Vaccinations have been made mandatory this summer for campers and staff in several counties north of New York City that annually fill up with kids from the Orthodox Jewish communities that have been hit hardest by measles.
Ulster County took the extra step of mandating the measles vaccine or proof of immunity at all day camps and overnight camps, becoming the latest county in the area to issue immunization requirements. Rockland County announced a similar order this month, following mandates from Sullivan and Orange counties.
"We have to make sure our t's are crossed and our i's are dotted in making sure all these vaccination records are in and have been fine-combed through to make sure everything is in compliance," said Rabbi Hanoch Hecht, of Ulster County's Camp Emunah, which hosts many girls from a Chabad community in Brooklyn's Crown Heights.
"In the past where we accepted religious exemptions for certain things," said Hecht, who is getting his own blood checked for immunity, "now we cannot."
Treatment, preventative care and vaccinations for measles across the world
Treatment, preventative care and vaccinations for measles across the world
A child receives a vaccination against measles by a family physician on April 16, 2018 in the Romanian capital, Bucharest.
Measles still claims young lives in Romania, where nearly 40 children have died in an outbreak that many blame on parents being misled by scare stories that vaccinating them is dangerous. Some 12,000 people have contracted measles since late 2016 in the European Union's second-poorest country, 46 of them died. Among the dead, 39 were children under the age of three who had not been vaccinated, making Romania one of the worst affected countries in the ongoing measles outbreak in Europe. / AFP PHOTO / Daniel MIHAILESCU (Photo credit should read DANIEL MIHAILESCU/AFP/Getty Images)
A family physician prepares a measles vaccine during a consultation on April 16, 2018 in the Romanian capital, Bucharest. - Measles still claims young lives in Romania, where nearly 40 children have died in an outbreak that many blame on parents being misled by scare stories that vaccinating them is dangerous. Some 12,000 people have contracted measles since late 2016 in the European Union's second-poorest country, 46 of them died. Among the dead, 39 were children under the age of three who had not been vaccinated, making Romania one of the worst affected countries in the ongoing measles outbreak in Europe. (Photo by Daniel MIHAILESCU / AFP) (Photo credit should read DANIEL MIHAILESCU/AFP/Getty Images)
A nurse was seen vaccinating school children at her school in Lhokseumawe, August 4, 2018, Aceh, Indonesia. Vaccination Measles-Rubella (MR) for Indonesian school children is part of the Indonesian government's health program to provide physical immunity from two dangerous diseases, Rubella and Measles in Indonesian children. (Photo by Fachrul Reza/NurPhoto via Getty Images)
Artists wearing superhero costumes comfort an elementary student while she receives a German Measles, also known as Rubella, vaccination in Pekanbaru, Riau province on August 1, 2018 as part of the Indonesian governments health program to combat childhood diseases. (Photo by WAHYUDI / AFP) (Photo credit should read WAHYUDI/AFP/Getty Images)
ALEPPO, SYRIA - APRIL 17 : A Syrian child is vaccinated during the measles campaign in Al-Bab district of Aleppo, Syria on April 17, 2018. Kids fled from Eastern Ghouta's Douma after Assad regime forces' suspected chemical attack on April 7, 2018 receive measles vaccine Al-Bab district of Aleppo. (Photo by Omer Alven/Anadolu Agency/Getty Images)
A Venezuelan woman is vaccinated against measles in Cucuta, Colombia, at the international brigde Simon Bolivar on the border with Venezuela, on March 21, 2018. / AFP PHOTO / Schneyder Mendoza (Photo credit should read SCHNEYDER MENDOZA/AFP/Getty Images)
Venezuelan, Yan Manuel, receives a free measles vaccine given by a volunteer, after showing his identity card at the Pacaraima border control, Roraima State, Brazil August 19, 2018. REUTERS/Nacho Doce
A member of the Free Revolutionary Police carries out an inspection on a measles vaccine in the southern Idlib countryside September 17, 2014. Fifteen children died after being vaccinated against measles in northern Syria, resulting in the programme being halted, aid workers said on Wednesday, a tragedy likely to damage trust in health services in opposition-held areas. The Free Revolutionary Police is a newly launched unarmed police movement that works in areas controlled by the Free Syrian Army to solve the day-to-day problems in Idlib, the group said. Picture taken September 17, 2014. REUTERS/Khalil Ashawi (SYRIA - Tags: CIVIL UNREST CONFLICT HEALTH)
A girl receives anti-measles vaccination drops at a health centre in BASECO compound in Tondo, Manila September 3, 2014. Philippine President Benigno Aquino said on September 1, 2014 between 11 to 13 million people in the country are at risk from measles, polio and rubella (German measles), and asked the public to cooperate in eradicating the preventable diseases, during Monday's launch of a mass national vaccination campaign against measles and polio, reported local media. REUTERS/Erik De Castro (PHILIPPINES - Tags: HEALTH SOCIETY)
