The biggest and longest-lasting outbreaks are in New York’s Rockland County and Brooklyn, centered in ultra-Orthodox Jewish communities, where misinformation about the safety and effectiveness of the measles, mumps and rubella vaccine has spread, officials said.

Thirteen outbreaks have been reported in 2019, accounting for 663 cases, or 94 percent of all cases. The CDC defines an outbreak as three or more cases. Half of those outbreaks were associated with close-knit religious or cultural communities that were undervaccinated, accounting for 88 percent of all cases.

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In response to the record number of cases this year, New York City has imposed a mandatory vaccination order, and Rockland County has required that anyone with measles avoid public spaces or face a $2,000-a-day fine. On Monday, New York city officials said it had closed two schools, and 57 individuals have received summonses for violating the emergency order; they face a $1,000 penalty if the summons is upheld, and a $2,000 fine if they don’t appear at a hearing or respond to the summons.

In California, hundreds of college students were quarantined last week after one student with measles attended classes on three days while contagious at the University of California at Los Angeles, and another contagious person spent hours at a library at California State University Los Angeles. As of early Monday, 343 students and employees remained under quarantine and have been told to stay home and avoid contact with others as much as possible.

The rare and extreme measures reflect the seriousness of this year’s outbreaks. In a statement Monday, Health and Human Services Secretary Alex Azar said, “We have come a long way in fighting infectious diseases in America, but we risk backsliding and seeing our families, neighbors, and communities needlessly suffer from preventable diseases.”

“We are very concerned about the recent troubling rise in cases of measles,” Azar said in a briefing with reporters. Measles is not a harmless illness but one with deadly consequences that most people, even doctors, have never seen because it was eliminated in 2000. “Vaccine-preventable diseases belong in the history books, not in our emergency rooms. The suffering we are seeing today is completely avoidable. Vaccines are safe because they are among the most-studied medical products we have,” Azar said.

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There are no treatments and no cures for measles, CDC Director Robert Redfield said. “There is no way to predict how bad a case of measles will be,” he said. Most of those sickened in this year’s outbreaks have been unvaccinated, and most are children younger than 18, he said. “Measles can be serious in any age group, but particularly in children younger than 5 and older adults, they are more likely to suffer complications.”

No deaths have been reported in outbreaks this year.

CDC officials said the United States is experiencing so many measles cases this year primarily because of the large outbreaks in New York and Washington state. The New York City outbreak continues to grow; 33 new cases were reported in the last five days, officials said Monday, bringing the total to 367 cases so far in 2019. Officials in Washington, where 72 people have become ill, declared the outbreak over on Monday.

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In recent years, anti-vaccine groups have spread discredited claims about the safety of the vaccine and minimized the dangers of measles. CDC officials blamed misinformation for low vaccination rates in some communities now hard hit by the outbreaks.

“Sadly, these communities are being targeted with inaccurate and misleading information about vaccines,” said Nancy Messonnier, who oversees CDC’s National Center for Immunization and Respiratory Diseases.

To combat that misinformation, the agency has increased its work with health-care providers and community leaders, she said. This includes reminding clinicians about the guidelines for identifying measles. The CDC is also working with rabbinical, camp and medical associations to help “spread clear, consistent, and credible vaccine information through trusted sources” to address questions from parents who are considering delaying or refusing vaccination, she said.

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Asked whether President Trump’s previous public embrace of long-discredited claims about vaccine safety has contributed to the spread of misinformation, Azar said Trump’s statement last week supporting the importance of vaccination was “very firm” and said he was “delighted by the president’s very strong leadership.”

Last week, Trump told reporters at the White House that parents need to vaccinate their children.

“They have to get the shots. The vaccinations are so important. This is really going around now. They have to get their shots,” Trump said.

Measles can be deadly, especially for babies and young children. Some people may have severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain), which can lead to hospitalization and death. Measles may cause pregnant woman to give birth prematurely or have a low-birth-weight baby.

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One dose of the measles, mumps and rubella vaccine is 93 percent effective, and the recommended two doses are 97 percent effective in a given person in preventing measles. The first dose is normally given at about 12 months, and the second at 4 to 6 years.

In the measles cases reported, the vaccination status of 125 people was unknown, and an additional 76 people had been vaccinated, according to the CDC report. But it wasn’t clear how many of the 76 people had received one dose or two. Even with two doses, there is still a 3 percent chance of becoming infected if you’re e exposed to the virus, clinicians have said.

With holidays and summer travel approaching, the CDC is recommending:

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Infants 6 to 11 months old should get one dose of the MMR vaccine before international travel

children 12 months and older need two doses, separated by at least 28 days

adolescents and adults who have not had measles or been vaccinated also should get two doses, at least 28 days apart.

Adults in high-risk groups, including those who are traveling internationally, health-care workers and those in communities with ongoing outbreaks to check with their health-care providers.

Ideally, it’s best to be fully vaccinated at least two weeks before travel. But if there’s not enough time, people should still get one dose before departing, CDC officials said.

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As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children. About 1 child out of every 1,000 who get measles will develop encephalitis, which can lead to convulsions and can leave the child deaf or with intellectual disabilities. On average, for every 1,000 children who get measles, one or two will die of it.

The United States was able to eliminate person-to-person transmission of measles in 2000. But because the virus is so contagious, communities need to have near-perfect levels of 93 percent to 95 percent of the population vaccinated to protect against it.

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Gaps in immunization coverage in the United States and around the world in recent years have resulted in lower immunization rates, and many countries in Europe, Asia, the Middle East and Africa are experiencing large measles outbreaks.

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As a result, when unvaccinated travelers get measles abroad and return to the United States, especially to close-knit communities with low vaccination rates, these communities are “at risk of sustained measles outbreaks,” the CDC report said.

Washington state’s outbreak began Jan. 3, with a child who traveled to Clark County from Ukraine. Officials said Monday that they could not determine whether this case was the source of the outbreak. More than 90 percent of cases were in children younger than 18, and people who were not immunized. One person was hospitalized.

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There were 53 public locations — including airports, sports arenas, health-care facilities, retail stores, churches and schools — where contagious people may have exposed others to measles, officials said. Clark County officials identified and contacted more than 4,100 people who were exposed, and made daily monitoring phone calls to more than 800 people considered susceptible to contracting measles. Local schools identified and excluded 849 susceptible students who were exposed to measles.

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Personnel worked more than 19,000 hours on the outbreak. The statewide effort to fight the outbreak cost nearly $1.9 million, including $864,000 in Clark County.

The virus lives in the nose and throat of an infected person. It can spread by direct contact with infectious droplets or through the air when an infected person breathes, coughs or sneezes. The measles virus can remain infectious in the air for up to two hours after an infected person leaves an area. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses or mouths, they can become infected. Measles is so contagious that if one person has it, up to 90 percent of the people who are close to that person or who walk through the same area and are not immune may become infected.