Intended for healthcare professionals


US county bars unvaccinated children from public spaces amid measles emergency

BMJ 2019; 364 doi: (Published 28 March 2019) Cite this as: BMJ 2019;364:l1481

Linked opinion

Measles in America—what’s playing out in New York State is nightmarish

  1. Janice Hopkins Tanne
  1. New York, USA

In the face of a six month measles outbreak, Rockland County in New York has declared a state of emergency and banned unvaccinated children under 18 from schools, stores, restaurants, and houses of worship. Outdoor spaces such as playgrounds are not included.

County executive Ed Day announced the ban at a press conference on 26 March “to prevent any more children from falling ill with this dangerous disease. Anyone who is under 18 years of age and is unvaccinated against measles will be barred from public places until the declaration expires in 30 days or until they get their first measles, mumps, and rubella (MMR) vaccine.”

He added, “There will not be law enforcement or deputy sheriffs asking for your vaccination records. Parents will be held accountable. If you are found to be in violation of this declaration your case will be referred to the district attorney’s office.” The penalty for violating the order is up to six months in jail or a $500 (£379; €444) fine or both.

Children with a “confirmed, documented” medical reason not to be vaccinated are exempt. The ban went into effect at midnight on 27 March. It was timed to coincide with the upcoming Easter and Passover holidays when many families get together.

Day said the ban was the first such effort nationally. He said the focus was on getting parents to vaccinate their children. The vaccination rate for Rockland County is 72.9%, below the state rate. He praised the health department for investigating cases, holding clinics, and giving nearly 17 000 vaccinations.

According to the Centers for Disease Control and Prevention, there have been 314 confirmed cases of measles in 15 US states up to 21 March.1

Rockland County, about 15 miles north west of New York City, has a population of over 300 000. It has the largest Jewish population per capita (31.4%) of any county in the US—about 90 000 people.2 The Jewish population is predominantly ultra-Orthodox.

The Rockland epidemic seems linked to an outbreak in an ultra-Orthodox community in Brooklyn, New York, and to travellers from overseas.3 Although both communities have had information about vaccine safety and most rabbis have endorsed vaccination, some ultra-Orthodox Jews refuse vaccines.4

Day said, “Last year, not just one but seven unvaccinated travellers diagnosed with measles entered our county between 1 October and 17 October, leading to 153 confirmed cases. This is the longest measles outbreak in the US since the disease was officially eradicated in 2000.

“This is an opportunity for everyone in our community to do the right thing. We must do everything in our power to end this outbreak and protect the health of those who cannot be vaccinated for medical reasons and children too young to be vaccinated.”


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