beyond the current legislation” by requiring students to be vaccinated should adopt such a policy immediately.

“We’re hopeful that this [outbreak] will begin a conversation that will go beyond just talking about the medical risks, but of implementing some changes that will provide greater protections for all,” he said.

To jumpstart that conversation, and to educate the community on the risks of measles, Ten convened a Jan. 9 teleconference that included more than 70 Jewish day-school faculty and synagogue rabbis from the greater Los Angeles area, he said.

On the call was Dr. Franklin Pratt, medical director for the L.A. County health department’s immunization program, and other experts. Ten said Pratt confirmed the outbreak on the call and said the health department expects the number of cases to rise before it is over.

Ten said there was no excuse — religious, economic or otherwise — for parents not to vaccinate their children. In the past, Bikur Cholim has brought county health department nurses into community centers such as Beth Jacob Congregation and Yeshiva Rav Isacsohn to administer free vaccinations.

In Judaism, Ten said, “a basic tenet is to lead a healthy lifestyle and to protect one’s family and to protect one’s community.” Vaccinating children falls under that tenet, he said.

Parents with a child showing symptoms of measles — high fever, red and watery eyes, runny nose and a rash — are encouraged to call a doctor rather than bring the child directly to an emergency room or doctor’s office, where they would risk infecting others.

Should parents vaccinate their children? One pediatrician thinking about measles

Every pediatrician, each in his or her own way, faces those few parents who are afraid to immunize their children. It’s not a dramatic moment. Fairly early in the process of getting to know who this patient is, a parent will say, “It’s too much.” Or, “It will overwhelm his immune system.”

This opens up a new window into who they are, along with a question — will I be able to convince them or not? In a way, it’s basic medicine: You find out something new about someone, and now you have to figure out what it means and what they will need from their doctor. 

The measles virus, like the polio virus, only lives — in the strange way that viruses live — in people. These viruses are part of the natural world. We aim to improve upon nature by getting rid of these illnesses, thereby making this virus extinct, without apology. Smallpox was eradicated in the 20th century. The eradication of polio was a goal within reach, though now it seems to be slipping further from our grasp. 

My father had polio before it was preventable. Both of his legs were paralyzed. In his childhood, he got around on a kind of homemade skateboard, or he was carried like Dickens’ Tiny Tim. After many surgeries a long train ride from home, he got around quite well with a brace and crutches. His handicap was an important part of my formative experience, 30 years after the polio virus had done its damage to him. Of course, I got the polio shots as soon as they were available. And soon after that, I got the oral vaccine too, just to be sure.

Lots of things are complicated, but why is the immunization of children against measles one of them? It should be a no-brainer. Measles is a serious illness, bad enough that it’s worth preventing.  

Antibiotics don’t do anything against measles. Treatment is “supportive,” meaning watch and wait, managing complications as possible. Days of fever of 104 degrees and higher, maybe pneumonia, maybe hospitalization — burning through your deductible — and sometimes permanent consequences. I saw a patient once who was having seizures every minute for years after measles. 

Around the world, measles is still a major cause of mortality in children. Almost all of us over 60 are “survivors”; we had measles when we were little. I had measles and got over it. And I rode around in a car without a car seat or seat belt and survived that, too. Not everyone was so lucky.

Seat belts and car seats save lives. And immunization works. It works so well that U.S. cases, which used to number in the hundreds of thousands every year, have been knocked down to fewer than a hundred, until recently. The MMR vaccine prevents measles, mumps and rubella. Incidentally, we don’t see as much infertility from mumps as we used to. And congenital rubella — a much worse illness than measles — has mostly disappeared from this part of the world, for now. I’ve seen congenital rubella with my own eyes: a frail blind girl, with a tiny brain that didn’t work very well.

Most of the people in the world live in places where measles is seen all the time. Mainly, it’s just one, and not the worst, feature of poverty. Since the continuous circulation of measles ended in the U.S. in 2000, we have had occasional measles outbreaks, each starting with an importation. Since then, measles in the U.S. has mostly been imported by Americans returning from Europe and Asia. Someone inhales the measles virus in the course of his or her adventure. Later, safe at home, a nasty “flu” with “pink eye,” fever and cough ensues. Days pass in misery without any rash. Friends, classmates, co-workers, health care workers are exposed. With every cough, he is spreading measles virus generously around; it lingers for an hour or two wherever he’s been. No one has figured out he has measles yet because the rash comes later. 

