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One Stop Kosher Food Market in Southfield, Michigan will be photographed on Friday, April 12, 2019. (Photo: Kimberly P. Mitchell, Detroit Free Press)

It was a traveler from Israel, state health officials said, who unconsciously brought measles to Oakland County in early March and triggered the largest measles outbreak in Michigan for 28 years.

Before coming to an orthodox Jewish enclave in Southfield and Oak Park, the man spent some time in New York, where a disconnected and rapidly spreading measles outbreak among mostly unvaccinated children led the mayor last week to make a statement Emergency.

Arriving in Michigan, from 6 to 13 March, the man spent daily in Jewish synagogues and institutions to pray and study. He did not know that he had spread the virus along the way.

The disease has an incubation period of seven to 21 days after exposure, according to the US Centers for Disease Control and Prevention. A person may be asymptomatic and contagious up to four days before the onset of symptoms and up to four days after the rash begins.

It is extremely contagious – nine out of ten people with no immunity to which they are exposed develop measles. And in the beginning, symptoms can be known to mimic the cold and flu.

"I saw three cases … of children who had measles symptoms and a rash," Dr. Gary Ross, who works in the emergency department of the Beaumont Hospital in Dearborn, on patients whom he had treated in the first week of the year April. "Since there is an outbreak, we're checking them all in. You've tested positive for influenza … Most colds start out as measles, and it's very hard to spot.

"That's why the message to the community is if you have a runny nose and / or fever and / or cough to stay home."

Eliav Shoshana, a six-year-old Southfield father, did not know that the traveler had exposed him to measles on March 9 at the Yagdil Torah Congregation in Southfield, his wife Henny Shoshana said.

"My husband was in a synagogue studying the Torah and praying that day," said Henny Shoshana. "In hindsight, he realized that there was one person who seemed ill and had a lot of coughing." He covered his mouth, I'm sure he was horrified to realize what had happened, he probably had no idea he had measles that it is so contagious that even the mouth can be covered so that some droplets can escape. "

The virus is transmitted through human-to-human contact and also through the air, usually after coughing or sneezing an infected person. It is so contagious that it can live in the air for up to two hours after an infected person leaves the room.

Five days after Eliav Shoshana was exposed to measles, the Michigan Department of Health and Human Services confirmed that travelers infected with measles were actually in the same synagogue Shoshana used to pray.

The MDHHS and the Oakland County Health Division sent out warnings to the news media and the public on March 14, saying that the traveler was also contagious when visiting several other places nearby where many Orthodox Jews buy food and medicines, Study and visit – One Stop Kosher Market, Jerusalem Pizza and the Ahavas Olam Torah Center in Southfield and Yeshiva Gedolah of Greater Detroit, Kollel Institute of Greater Detroit and Lincoln Liquor & Rx in Oak Park.

The news spread quickly, said Rabbi David Shapero, who was also exposed to measles at the Yagdil Torah Congregation, but did not get infected with the virus.

"Communication within the community was tight," he said, "and within hours, everyone had a text, a voicemail or an e-mail, everyone knew it overnight.

Rabbi David Shapero, who was also exposed to measles in the Yagdil Torah Congregation, did not cling to the virus. (Photo: Rabbi David Shapero)

"In our community, there are always things that everyone wants to know about – usually a happy occasion – someone has become engaged and there will be a reception that everyone should know or someone has died in our community In the morning someone dies, the funeral will be this afternoon If someone dies in the afternoon, the funeral is the next morning … They use call posts and people have lists, and within a short time they are called post office goes to the community Something good has happened and they should pay attention or something sad has happened, we can get one or two or three call items a day on different topics. "

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Only in the following week showed first symptoms of Eliav Shoshana.

He had a headache on March 19th, said Henny Shoshana, feeling a bit run down. But these complaints seemed insignificant and could be explained by fatigue.

