Measles-Update_June-4_2013_FINAL-VERSION2.pdf

NEW YORK CITY DEPARTMENT OF
HEALTH AND MENTAL HYGIENE
Thomas Farley, M.D., M.P.H.
Commissioner
June 4, 2013

ALERT # 15: Update on Measles in New York City: New Vaccine Recommendations

1) 48 cases of measles have occurred in the Orthodox Jewish community residing in
Borough Park and Williamsburg, Brooklyn.

2) Because measles cases continue to occur, particularly among young infants,
healthcare providers should now administer the first dose of MMR vaccine to all
Orthodox Jewish children aged 6 months and older living in Borough Park,
Williamsburg, and Crown Heights.

Distribute to All Primary Care, Infectious Disease, Emergency Medicine, Internal
Medicine, Pediatrics, Family Medicine, OB/GYN, Laboratory and Infection
Control Staff

Dear Colleague,

There continues to be ongoing measles transmission among the Orthodox Jewish communities in
Borough Park and Williamsburg, Brooklyn. To date, there have been 48 confirmed cases,
including 28 in Borough Park and 20 in Williamsburg. Additional suspected cases are being
investigated. In recent weeks, cases have begun occurring in younger children. During the past
month, the median age of cases has declined to 2 years (age range 10 months – 17 years) with
19% aged less than 12 months, 52% aged 12 months to 4 years, and 29% aged 5 – 18 years. All
cases were in persons who were unvaccinated at the time of exposure, because they were too
young to have been vaccinated or because their parents delayed or refused vaccine for their
children. Over 2,000 identified people have been exposed to measles in households (through
relatives or friends), apartment buildings, and medical provider offices.

Measles transmission has been sustained by two factors: a large pool of susceptible children
under 12 months of age and large family and communal gatherings. To interrupt the spread of
measles in this community, the Health Department recommends that the first dose of measles-
mumps-rubella-vaccine (MMR) now be given at 6 months of age to all Orthodox Jewish children
living in Borough Park, Williamsburg, and Crown Heights. Although cases of measles have not
yet been identified in Crown Heights, we are extending this recommendation to this community
to prevent introduction of measles. Further, non-Orthodox children receiving medical care in
practices that serve predominantly Orthodox Jewish patients, should also receive MMR vaccine
beginning at 6 months of age because of the increased risk of exposure.

A dose of MMR vaccine given prior to the first birthday (there is a 4 day grace period) will not
be considered a valid dose in the Citywide Immunization Registry (CIR) or for daycare or school
entry. Infants who receive MMR vaccine before their first birthday should receive an additional
dose at 12 months of age as long as 28 days have passed after the initial vaccine dose. These
children will still require a ‘second valid’ dose prior to school entry at 4 – 6 years of age.
In the setting of this outbreak, Orthodox Jewish children aged 12 months and older living in
Borough Park, Williamsburg, and Crown Heights who have received their first dose of MMR
should receive their second MMR dose now, as long as 28 days has elapsed after the first dose.
This second dose will be considered valid and will count toward the school immunization
requirements.

Vaccination at an earlier age is recommended by the Centers for Disease Control and Prevention
for outbreak control when many cases are occurring among infants <12 months of age. This will
increase the proportion of infants who are protected against measles. Ninety five percent of
infants who were 6 months old at the time of vaccination demonstrated a response to the vaccine
as measured by cell mediated immunity and/or seroconversion (Gans et al. JID 2004;190:83-90).
The same study documented that an infant’s ability to respond to a second dose of MMR is not
compromised by early administration of vaccine. MMR vaccination of children 6 – 11 months of
age who will be traveling overseas is already a routine Advisory Committee on Immunization
Practices recommendation and is considered safe.

Providers who need additional MMR vaccine should place an order with the Vaccines for
Children (VFC) Program through the Online Registry as per current procedures. Practices in the
affected neighborhoods will be able to order the quantity of vaccine required to implement this
recommendation. For questions or assistance with ordering VFC vaccine, please call 347-396-
2400. Providers will need to purchase additional vaccine for their privately insured patients. The
Health Department will communicate with the New York State Insurance Department to prevent
problems with insurance claims. If you have trouble with reimbursement, please notify the
Bureau at the number above or by e-mailing nycimmunize@health.nyc.gov.

Information about reporting suspect cases of measles, laboratory testing, isolation of suspected or
confirmed cases, or post-exposure prophylaxis recommendations have been previously sent and
are available at http://www.nyc.gov/html/doh/html/diseases/immmea.shtml
Please call DOHMH if you have questions at 347-396-2402 (weekdays 9-5pm) or 212-764-7667
(after hours and weekends). Your cooperation is appreciated.

Sincerely,

Jennifer Rosen

Jennifer Rosen, MD
Director, Epidemiology and Surveillance
Bureau of Immunization
NYC DOHMH


Jane R. Zucker

Jane Zucker, MD, MSc
Assistant Commissioner
Bureau of Immunization
NYC DOHMH