Now we come to “herd immunity.” No vaccine works perfectly, meaning that some people get measles when exposed in spite of having been immunized. But for each individual, the chance of getting it is very much reduced by having been immunized. The fewer the people in the “herd” — more felicitously known as the community — are vulnerable, the lower the chance that the “index patient,” the importer, will be able to infect someone else. For those who cannot be immunized — especially babies, people with HIV or on chemotherapy —  “herd immunity” means they hope to get away with being vulnerable because measles won’t start going around if all the contacts of the index patient are immune. 

And because the vaccine isn’t perfect, even those of us who are immunized benefit from the herd, because the fewer people around us have measles, the lower our chance of being in the 1 or 2 percent “vaccine failure” group.

So why is there so much push back? Stumbling blocks were deliberately placed in front of the blind: False and fraudulent assertions of a link between the MMR and autism were made. Although the claims were finally and definitively debunked several years ago, spinoff descendants continue to appear. In the American spirit of “Don’t Tread on Me,” parents — like physicians — don’t want government telling them what to do. And some people believe they can protect their children from all harm if they avoid “toxins” and “chemicals” — never mind the “toxicity” of the diseases themselves to muscles, fertility and sometimes to the brain. Others are leery of “Big Pharma” and the Medical-Industrial complex. And not a few parents are just anxious.

Should a pediatrician refuse to take care of children whose parents refuse immunizations? Should a doctor refuse to see people who are sick? We routinely treat folks who eat too much, watch too much TV, don’t exercise regularly, smoke or drink and put others at risk, and even who ignore good medical advice. Why should some absurd ideas about immunization be a disqualifying condition for having a doctor?  

Very few of us are completely rational, and for those who are, it’s usually seen as a disability. Our judgments of priority are colored by our experiences. I didn’t need medical school to know that polio was bad. Everyone sees the world from a different point of view. The physician has to start by listening to the patient. Immunizations are important; lots of things are important. 

To what extent is the pediatrician, an agent of the state, charged with enforcing some standard? Our primary obligation is to the children in our care, but we rely on the parents to provide it; there is rather little we can do without their active participation. So pediatricians perform a delicate dance — we have to convince the parents to see it our way. 

But now measles is here. This week, I began requiring my patients who can be immunized to be immunized against the contagious illnesses that could jeopardize my other patients.

I have to take care of the patient that I have in the family that he has, in the context where I find him. Being invited to enter into that world is a privilege, and it’s my main tool. It’s also where the real drama is, and where both healing and prevention begin. But I am reminded that the context of the physician-patient relationship includes the community of my practice — my “herd.”

David H. Keene, M.D. is a pediatrician in Los Angeles.

California lawmakers seek to end ‘personal belief’ vaccine exemptions

Responding to an outbreak of measles that has infected more than 100 people, two California lawmakers said on Wednesday they would introduce legislation to end the right of parents in the state to exempt their children from school vaccinations based on personal beliefs.

California public health officials say 92 people have been diagnosed with measles in the state, many of them linked to an outbreak that they believe began when an infected person from outside the country visited Disneyland in late December.

More than a dozen other cases have been confirmed in 19 other U.S. states and Mexico, renewing a debate over the so-called anti-vaccination movement in which fears about potential side effects of vaccines, fueled by now-debunked science, have led a small minority of parents to refuse to allow their children to be vaccinated.

“The high number of unvaccinated students is jeopardizing public health not only in schools but in the broader community. We need to take steps to keep our schools safe and our students healthy,” state Senator Ben Allen said in a written statement announcing the legislation he is co-sponsoring with fellow Democrat Richard Pan.

The measure would make California the 33rd state to bar parents from opting out of vaccinations based on personal beliefs.

Also on Wednesday, a top Los Angeles County health official said that a total of 21 cases have been recorded in the county but that after the initial wave of reports, the number has fallen to four in the latest two-week period.

“We're getting to a number of cases that’s manageable, and I'm hopeful that within weeks or a couple of months we will be able to turn the corner on this particular outbreak,” Interim Health Officer Dr. Jeffrey Gunzenhauser told a press conference, although he cautioned that a lag in reporting could still add a few more cases.

A day care center at a high school in the Los Angeles suburb of Santa Monica closed earlier this week and more than a dozen infants placed under a three-week quarantine after a baby enrolled in the program was diagnosed with measles.

Measles was declared eliminated in the United States in 2000 after decades of intensive childhood vaccine efforts. But last year the nation had its highest number of measles cases in two decades.

Most people recover from measles within a few weeks, although it can be fatal in some cases.

Los Angeles area daycare center shuts down after baby contracts measles

A daycare center at a Southern California high school has been closed and more than a dozen infants placed under three-week quarantine after a baby enrolled in the program was diagnosed with measles, a school district official said on Monday.

