The New York City Health Department says its efforts have been significant, but that the measles continues unabated in the affected zip codes.

QUEENS, N.Y. (CN) – The New York City Board of Health voted unanimously Wednesday to continue an emergency measles vaccination order, part of bid to squelch an outbreak that has already sickened hundreds.

The order, first declared alongside a public health emergency April 9, requires people who live or work in four Brooklyn ZIP codes to receive the measles, mumps and rubella (MMR) vaccine if they cannot show proof of immunity or provide medical exemptions. New York’s outbreak has been concentrated overwhelmingly in a close-knit Orthodox Jewish community.

Before the vote this morning, the board reviewed a presentation from Demetre Daskalakis, deputy commissioner for the Division of Disease Control at the New York City Department of Health.

Daskalakis, who holds a degrees in medicine and public health from Harvard, highlighted efforts by anti-vaxxers to spread what he called “anti-vaccination propaganda” in the Orthodox Jewish community.

The slideshow included examples of a “Vaccine Safety Handbook,” as well as articles headlined “Do You Know What’s In A Vaccine?” and “How To Prevent Your Children From Being Damaged By Vaccines.”

Daskalakis noted that persistent rumors linking the MMR vaccine to autism have been debunked, with scientists pulling their strongest evidence from a decade-long study in Denmark that involved more than 600,000 children.

“The scientific evidence is unequivocal that the MMR vaccine is safe,” Daskalakis said.

It is also highly effective, with a 97 percent prevention rate after both doses. The vaccine relies on “herd immunity,” or vaccinating as many people as possible, to keep the diseases at bay.

Noncompliance with the vaccination order is punishable by a possible of $1,000. New York City Health Commissioner Oxiris Barbot told reporters Wednesday no fines had yet been issued, but the city did shut down a preschool in Williamsburg for failing to provide vaccination records.

After the vote, he stressed that the city doesn’t want to take punitive measures against the unvaccinated.

“The purpose of this emergency order isn’t to fine people,” Barbot told reporters. “It’s to stress the urgency and the importance of getting vaccinated, and to enlist as many people as possible spreading the message that these vaccines are safe and effective.”

Since Oct. 1, 2018, an estimated 16,750 additional doses of the MMR vaccine were administered to NYC children, ages 18 and under, as compared to the same time period last year. About 4,733 of those doses were to children in Williamsburg. Increasing MMR coverage showed some initial success, but progress in Williamsburg waned.

Since the emergency order came into force, Daskalakis said Williamsburg has seen a “surge” of vaccinations: around 400-500 people, many of them young children, have gotten vaccines in the last week or so.

Daskalakis said the city’s recommendations are driving this shift, but about 14% of Williamsburg children between the ages of 1 and 5 still have not received any doses of the MMR vaccine.

Although not usually deadly, the measles virus is extremely contagious: It spreads to 90% of nonimmunized close contacts through droplets and the air, and carries with it the danger of serious side effects. It also carries a long incubation period, meaning people can be contagious well before they know they have the virus.

Lynne Richardson, a member of the health board who is a practicing emergency physician, underlined the burden that the measles outbreak has caused to New York City hospitals.

“Now is the time to use every tool available to us to stop this outbreak,” Richardson said.

Because an infected child could present with a fever before the telltale measles rash, Richardson said, every emergency department in the city has had to conduct additional screening to protect other patients. Such preparation “rivals” the way New York’s health care providers prepared for Ebola patients during that outbreak in 2014, she said — and measles is even more contagious than Ebola.

The long incubation period, and the number of children who remain unvaccinated, mean the outbreak is likely to get worse before it gets better. City health officials have counted 329 cases since Sept. 30, 2018. That number was at 285 a week ago.

Williamsburg is home to 81% of the measles cases, with Borough Park, another Brooklyn neighborhood, trailing behind at 16 percent. Children ages 1 to 4 represent 49% of cases.

Almost all New York City cases have been concentrated within the Orthodox Jewish community, and the city has focused recent efforts on encouraging vaccination before families see relatives for Passover.

Daskalakis told the board the city has partnered with community members on its outreach work. Five hundred of the Orthodox community’s most trusted medical providers across the country signed onto a letter calling for vaccinations, he said, and the most widely circulated Yiddish newspaper for the Orthodox community, Der Yid, published an editorial making the same plea.

Board member Joel Forman soberly recalled his own arrival as a physician in New York City during a 1990s measles outbreak, when a child died from a complication in the central nervous system.

“To me, it feels like a real, true health emergency,” he said.

The U.S. Centers for Diseases Control and Prevention reported Monday that measles cases are on the rise, nearly 20 years after the vaccine and other measures had succeeded in eliminating the disease from the U.S.

Confirmed measles cases have risen to 555 across the country, almost 100 more cases than last week. Two-thirds of the new cases, including 85 percent in the last week, are in New York, mostly in Orthodox Jewish communities.

Wednesday’s order is expected to remain in place for as long as the outbreak continues.

The earlier version spurred a lawsuit Monday from five anonymous parents. A temporary restraining order was denied, and the parties will appear in court tomorrow.