Measles cases in New York have climbed to 169 as of Oct. 20, up more than 50% since Gov. Kathy Hochul declared a statewide emergency earlier this month. That’s the highest count in the state since 2019.
In declaring the emergency, Hochul cited rising cases in New York and a far higher number in nearby Pennsylvania. Her executive order temporarily allows healthcare workers other than doctors and nurses to administer the measles-mumps-rubella (MMR) vaccine. Vaccination with the MMR or MMRV (MMR plus chickenpox) vaccine is the only reliable way to prevent measles, a highly contagious disease. Health officials are also worried about the spread of vaccine misinformation.
Most of this year’s cases are concentrated in rural counties upstate, particularly in the Finger Lakes region, and among communities with low vaccination rates. In 2019, when New York reported 911 measles cases, the state was the epicenter of a national outbreak, with transmission concentrated in Orthodox Jewish communities with low vaccination coverage. In most years, New York City sees either no cases or a handful imported by travelers. The city has reported seven cases as of Oct. 16, which some experts believe may be an undercount.
One of them, Dr. Sharon Nachman, division chief for pediatric infectious disease at Stony Brook Children’s Hospital on Long Island, believes other cases could be going undetected because people aren’t coming forward. Some families, she said, may have recognized a symptom like a rash, but decided that their child didn’t need to see a doctor.
“It’s unlikely that those measles cases happened in a vacuum,” Dr. Nachman said. “It’s much more likely that they also infected other patients, adults and/or children, and we don’t know about it.”
Epicenter NYC spoke with her about the state of emergency, the effects of measles on individuals and the broader community, and steps families can take to protect themselves and their neighbors. Edited excerpts of the conversation are below.
Epicenter NYC: What does Hochul’s emergency declaration mean for New Yorkers?
Dr. Nachman: I think it is a very important and very smart move on the governor’s part, and I applaud it 100%. The reason it’s so important is that it takes measles discussions out of the back room, saying, “Oh, it’s this patient or that patient,” and shows it to the entire state, saying measles is everyone’s problem. It’s not the one or two children that have measles that you don’t know, haven’t heard about. Rather, it recognizes that measles is an issue across the state, and more importantly, it’s everyone’s responsibility. By that order, Governor Hochul is now pushing nontraditional providers of vaccines to go ahead, have those discussions with families and vaccinate if appropriate.
Epicenter NYC: When is vaccination appropriate?
Dr. Nachman: That child has not been vaccinated, the adult has not been vaccinated, they don’t have a vaccine record, they were in contact with someone who had measles — all of the things that we worry about and try to help do to prevent measles transmitting further. These nontraditional vaccine providers are in the right place at the right time. They’re seeing different populations than the regular pediatricians, and by empowering them to have discussions about measles and provide vaccines, she’s giving us another layer of protection in our communities.
Epicenter NYC: How does the emergency declaration actually help New Yorkers in practical terms? Is it about more access to the vaccine?
Dr. Nachman: It’s access — it’s other health providers that can also talk with you about your risk and administer vaccines. It means that, at any point in the cascade of you seeing another provider for a different reason, they can approach you about vaccinating and talk to you to answer your questions. It just allows more people to say, “Have you been vaccinated? Do you need me to give you a vaccine?”
You may not go to your child’s pediatrician except once a year if your kid is a 10-year-old. But when they have to go to the pharmacy to pick up their Tylenol, or they have to go to sports medicine and see a physical therapist, all of those people can now give the vaccine.
Epicenter NYC: What is it about measles that makes it so contagious? And can someone spread it before they even see or notice those symptoms?
Dr. Nachman: Yes. So you can certainly spread it for a few days before your first symptom, and that’s what makes it such a difficult virus to track because you’re infectious even before your first rash appears. So, what is it? It’s quite a difficult and complicated virus, and because it aerosolizes so easily, it’s not just a foot or two feet. It’s 40-plus feet away, that makes it so highly contagious.
