Current Measles Outbreak Hit ultra-Orthodox the Hardest

Scope of current outbreak has improved image of vaccination among usually skeptical community.

One morning this week, at the Breslav Hasidism's central synagogue in Jerusalem's Mea Shearim neighborhood, a healing ritual was performed to cure a child with measles.

In the worst case of this year's measles outbreak, the 12-year-old girl has been on artificial respiration in Shaare Zedek Hospital's intensive care unit since the beginning of the week. On Wednesday, her condition was described as serious.

Most of the 180 people who have contracted the disease this year are from the ultra-Orthodox communities of Jerusalem and Bnei Brak, where there remains some resistance to vaccinations. However, the scope of the disease this time around has led to an unprecedented vaccination drive of more than 10,000 ultra-Orthodox school children. The Israel Association for Public Health Services is responsible for vaccinations in schools, under the Health Ministry's supervision.

The latest flare-up of measles began at the end of summer, when two carriers of the virus arrived from London to attend an ultra-Orthodox wedding in Jerusalem. The two were hospitalized in Jerusalem. Shortly afterward, dozens of patients, mostly children and pregnant women from ultra-Orthodox families who did not vaccinate their children, contracted the disease in Jerusalem and Bnei Brak.

Dr. Nitza Abramson, the deputy Jerusalem district health officer, said there may be even more measles cases. "We assume that dozens of patients have not been reported," she said.

The ultra-Orthodox refusal to be vaccinated is connected to a traditional rejection of Zionism. Following the establishment of the State of Israel, many refused to cooperate with its institutions, including the National Insurance Institute, the Histadrut's health maintenance organization and well-baby clinics. Vaccinations were seen as government policy and boycotted.

In any case, the ultra-Orthodox public largely believes that everything is in God's hands. Even though one must make the effort and go to the doctor, measles was not seen as a disease people die from.

Over the years, the ultra-Orthodox boycott of many state institutions has weakened and today Mea Shearim residents have become ardent HMO members and most of them even vaccinate their children. However, pockets of resistance to vaccination remain in Neturei Karta and Hasidic courts such as Satmar, Dushinsky Dushinsky, Toldos Aharon and Toldos Avraham Yitzhak. Some families don't vaccinate their children for other reasons, preferring alternative medicine, whose popularity is spreading among newly religious people and the Breslav community.

The Health Ministry's efforts to inform the ultra-Orthodox about the importance of vaccinations was blocked until recently and even talks with their rabbis did no good. During the previous measles outbreak, in 2003, an ultra-Orthodox child died, but the authorities' bid to vaccinate the community was only partially successful.

Ahuva Holtzberg, the head nurse of the Israel Association for Public Health Services, believes that the ultra-Orthodox community's cooperation with the present vaccination operation derives from the fact that it is not being run by the Health Ministry itself.

"It's like a burst dam -- when one school hears that another's children are being vaccinated, it quickly decides to vaccinate its own pupils also," said Eli Haimo, a veteran association nurse.

Haimo also said the notices that the association sent parents did not bear the Health Ministry's logo, so as not to deter them. School principles were promised that the names of the inoculated children would not be passed on to the Health Ministry. Male nurses conducted the vaccinations in boys' schools while female ones did the work in the girls' schools. In addition, many parents of smaller children bring them to association centers for inoculation.