A few days ago, Rockland County, New York, declared a state of emergency over the outbreak of measles that has been going on there since late last year. The order that accompanied the declaration bars children and teenagers from public spaces if the children are not vaccinated against measles. According to the County Executive, this doesn’t mean that police will be checking vaccination records or anything like that. It does mean that people found retroactively to have violated the order will be fined up to $500. What does “retroactively” mean? For example, if any of those children develops measles and are questioned about the places they visited as part of the investigation into their disease, and they are found to have been to a public place in the county, the parents will be fined. The parents then will have the opportunity to challenge the fine in court, just like one does with any other fine or penalty imposed by the government.
On Thursday, March 28, a few parents and their children protested in a public space against this order. Some of the parents admitted to not allowing their children to be vaccinated, and some also expressed a good deal of misinformation about vaccines. For the most part, the arguments against the order seemed to stem from a misunderstanding about the authority of a local government to protect public health, an authority long protected by traditional and legal precedent. (See this analysis on the Supreme Court’s ruling in Jacobson v. Massachusetts for more information.)
This is not the first time that a local or state authority orders someone to stay home or stay away from public places. In the early 1900s, all of Chinatown in San Francisco was quarantined out of fear of the bubonic plague spreading. More recently, in 2004, the state of Iowa ordered several people to stay home after they were exposed to measles and found not to be immune. In that outbreak:
“Seven persons who had potentially been exposed to measles refused PEP, even though they were aware of the potential for being quarantined. Initially, all seven agreed to be quarantined in lieu of receiving vaccine, but because of their subsequent unwillingness to comply with voluntary quarantine, all seven were served by the local public health nurse with state-issued involuntary home quarantine orders, some with the assistance of local law enforcement officers. (Examples of Iowa’s quarantine orders are available at http://www.idph.state.ia.us/adper/cade.asp.) Although none reported a history of full vaccination or symptomatic measles, within days of being quarantined, four of the seven were determined serologically to be immune and were released from quarantine; the other three completed their 2-week quarantine.
IDPH and the local health department monitored compliance with quarantine orders with at least daily unannounced home visits or telephone calls and released the persons from quarantine via oral communication. In the future, because of confusion about the exact time of day the quarantine should end, written release-from-quarantine notices will be served. No known breaks in quarantine occurred. None of those persons in quarantine acquired measles. No additional cases were reported.”
Whether or not the quarantine order in Rockland County will prevent further cases of measles there will probably not be known because, if the quarantine works, then there will be no new cases associated with public exposure. Proving a negative is a little difficult in this case. It will also be interesting to see if anyone gets fined or prosecuted for breaking the quarantine, and what the courts will say about that.