The defining case in the field, according to Daniel A. Salmon, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, is the 1905 Supreme Court ruling in Jacobson v. Massachusetts. The court upheld the authority of states to enforce compulsory vaccination on the grounds that, when danger loomed, an individual’s freedom could be subordinated to the common good. The plaintiff, Henning Jacobson, was a Cambridge, Mass., pastor who had been vaccinated against smallpox as a child in Sweden and claimed it had caused him lifelong suffering. He also argued that vaccination was an “invasion of his liberty” under the 14th Amendment. During a smallpox outbreak, he refused to let himself or his son be vaccinated and was fined $5. Massachusetts was then one of 11 states with compulsory vaccination laws, but it did not allow vaccination by force. By a 7-to-2 vote, the court let the fine stand and said imprisonment could also have been imposed. But Justice John Harlan wrote for the majority that individuals could not be forcibly vaccinated. Yet vaccination by force was used in 1991 in Philadelphia, said Dr. Paul A. Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. A measles outbreak that year infected over 1,400 people and killed several children. It had begun in two fundamentalist churches that rejected modern medicine and practiced faith healing.<doc-sep>New York City officials declared a public-health emergency as authorities elsewhere in the state announced new measures to halt the spread of measles, stepping up their responses after a recent surge in cases. The city on Tuesday ordered mandatory measles-mumps-rubella vaccinations and fines for noncompliance in certain ZIP Codes in Brooklyn, where a measles outbreak began last fall in the Orthodox Jewish community. The move is the first time the city has imposed mandatory vaccinations. Share Your Thoughts How should a densely populated city like New York fight a spreading infectious disease? Join the conversation below. “We cannot allow this dangerous disease to make a comeback in New York City,” Mayor Bill de Blasio said Tuesday at a press conference. North of the city, Rockland County, home to another significant Orthodox community, has also been contending with a measles outbreak. A state Supreme Court judge Friday blocked an executive order by county officials that barred unvaccinated children from public places for 30 days unless they received the MMR vaccine. The restraining order came after a group of parents filed a lawsuit over the ban. The county said Tuesday that it had appealed the order and is working on a plan to require exposed but unvaccinated people to remain home for an incubation period, which is typically 21 days. Violators would face fines of up to $2,000, they said. “How high must our case count be before you consider it an emergency?” said Rockland County Executive Ed Day. “This outbreak is an imminent threat to our public health. Doing nothing is absolutely not an option.” New York City Mayor Bill de Blasio spoke at a news conference declaring a public health emergency in parts of Brooklyn in response to a measles outbreak. Photo: shannon stapleton/Reuters In New York, the city health department said it would check vaccination records and track down adults and children who have been in contact with infected patients. People who haven’t received the MMR vaccine, or don’t have evidence of immunity, and then refused to be vaccinated could be fined $1,000. The measures are unusual and could face legal opposition. But public-health officials say they are necessary as they struggle to halt outbreaks and fight misinformation about vaccinations. The outbreak in New York City is the city’s largest since 1991, with 285 cases of measles since October, including 246 cases in children. Twenty-one people have been hospitalized, with five ending up in intensive care, but there have been no deaths. Herminia Palacio, New York City’s deputy mayor for Health and Human Services, said the city was counteracting antivaccination campaign that has included pop-up phone numbers for conference calls with “intentional efforts to give misinformation” and measles parties. The parties are intentional gatherings with at least one infected person to share the virus with others who aren’t infected—with the idea to help the children develop an immunity without a vaccine. “There are people actually urging people against vaccines,” said Dr. Palacio. “There are frank untruths being propagated.” The city estimates 1,800 unvaccinated children are in the areas where there is now a vaccine mandate. The emergencyorder covers four neighborhoods in and around South Williamsburg, Brooklyn, home to a dense concentration of schools, synagogues, shops and services for the insular Orthodox community. City officials emphasized that the emergency order’s goal is to get residents in Williamsburg vaccinated—not to issue fines. The urgency is related, in part, to the coming Passover holiday, when many people will be gathering and traveling. There was an uptick in exposures to measles after the Jewish holiday in March of Purim, health officials said. “It was time to take a more muscular approach,” Mr. de Blasio said. “We can turn this around quickly, we can stop this.” Mandatory vaccination orders, though rare in modern times except for school immunizations, are a lawful tool to combat outbreaks, said Lawrence