A worrisome outbreak of measles is putting a spotlight on high school students, especially at private schools where health policies can differ from those at public schools. Correspondent Hannah Jannol of The Boiling Point, Shalhevet High School’s student-produced newspaper and website, investigates.
LOS ANGELES — Los Angeles’ latest measles outbreak, which was centered in the Orthodox Jewish community, has been over since February. But low school immunization rates may have caused it, and uncertainty around immunization rates may contribute to the next one, according to county health officials.
Eighteen cases of the illness, 15 of them occurring among people who knew each other, were reported in the Orthodox community beginning in early December. The outbreak was declared over on Feb. 5, when the incubation period of 21 days had passed from the last known diagnosis without another new case being reported.
Measles, an extremely contagious virus that causes a rash and fever, according to WebMD, has mostly disappeared from developed countries but is a leading cause of death among children worldwide, according to the World Health Organization. WHO said 134,200 died of measles worldwide in 2015.
The disease is caused by a virus that can be prevented with a vaccine. WHO says 85 percent of the world’s children were vaccinated as of 2015.
Los Angeles County officials would not say which Jewish day schools had been affected in the recent outbreak; they said that schools’ immunization rates are surprisingly difficult to discern.
“What makes it difficult in the Jewish day school environment is that if you go to a public school, the public school system has a whole infrastructure to track immunizations,” said Dr. Julie Higashi of the Los Angeles County Health Department.
“The private schools also need to be in compliance with the law,” she added, “but they don’t have a huge centralized system like LAUSD to set up all the paperwork, to process it, to make it easy for parents to know what to do and to know for the schools what to do.”
Rabbi Hershey Ten, who heads the Bikur Cholim organization — a Jewish social support agency that helps families find and coordinate medical care — worked with the Los Angeles Health Department to contain the outbreak.
He said there’s a simple solution, which is apparently not being followed: All Jewish schools should immediately adopt official policies barring entry to non-immunized students.
“It’s safe to say that there are a significant number of schools in the Pico-Robertson area and the Beverly-Fairfax area that still have children enrolled” who are not immunized, Ten said.
“Unlike public schools that cannot make private policy, a Jewish day school can make private policy that goes above and beyond the policy of the state,” he added. “We can be stricter, basically.”
Why “the herd” is important
This year’s measles outbreak came fewer than two years after the previous one, which started in Disneyland. That outbreak, which had more than 50 cases — including some in the Orthodox community — sparked wide concern and led to the passage of Senate Bill 277, which was signed by California Gov. Jerry Brown in 2015.
The new law mandated that all students in California schools be immunized, and that schools confirm their vaccination status upon entering kindergarten and again upon entering seventh grade.
Its goal is for the state to benefit from something called herd immunity, which occurs when enough of a population is made immune to an infectious disease that its spreading would be improbable.
According to the U.S. Centers for Disease Control, a group has herd immunity if at least 96 percent of its members are immunized. With herd immunity, “even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community,” the CDC says on its website.
Since the law’s enactment, California’s immunization rate has risen from 90.4 percent to 92.9 percent, according to the Los Angeles Times.
Herd immunity is especially important when dealing with measles, which is more contagious than pertussis, smallpox, mumps, diphtheria or the flu, according to the European Centre for Disease Prevention and Control.
“Measles is one of the most contagious diseases known to mankind,” Higashi said. “Anybody that sneezes or coughs, you have to worry about being within six feet of them because some of the droplets might land on you, and you might inhale them.”
Higashi said that the source of this year’s outbreak was not reported for safety reasons.
“If you disclose the actual site, then the community that you’re trying to work with goes underground and won’t cooperate, because they’re so upset that everyone knows their business,” Higashi said.
“I know the Health Department is really trying to protect the privacy of the community involved because they don’t want to stigmatize the Jewish community, the Orthodox community, because there are many sections of the Orthodox community in Los Angeles,” she added.
A statewide database tracks kindergarten immunization rates for every school in California, including all of the Jewish schools, and can be viewed online at EdSource.org.
The database shows uneven — though mostly improving — kindergarten vaccination rates among Shalhevet’s feeder schools.
Sinai Akiba Academy in Westwood did not have herd immunity in 2013 and 2014, but with a 91 percent kindergarten rate in 2015, it is slowly inching toward the target 96 percent. Pressman Academy was fully immunized in 2014 and dropped to 91 percent in 2015, while Yavneh Hebrew Academy jumped from a mere 55 percent in 2014 to 93 percent a year later.
In the same period, Harkham Hillel Academy‘s kindergarteners stayed at or below the threshold for herd immunity, with 74 percent of entering kindergarteners fully immunized.
But these numbers can be misleading, according to Higashi. Although not every student is immunized on the first day of kindergarten, some may have been by the end of the year.
“I think a lot of families might not have a work schedule that’s flexible and allows them to take their kids to the doctor when they’re supposed to,” Higashi said.
