Tuesday, December 22, 2009

Why is Mumps Spreading in Monsey and Boro Park

In 2006-2007 almost 1500 confirmed cases of measles were reported in Israel, primarily among ultra-orthodox Jewish communities in the Jerusalem Health District and to a lesser extent in other areas. (Remember, not every case is confirmed with a blood test; many cases never even see a doctor.)

My hunch is that there are significant similarities between the ultra-orthodox Jewish community in Jerusalem that suffered from measles and the ultra-orthodox Jewish communities in Boro Park and Monsey currently suffering from mumps. After the jump I provide a salient quote

From long personal experience and interaction with the ultra-orthodox community in Israel we hypothesize that a chief cause of under-vaccination in ultra-orthodox Jewish communities is a lack of interest among many of its members in modern methods of infectious disease pre- vention, stemming from a lack of appreciation in some communities of the potential seriousness of the so-called ‘‘childhood diseases.’’ A closely related issue is a disinclination on the part of the more insular ultra-orthodox groups to interact with government health officials. These two mutually reinforcing attitudes - apathy toward preventive healthcare measures in general and hostility toward services provided by the public health system - result in a failure to vaccinate against measles, creating local pockets of susceptibility to measles infection and weakening the herd immunity required to protect the community. Personal visits by district health office physicians and senior health ministry personal to rabbinic figures were of limited effectiveness during the 2007 08 outbreak, because de-
cades of indifference and mistrust could not be overcome by hurried rabbinic pronouncements, and because not all affected communities professed allegiance to the few religious leaders visited.

Beyond the problem of low vaccination coverage, other characteristics of the ultra-orthodox Jewish population make this sub-group particularly vulnerable to such a highly communicable disease as measles. One third of ultra- orthodox families in Israel consist of five or more children (in the non-ultra-orthodox Jewish population only three percent of families included as many children), and the share of ultra-orthodox children up to age four is nearly three times higher than in the rest of Jewish-Israeli society.19,20 The community’s large family units, with many children eating and sleeping in close quarters on a daily basis, can significantly increase the transmission potential of each infected family member. Another factor is the voluntary physical separation of the ultra-orthodox from the rest of Israeli society, both in residential housing and in the school system, making them far less protected by the herd immunity prevalent among Israel’s highly vaccinated general population.

If the risk of future outbreaks is to be minimized, Israeli public health officials need to work toward achieving herd immunity in ultra-orthodox communities, and among other groups and individuals whose vaccine uptake is below optimal levels.

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