Community

How Failure to Immunize makes Mumps a Hazard in the Beit Midrash

September 30, 2013

Mumps sick medicineThe spread of mumps has an unlikely ally: chavruta learning.

An article in The New England Journal of Medicine reports that an outbreak of mumps that occurred in four Orthodox communities in the tri-state area in 2009-2010 was found to have been transmitted in the course of intense one-on-one study among boys in yeshivot. More than 3,000 cases occurred in New York State’s Kings (Brooklyn), Rockland, and Orange Counties and in New Jersey’s Ocean County, which includes Lakewood. The paper also apparently marked the first time that the word “chavrusa” has ever appeared in the New England Journal of Medicine.

“Yeshiva study is typically interactive, involving a ‘chavrusa’ (a study partner),” the paper explained, using the Ashkenazic pronunciation. “Partners face each other across narrow tables or lecterns to study religious texts; the format is face-to-face, often with animated discussion. Frequently, several pairs of students study at a single table. A typical day involves several study sessions, with students changing partners for each session.”

The study stated that the intense pairing enabled a “particularly efficient transmission of mumps virus.” Even though mumps is a respiratory infection it requires closer exposure than most other airborne diseases, like measles. After spreading through yeshivot, the disease spread to families and other parts of the community.

Dr. Gregory Wallace, the lead doctor of the mumps team at the Centers for Disease Control and Prevention who was involved in the study, explained that one of the researchers in the study was Orthodox and that the chavruta link was uncovered by process of elimination.

“We had already had the idea that crowding facilitates mumps and we were looking for something to explain it,” he said.  A similar outbreak that occurred in 2006 in a college in the Midwest was attributed to living conditions.

Mumps is one of the most easily vaccine-preventable diseases. Children are routinely immunized to mumps by the Measles Mumps Rubella (MMR) vaccine.  A first dose of the vaccine is given to children between the ages of 12-16 months; a second dose is given between 4-6 years.

The primary symptom of mumps is swelling of the salivary gland along with some respiratory problems, though symptoms don’t manifest in some cases. Complications can include testicular swelling in post-pubescent males and rare complications include meningitis and encephalitis (swelling of the brain). Prior to the development of the vaccine in 1963, mumps was one of the leading causes of encephalitis.

Vaccination levels have decreased around the world since 1998 when the respected medical journal The Lancet published what turned out to be a fraudulent paper by Dr. Andrew Wakefield that linked the MMR vaccine to autism. The study was discredited and retracted in 2010 and Wakefield lost his license to practice medicine in the United Kingdom. (He also was found guilty on several counts of abusing developmentally disabled children during the course of the study.)

The carrier that began the New York-New Jersey epidemic was an 11-year-old English boy attending a Jewish summer camp in the Catskills. Most of those in yeshiva settings have already been vaccinated, however, leading researchers to hypothesize that while vaccination prevents most cases of mumps, repeated exposure can hinder the vaccine’s effectiveness.

“Our theory is that if you’re exposed to a high enough dose it can overwhelm the protection you have from the vaccine,” said Albert Barskey, another author of the study. He added that the outbreak would have been far greater had vaccination levels in the affected communities not been as high as they were. To control the outbreak a third round of vaccinations was offered in select communities as well as other measures.

The movement against vaccination sparked by the 1998 fraud has also caught on somewhat within the Jewish community.

“There’s unfortunately a number of pockets in the Jewish community that don’t vaccinate,” explained Rabbi Aaron Glatt, an infectious disease specialist and CEO of Mercy Medical Hospital on Long Island, and the assistant rabbi at Young Israel of Woodmere. “This should be 100 percent. It’s a shame. In the frum community we’re a people who pride ourselves on knowledge and there’s not a shred of evidence against vaccination.”

Dr. Susan Schulman, a pediatrician in Borough Park, said that the Wakefield study, though thoroughly disproven, is still having an effect.

“It’s easy to scare people but very difficult to unscare them,” she said.