Citing pockets of resistance that are impeding Rockland's efforts to stem a measles outbreak that has risen to 153 cases since October, County Executive Ed Day declared a state of emergency Tuesday.

Starting at midnight, anyone who is under 18 and not vaccinated against the measles was banned from public places. This ban will last until the declaration expires in 30 days or until people are vaccinated. Children with medical exemptions are not included in the ban.

"Parents will be held accountable if they are found to be in violation of the state of emergency and the focus of this effort is on the parents of these children," Day said. "We are urging them, once again, now with the authority of law, to get your children vaccinated."

Day said 72.9 percent of children between the ages of 1 to 18 in Rockland County were fully vaccinated against measles, according to the New York State immunization information system. Herd immunity is effective at 95 percent, according to health officials.

Of the 153 people who have contracted measles, 83.7 percent or 128 people were 18 or younger, Day said.

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Places covered under the ban include shopping centers, restaurants, schools and places of worship. Outdoor gathering places are not included.

The county will be disseminating signs explaining the ban to be posted in public areas included in the ban.

Although Rockland's outbreak has primarily affected members of the Orthodox Jewish community, Day said there’s no religious exemption. He said he has met with community leaders and stakeholders who supported the measures the county has taken to contain the outbreak.

Some Jewish community leaders are concerned about the backlash from the emergency declaration.

"I'm very concerned about it because there are folks in this community, in this county, who will use this as an opportunity to be prejudiced," said Gary Siepser, the CEO of the Jewish Federation and Foundation of Rockland County. "I'm very concerned at how people will be viewed and what could happen when people go into the mall or try to go into Target or wherever they want to go shopping and be out. That's my concern."

In the 26 weeks since the outbreak began, health officials administered 16,958 vaccines, the majority by the Refuah Health Center in Spring Valley, Day said.

County health officials will be holding a free MMR vaccination clinic Wednesday between 1 and 3 p.m. at the Robert L. Yeager Health Complex, 50 Sanatorium Road, on the second floor of building A. The county plans to hold more clinics for residents.

Day cited pockets of resistance the county has begun to encounter in his declaration, as well as the upcoming major religious holidays of Easter and Passover. The county has decided to only make a single MMR mandatory in the emergency declaration.

"We don't want to see a repeat of how this outbreak started, when we saw people gathered together and then fall ill last fall," Day said. "We want everyone to enjoy their friends and families, something quite difficult with the specter of measles hanging over their heads."

Noncompliance will carry penalties of six months in jail or a $500 fine, although Day said law enforcement would not be deployed at any location seeking proof of vaccination. If a person is found to be in violation, the case would be referred to the county District Attorney's office.

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The announcement comes days after county health officials announced six new exposure sites in Spring Valley and Monsey, including Target in Spring Valley Marketplace, All Fresh Supermarket, Atrium Plaza, Designer’s Spot, TOR bus loop 2 Eastbound and International Taxi.

This was the first time the county released new exposure sites since Thanksgiving weekend, although new measles cases have continued.

State health officials declined to declare a state of emergency in Rockland last month after measles got national attention due to an outbreak and emergency declaration in Washington state. Officials said they were holding regular emergency preparedness calls with local health departments since October after activating its incident management system. At the time there were 137 total measles cases in the county.

Rockland's exposure sites have mostly been in Monsey or Spring Valley, and anti-vaccination advocates last fall used a phone hotline called Akeres HaBayis to tell parents to continue sending their children to school.

But Rockland health officials caution that due to the small geographic size of the county, anyone who is unvaccinated is at risk for measles.

Day said the county is also drafting a local law to protect residents and visitors in the event of an outbreak of a communicable disease.

Rockland County Legislator Aron Wieder, D-Spring Valley, said he reserved comment until he's heard more details. He was unaware of the planned state of emergency until a press announcement was issued.

"Overall, I think that people should be mindful about this terrible disease," said Wieder, who is Hasidic. "I think there is a false perception that people in the Orthodox Jewish community are not vaccinated. That’s not the case. I'm vaccinated. All my children are vaccinated."

Potentially unprecedented

Infectious disease experts described broadly banning unvaccinated minors from public places as a potentially unprecedented government action in combating a measles outbreak.

“It’s not something that I’ve seen before in my professional experience,” said Dr. Jeffrey Duchin, a top public-health officer in Seattle, Washington.

“What that says to me is that the local public-health people feel that they have an extraordinary outbreak on their hands,” he added.

Enforcing a community-wide ban on access to public places presents a variety of challenges, experts said, citing the difficulty in monitoring the movements of a select group.

Earlier order affecting schools

This ban supersedes an order issued Dec. 5 by Rockland County Health Commissioner Dr. Patricia Schnabel Ruppert that mandated that schools in the 10952 and 10977 ZIP codes with vaccination rates under 95 percent had to ban unvaccinated children from attending.

Under the emergency declaration, no unvaccinated student can attend school, regardless of the school's vaccination rate, Day said.

Nine yeshivas were fined in November for not reporting unvaccinated students. A federal judge denied a temporary injunction to allow unvaccinated students to return to class at the Green Meadow Waldorf School after parents brought a lawsuit against the county.

In a letter sent out to public school parents late this afternoon, Rockland County BOCES CEO Mary Jean Marsico said that "any individual under 18 and unvaccinated against measles will be barred from public places."

Marsico says the responsibility for enforcement is on the parents. County health officials are expecting to say that parents and guardians "will be held accountable."

For Green Meadow Waldorf School, will "comply with the terms" of the emergency, said Vicki Larson, the director of communications and marketing.

"Green Meadow Waldorf School remains under the county Department of Health exclusion order that prohibits students who are unvaccinated or under-vaccinated for measles from being in attendance at our school," Larson said.

New York City's health department has reported 181 measles cases as of March 19. A new outbreak with eight measles cases in New Jersey began earlier this month after an outbreak linked to the one in New York was declared over in January.

The original measles cases in New York and New Jersey in October came from travelers visiting from or traveling home from Israel, which is experiencing a measles outbreak that has affected more than 3,400 people and caused at least two deaths.

The Centers for Disease Control and Prevention listed 314 measles cases in 2019 as of March 21 in 15 states, including New York, New Jersey and Washington.

Measles has been eliminated in the United States due to high vaccination rates, but pockets of measles outbreaks can break out in un- or under-vaccinated areas due to travelers bringing in measles from outside of the U.S., officials said.

Twitter: @MattSpillane