A Measles Outbreak in the Tel Aviv District, Israel, 2018–2019

Abstract

<jats:title>Abstract</jats:title> <jats:p>During a national measles outbreak in 2018-2019, the Tel Aviv District suffered a major upsurge of cases, with 413 patients reported. Among them, 100 (24%) were under the age of one, 92 (22%) patients were aged 12 months to 4 years, 47 (11%) were 5-18 years, 169 (41%) were aged 19-60 years, 5 (1%) patients were older than 61 years (born before 1957). Among all cases, 230 (56%) were part of the Ultra-Orthodox Jewish community, 55 (13%) were among undocumented African immigrants. Despite high vaccination coverage, sustained measles transmission occurred, owing in part to importations and numerous exposures in medical settings by a susceptible birth cohort. The Ultra-Orthodox Jewish community was particularly afflicted owing to its condense population, high birth rates and multiple exposures in crowded religious settings. This outbreak demonstrates the necessity of addressing immunity gaps as well optimal healthcare planning in order to prevent future outbreaks.</jats:p>

‘I don’t know anybody who said, “oh great, let’s get measles”’: a qualitative study of responses to childhood vaccinations (MMRV) among Orthodox Jews in Jerusalem following the 2018-19 measles outbreaks

“…5 Epidemiological and social science studies have located the issue of suboptimal vaccination coverage and measles outbreaks among Haredi Jewish neighbourhoods. [2][3][4][5][6]21,22 In this study, PH professionals were concerned by a deficit of research examining vaccine decision-making across Orthodox Jewish sectors in Jerusalem and Israel.…”

“…1 Yet, coverage is consistently lower in Orthodox Jewish neighbourhoods in Jerusalem 2,3 and central Israel, 4 which has led to a series of localized and national measles outbreaks. [2][3][4][5][6] The largest measles outbreaks in a quarter century were recorded in Israel and the USA in 2018-19, which were linked to unvaccinated Orthodox Jewish travellers. 7,8 In Israel, the burden of the 2018-19 outbreaks were disproportionately located in Jerusalem -where 52.9% of measles cases occurred.…”

“…5 Most studies since the 2018-19 measles outbreaks have been epidemiological, highlighting that Orthodox Jewish populations were underimmunized and which public health interventions were developed to boost vaccination coverage levels. [2][3][4][5] The aim of this study is is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint…”

The measles outbreak in Israel in 2018-19: lessons for COVID-19 pandemic

“…Possible attributing factors are high population density, low socio-economic level, and large households, increasing the probability of communicable disease transmission. 5,7,25 As to households' size, the total fertility rate in Israel was the highest among Organization for Economic Co-operation and Development (OECD) countries in 2016 (3.1), and exceptionally high among ultraorthodox Jews (7.1). 26 Neighborhoods and cities with sizable ultraorthodox Jewish population showed a disproportionately increased fraction of the COVID-19 cases.…”

“…29 In that context, the ultraorthodox Jewish population in Israel has previously shown lower childhood vaccination coverage rates, vaccination delay, and increased risk for outbreaks as compared to other population groups. [4][5][6][7]10,25,30 The role of the community-based child health services and particularly that of the public health nurses are indeed vital in promoting sustainable measles immunization coverage. 31 Therefore, the preventive child health services should be given substantial support and proper budgeting in order to assure coping with the increase in the population of children and the requirements of special population groups.…”