Gostin, director of the World Health Organization Collaborating Center on National & Global Health Law at Georgetown University. “The city has the power and duty to safeguard the health of its population, particularly to protect vulnerable children from dangerous infectious diseases,” he said. But limiting it to certain ZIP Codes opens the city to criticism, and potential legal challenges it is targeting specific religious groups, he said. “Why create a special order that singles out certain religious communities, when it would be fairer and more effective to require it of all residents?” he said. Mr. de Blasio said that the move was evaluated by the city’s law department and that the action was “an appropriate use of our emergency powers.” “If anyone is thinking of a legal challenge, we are absolutely comfortable that we will win that legal case,” he said. Rockland County, which has had 168 measles cases since October, is also on solid legal footing in requiring exposed unvaccinated people to stay home, said James Hodge, Western Region Director for the Network for Public Health Law at Arizona State University’s Sandra Day O’Connor College of Law. “They’ve got a significant measles outbreak,” he said. “This is within the realm of their public health powers.” Rabbi David Niederman, president of United Jewish Organizations of Williamsburg and North Brooklyn, said some parents had been misled by antivaccination groups. The city order “will definitely help persuade the holdouts to vaccinate their children,” he said. —Katie Honan contributed to this article. Write to Melanie Grayce West at melanie.west@wsj.com and Betsy McKay at betsy.mckay@wsj.com<doc-sep>New York Mayor Bill de Blasio declared a public health emergency Tuesday for parts of Brooklyn's Williamsburg section following a measles outbreak affecting the Orthodox Jewish community fueled by a growing movement against vaccinations. Unvaccinated people living in designated ZIP codes who may have been exposed to measles will be required to receive the vaccine to protect others from the outbreak, the mayor said. Measles is highly contagious, but the vaccination is considered 97% effective, according to the Centers for Disease Control and Prevention. “There’s no question that vaccines are safe, effective and life-saving,” de Blasio said. “The bottom line is to recognize that this is something that has become even more urgent." Health Commissioner Oxiris Barbot said the outbreak was being "driven by a small group of anti-vaxxers" in the targeted neighborhoods. "They have been spreading dangerous misinformation based on fake science,” he said. “We stand with the majority of people in this community who have worked hard to protect their children and those at risk." The outbreak began in October, but many of these new cases were confirmed in the past two months. The vast majority of cases are children under 18 – and most of these measles cases were unvaccinated or incompletely vaccinated people, health officials said. Members of the City’s Department of Health and Mental Hygiene will check the vaccination records of people who may have been in contact with infected patients. Those who have not received the vaccine or do not have evidence of immunity may be given a violation and could be fined $1,000, the mayor said. Barbot is concerned about measles outbreaks spreading as people travel for Passover, which begins in less than two weeks. "We’ve seen a large increase in the number of people vaccinated in these neighborhoods, but as Passover approaches, we need to do all we can to ensure more people get the vaccine," Barbot said. The primary symptoms from the disease include fever, runny nose, cough and a rash that can spread across the entire body. People who are immunocompromised can develop pneumonia, swelling of the brain or other serious symptoms. Measles can cause men to become sterile and pregnant women to deliver prematurely. "It's not Ebola, but it's a serious disease," said Lisa David president of Public Health Solutions, a major public health nonprofit in the city. "It was a major achievement to eradicate it (in the U.S.) in 2000." Measles was introduced into the community by someone who picked up the disease in Israel, which is dealing with its own outbreak, health officials said. Ogbonnaya Omenka, an assistant professor at Butler University who has a doctorate in public health, says the New York outbreak shows that people shouldn't believe they are safe without a vaccination because almost everyone else around them was vaccinated. "Herd immunity can only carry a community so far," he said. "This mandatory vaccination order is a bold step, (but) this measles outbreak is serious, both from health and statistical perspectives." In February, the department expanded vaccination recommendations for providers serving the Orthodox Jewish community to include an early, extra dose of the vaccine for children ages 6 months to 11 months who live in Williamsburg and Borough Park. "It does interconnect with the anti-vaxx movement that is not just in the community, it's national and it's causing lots of problems," de Blasio said Tuesday. On Monday, the city Health Department issued formal orders to all yeshivas – Jewish schools – in Williamsburg to comply with the mandatory exclusion of unvaccinated children or face fines and possibly be shut down. The emergency was declared one day after