The family was preparing to celebrate Purim, a festive Jewish holiday that included large joint meals, parties, and food sharing. She and her husband had been little sleep in the days before the holidays, and some of her children had recently recovered from the flu and sore throat.

"There was this perfect storm that led to the outbreak of the Orthodox community in Michigan," said Henny Shoshana. "In the run-up to this vacation, which, as you can imagine, requires a lot of preparation … people were infectious, but they were unaware that they were ill – either totally asymptomatic or feeling a little under the weather.

"Because it was about Purim, the reach of the exposure was obviously enormous, so that's really the story of what happened here."

She remembers celebrating Purim at parties on the evening of March 20 and continuing until March 21st.

"We participated in this big party involving at least 150 people, including babies and pregnant women," she said. "And again we did not know he was ill at all, and certainly not with the measles." Then he came home that night, and it was very clear he had a fever, so he stayed in bed. "

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The Yagdil Torah Congregation in Southfield, Michigan was photographed on Friday, April 12, 2019. (Photo: Kimberly P. Mitchell, Detroit Free Press)

Second wave of measles masked as a flu

When Eliav Shoshana fell ill, state and local health officials confirmed the second wave of measles cases.

Four other people had measles infections – all tied to the travelers from Israel. According to health officials, three other people had suspected cases. Numerous new exposure locations were announced, including not only the places visited by the Orthodox Jewish community, but also secular sites, including Kroger, Meijer, Westborn Market, medical buildings, an ABC warehouse, and Lowe's Home Improvement Store ,

On the morning of March 22, Henny Shoshana said that her husband "felt very flu-like, feverish, feeling tired and tired, and he noticed … that his neck hurt a little."

That day, Henny Shoshana said the family had received a message Hatzalah, a volunteer emergency response group serving the Jewish community of Oak Park, Huntington Woods and Southfield. People should be urgently vaccinated if there is a possibility of being exposed to measles.

The Oakland County Health Division had extended hours for their vaccination clinic, and Hatzalah informed the community that MMR vaccination within 72 hours of contact with measles may prevent or limit the severity of the infection. Immunoglobulin, a blood product with antibodies to protect against the virus, was also available in the clinic for people who could not be vaccinated, such as infants, pregnant women and people with weakened immune systems.

The Shoshanas were both sure that they had been vaccinated as children and did not think Eliav Shoshana might have caught the virus.

"The classic measles symptoms are fever, rash and … runny nose, sneezing, coughing and conjunctivitis." All he had was a fever, "said Henny Shoshana. However, they were worried about their 3-year-old son, who had received his first MMR vaccine at 12 months; He was still too young to have received his second dose, which according to CDC should be administered at the age of 4 to 6 years. The Shoshanas agreed to take her son to a vaccination clinic later this weekend, she said.

Her husband went to an emergency center that day, where he tested positive for both strep throat and influenza A.

"His doctor prescribed Tamiflu and Augmentin for streptherapy and that was it," she said – until the next morning.

"He woke up around 11am and one of the kids said," Oh, you have something on your forehead, "said Henny Shoshana." He had a very mild rash that started to break out. … And I tell myself, there's no way he has flu, streps and measles. There is no possibility."

They thought he might be allergic to the antibiotic. But because March 23 was a Saturday, a holy day in the Orthodox Jewish community called Shabbat, where there's no work to do, no phone calls, and the Internet is not used, Eliav Shoshana went to see his neighbor, a doctor. to ask if he should be affected.

"And he's the way it is, there's no way that these are the measles, this is certainly a classic allergic reaction to your Augmentin," said Henny Shoshana. "He was like, take Benadryl and do not take Augmentin for now."

Although they did not care about measles, they were worried that Eliav Shoshana was not getting the antibiotics he needed to treat the sore throat. Later that evening, he went to the synagogue near their home because he knew his family doctor was praying there. He had hoped his doctor would send a new prescription to the pharmacy after Shabbat.

"At that point, he felt a little bit better, so he thought, just let me go there, find him and tell him," his wife said.