Epicenter NYC: What are some of your biggest concerns around the effects of measles?
Dr. Nachman: It’s not just about mortality. The first is: the measles illness itself wipes out your immunity to other things that you have seen in the past. So even if you’re immune to other infections now, measles wipes out that prior immunity. So you’re as if you are a newborn babe. You’re going to go out there and see your child. Maybe you have a kid in daycare. Maybe you have someone else, and you’re going to get all the infections that they have. You have no protective immunity.
The second is 20% of unvaccinated people in the United States who get measles wind up being hospitalized with serious complications such as pneumonia and encephalitis. Pneumonia is a severe illness where you may have to be put on a respirator. It can lead to chronic lung disease. Encephalitis is inflammation of the brain, and that’s not an illness we want anyone to have, because it has lifelong consequences.
Epicenter NYC: What is it about measles that wipes out prior immunity to other infectious diseases?
Dr. Nachman: Measles is a complicated virus, and it does stuff now and it does stuff long-term. That’s why we have measles vaccines — because all of those are reasons to prevent that illness. It’s not just, “Oh, you have a rash and fever and you’ll feel better.” Even if you don’t wind up hospitalized with your pneumonia or your encephalitis, if I wiped out your immunity, that means that you are a walking petri dish, and any infection that you see, even if you’ve seen it in the past, you are 100% at risk for, and you can be sick and die from any of those other illnesses. So it’s not just, “Oh, it’s a simple virus. Oh, it’s like a respiratory infection with a rash, no big deal.”
Epicenter NYC: Is it 100% if you do get the measles that the telltale rash will appear, or is that just the most prominent or well-known of the symptoms?
Dr. Nachman: We expect the rash to appear in pretty much 100% of the children, but as you can imagine, not everyone presents to their physician when they have a rash. Or they present a week or so later when the rash has changed over time, so it’s not like you can walk in the street and point at people and go, “Oh no, that child has measles.”
If they’re not out, they’re not in school, or we don’t see them, we’ll miss the initial presentation of measles, which is a cough, coryza, [which is] a horrible runny nose and a rash, and we may miss that. So timing is everything.
Epicenter NYC: To clarify, the rash is typically not one of the first symptoms of measles to appear?
Dr. Nachman: It’s typically the cough, the runny nose, the fever and then the rash.
Epicenter NYC: If someone learns they may have been exposed to the measles, they may have been in close proximity to someone with the measles, and they themselves are unvaccinated, what should they do first?
Dr. Nachman: The first thing that you should do is isolate. Don’t keep going out in public. Call your physician. Figure out where you were, how long you were exposed. Are you truly not vaccinated? You may have been vaccinated as a child and you don’t remember it, but we can still figure that out.
Then the next is, if you’re truly close contact, and it was a short time ago [within 72 hours of your first exposure], we may be able to give you a vaccine because you make a quicker response to the vaccine. If it was longer than a short time ago, we’ll give you measles immunoglobulin, because we really need to prevent your infection, but that measles immunoglobulin is not readily available. It’s not like you can go to the local pharmacy and just order some up and get it. It has to be administered intravenously in the appropriate situations, and we have to have enough of it.
So again, it’s all about isolating. Don’t get anyone else infected. Let’s get the story straight, but it all starts with the recognition that you were exposed. Speak to your doctor and then go from there.
Epicenter NYC: When you say “truly close contact,” what do you mean?
Dr. Nachman: It’s respiratory. So if you are in their room within two hours to three hours of them having been in that room, you are now infected. Because it stays in the air. That’s why we get so concerned when we hear there’s an exposure in an airport, because so many people travel through the airport, and as you can imagine, those airports have open air exchange in the corridors. So that virus just sits there.
Epicenter NYC: If someone thinks they or their child has the measles, how should they seek out medical care without exposing other people?
