Each new update in the nationwide surge of measles cases takes Dr. Paul Offit back to the battlefield that was Children's Hospital of Philadelphia during a regional outbreak that began in 1990. By the time it ended the following year, more than 1,400 city and suburban residents had contracted the disease and nine children were dead.
Then an attending physician at the University City hospital supervising the care of young measles patients, Offit "saw how bad it could get," he recalled. "It was harrowing, like a war zone."
Back then, the outbreak was centered on Faith Tabernacle Church in North Philadelphia, as well as the offshoot First Century Gospel Church in the Juniata section. Both congregations believed that the Bible opposed all means of healing apart from "God's way." Hundreds of children in the church school had not been immunized, and six of them died. Within those congregations alone, 486 people were infected.
Nationwide In the current scourge, 764 cases have been reported this year through May 3, according to the Centers for Disease Control and Prevention. Pennsylvania has five of them, all in Allegheny County; New Jersey officials have confirmed 14.
Some of the highest numbers, however, have come from New York, Detroit, and Baltimore, in particular from several Ultra-Orthodox Jewish communities.
Although the "vast majority of Jews, including those who are Ultra-Orthodox, have their children vaccinated," there are some outliers who refrain out of fear and misinformation, said Rabbi Joshua Waxman, president of the Board of Rabbis of Greater Philadelphia.
For the most part, the Philadelphia area's Orthodox communities support immunization, said Rabbi Albert Gabbai, of Congregation Mikveh Israel in Society Hill. Judaism teaches that "when one life is lost, it's like a part of God is lost," he said. "It is an obligation to do everything we can do to preserve life. If a vaccination has been scientifically proven to preserve life, then it is an obligation to preserve one's life."
New York, with the highest tally of cases, has more insular enclaves of Jews than does Philadelphia. Anti-vaccination activists often target such small communities, whose religious views or cultural isolation make them vulnerable to claims disproven by medical science and refuted by faith leaders, said Offit, now the director of the Vaccine Education Center at CHOP and author of several books on the subject, including "Bad Faith: When Religious Belief Undermines Modern Medicine."
In most states, Pennsylvania and New Jersey among them, residents are allowed to opt out of immunization because of religious beliefs, said Rita Swan, a former Christian Scientist who advocates on behalf of children's rights to medical care. Nonetheless, she said, courts have repeatedly ruled that parents do not have a constitutional right to deprive their child of immunization and that states have the authority to compel it in the interest of public welfare.
Families from a variety of religious traditions decide not to immunize their children despite repeated assurances from faith leaders that God wouldn't object. They disagree or they may be confused about the theology, said Rene Najera, of Hanover, an associate scientist at Johns Hopkins University who edits the History of Vaccines website for the College of Physicians in Philadelphia.