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Jerusalem Pizza and Bagels in Southfield, Michigan will be photographed on Friday, April 12, 2019. (Photo: Kimberly P. Mitchell, Detroit Free Press)

At that moment, the first kernel of doubt has taken root in her head: Could Eliav Shoshana also have the measles?

"The doctor who looks at it in this context is like," Oh my god. "Then he was like," No. That can not be. There is no way that this is the measles. You have the flu. They have streps. There is no way. But you know, let's be sure. When the Shabbat is over, let's just say "be on the safe side, check it again and get a swab to rip it off," Henny Shoshana said.

"My husband who hears that, turns around and goes home, as if there is a possibility that these are the measles, I will go home."

From that point on, Eliav Shoshana's rash developed like a classic case of measles. He had characteristic white Koplik spots in the mouth.

"The rash spread behind the ears and on the forehead," said Henny Shoshana, "and in classical progression down his arms and torso, so we said, OK, forget that." These are the measles, then we're in For the next 24 hours, he called everyone we knew and he had the measles.

"This is important for the public's awareness: people need to know if you have a fever by themselves. In the context of this outbreak you need to be careful and careful and make sure that you do not spread the measles and can go out and infect more people. "

More: How 2 kids from Michigan tested positive for measles but did not have any disease

More: Measles outbreak in Michigan: This is the most vulnerable

And when the Shoshanas realized that the virus had settled in their home, the number of cases in the community continued to increase. By March 25, the state DHHS confirmed 18 cases. The following day, it was 22, including one from Wayne County.

All were tied to the original traveler who brought the first case to Michigan.

Missing shots lead to confusion

"The rapid spread of the virus," said Lynn Sutfin, a state DHHS spokeswoman, "had more to do with how many places he visited, how many people were originally exposed (a few weeks before Purim), and then confirmed close / household contacts cases.

"The other thing that matters is the number of people who are susceptible to measles, but unfortunately there were many adults who thought they were immune to measles but would eventually be vulnerable."

The Council of Orthodox Rabbis of Greater Detroit issued a statement on March 22 requesting all members of the community to be vaccinated:

"Given the recent proliferation of measles in our community, each individual is halakhically committed to taking the necessary precautions to protect himself and his family and prevent the spread of the disease to others," the letter said.

The Council of Orthodox Rabbis of Greater Detroit issued this statement on 22 March, calling on community members to receive the measles, mumps and rubella vaccine to prevent the spread of measles. (Photo: Council of Orthodox Rabbis of Greater Detroit)

"Because of the outbreak, the Michigan Department of Health has issued updated vaccination guidelines, and every member of the community should follow these guidelines to make sure they are fully vaccinated If you see any symptoms of measles … you'll be halakhically needed if you're at home Immediately ask your doctor for further instructions, and it is absolutely forbidden for persons suffering from symptoms to go out (even to Shul), expose others, and endanger them. "

These guidelines called for people to check their vaccination status.

"It is believed that anyone born before 1957 had the measles because the disease was very prevalent back then," said Leigh-Anne Stafford, a spokeswoman for the Oakland County Health Division. "However, it is possible that individuals did not have it, which makes them vulnerable now, and we recommend that anyone, regardless of their age, check their vaccination status if they do not have two documented measles vaccines (MMRs) from a doctor or the registry If you are not sure if you have been vaccinated or if you have had measles in the past, contact your doctor for vaccination to improve your medical health (MCIR) in Michigan. "

As a result, members of the Orthodox Jewish community flocked to vaccines.

In just three days – from March 22 to 24 – 970 MMR vaccinations were performed. It also ran a remote clinic in the Young Israel synagogue in Oak Park to make vaccinations even more accessible to the community.

"Within a week, the Ministry of Health delivered more than 2,000 vaccines, but not hundreds of vaccines that were given in many private practices," Dr. Janet Snider, pediatrician at Bingham Farms. "These were given to babies, toddlers, and adults who could not find vaccines, had a single vaccine, or had a non-immune status.

