To the Editor: Measles outbreaks have been reported in Orthodox and ultra-Orthodox Jewish communities across Europe and Israel (1–5). We describe an ongoing outbreak within the largest European Orthodox Jewish community (including a Charedi population of 17,587), based in London, focused in Hackney (6). Vaccination coverage within this community is lower than in the general population of London, causing low herd immunity and outbreaks of vaccine-preventable diseases. Vaccination coverage data within the communities cannot be extrapolated, because membership is not classified as an ethnicity and not collected within health electronic recording systems. However, general practice surgeries in Hackney known to have high proportions of Orthodox Jewish patients have considerably lower vaccination coverage (55%–75% of patients 24 months of age had received measles, mumps, rubella [MMR] vaccine in the 3rd quarter of 2012) compared with the London average (87.3%) (7). Health beliefs, family size (the average Charedi household size is 6.3 persons), and underutilization of immunization services contribute to low coverage (8,9).
The outbreak clinical case definition was taken from Public Health England’s guidance (10). It also included membership in the Orthodox Jewish community; residency in the London borough of Barnet, Hackney, or Haringey; and notification during December 20, 2012–March 19, 2013.
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