New York City declares a state of public health emergency in Brooklyn as the measles outbreak has reached at least 285 cases.

Mayor Bill de Blasio issued mandatory measles vaccination to people living in or near Williamsburg. Those who refused to get immunized within 48 hours will risk receiving violation tickets or incurring fines of $1,000.

Most Notorious Outbreak

The U.S. Centers for Disease Control and Prevention reported at least 465 individual cases of measles in 19 states in the past three and a half months. This outbreak has the second greatest number of infected individuals since measles was eradicated in the country in the 2000s.

In March, state health officials banned unvaccinated children from attending schools, visiting shopping malls, and even occupying public places in Rockland County.

The NYC Health Department recently issued an order banning all unvaccinated members of the Orthodox Jewish community in Williamsburg from entering yeshivas and day care programs. Non-compliant schools could be subject to closure.

"We stand with the majority of people in this community who have worked hard to protect their children and those at risk," said Health Commissioner Dr. Oxiris Barbot from the NYC Health Department. "We've seen a large increase in the number of people vaccinated in these neighborhoods, but as Passover approaches, we need to do all we can to ensure more people get the vaccine."

In February, the department increased the recommended MMR vaccine dose for children between ages 6 months and 11 months who live in Williamsburg and Borough Park. Infants are advised to get immunized prior to international travel.

Unvaccinated individuals may dial 311 to get a list of providers that offer MMR vaccines with minimal to low cost.

Currently, New York's MMR vaccination rate is at 91.1 percent, below the 94 percent requirement to achieve herd immunity.

Non-Medical Exemptions

An analysis published in PLOS Medicine indicated that non-medical exemptions increased in 12 out of 17 states with relaxed laws on immunization. Arkansas, Arizona, Idaho, Maine, Minnesota, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, and Utah gave leeway for philosophical beliefs as a basis to refuse the vaccine.

Measles hot spots were gearing toward tighter policies. Fewer students in California skipped their shots and statewide vaccination rates rose to 94 percent as a result of discarding its personal-belief exemptions.

Authorities said they are now reviewing a bill to ensure that only patients with a qualified medical history like chemotherapy or organ transplantation will be given an exemption.

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