Where Will Measles Break Out Next?

Chicago, Los Angeles or Miami,

Scientists Predict
A new study ranks the risks in U.S. counties by the numbers of
unvaccinated children and proximity to international airports. But no
one predicted the outbreak in Brooklyn.

A health clinic in an Orthodox Jewish community in Williamsburg,

Brooklyn. A new study ranks the risk of a measles outbreak in various
American communities. But the researchers failed to predict the
nation’s largest outbreak, in Brooklyn.CreditJustin Lane/EPA, via
Shutterstock

By Donald G. McNeil Jr.

 May 10, 2019
Researchers at the University of Texas at Austin and Johns Hopkins University mapped
the 25 American counties most at risk of measles because of their vaccine-exemption
rates and proximity to airports.

A similar map published last year proved surprisingly accurate at forecasting many of
this year’s cases. But both groups of scientists failed to predict the measles outbreak that
began in Brooklyn, currently the nation’s largest.

These prediction models need refining, one expert noted, and the Centers for Disease
Control and Prevention should make it a priority in order to get ahead of measles cases.

The study, published this week in The Lancet Infectious Diseases, found that Cook
County, which includes Chicago, was likeliest to experience a measles outbreak. Los
Angeles and Miami-Dade counties were next, followed by New York’s Queens County
and the counties that include the cities of Seattle, Phoenix, Fort Lauderdale, Las Vegas,
Houston and Honolulu.
To assess risk, the researchers looked at how many children in counties across the
country had nonmedical vaccination exemptions — which include “religious,”
“philosophical” or “personal belief” exemptions, depending on state law.

The team then focused on counties with international airports, because every American
outbreak since 2000 has begun with a case imported from overseas.

They gave greater weight to airports with many passengers arriving from countries with
thousands of measles cases, including India, China, Mexico, Japan, Ukraine, the
Philippines and Thailand.

However, both studies failed to foresee what is now the country’s largest outbreak — the
one among Orthodox Jews in the Williamsburg neighborhood of New York — which is in
Brooklyn, not Queens.
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(The Lancet authors said their forecasts were correct about two-thirds of the time, as
long as counties “spatially adjacent” to the ones they saw as potential hot spots were
included.)

In September last year, the virus spread from Ukraine to Orthodox Jewish communities
in Israel. One month later, Orthodox Jews from New York carried measles almost
simultaneously to Brooklyn and to suburban Rockland County, N.Y. The outbreak
spread from New York to Orthodox communities in Michigan.
“What we did not calculate at all was that it would come from Israel,” said Sahotra
Sarkar, a professor of philosophy and integrative biology at the University of Texas at
Austin and a co-author of the new study.

A similar study published last June in PLOS Medicine ranked the risk of measles
outbreaks in 18 states with philosophical or personal belief exemptions to vaccination.
The research was prescient: almost half the “hotspot” metropolitan areas the scientists
noted — particularly Washington State, Texas and Michigan — saw outbreaks this year.

“In the major leagues, that’s an all-star batting average,” said Dr. Peter J. Hotez, a
director of the Texas Children’s Hospital Center for Vaccine Development and a co-
author of the PLOS Medicine study.

Dr. Hotez and his colleagues did not look at New York State because it does not have
“philosophical” exemptions to vaccination, although the state permits religious ones — a
loophole that the legislature is considering eliminating.

“What I never expected was an outbreak in Jewish communities,” Dr. Hotez joked. “In
my book, Jews makethe vaccines.” (Dr. Hotez, who is Jewish and researches vaccines
against tropical diseases, cited such pioneers as Albert Sabin, Jonas Salk, Stanley
Plotkin and Rachel Schneerson.)
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To refine their predictive models, both Dr. Hotez and Dr. Sarkar said they would need to
learn to account for the fact that vaccination rates are not evenly spread out across
urban counties; low rates tend to cluster in smaller ethnic, religious or educational
communities.

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In the last five years, according to the C.D.C., 75 percent of measles cases have occurred
in tight-knit communities, such as Somalis in Minneapolis, the Amish in Ohio and
Orthodox Jews in Brooklyn.

This year’s measles outbreak in Washington State’s Clark County, near Portland, Ore.,
includes 72 cases linked to Russian-speaking immigrants from the former Soviet Union,
according to a Vox article citing C.D.C. sources. Many of the immigrants were skeptical
of government medical requirements, including vaccination.

Near Austin, Tex., Dr. Sarkar said, vaccination rates are lowest among children
attending Waldorf schools and a few charter schools where families reject vaccination.
 Many are influenced, he said, by Andrew Wakefield, the former British doctor who
started the misconception that the measles vaccine causes autism, even though that
research was discredited long ago.

After losing his medical license, Mr. Wakefield moved to Austin, where he directs films
condemning vaccination.

“He has a very well-heeled following here,” Dr. Sarkar said.

The Austin area is number 22 on his list of places most likely to see a measles outbreak.

Donald G. McNeil Jr. is a science reporter covering epidemics and

diseases of the world’s poor. He joined The Times in 1976, and has
reported from 60 countries.

A version of this article appears in print on May 11, 2019, on

Page A12 of the New York editionwith the headline: Where Will
Measles Hit Next? Scientists Crunch Data to Make a Guess. Order
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The New York Times

Where Will Measles Break Out Next? Chicago, Los Angeles or Miami, Scientists
Predict by Donald G. McNeil Jr.
Comprehension Questions

1. What are the two main facets researchers at University of Texas and Johns Hopkins
University use to map out the counties most at risk of measles?
2. Why did both groups of scientists fail to predict the measles outbreak in Brooklyn?

3. From the context of the article, what can you infer the difference is between a city and a
county in the United States?

4. What do “nonmedical vaccination exemptions” include?

5. According to Dr. Hotez and Dr. Sarkar, what do they need to learn to refine their
predictive models of measles outbreaks?

6. Seventy-five percent of this year’s measles outbreaks happened in what kind of

community? What does that term mean?

7. Who influences many parents to reject vaccinations for their children? Why is this
person significant?

8. A. What does ‘misconception’ mean? It’s a noun, make it a verb.

B. What does to ‘condemn’ mean? It’s a verb, make it a noun.

C. What is it called to change how a word operates again?

9. What do you think “well-heeled” means? i.e.: “a well-heeled following.”

10. What is the thesis you gather from this article? And why is it important?