Yeshiva Kehilath Yakov Pupa in Williamsburg failed to bar unvaccinated children from attending class, Health Department officials said. Image via Google Maps

A single school’s decision to allow an unvaccinated child to attend class led to more than 40 measles cases and the eventual proliferation of the disease across New York City, a top health official said on Monday.

Demetre Daskalakis, deputy commissioner of the city’s Department of Health, revealed at a conference hosted by NYU Langone that Yeshiva Kehilath Yakov Pupa in Williamsburg was the catalyst for what would become the worst outbreak in decades — with 609 confirmed cases as of Monday.

“One school failed to exclude people in Williamsburg,” Daskalakis said. “We had one measles case in that school, and subsequently every unvaccinated child who was not excluded came down with the measles, creating really the spark that ignited Williamsburg and created a true fire of measles in that neighborhood.”

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The infected child had the disease but had not yet begun showing symptoms when he showed up for class at the yeshiva, an ultra-Orthodox Jewish private school, in late January.

The school did not immediately respond to a request for comment.

The outbreak began spreading in the fall of 2018, when Health Department officials announced that six Brooklyn children had contracted the disease. The initial Brooklyn case was acquired by a child on a visit to Israel, where a large outbreak was taking place.

The epidemic has been contained mostly to the Orthodox Jewish communities of Williamsburg and Borough Park, with more than a dozen confirmed cases also in Sunset Park among the Latino population.

Mayor Bill de Blasio declared a public health emergency on April 9 requiring mandatory measles-mumps-rubella vaccinations for residents who live in the northern Brooklyn ZIP codes of 11205, 11206, 11211 and 11249.

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Gov. Andrew Cuomo signed a bill on June 13 banning any non-medical exemption to vaccinations, including religious exemptions.

The outbreak has cost the city roughly $2 million, according to Daskalakis. He said that despite their greatest efforts to send out exclusion letters, monitor schools and audit them, the disease has still led to dire consequences, including 50 hospitalizations and 18 ICU visits.

“We’ve had a lot of close calls with kids who have been very very sick,” he said.

As of June 14, 11 institutions had been shuttered by the city for failing to adhere to the emergency order. (UTA of Williamsburg – Yeshiva Torah V’Yirah at 590 Bedford Ave. was closed twice.)

Daskalakis said that further exacerbating the outbreak, and likely influencing the operators of lone wolf yeshivas, was a highly sophisticated campaign of anti-vaxxers seeking to undermine the city’s order through misinformation.

Some residents were also deliberately attempting to have their children contract measles to build up a natural immunity to the infection. “Rather than the spark igniting the kindling, we had the kindling actually looking for the spark,” Daskalakis said.

Although the disease is primarily affecting the Orthodox Jewish community, Daskalakis wanted to break the myth that the general Orthodox Jewish community is resistant to vaccines. “It’s not true,” he said, citing the fact that after the outbreak was announced, vaccination rates in Williamsburg rose from around 70 percent to about 92 percent.

“We’re not out of the woods, but the slope is going down in the direction that feels comfortable,” he said. “Not that we’re slowing anything down — our violations continue, our audits continue, all the work continues — but the measles are slowing down.”

Health Commissioner Dr. Oxiris Barbot, who attended Monday’s conference, made it clear that there is not a problem with the city’s approach to vaccines, revealing that 99 percent of school-age children are vaccinated — the highest percentage in the country.

That percentage translates to roughly 1 million students, more than the populations of San Francisco and Boston.

“We don’t have a problem with our vaccination system,” she said. “We are very rigorous in the way in which we ensure that our school-age population is immunized.

“What we have a challenge with is there are pockets of our community that have been infiltrated with misinformation and, through inertia, that community has not been engaged enough.”

Follow reporter Scott Enman on Twitter.

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