"Their leadership in the outbreak is surpassed only by the kindness they have shown to the community, and community activists, rabbis, doctors and volunteers have partnered with the health department to stop this highly contagious disease. Prevent it in the future."

Henny Shoshana and her three-year-old son were there on March 24 to get their shots. Although she was sure that she had two doses of vaccine in her youth, like her husband, she had no proof of her vaccinations. To be extra careful, she got another vaccine. They also went into quarantine and were careful until all the others were exposed to the virus until 21 days had passed.

Meanwhile, the number of cases in Michigan has continued to increase. By April 1, the state had confirmed 30 cases. By April 2, it was 34. By April 5, the number rose to 39.

As news spread about the outbreak, Henny Shoshana discovered that there were others in the close-knit community who, like her husband, also wore measles, although they were sure that they were being vaccinated as children. Nor did they have the evidence that public health officials counted them among the vaccinated because documents were not kept from their childhood, and the doctors' offices that used to give their vaccines decades ago were closed for a long time.

A community plagued by false narratives

Public health officials must classify people such as Eliav Shoshana for the measles outbreak as individuals who are either not vaccinated or have an unknown / unconfirmed MMR vaccine status because they have no documentation.

Henny Shoshana was worried that a false narrative about the Jewish Orthodox community might emerge, giving people the impression that they were anti-Vaxxians.

"I had friends who said they went into the community and people looked at them suspiciously," she said. "I think it is important to say that the Orthodox Jewish community is not unequivocally anti-vaccination people, and these are people who, as you know, have followed their parents' protocol of their generation.

"In fact, the Torah, which is like the Bible of the Orthodox, and our rabbis and our religious leaders are not just vaccinations, but they are actually very vaccines," she said. "It is essentially considered a religious requirement, and there is a Hebrew quote from the Bible that states that it is our duty to protect and protect our health, as our bodies are gifts from God."

This is a misunderstanding that also David Kurzmann, CEO of Council of Jewish Community Relations of Metro Detroit / AJC.

"It is worrying to hear that perception, and … unfortunately, we saw how that story formed," he said.

"Let's set the record The reality is that the Council of Orthodox Rabbis of Greater Detroit, which is a sort of umbrella for all Orthodox synagogues and rabbis, has made a very clear and unequivocal statement that families need to be vaccinated their children and the unvaccinated parishioners are required by the Jewish law to be vaccinated, and from their point of view, if you show symptoms of measles, you are prohibited from engaging in community.

"In Judaism, the protection of life and the preservation of life replace all other commandments and commandments, they can break the rules of the Sabbath to save a life, there is nothing more important than that." And so is the perception that is Jewish Those who deliberately commit this are in fact incorrect, and you know that causes great anxiety to many members of our community because, frankly, it is offensive. "

Kurzmann said that people wrongly made parallels between the outbreak of measles in the Orthodox Jewish community of Michigan and that in Rockland County, New York, where the vast majority of the 180 people infected with measles (on April 11) were unvaccinated children.

In Michigan, state health officials say the majority of measles cases in adults. And in six of the meanwhile 39 cases, people are affected who have been shown to receive the age-appropriate doses of the MMR vaccine. the remaining 33 either have no vaccine status like Eliav Shoshana or are not vaccinated.

"That's a different story," he said. "It's apples and oranges, and I think sometimes people throw them together … The top-level Detroit Orthodox community has set itself the task of solving this problem, and hopefully the measles will return be eradicated. "

Michigan's outbreak now includes people ages 8 months to 63, including a student at Derby Middle School in Birmingham. Sutfin said that so far, none of the people who undergo measles in Michigan have been hospitalized or have had severe complications of the disease, which may include deafness, pneumonia, encephalitis, permanent brain damage, and death.

Dr. Ross, the Beaumont Emergency Department ambulance, said it was not the swift action of the state and health authorities in Oakland County and the effective communications network of the Orthodox Jewish community that urged people to look for symptoms and symptoms at home The Michigan outbreak would probably be far worse to vaccinate.

