A measles outbreak in London has reached more than 300 people in the past six months Infections have mostly been within the strictly Orthodox Jewish Charedi community, where inoculation rates have generally been low

A measles outbreak in north-east London has affected more than 300 people since October of last year.

Hackney and Haringey have seen 322 cases between since the beginning of October, Public Health England told i. In early December, around 60 people had contracted the disease, but since then the number has risen significantly.

The cases have mainly occurred among the area’s strictly Orthodox Jewish Charedi community, where vaccination rates have historically been low.

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Between 2006-2013, the community experienced measles at a rate of 117 per 100,000. The latest outbreak is affecting people at 10 times that rate, and the data suggests it has now reached between 1 and 2 per cent of the approximately 20,000 strong community.

Hackney Clinical Commissioning Group is running immunisation clinics in an attempt to address the issue, with particular focus on education within Charedi communities.

Why now, and why north-east London?

The MMR (Measles, Mumps and Rubella) vaccination is usually delivered in two doses, and Haringey and Hackney as a whole have relatively low rates for completing the process. In 2018, they were at 70.2 per cent and 69.7 per cent.

Those numbers are well below the national average, which is 87.2%. The WHO recommends 95% coverage to ensure herd immunity, the form of indirect protection from infectious disease created when enough of the population is immune.

Israel has seen an outbreak of measles in the past year, recording 3,600 cases since March 2018. Travel between the country and north-east London is common, and believed to have sparked the recent explosion in cases.

Similar circumstances contributed to the measles epidemic in Rockland County, which resulted in the banning of unvaccinated children in public spaces after a state of emergency was announced. The New York Times reported that there had been 153 confirmed cases of measles there since October, primarily among the ultra-Orthodox Jewish communities in the county.

What is measles? Measles is a disease that can lead to serious complications, such as pneumonia and even death. It is caused by a highly contagious virus that is spread through the air by breathing, coughing, or sneezing. It can be avoided by having the (MMR) vaccine which is given in two doses. A spokesperson for Public Health England told i one in every ten people who get the disease end up in hospital with complications and one in every thousand die.

The Charedi community is particularly vulnerable to measles as its vaccination levels are much lower than in the general population. This has been attributed to an anti-vaccination movement in the US, stemming in part from a distrust of secular media, and strong religious views that can come into conflict with science.

Many in the community have been fighting against the trend for a number of years. A Stamford Hill GP, Dr Joseph Spitzer, spoke to the Jewish Chronicle in 2017 about his efforts to combat the issue, which included hiring a Charedi nurse at his surgery to improve take-up. That nurse, Naomi Freeman, had previously been employed by Hackney Public Health in a similar role, where she said she had improved vaccination rates in part of the community from 54 to 87 per cent.

Dealing with the outbreak

Public Health England has written to local GPs, Orthodox Jewish independent schools and nurseries, and children’s centres to raise awareness of the outbreak. Leaflets are being distributed in both English and Yiddish, and the CCG is running immunisation clinics.

Dr Anita Bell, a consultant at Public Health England’s local Health Protection Team, told i: “Measles spreads very easily among anyone who has not had two doses of MMR, particularly children, and this is why large outbreaks can occur in local communities. Last year in London, the majority of measles cases were in children aged one to nine years old followed by teenagers and young adults.

Rabbi Avrohom Pinter, chairman of the Orthodox Jewish Health Forum and principal of the Yesodey Hatorah Senior Girls’ School, said he was hoping to introduce lessons on immunisation within the curriculum before 2020.

Responding to the statistics, he said that the councils were “over the worst of it” and compared to a year ago, uptake for vaccines had improved. He added there was still more improvement that needed to be seen however.

He pointed to the mass spread of misinformation and ongoing belief in Andrew Wakefield’s 1998 research falsely linking the MMR vaccine to autism. Rabbi Pinter explained that within the community were groups of people specifically campaigning against vaccination and it’s this influence that needs to be addressed, which could be done through education.

He added that many also considered measles to be a low-threat illness, therefore not realising the benefits of vaccination for the community.

What do the councils think?

Local councils said they were working on promoting the vaccine. Hackney Councillor Feryal Demirci, Cabinet Member for Health, Social Care, Transport and Parks, told i: “Immunisation and vaccination is commissioned by NHS England but I am really proud of the amazing response by our local health partners to mobilise quickly to respond to the recent outbreak – by working closely with Public Health England and funding extra clinics across the borough.

“There has been an improvement in uptake over the months that the extra clinics have been provided and thanks to the efforts of staff within GP practices. There are also an extensive range of programmes to inform parents about the safety and effectiveness of the MMR vaccination. We will also be running a campaign to remind families of the importance of keeping up to date with childhood immunisations.”

A spokesperson for Haringey Council told i: “As a community we can all help to stop the spread of measles – the most powerful way of doing this is by ensuring our young residents receive the MMR vaccine.”

“As a council, we will continue to work with partners to ensure the right guidance is available and that the vaccine is accessible to the community.”

Dr Bell added: “Protecting your children with two doses of the MMR vaccine is the best way to ensure they are not at risk of catching measles, mumps or rubella. The first dose is given around their first birthday and the second just before they start school, however it’s never too late to get immunised.

“It’s never too late for your children and teenagers to catch up with their vaccinations if they are behind or have missed any. If you are unsure if your children have had the full two doses of MMR, speak to your GP who will have a record of the vaccinations they have received.”