A vial of measles, mumps and rubella vaccine and an information sheet is seen at Boston Children's Hospital in Boston, Massachusetts February 26, 2015. REUTERS/Brian Snyder (UNITED STATES - Tags: HEALTH)
Rowan Walters, aged four, is held by her mother as she given an MMR injection at the Paediatric Outpatients department at Morriston Hospital in Swansea, south Wales April 6, 2013. Following an increase in the number of confirmed cases of a measles in south Wales, parents in the area were urged to vaccinate their children, and hospitals in the region opened drop-in clinics on Saturday, local media reported. REUTERS/Rebecca Naden (BRITAIN - Tags: SOCIETY HEALTH)
A health worker in Ciudad Juarez at the Mexican border crossing with El Paso, Texas, hands out leaflets to passing motorists and people as part of a measles prevention programme, February 16, 2015. California public health officials have confirmed three more cases of measles in an outbreak that began in late December, bringing to 113 the total number of people believed to have been infected in the state. Health officials in Arizona, where seven cases of measles have been documented, said the outbreak would likely be considered over in that state if no further infections were reported over the weekend. Across the United States, more than 150 people have been diagnosed with measles, many of them linked to an outbreak that authorities believe began when an infected person from out of the country visited Disneyland in late December. REUTERS/Jose Luis Gonzalez (MEXICO - Tags: SOCIETY HEALTH IMMIGRATION)
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The state of New York requires summer camps to keep immunization records for all campers but doesn't bar children from attending if they haven't gotten a measles shot.
Children are required to get the measles vaccine to attend schools in New York, however, and Gov. Andrew Cuomo signed legislation Thursday eliminating an exemption for kids whose parents object to vaccinations on religious grounds.
The Centers for Disease Control and Prevention reported that, as of June 1, more than 1,000 measles cases had been reported in the U.S. since the start of the year, up from fewer than 100 cases a year a decade ago. The bulk of those cases have been diagnosed in ultra-Orthodox Jewish neighborhoods in Brooklyn and suburban Rockland County.
The CDC recommends everyone over a year old should get the vaccine, except for people who had the disease as children. Those who have had measles are immune.
The vaccine, which became available in the 1960s, is considered safe and highly effective — paving the way for measles to be declared all but eliminated in the U.S. in 2000. But it has had a resurgence several times, including 667 cases in 2014.
Hecht and others stressed that vaccinations are widely accepted by most members of the Orthodox community, echoing rabbis in Brooklyn and Rockland County who say it is a relatively small group of parents influenced by anti-vaccination propaganda — not religious teachings — who have resisted inoculations.
The Orthodox Union said it has previously required up-to-date vaccinations, including the MMR vaccine, for its 37 summer programs.
"Most of the leaders and rabbis have taken the approach that vaccination is required," Hecht said.
Health officials in New York City have taken a tough approach, making measles vaccinations mandatory for everyone living in the Brooklyn neighborhood that is the epicenter of the outbreak, fining people for failing to get inoculated and closing 12 schools for failing to exclude staff and students who couldn't document immunity. The city announced the two most recent closures Thursday.
Now, as schools prepare to close down for the summer, the fight is spreading into the Catskills and Hudson River Valley.
Sullivan County is in the heart of the traditional Borscht Belt, and the lake-laden area still attracts thousands to its camps and bungalow colonies each summer. Of the 170 state-regulated camps in the county, 139 are Orthodox Jewish camps.
"We draw such a population from New York City, where this measles outbreak was," Sullivan County spokesman Dan Hust said. "It was considered prudent and wise."
Not everyone agrees. The orders from Sullivan and Orange counties were challenged in state courts by parents of various religious faiths. However, civil rights attorney Michael Sussman said Friday he believes those cases will have to be withdrawn given New York's removal of religious exemptions.
Several camp administrators interviewed by The Associated Press expressed no objection to mandatory vaccinations.
"We have no issue with that," said Yoel Landau, director at Camp Rav Tov, a camp for Hasidic boys in Monticello. Landau said schoolboys from New York City attending the camp should have already been vaccinated because of the city's order in April.
Rabbi Dovid Teichman, director of Camp Govoah, which caters to Orthodox campers in rural Greene County, said staffers were "combing through each and every application to make sure that everyone is vaccinated."
"I can't jeopardize anybody," he said. "So if I find somebody that's on the list that's not vaccinating, I'm not taking them into camp."