22 | NewScientist | 20 April 2019MEASLES is making a comeback in
the US. Public health departments
are starting to take serious
measures to curb the disease,
but in an age of misinformation,
simply telling people to get
vaccinated may not be enough.
New York City is taking drastic
action. On 9 April, mayor Bill
de Blasio declared a state of
emergency in the borough of
Brooklyn, and mandated that
anyone living in the four zip codes
where a measles outbreak has
raged since October must be
vaccinated or face fines of up to
$1000. The unprecedented move
was a result of the staggering
rise in the number of measles
cases, which have mostly beenconfined to the Orthodox Jewish
community in Williamsburg, the
mayor said in a press conference.
In 2017, there were two cases
of measles in New York City. In the
past six months, there have been- “That’s got our full attention,”
said de Blasio, adding that the city
will offer free vaccines for those
without health insurance.
These measures are required
because the city is really
fighting two epidemics. Measles is
fast-spreading and can be deadly.
So is the anti-vaccine movement,
which has infected the US over the
past 20 years, aided by social
media platforms and organised
misinformation campaigns (see
“Computer virus”, right).
There have already been
465 cases of measles in the
US this year, according to the
Centers for Disease Control and
Prevention (CDC). If the disease
continues to spread at that
rate, there could be more than
1800 cases by the end of the year.
This comes as a shock, given
that in 2000, the CDC declared
measles to be eradicated in
the US. Around the same time,
the anti-vaccine movement
took hold. Patient zero was a
discredited 1998 study linkingthe measles, mumps and rubella
(MMR) vaccine and autism.
The study has since been
retracted, but the damage it did
continues to ripple across the US.
The anti-vaccine sentiment has
“grown from a fringe movement
into a media empire”, says Peter
Hotez at Baylor College of
Medicine in Texas.
It has also led to a weakening of
medical regulations, the effects of
which are now being felt. All 50 US
states require children who attend
public schools and some childcare
centres to be vaccinated. However,
most now allow exemptions for
people who have religious beliefs
against immunisation. And
18 states allow non-medical
exemptions (NMEs) based on
personal objections to vaccines.
As a result, the CDC says that the
number of unvaccinated babies
and toddlers has quadrupled
between 2001 and 2015, going
from 0.3 per cent to 1.3 per cent.
That may sound small, but the
effects could be disastrous. The
spread of measles can only be
prevented with herd immunity,
meaning 90 to 95 per cent of
people have been vaccinated. Very
young children were at 91.1 per
cent in 2016, according to the CDC.
Last year, he and his team
collected data on the number of
pre-school children per county
that have remained unvaccinated
under NME. They plotted the
urban areas with the highest rates
of NMEs, which ranged from
400 to nearly 3000 unvaccinated
children (see map, above right).
“It turns out we generated a
pretty good measles prediction
map,” says Hotez. Many of the
15 urban area hotspots his team
identified have had measles
outbreaks in 2019, he says.
Threatening people with
fines, as New York City is doing,
isn’t the only way to fight an
outbreak. In 2017, measles took
hold in the Somali-American
religious community inINSIGHT MEASLES OUTBREAKS
Stop the spread
Measles, once thought eradicated from the US, has made
a shocking return. Chelsea Whyte reportsOH
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“There have been 465 cases
of measles in the US so far
this year. At that rate, it
could hit 1800 by year end”Rockland County, New York, is the
site of a major measles outbreak