Fighting a health crisis in New York

New York has suffered the worst measles outbreak in a quarter of a century.  A staggering 75% of measles cases reported in the country are linked to outbreaks in New York. Out of these cases, most are reported from communities that have the highest rate of vaccination exemption due to religious beliefs.

This year, the United States already has over 1,000 confirmed cases of measles in the first six months. New York City alone has 566 confirmed cases from the past academic year (September 18 through June 2019).  All of these new dramatic numbers are out there since we claimed victory over the complete eradication of measles in 2000.

This is a public health crisis.  Measles is the most contagious virus on the planet.

To help stem the crisis in the state, Governor Andrew Cuomo has signed into law A2371A which repeals subidivision 9 of Public Health Law (PHL) 2164 essentially eliminating religious exemption from mandatory vaccinations. 

In a public statement made in June 2019, the Governor noted, “"While I understand and respect freedom of religion, our first job is to protect the public health and by signing this measure into law, we will help prevent further transmissions and stop this outbreak right in its tracks."

PHL 2164 requires every student entering or attending public, private or parochial school in New York State (NYS) to be immune to diphtheria, tetanus, pertussis, measles, mumps, rubella, poliomyelitis, hepatitis B, varicella and meningococcal in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations. In the 2019-20 school year, meningococcal immunization is required for grades 7, 8, 9, 10, and 12.

Every child in day care, Head Start, nursery school or prekindergarten in NYS must be immune to diphtheria, tetanus, pertussis, measles, mumps, rubella, poliomyelitis, hepatitis B, varicella, Haemophilus influenzae type b (Hib), and pneumococcal disease.

Public Health Law Section 2164 still provides for medical exemptions to immunization.

What does this mean?

The law basically mandates all children entering the school system, public or private/parochial, to get vaccinated.

By now, if your child is admitted at school, you would have had to submit form CH-205 which is a new admission physical examination form certified by a licensed physician. The form covers general physical health including vision, hearing, dental, developmental assessment and immunizations.

Religious and other non-medical exemptions to immunizations are no longer accepted to waive the vaccination requirement.  Some of the deadlines to keep in mind:

• Within 14 days of the first day of school or day care – children must receive the first age-appropriate dose in each immunization series to attend or remain in school or day care.
• Within 30 days after the first day of school or day care – parents or guardians must show that they have appointments for the next required follow-up doses for their child. Deadlines for follow-up doses depend on the vaccine.

As a public servant and health advocate, I support the updated requirements to protect our school children from the adverse effects of measles and other preventable diseases through mandatory and scheduled vaccinations. The concerns and risks outweigh the benefits of immunizing our children by a wide margin. Dozens of studies throughout the years have been conducted to prove the efficacy of immunization against vaccine-preventable diseases.

As a parent, I am just as concerned about the health and general well-being of my school-age children. Viruses such as measles are contagious. The effects on those afflicted are painful to watch and treat as a physician; much more excruciating to feel as a parent.

The spread of misinformation about vaccination has taken its toll on the public.  To make a point, since the country declared itself “measles-free” in 2000, we have had only 60 cases in the following ten years.  Fast forward to this year – we have had over 1,300 cases in just over six months. The Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) have both debunked the myths and concerns brought on by anti-vaccination advocates. While we respect their expressions and debate the subject in public forums, we must take into consideration the risks to our younger, apolitical audiences who are at far greater public and personal health risks. 

Measles signs and symptoms appear around 10 to 14 days after exposure to the virus. Signs and symptoms of measles typically include:

• Fever, dry cough, runny nose, sore throat, red or reddish inflamed eyes
• Koplik’s spots which are small discernable white spots with bluish-white centers on a red background found inside the mouth (inside cheek).
• Large, flat blotches on the skin

The infection occurs in sequential stages over a period of two to three weeks.

• Infection and incubation: For the first 10 to 14 days after a person is infected, the measles virus incubates. There are NO signs or symptoms of measles during this time.
• Signs and ‘mild’ symptoms: Measles starts to present itself with mild to moderate fever accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This usually lasts up to 3 days.
• Acute illness and rash: Red spots start to appear on the face. The rash consists of small red spots, with some slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance.Typically within a few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. Moderate to high fever accompanies the skin symptoms. (Very high fever and related symptoms especially in young children have been attributed to hospitalizations and death.) Measles rash gradually recedes, fading first from the face and last from the lower extremities such as the thighs and feet. 

• Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.

For more information and helpful resources, please check:

NYS Department of Health 

Centers for Disease Control 

American Academy of Pediatrics 

New York City Board of Education 

Author

Marigold Castillo, M.D. Dr. Marigold "Dr. Gold" Castillo is a board-certified physician specialist practicing in Bayside, New York. She is an assistant professor of Pediatrics at Zucker School of Medicine of Hofstra/ Northwell. She focuses on personalized care in general pediatrics and adolescent medicine.