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ZIP codes on Staten Island and in Manhattan's Hell’s Kitchen neighborhood have some of New York City's lowest measles vaccination rates among young children, according to city data — putting those communities at higher risk for infection and challenging public health officials as they look to prevent the kind of outbreaks hitting other parts of the United States.

Across Staten Island, no ZIP code has higher than a 74% vaccination rate for measles, mumps and rubella among children 24 to 35 months old, making it the borough with the least protection against measles, according to city data shared with Gothamist. A rate of 95% is needed for herd immunity, which provides protection to those too young to receive the vaccine or who refuse it, according to the state health department.

The lowest MMR vaccination rate for 2-year-olds is in Staten Island’s 10309 ZIP code encompassing Rossville and Village Greens, where just 65% of children between 24 and 35 months have gotten their first dose. Three Hell’s Kitchen ZIP codes also have vaccination rates under 70%, as does the 11414 ZIP code covering Queens’ Howard Beach, according to city data.

Citywide, only about 81% of children between 24 and 35 months have received their first MMR shot, and rates vary from 65% to 99% across the ZIP codes, according to the data.

“There are numbers that are still deeply troubling,” Gov. Kathy Hochul said last week, following confirmation of the state’s fourth measles case this year. The governor called on clergy and other “pillars of our communities” to help promote vaccination in New York as measles spreads in parts of the United States and Canada.

The approach to raising vaccination rates will have to be tailored to each specific community, said Dr. Adam Ratner,  director of the Division of Pediatric Infectious Diseases at NYU Langone’s Hassenfeld Children's Hospital.

“ The issue with the Hell's Kitchen rate may be very different from the issue with the Staten Island rate, which may be different from Williamsburg,” Ratner said.

Three Williamsburg ZIP codes that were placed under a vaccine mandate by then-Mayor Bill de Blasio during the city’s 2018-2019 measles outbreak currently have MMR vaccination rates between 70% and 76% for children between 24 and 35 months old.

On the other end of the spectrum, Queens' Breezy Point neighborhood has a 99% MMR vaccination rate for children between 24 and 35 months old, as does the area around JFK Airport. But most neighborhoods fall somewhere in the middle.

”Measles is the most contagious disease that we know of and consequently, you need very high vaccination rates to prevent outbreaks,” Ratner said.

In New York City, almost all children enter kindergarten with two doses of the MMR vaccine, due to the state’s strict school vaccination rules, which don’t allow for religious exemptions. The U.S. Centers for Disease Control and Prevention recommends the first dose of the vaccine be administered between 12 and 15 months.

Staten Island parents often raise concerns about vaccine safety and side effects, express a preference for natural immunity or have the misconception that vaccination could lead to autism, said Dr. Anna Cornish, the medical director of ambulatory pediatrics at Northwell Health’s Staten Island University Medical Center.

Cornish said pediatricians at the hospital educate patients about the MMR vaccine, and tailor information to their specific concerns.

For instance, if a parent said they preferred their child achieved natural immunity through exposure to measles, Cornish said she would explain that contracting measles can “lead to severe complications, hospitalizations, long-term health problems, even potentially death.”

Vaccine education should also happen in schools and other community settings, Cornish said.

New York has had four measles cases so far this year, including three in New York City, and health officials have yet to identify signs of community transmission.

Measles vaccination coverage is the most important factor in determining a community’s risk for an outbreak, according to the city health department. But other factors also play a role.

If someone gets measles while traveling and returns to an undervaccinated community, the size of any resulting outbreak will likely depend on how many people are directly exposed to that person, how densely populated the area is and the strength of the public health response, according to the CDC.

Most large outbreaks that occurred in the United States between 2021 and 2023 took place in undervaccinated communities that were “close-knit” and had a high population density, the CDC says.

Currently, there are outbreaks in Texas and New Mexico, and in the Canadian provinces of Ontario and Quebec.

A headline for this article was updated with additional information.