Measles Vaccination in the US: Need of the Hour!

Measles Vaccination in the US: Need of the Hour!

Author -  Dr. Kaushik Bharati, MSc, PhD, FRSPH (London)
Article Reviewed by 
The Medindia Medical Review Team on May 25, 2019 at 4:33 PM
  • Measles vaccination with the measles, mumps and rubella (MMR) vaccine is urgently needed in the US
  • Recent outbreaks originating from New York’s ultra-orthodox Jewish community have been reported
  • Vaccination will effectively prevent measles outbreaks and appreciably reduce the disease burden

Measles vaccination is currently the need of the hour in the US. Despite being declared eradicated in the US in 2000, measles is re-emerging, with recent outbreaks reported in several US states. In 2019, 704 people in the US were infected with the highly contagious measles virus, of which 500 never received the measles vaccine, while the others didn't receive the recommended second dose of the vaccine.

It is believed that recent measles outbreaks in New York City and Rockland County in New York, originated from the ultra-orthodox Jewish community whose children had not been vaccinated against the virus. The outbreaks have been declared a public health emergency by the New York City Department of Health and Mental Hygiene, Long Island City, New York.

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These measles outbreaks have raised many concerns, encompassing medical, ethical, public health, and legal issues. Moreover, this could have an impact on the right of parents to choose whether to vaccinate their children or not. However, from a scientific standpoint, the necessity of vaccination for achieving 'herd immunity' should not be forgotten.

'Herd immunity' is said to occur when a sufficiently large number of individuals in a population is vaccinated against an infectious disease so that the remaining population becomes immune to the disease. In the case of measles, at least 90-95 percent of the population needs to be vaccinated in order to achieve 'herd immunity.'

These issues have been addressed in a commentary published in the American Journal of Medicine by researchers at the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA. The senior author of the commentary was Professor Charles H. Hennekens, MD, DrPH, who is the first Sir Richard Doll Professor and Senior Academic Advisor at the Charles E. Schmidt College of Medicine, Florida Atlantic University, USA.

The co-authors of the commentary were Rachael Silverberg, MPH, a third-year medical student; Jennifer Caceres, MD, Associate Dean for Student Affairs; Sara Greene, MSW, Coordinator, Department of Biomedical Science; all within the Schmidt College of Medicine, Florida Atlantic University; and Mark Hart, EdD, Clinical Assistant Professor, University of Florida.

Basis of the Commentary

The commentary is based on data collected from a series of interviews with ultra-orthodox Jewish mothers in Williamsburg County, South Carolina and Rockland County, New York. The interviews highlighted the mothers' perceptions about the barriers to vaccination of their children. The gist of the findings of the interviews is briefly presented below:
  • Perception of vaccination as a suspicious activity
  • Influence of cultural factors discouraging vaccination of children
  • Preference for extended vaccination schedule arising from the belief that longer breaks between shots would be less harmful to the children
  • Influence of religious fatalism on non-vaccination of children
Both Hennekens and his co-authors felt that the strong social networks prevailing in the ultra-orthodox Jewish community could be judiciously exploited to stop the spread of misinformation about vaccines.

"Our data suggest the possibilities that establishing trust, influencing social networks as well as media and cultural or religious factors among ultra-orthodox Jewish mothers may have a favorable impact on measles vaccination," says Hennekens.

Measles Vaccination Challenges among the US Ultra-Orthodox Jewish Community

  • Anti-vaccination Propaganda: Dissemination of anti-vaccination pamphlets within the ultra-orthodox Jewish community
  • Distrust in Health Services: Lack of trust in health interventions such as vaccination campaigns implemented by health personnel outside their community
  • Poverty: Abject poverty is a major factor that deprives access to healthcare services. Of the 16 percent ultra-orthodox Jewish households that make up the total Jewish population in New York City, 45 percent families live 150 percent below the federal poverty line
  • Lack of Education: This directly impacts how informed choices are made about health interventions. In 62 percent of ultra-orthodox Jewish households, neither parent is educated above high school standard
  • Large Family Size: Ultra-orthodox Jewish families, on average have over 8 children, making them vulnerable to catching infections due to intermingling
  • Overcrowding: Having large families means domestic overcrowding, which increases the chances of transmission of infectious diseases like measles
"Community members of influence, including rabbis, health care practitioners, and mothers of high social standing should be identified and recruited to serve as advocates for childhood immunization," says Silverberg. "The success of these partnerships would be dependent upon the strength and durability of relationships forged between health officials and the community."

Measles Vaccination Challenges among the US General Population

  • Lack of Vaccine Coverage: US citizens born between 1957 and 1989 have received only one dose of the measles, mumps and rubella (MMR) vaccine, which confers 97 percent protection against the virus. Since 1989, two doses of the MMR vaccine has been recommended
  • Increased Vulnerability to Infections: Living in close proximity within the same room or apartment, without being vaccinated, can increase chances of catching measles from an infected roommate by 90 percent
  • Requirement for Revaccination: This is recommended under the following circumstances:
  • Persons who were vaccinated before one year of age
  • Persons who received the killed measles vaccine (KMV)
  • Persons who were vaccinated between 1963 and 1967 with an unknown and uncharacterized vaccine

Concluding Remarks

Hennekens concludes: "Health care providers and their patients may wish to consider that vaccination of a few may abort future epidemics and the need for vaccination of many to reduce the preventable morbidity and mortality from measles."

Reference :
  1. Measles Vaccination: 'All for One and One for All' - (

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