federal health officials reported that the number of measles cases recorded across the USA rose by almost 100 last week. More:What are states doing about measles cases? More:Anti-vaxxers open door for measles, mumps, other old diseases The CDC said Monday that 465 cases have been confirmed in 19 states in 2019, the second-highest total since measles was declared eliminated in the USA almost two decades ago. The surge has been fueled in part by the anti-vaccination movement – most people who contract measles have not been vaccinated, the CDC said. If one person has the disease, up to 90% of the people close to that person will become infected if they are not immune, the CDC warned. The World Health Organization described the disease as a prominent cause of death among young children, despite the availability of an effective vaccine. More than 110,000 people, mostly children, died of measles worldwide in 2017. The last U.S. measles death on record was in 2015. Omenka lauded the "messaging approach" employed by New York. "The threat was clearly defined, the susceptibility of individuals was presented," Omenka said. "Additionally, by pointing out that none of the reported cases had led to death, as opposed to cases in other countries, the public health threat was put in perspective." More:Vaccines are definitely not linked to autism, and other facts<doc-sep>
EMBED >More News Videos Danielle Leigh looks into questions regarding the legality of mandating vaccines. WILLIAMSBURG, Brooklyn (WABC) -- New York City Mayor Bill de Blasio declared a public health emergency Tuesday in the ongoing measles outbreak affecting the Orthodox Jewish community and ordered mandatory vaccinations in several neighborhoods.The order applies to anyone living, working or going to school in four zip codes in Williamsburg and requires all non-vaccinated people who may have been exposed receive the measles-mumps-rubella (MMR) vaccine, including all children over 6 months old.Those zip codes are 11205, 11206, 11211 and 11249.Under the mandatory vaccinations, members of the city's Department of Health and Mental Hygiene will check the vaccination records of any person who may have been in contact with infected patients. The city can't legally physically force someone to get a vaccination, but those who have not received the MMR vaccine or do not have evidence of immunity may be given a violation and could be fined $1,000. "There's no question that vaccines are safe, effective and life-saving," de Blasio said. "I urge everyone, especially those in affected areas, to get their MMR vaccines to protect their children, families and communities. "The order raises questions about the legality of mandating vaccines, and New York Civil Liberties Union Executive Director Donna Lieberman issued the following statement:7 On Your Side Investigates' Danielle Leigh also looked into the questions of legality:The public health emergency declaration comes one day after the city threatened to close yeshivas if non-vaccinated students are allowed to attend classes during the current measles outbreak.There have been 285 cases since the outbreak began last October, though it is unclear how many cases are current. There have been no fatalities and only three measles-related deaths in the past two decades, but health officials say there have been complications in the current outbreak, including 21 hospitalizations.In December, the health department ordered yeshivas and childcare centers serving the Orthodox Jewish community in the affected zip codes in Brooklyn to exclude all non-vaccinated students from attending school or daycare until the outbreak was declared over. But in January, one yeshiva in Williamsburg fell out of compliance with the exclusion mandate, allowing non-vaccinated children back into school or daycare.Officials say this single yeshiva is connected to more than 40 cases.The health department has since issued Commissioner's Orders to all yeshivas in Williamsburg to comply with the mandatory exclusion of non-vaccinated children or face violations subject to fines and possible school closure.The city's health commissioner, Dr. Oxiris Barbot, said that the majority of religious leaders in Brooklyn's large Orthodox communities support vaccination efforts, but that rates have remained low in some areas because of resistance from some groups that believe the inoculations are dangerous. "This outbreak is being fueled by a small group of anti-vaxxers in these neighborhoods," she said. "They have been spreading dangerous misinformation based on fake science. We stand with the majority of people in this community who have worked hard to protect their children and those at risk. We've seen a large increase in the number of people vaccinated in these neighborhoods, but as Passover approaches, we need to do all we can to ensure more people get the vaccine. "Measles is a highly contagious disease and can cause pneumonia, encephalitis, and in rare cases, death. The vast majority of cases are children under 18 years of age, while there have been 39 cases in adults.Health officials say individuals traveling to areas with ongoing large outbreaks, including Israel, Europe, upstate New York, and other parts of the United States should make sure they and their children are appropriately vaccinated with MMR.For more information on the MMR vaccine, call 311 or CLICK HERE ----------