“Zero tolerance” for unprotected students
At Hillel, Principal Jason Ablin said that since the new law went into effect, every incoming student must be immunized. He said at least one family had been turned away from the school for refusing to comply.
“We have a zero tolerance policy,” Ablin said. “Everyone is required to come into school with immunizations, according to California state law.”
According to Edsource, only 74 percent of Hillel kindergarteners were vaccinated on the first day of school in 2015. But Ablin said students keep getting immunized throughout the year.
“The data looks like the kids are un-immunized, but that’s not the story,” he said. “Certain doctors have different rates by which they gave immunizations, some doctors give them all at once, some doctors give them over a series of, let’s say, six months. So kids come in with some immunizations, but with a note from the doctor saying they’re getting the other immunizations later.”
Ablin said all of Hillel’s students were immunized by the end of their kindergarten year.
Seventh graders are required to have a booster shot for tetanus, diphtheria and pertussis, and Ablin said usually about 80 percent are already immunized when the school calls. The rest, he said, usually say they didn’t know about the requirement.
“For some reason, which I don’t know, some parents aren’t well-educated about that and they don’t know,” he said. “I think it’s just a matter of timing, meaning they haven’t gone with their kid for their seventh grade annual physical by the time they hit seventh grade so they don’t know, and then they say, ‘Of course, we’ll go get it right away,’ and then we’re at a 100 percent. But that’s usually the process we go through.”
Ablin said Hillel changed its policy after the Disneyland outbreak, and that the school has refused entrance to families who had principled objections to the practice.
“Once the California state policy changed, we changed also,” he said, “and we said no more exceptions; everyone who comes in has to be immunized.”
The situation at Shalhevet was likewise not entirely clear, although the school’s herd immunity seems assured. High schools are required to have students immunized, but they are not required by law to check students’ immunization records.
In early February, head of school Rabbi Ari Segal said there were fewer than five students this year who were not immunized, and he said the school was “in the process” of complying with the new law.
Segal said the non-immunized students had been admitted under the state’s previous law, which allowed schools to issue waivers to families who did not want to immunize their children for personal or religious reasons.
“We were operating under the previous policy where families could file for an exemption,” Segal wrote in an email, adding that the school is aware of the new law and is “in the process of complying with it.”
The school”s executive director, Sarah Emerson Helfand, said Shalhevet’s enforcement of the policy had been updated.
“We’ve brought the school into compliance with the current regulations,” Emerson said, by getting “the required documentation.”
“The law requires that if there is an exemption, it has to be signed off by a medical professional, not just a parent waiver — it must be a medical waiver,” she said. Medical waivers are generally granted only to students with compromised immune systems.
If the school truly has fewer than five un-vaccinated students, then more than 96 percent of Shalhevet’s students are immunized already, giving the school herd immunity.
The “most contagious” disease
Although the Los Angeles County Health Department never revealed the source or school names in this year’s outbreak, rumors spread that the cases were confined to Chasidic or Haredi schools, and that Modern Orthodox institutions like Shalhevet were not threatened.
Ten denied this emphatically.
“Measles is the most contagious disease that is out there; it will linger in a room for almost two hours after a person leaves the room,” he said.
Because the disease spreads so easily, Ten said, shoppers in line at a market could catch it from one another without knowing anyone near them was sick.
“We are not living in a bubble, and I don’t know who made the determination that it was the quote ‘right-wing community’ (that spread the disease), but we are all impacted by this,” he said. “Measles spreads very quickly; it finds the weakest among us. We live today in communities where people are moving around all the time.”
Ten said families who have sought waivers for non-medical reasons come from all walks of Jewish life. Some have heard of long-debunked studies that claimed to show a link between the vaccines and autism. Ten, like Higashi, the county health department and the CDC, said there is no evidence at all that immunizations cause autism.
Fearing vaccine, but following new law
The Boiling Point interviewed a mother whose children attend a local Orthodox Jewish day school, and who did not vaccinate her children before the 2015 law. She spoke only on the condition that her name would not be used, fearing community disapproval.
The woman said she believed that vaccines would “impact her children’s bodies negatively,” and that the immunizations did not guarantee her children wouldn’t still get sick.
California law has now outlawed waivers for fears like these. When the law changed, she got them the shots “because I am forced to,” she said.
This is exactly the kind of change the new law is hoping will boost herd immunity for all Californians, and prevent new outbreaks like the one that just ended.
“Over the years, the incidence of non-immunized children because of personal belief is not specific to those who are poor or uneducated,” Ten said. “Many who are educated or upwardly mobile do not immunize their children. This disease has nothing to do with a person’s wealth, or religiosity or cultural background.”
— Boiling Point staff writer Nicholas Fields contributed to this story.
— This is an edited version of a story originally published on shalhevetboilingpoint.com, the student publication of Shalhevet High School in Los Angeles.
— Featured photo caption: The Centers for Disease Control in Atlanta, pictured here, say a community is protected from measles if at least 96 percent of members are immunized. By that criteria, no one at Shalhevet is likely to catch the very contagious disease. (Photo: CDC.gov)