The move comes as public health officials reported that more than 100 people across the United States were infected with measles, many of them traced to an outbreak that began at the Disneyland theme park in Anaheim in December.

The child, who is under a year old and therefore unvaccinated, was enrolled in the daycare center at Santa Monica High School, said Gail Pinsker, spokeswoman for the Santa Monica-Malibu Unified School District.

A freshman baseball coach at Santa Monica High School was diagnosed with measles last month, but Pinsker said the two cases were not connected and that the coach had recovered from his illness.

“There is concern in the community over this. This is a concerning disease,” she said. “Over the last couple weeks we've encouraged families to get students immunized.”

Pinsker said that the “infant room” at the daycare center had been closed indefinitely following the diagnosis and that 14 other babies enrolled there had been placed under 21-day quarantine on the orders of Los Angeles County health officials.

The daycare center's “toddler room” had been closed through Thursday, she said, and all children would be required to show proof of immunization before they would be allowed to return.

“The district is trying to stay on top this and being as transparent as possible,” Pinsker said. “The health and safety of our students and staff is our first priority.”

The California Department of Public Health said on Monday that 92 cases of measles had been confirmed in the state, up from 91 on Friday. More than a dozen other cases have been confirmed in 13 other U.S. states and in Mexico. No deaths have been reported.

Measles was declared eliminated in the United States in 2000 after decades of intensive childhood vaccine efforts. But last year the nation had its highest number of measles cases in two decades.

Most people recover from measles within a few weeks, although it can be fatal in some cases.

My son is too young to be vaccinated

I remember when I read the news on January 5th about measles being linked to Disneyland visits between December 15-20, 2014. I frantically googled how long someone can be exposed to measles before the disease manifests. I found out that at the longest, it’s three weeks. I was relieved, and then I was angry.

My son isn’t vaccinated.

I was relieved because it had been just about three weeks since my family, including my then 2-month-old son, were at Disneyland. And I was angry that measles, a preventable disease, was spreading through southern California.

Even though we were safe from the initial outbreak at Disneyland, we live just a few minutes away from other places where the outbreak is just beginning to show up.

My son wasn’t vaccinated because he’s too young.

I believe in vaccines. I am also a baby-wearing, breastfeeding, co-sleeping, and organic-eating mommy (or try my best to be.) I’m not super “crunchy,” but some would argue I have a lot in common with the stereotypical “anti-vaxxer.” My son is lucky; he did not get measles. He has passive immunity because he is breastfed, and I have been fully vaccinated.

I am a “vaxxer.” I believe vaccines not only help my own child, but are our social responsibility to others who are medically unable to vaccinate to protect themselves. While pregnant, I had my entire family (30 people) get their TDaP booster because I was not risking my son getting whooping cough. He can’t protect himself yet, so it’s our responsibility to protect him. Likewise, the people of society should do so for each other. We might not be family, but we must live together.

Those who are medically able to withstand the minimal risks/ effects of a vaccine should be vaccinated.  I know vaccines aren’t 100% effective in preventing a disease, but they do a great job of arming the body with immunity to fight against the disease. So, if someone were to contract the disease, that person is less likely to pass the disease to another and is better able to fight it, making the duration of the symptoms shorter and less intense than if that person had no immunity whatsoever. 

Furthermore, even IF vaccines caused autism (which they don’t), I’d rather have a living autistic child than a deceased non-autistic child from a preventable disease like measles.

Having most members of a community, 95% vaccinated, creates herd immunity. People who are immunocompromised, or severely allergic, or too young  (like my son) to receive vaccinations depend upon that immunity. It's what keeps preventable diseases at bay and keeps diseases from mutating. It is because so many have been vaccinated that this measles outbreak isn't worse.

That’s why the measles vaccine has been so effective. The strain has remained relatively the same for the past five decades. However, with so many anti-vaxxer clusters, communities have created a sort of petrie dish allowing the virus room to mutate. We see how readily viruses mutate each year with the flu. And measles is much more contagious than the flu.

Do you wonder why we see mothers in poorer countries walking miles to vaccinate their young children? It's because they have seen death first–hand from preventable diseases. There is a reason why we see so few deaths in the US from measles and other preventable diseases. It is because of our access to vaccines and healthcare.

I would hate for children too young to receive a vaccine to die because of another parent’s selfish choice to not vaccinate their child.  It’s selfish because that choice affects others. The scariest thought is if the disease is allowed to mutate, then no one, not even the vaccinated, will have immunity.