Dr. Nachman: First, call. Second is to put on a [N95] mask if they’re going to ever have to leave that room before they go, and certainly call ahead because we don’t want them sitting in a waiting room. If someone is going to be referred to our emergency room, we want to know exactly when they’re coming. We want to have a clear area for them to walk in. We want them masked before they enter the building, and we want them to go straight into an isolation room.
Epicenter NYC: What symptoms would warrant urgent medical care?
Dr. Nachman: Certainly anyone that has any respiratory issue. So if you have your rash at home and we think you have measles, but then you’re having difficulty breathing, you need urgent, emergency care. If you’re having encephalitis, evidence of inflammation of the brain, seizures, memory issues, can’t talk — encephalitis is a serious and significant inflammation of your brain. So anyone that has those symptoms needs urgent care.
Epicenter NYC: For someone who’s not a professional, while they’re trying to monitor and see if there are signs of the encephalitis, are there certain questions that you could ask your child, or certain signs you could notice?
Dr. Nachman: It’s actually them not acting themselves. That’s probably the easiest way to describe it. Parents talk to their children all the time. They know their children. You ask appropriate questions and you get a bizarre answer. That’s an issue for you.
Epicenter NYC: How long should someone with the measles stay home from school or work?
Dr. Nachman: At least two weeks after the first symptoms.
Epicenter NYC: And if someone has the measles and is staying home, what can families do to reduce the risk of spreading it to others?
Dr. Nachman: They have to isolate that child. That means keeping the door closed, and whoever has to go into that room has to wear a mask and have the child wear a mask when they’re going in. I often tell families to keep the outside window open, so at least the air exchange in the room is reasonable.
But it really is important to make sure that everyone in the family is vaccinated, because that’s their only best protection. Everything else is like a Band-Aid. Vaccine is protection.
Epicenter NYC: Would that outside window open increase the risk of infection or exposure to the measles from outside?
Dr. Nachman: It really depends on the situation of the house or the apartment. If they’re in a house and the child’s in the upstairs room, keep the window open. It’s not going to spread to the houses next door. But it has to be taken in context.
On the other hand, you can try all these Band-Aid approaches. But the most important one is vaccinating everyone else in that household.
Epicenter NYC: How can adults figure out whether they’re protected, especially if they were vaccinated many years ago or grew up outside the U.S., maybe don’t have the records?
Dr. Nachman: For those families, we tell them just go ahead and get another vaccine. An extra dose of a live vaccine only boosts your immune response. So if you never got it, you will never be protected, and if you had one in the very distant past, it will boost your immunity.
Epicenter NYC: So you’re not necessarily recommending that anyone who got their MMR dose as a kid during the recommended timeline get it again now?
Dr. Nachman: Only if it’s a high-risk situation.
Epicenter NYC: Are seniors a vulnerable group, or should they be getting the MMR dose since it’s been so long for some of them?
Dr. Nachman: Seniors are very interesting because if they’re born before 1957, they had measles as a child. They’re within the population of rampant [measles] — more likely than not, they had native disease.
Epicenter NYC: So then, would that make it more likely that seniors have immunity to the measles from that childhood exposure?
Dr. Nachman: It’s hard to get broad-based recommendations for that population because they often have intercurrent other illnesses. So for that population, I would say you would have had native measles as a child. But the idea of getting an additional vaccine, you should discuss with your primary care provider. We can’t make a blanket statement. We don’t know if they are on immunosuppressants, steroids, cancer, radiation. So the answer is, stick with your doc’s recommendations.
Epicenter NYC: Are there any kind of supplements or alternative treatments or other remedies that you’ve been hearing people try to do besides vaccination that they should be really cautious about?
Dr. Nachman: We’ve seen practitioners that made up some pill in their office that they say will work as a vaccine, and of course there’s no science behind that. And we’ve seen people say, “Well, we’ll adjust your spine.” There’s no science behind that. The answer is a vaccine is a vaccine is a vaccine, and there’s no way around it. Nothing replaces it. Chiropractic care is a very well-respected help for families, but it’s not going to prevent a viral illness.
