On Wednesday, officials from Rockland County, New York declared their almost year-long outbreak of measles over—a mere week before the U.S. would have to forfeit its status of having eradicated any local traces of the disease. If nearby neighborhoods report any more cases in the next few days, we could still lose our measles-free status, but things are finally looking bright.
The Rockland County outbreak formally began on October 1, 2018, making it the longest and eventually the largest single cluster of cases in the U.S. to have happened during this time period. From then up until this month, 312 residents were confirmed to have come down with the viral, vaccine-preventable disease, which led to several hospitalizations. Nearly 80 percent of victims were under the age of 19; a similar percentage were unvaccinated.
This year, the UK and three other European countries lost their measles-free status, certified by the World Health Organization, amidst a dramatic resurgence of the disease in Europe. The measles-free status of the U.S. (declared in 2000) is still officially up in the air for the time being. A country loses its eradication status if an outbreak brought in from elsewhere lasts longer than 12 months. At that point, it’s assumed the germ has found enough reservoirs to re-establish itself as a local threat again.
Measles is an incredibly contagious but predictable disease. An outbreak can be considered over if no new cases have shown up 42 days after the last instance of someone developing a telltale rash (the span of time covers two incubation periods, or how long it takes for someone infected to start showing signs). For Rockland, that was August 13. But it certainly wasn’t easy to stop this outbreak in its tracks.
“We vaccinated nearly 30,000 residents—the actual number was 29,027—and that was up to a week ago. And that’s three times the average baseline for our county,” Rockland County health commissioner Patricia Schnabel Ruppert told Gizmodo via phone.
In addition to that, more than 1,000 people were actively quarantined or monitored, and the county declared two state of emergencies that tried to restrict the movement of high-risk people. The initial order, which banned unvaccinated minors from certain public spaces, was eventually annulled by a judge, following a legal challenge from a group of parents, but the second, which only applied to people diagnosed with measles, was left in place. At times, Ruppert said, the county was also forced to use subpoenas and legal orders to compel people to provide information on their or their children’s vaccination status, as well as to exclude unvaccinated children without a medical exemption from attending school.
New York City, which had its own outbreaks in Brooklyn and Queens, also took drastic steps to curb the disease. It issued a mandatory order to people living in the area of Williamsburg, an epicenter of the outbreak, to get themselves or their children vaccinated or face a $1,000 fine.
Many of the outbreaks that dotted the country this year originated with people traveling and returning from Israel, where measles has also been a big problem. The cases then spread largely among the Orthodox Jewish community. And while many people and religious leaders within these communities do embrace vaccination, it was still hard to convince some people to cooperate with health officials.
“Some people in the community do not trust the government very easily, but I do want to say that most did trust the health department,” Ruppert said. “For those concerned, though, we were able to meet with the community leaders, with the rabbis, administrators, and, of course, members of the medical community, in order to get the word out and utilize their assistance to educate.”
Another challenge were anti-vaxxers, who have taken to seeding these communities with misleading propaganda about the dangers of vaccines in recent years.
“The anti-vaccination movement had been providing this kind of information to the community longer than we had originally even thought. And we found that a lot of the growth in this movement came from other states. They weren’t necessarily local people—they came from other states, and they’d come in for different group meetings and assemblies, where they would gather those who were more local and rather sort of interested in this,” said Ruppert.
“They were a small but loud group,” she added.
According to the Centers for Disease Control and Prevention, Rockland was the sole remaining active outbreak in the U.S. But there had been cases reported in two nearby counties that were recorded later than August 13, and these are still connected to the Rockland outbreak.
A CDC spokesperson told Gizmodo by email that the latest remaining case was detected August 19 in Orange County. That means the all-clear date would be September 30, next Monday. Given that the two-day Jewish holiday of Rosh Hashanah begins Sunday evening, it’s expected that New York state officials and the CDC will hold off on declaring the U.S. still free of measles until October 2. That’s assuming, fingers crossed, that no new cases from the area are found between now and then.
It’s a public health victory that won’t have come cheap, though. In Rockland alone, the early estimated cost of containing the outbreak may have been anywhere from $2.5 to $6.5 million. And the country as a whole has experienced more measles cases this year than since the early 1990s.
Yet these cases have galvanized lawmakers into taking vaccination more seriously. New York State, for instance, passed a law that bars parents from using non-medical exemptions to keep their children attending public school unvaccinated, as did other states and cities. That had been a longstanding policy recommendation from many experts, one that Ruppert sees as crucial to preventing future outbreaks. But perhaps more important than any single law is establishing the trust needed for people to feel comfortable with vaccination in the first place.
“I think we have to keep communication open with our entire community in Rockland and educate—educate and vaccinate. That’s the other major thing to take away from this.” she said.