Slide 1: An 8-month-old child from a Hasidic Jewish neighborhood in NY presents to the ED with fever, cough, and rash. It’s good medicine to suspect measles. But is it fair to wonder if the family opposed vaccination?

Slide 2: From January 1, 2019 to June 20, 2019, 1,077 cases of measles have been confirmed in the USA. 871 of these were in the NYC area – largely within Hasidic Jewish neighborhoods where anti-vaccine propaganda took a foothold last year.

Slide 3: Many confirmed measles cases in NYC have not been the result of vaccine opposition or misinformation. In fact: the majority of ultra-Orthodox individuals are vaccinated, and consider adherence to medical recommendations to be a central tenet of their religious beliefs.

Slide 4: So – why the outbreak?
– Many infected were too young to receive one or both doses of the MMR vaccine –even if administered early.
– Pediatricians may defer shots on visits if children are ill, though it’s not medically necessary.
– Hasidic communities are close-knit, insular, and densely populated.
– Measles is extremely infectious. One person with measles can infect 12-18 others who are not vaccinated.

Slide 5: The takeaway

Demographic information provides important data points that can help us calculate real-world risks for disease and illness.

However, these heuristics are a double-edged sword, and can lead us to jump to incorrect conclusions. Let us remain wary of assumptions we make about our patients given only parts of the picture. 

The Food For Thought

If you’ve been following the 2019 measles epidemic you might associate it with anti-vaccine sentiments in the ultra-Orthodox Jewish communities of Brooklyn and NJ. This isn’t wrong – but it’s far from the whole story. A large proportion of affected families don’t oppose vaccination or endorse anti-vax ideology, but were made vulnerable by other circumstances.


  • “Measles”. NYC CDC. Link.
  • “Measles: Cases and Outbreaks”. CDC. Link.
  • “Measles Information”. Rockland County CDC. Link.
  • Pager T. “Monkey, Rat and Pig DNA’: How Misinformation Is Driving the Measles Outbreak Among Ultra-Orthodox Jews”. New York Times. April 9, 2019. Link.
  • Guerra FM, Bolotin S, Lim G, Heffernan J, Deeks SL, Li Y, Crowcroft NS. The basic reproduction number (R0) of measles: a systematic review. Lancet Infect Dis. 2017 Dec;17(12):e420-e428. PMID 28757186.