"People took it seriously enough and the outbreak slowed down from the first exposure," he said. "As a community, we do not want people to get sick because of us inside or outside the community."

Henny Shoshana said she was grateful that she and her children were spared the measles and that her husband has recovered.

"My husband is fine now," she said. "He is still weak, but we are just so thankful … we count our blessings."

She said the measles outbreak in Michigan could get worse, but she hopes that will not be the case.

"We can hope, for the most part, I think it's to our advantage that there is a good network and people want to do the right thing and play it safe," she said.

If you or someone you know lives in Michigan and has the measles, contact Kristen Jordan Shamus at 313-222-5997 or kshamus@freepress.com. Follow her on Twitter @ Kristenshamus.

New, independent measles case comes from Germany to Michigan

Another traveler – from Germany – came to Michigan in early April with the measles, health officials said on Friday. He could expose people to the University of Michigan campus in Ann Arbor, Detroit Metro Airport, and drugstores in several restaurants, bars, and restaurants.

According to the Washtenaw County Health Department, this person has not had any recent vaccinations, and it is not known if the child was vaccinated against measles as a child. This case is not linked to the previous Michigan measles outbreak involving a traveler from Israel.

Other people may have been exposed to the following dates, times and places measles.

April 1st

  • University of Michigan's Intramural Sports Building, 606 E Hoover Ave., Ann Arbor, 11am to 3pm
  • Lucky Market, 1919 S Industrial Highway, Ann Arbor, 1 pm-4pm

2nd of April

  • Lan City Hand Pulled Noodle, 2612 Washtenaw Ave., Ypsilanti, 6-10 pm
  • Whole Foods, 3135 Washtenaw Ave., Ann Arbor, 8.-11.

3rd of April

  • University of Michigan's Intramural Sports Building, 606 E. Hoover Ave., Ann Arbor, 10 am to 2 pm
  • University of Michigan North Quad Complex, 105 S. State Street, Ann Arbor, 8: 30-11: 30.
  • NeoPapalis, 500 E. William Street, Ann Arbor, 9-11 am.

4. April

  • University of Michigan Intramural Sports Building, 606 E Hoover Ave., Ann Arbor, 4-7 am
  • Mani Osteria and Bar, 341 E. Liberty Street, Ann Arbor, 11:00 to 22:00
  • Encore Records, 417 E. Liberty St., Ann Arbor, noon-3 pm
  • University of Michigan Computer Center at Angell Hall (The Fishbowl), 435 State St., Ann Arbor 1-6 p.m. April 4 from 1 to 6 am and 5, 4, 4 to 10:30 am

April 5th

  • University of Michigan Computer Center at Angell Hall (The Fishbowl), 435 State St., Ann Arbor, 4-10: 30 am
  • Jolly Pumpkin Café & Brewery, 311 S. Main Street, Ann Arbor, 12:30 – 16:30.
  • Blank Slate Creamery, 300 W. Liberty Street, Ann Arbor, 14:30 – 18:00
  • Asian Legend, 516 E. William Street, Ann Arbor, 20: 30-10: 30
  • Walgreens Pharmacy, 317 S. State St., Ann Arbor, 9:30 am to midnight.
  • CVS Pharmacy, 209 S. State St., Ann Arbor, 9:30 pm to midnight.

6th of April

  • Fortune Market, 1919 S. Industrial Highway, Ann Arbor, 13:30 – 16:30
  • CVS Pharmacy, 1700s. Industrial Highway, Ann Arbor, 10pm.
  • Rental Office and Clubhouse of Woodbury Gardens Apartments, 1245 Astor Ave., Ann Arbor, 11: 00-13: 30
  • Michigan Flyer-AirRide, 3:15 pm to 6:00 pm
  • McNamara Terminal at Detroit Metro Airport, 15: 55-7: 30.

– Kristen Jordan Shamus

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