On a recent Saturday morning in New York’s North Country, there were signs that work had fallen behind.
Standing on his porch in suspenders and shirtsleeves, 32-year-old David Stoltzfus pointed at a heap of logs, some thicker than telephone poles and stacked two stories high. He needed to saw them into lumber. But Mr. Stoltzfus was still playing catch-up after falling ill.
“You see the big pile of wood that all got piled up?” he asked, pointing to hundreds of logs. “That’s because of the measles.”
The viral illness ripped through his house five weeks ago, sickening him, his wife and their six children. “I was sick in bed for about four days,” he said. And it was weeks before he felt healed. Work lagged. “It was hard for a couple of weeks until I got energy,” he said.
All across Lewis County, N.Y., where the trees are already bare and stands selling maple syrup dot the roadside, Amish families — Mr. Stoltzfus’s included — have stories of measles sweeping through their homes in recent weeks, their community disproportionately affected by the virus. One man described how it had attacked nine of 10 people in his house. Another said it had infected eight of nine people.
“Right now, just about everybody” has recovered, said Samuel Stoltzfus, 23, a distant cousin of David’s who lives about eight miles away.
Except for a family living way down a private road, amid a fast-growing Amish settlement. There, on Nov. 1, an ambulance was summoned. Then the county coroner. A 7-month-old boy had died at home after contracting measles, according to the coroner.
It was the first death from the disease in New York in 30 years. On Tuesday, health officials reported that the state has recorded more than 235 measles cases since Aug. 1, with 16 in Lewis County. That is almost certainly an undercount, doctors and public health experts say. Families that have weathered infections without going to a doctor, opting for bed rest, aren’t typically included in official case counts.
“We’re only catching the tip of the iceberg,” said Dr. Jana Shaw, a pediatric infectious-disease specialist at SUNY Upstate Medical University in Syracuse who has treated Amish patients during this outbreak.
The outbreak, in its fourth month, does not appear to be subsiding. Only a few cases have been recorded in the counties with some of the largest Amish populations in New York, including St. Lawrence County, which neighbors Lewis County. In Seneca County, in the Finger Lakes region, the count of new infections is climbing rapidly, with health authorities having recorded 21 new cases in the first week of November.
Measles landed in the state after tearing through Amish settlements in Ohio and Pennsylvania. The Amish tend to have lower vaccination rates than the general population.
Dr. Shaw said she knew of five newborns who were infected with measles. Their mothers transmitted the infection during pregnancy or delivery — or shortly thereafter.
Lynne M. Brown, a nurse and the director of infection prevention at University of Rochester Medicine, said that nine children with complications related to measles had been admitted to Golisano Children’s Hospital in Rochester during this outbreak. Four were sick enough to be put on ventilators in the intensive care unit.
Doctors there have seen a worrisome pattern. Children, after being infected with measles, are prone to bacterial infections in the days or weeks after.
“We’ve seen some meningitis cases, and we’ve seen some pneumonias as well,” said Dr. Tyler Stephen, who specializes in pediatric infectious diseases at Golisano Children’s, part of the University of Rochester system.
Measles is among the most contagious diseases. If an infected person coughs or sneezes in a room, an infectious dose of the virus can linger in the air for up to two hours.
The virus was once all but vanquished in the United States. But cases have spiked in recent years, as more families forgo or delay vaccinating their children.
A number of insular communities — all with lower than average vaccination rates — have faced outbreaks. In 2018 and 2019, New York endured a significant outbreak among ultra-Orthodox Jewish communities in Brooklyn and elsewhere. Last year, measles rampaged through Colorado City, Ariz., and Hildale, Utah, adjoining cities that once were the stronghold of a polygamist offshoot of the Mormon Church. This year, a close-knit evangelical Slavic community in South Carolina bore the brunt of an outbreak that sickened nearly 1,000 people, mostly unvaccinated children.
In a court affidavit in 2023, Ezra Wengerd, an Amish leader who represents Amish schools in their dealings with state government, described his community’s approach to childhood illnesses.
“We have age-old practices for addressing when a child gets sick in our community including having them recover in bed, tended to by one parent, and not attending communal activities while sick,” he wrote.
Doctors and county health officials say that the outbreak in New York State remains largely confined to “Plain communities,” as Amish and Mennonite settlements are often called, referring to their unadorned clothes and way of living. That could change.
“Measles remains a threat to anyone who is unvaccinated,” the state Health Department said in a statement.
New York State has more than 25,000 Amish residents, according to the latest estimates by the Young Center for Anabaptist and Pietist Studies at Elizabethtown College in Pennsylvania. They are scattered across more than 50 settlements, from western New York to the North Country.
The population has grown substantially in New York, buoyed by Amish people who moved from Ohio and Pennsylvania, seeking cheaper farmland, or to form communities because of schisms and division within older communities.
“Coming here was a conservative decision, intended to establish new settlements and as much as possible to raise families who would farm,” said Karen Johnson-Weiner, a retired professor at SUNY Potsdam, who has written books about the Amish.
The outbreak in New York appears to have been seeded by measles infections picked up in Ohio and Pennsylvania, according to local news reports and county health officials.
Though most Amish people travel short distances by horse and buggy, they tend to travel longer distances by bus.
Under normal circumstances, the health authorities recommend that children receive their first dose of the M.M.R. vaccine — which protects against measles, mumps and rubella — at about 12 months of age. But given the active risk, New York State health officials have encouraged families in affected counties to have infants as young as 6 months vaccinated.
By age 2, about 81 percent of children in the state have received a first dose of vaccine. By the start of kindergarten, more than 97 percent have been vaccinated, reflecting New York’s strict school vaccination requirements.
Rates are far lower among Amish New Yorkers. Several Amish communities are locked in a legal fight with the state Health Department over whether their children must be vaccinated to attend small private Amish schools.
Some Amish parents oppose vaccinating schoolchildren for religious reasons, saying they must put their faith in God, not vaccines or state health regulations. Many believe that salvation requires that they live in tightknit religious communities — and keep worldly influences at bay.
Attitudes toward vaccination vary widely among the Amish. In Lewis County, one 50-year-old man, who spoke on the condition of anonymity because he wanted to maintain his privacy, said he had developed rheumatic fever as a boy, which left him frail. So his parents vaccinated him against measles and other diseases to give him more protection. But he had not vaccinated his seven children, he said, and they had all gotten measles in the last month.
Samuel Stoltzfus, the Amish man who said that most of the affected people in his community had recovered, paused on a walk home after a morning of hunting deer in nearby woods to describe his family’s experience with vaccines and the measles.
Wearing a tattered broad-brimmed straw hat and carrying a rifle in one hand and an orange hunting vest in the other, Mr. Stoltzfus said that only one of 10 people in his parents’ home had been spared the measles: his mother. She had been vaccinated as a young girl to protect a sibling with health issues.
In his own case, Mr. Stoltzfus was sick enough that he stayed in bed for two weeks last month.
“It’s miserable,” he said. “It starts in your head, and you get dots, like a red rash, around your eyes and it travels all the way down to your feet.”
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