Epicenter NYC: What should parents of babies younger than 12 months know about measles right now?
Dr. Nachman: The first is that in a case of emergency, such as a family member coming down with measles, and you have a kid under six to 12 months of age, you can go ahead and vaccinate that 6-month-old.
The original thinking about vaccines and age really was based on data that women had measles and that passed maternal antibodies to babies, and babies were protected, so you didn’t give them a vaccine because a vaccine wouldn’t take. So traditionally, we’ve waited until babies are 12 months of age to give them the measles vaccine.
Over time, though, we have women now who never saw measles, who had a measles vaccine, and the amount of antibody that they would pass to the babies is probably less and less and less, and gone by six months, so those 6-month-olds now who are at high risk can go ahead and get a vaccine. In an emergency situation. We’d rather wait until the kid is 12 months of age, because the vaccine is much better at 12 months of age than at six months of age.
Epicenter NYC: Why is that?
Dr. Nachman: Because your immune system is not so wonderfully mature.
Epicenter NYC: For babies who are recommended for an early MMR dose, does that replace the routine doses later on?
Dr. Nachman: It’s just an extra dose. It’s an extra piece of protection, and that’s all it is. It does not count towards their vaccine schedules as recommended by New York State.
Epicenter NYC: How can families protect babies who are too young to be vaccinated?
Dr. Nachman: You can pay attention to things like who are you with, who are you hanging out with, what’s the vaccine status of those people, and whether there is measles in your community.
If you find out there’s measles in the community, you’re certainly not going to be taking that baby grocery shopping, where there’ll be kids or adults unvaccinated, passing measles in the air in the grocery store. You’re going to be incredibly more cautious about where you take that child.
Epicenter NYC: Besides unvaccinated young children, people who are immunocompromised or underwent chemotherapy, are there any other groups we haven’t mentioned who are most vulnerable to serious complications from measles?
Dr. Nachman: The answer is everyone. We worry about everyone. There’s no one that we could say, “Oh, that person would never have a serious complication.” In fact, that’s not true at all. And when you look at the deaths that happened in Pennsylvania, they were across the ages, and no one’s reporting, “Oh, they had cardiac disease or lung disease.” No, they were deaths in normal hosts.
Epicenter NYC: Is there anything pregnant people should know about checking their measles protection?
Dr. Nachman: Often it’s up to the obstetrician to decide what they’re screening a mom for, a pregnant woman for. This announcement may make them be more cautious. The problem is, we don’t give MMR vaccines to pregnant women. Because we don’t want to run the risk that the virus will replicate in the fetus. It’s more of a theoretical risk than a practical risk, but that theoretical risk has led us to not vaccinate pregnant women.
Epicenter NYC: Is there anyone who should not receive the MMR vaccine besides those groups?
Dr. Nachman: Again, discuss with your physician because there are strict guidelines about who can and who can’t, and people have tried to shade the truth by saying, “Oh, I had an egg allergy.” Nope, egg allergy is not a reason not to get an MMR vaccine. “Oh, I had a friend who had a neighbor who had a swollen arm.” Nope, not a reason not to get the vaccine.
Epicenter NYC: Should New Yorkers change any plans to travel within the state or internationally because of measles right now?
Dr. Nachman: No, I think they would be better off saying, “Am I up to date on my vaccines? Do I have the right protection?” And then be smart about where you’re going, be smart about who’s going with you, be smart about whether you are up to date on your vaccines, and whether you have your medications that you need in case of emergency.
Epicenter NYC: If someone’s vaccinated and their children are vaccinated, is there anything else they should be doing right now?
Dr. Nachman: Just talking with their neighbors and being proud of the fact that their children are vaccinated. I just want people to remember that the virus doesn’t care who you are. It doesn’t care where you live. It doesn’t care what kind of a car you drive. It’s just a virus, and it will infect anybody.
