Once he got to Michigan, the man spent his time at Jewish synagogues and institutions to pray and study every day from March 6-13, unaware that he was spreading the virus along the way.
The disease has an incubation period of seven to 21 days after exposure, according to the U.S. Centers for Disease Control and Prevention, and a person can be asymptomatic and contagious for up to four days before symptoms appear and for up to four days after the rash begins.
It is extremely contagious — nine people out of every 10 without immunity who are exposed to it will develop the measles. And, in the beginning, symptoms can notoriously mimic the common cold and flu.
“I saw three cases … of children that came in with measles-type symptoms and a rash,” said Dr. Gary Ross, who works in the emergency department at Beaumont Hospital in Dearborn, of patients he treated in the first week of April. “Because there’s an outbreak, we are checking them all. They tested positive for influenza. … Most colds at the beginning also look like measles. It’s very difficult to identify.
“That’s why the message to the community is if you have a runny nose, and/or a fever and/or a cough, to stay at home.”
Eliav Shoshana, a father of six from Southfield, didn’t know that the traveler had exposed him to the measles at Congregation Yagdil Torah in Southfield on March 9, said his wife, Henny Shoshana.
“My husband was sitting in a synagogue and studying Torah and praying” that day, Henny Shoshana said. “He realized in retrospect there had been a person there who seemed sick and was coughing a lot. He was covering his mouth. … I am sure he was horrified when he realized what had occurred. He probably had no idea that he had measles and that it is so highly contagious, even covering your mouth can allow some droplets to escape.”
The virus is transmitted through person-to-person contact and also through the air, mostly after an infected person coughs or sneezes. It is so contagious, 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 the measles, the Michigan Department of Health and Human Services confirmed that measles-infected traveler had, in fact, been to the same synagogue where Shoshana also prayed.
The MDHHS and the Oakland County Health Division sent out alerts March 14 to the news media and the public, explaining that the traveler also was contagious when he visited several other places nearby, where many Orthodox Jews go to buy food and medicine, to study and to pray — One Stop Kosher Market, Jerusalem Pizza and the Ahavas Olam Torah Center in Southfield, as well as Yeshiva Gedolah of Greater Detroit, Kollel Institute of Greater Detroit and Lincoln Liquor & Rx in Oak Park.
Word spread fast, said Rabbi David Shapero, who also was exposed to the measles at Congregation Yagdil Torah, but did not contract the virus.
“The communication within the community was tight,” he said, “and within in a few hours every single person had a text or a voice mail or an email. Everybody knew overnight.
More:To stop measles spread, Birmingham school tells unvaccinated kids not to come to class
It wasn’t until the following week that Eliav Shoshana’s first symptoms began to show.
He had a headache on March 19, Henny Shoshana said, and was feeling a little run-down. But those complaints seemed minor and could be explained by fatigue.
The family had been getting ready to celebrate Purim, a festive Jewish holiday that involves large communal meals, parties, and the sharing of food. She and her husband had gotten little sleep in the days leading up to the holiday, and some of their children had recently recovered from the flu and strep throat.
“There was this perfect storm that led to the outbreak in the Michigan Orthodox community,” Henny Shoshana said. “In the run-up to this holiday, which as you can imagine takes a lot of preparation … people were contagious but not aware yet they were sick — either entirely asymptomatic or maybe feeling a little under the weather.
“Because it happened over Purim, the breadth of the exposure was enormous, obviously. That’s really the story of what happened over here.”
She recalls celebrating Purim at parties on the evening of March 20 and continuing until March 21.
“We went to this big party that had at least 150 people there, including infants and pregnant women,” she said. “And again, we went not knowing he was sick at all, and certainly not with the measles. Then, that night, he came home, and it was very clear he had a fever. So he stayed in bed.”
The Oakland County Health Division had extended hours for its immunization clinic, and Hatzalah informed the community that receiving an MMR vaccine within 72 hours of exposure to measles can prevent the infection or limit its severity. Immune globulin, a blood product with antibodies that can help protect against the virus, also was available at the clinic for people who weren’t able to be vaccinated, such as infants, pregnant women and people with compromised immune systems.
The Shoshanas both were sure they’d been vaccinated as children, and didn’t consider that 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,” Henny Shoshana said. But they were worried about their 3-year-old son, who had gotten his first MMR immunization at 12 months old; he was still too young to have received his second dose, which the CDC recommends should be administered between the ages of 4 and 6. The Shoshanas agreed to take their son to a vaccination clinic later that weekend, she said.
Her husband went to an urgent care center that day, where he tested positive for both strep throat and influenza A.
“His doctor prescribed Tamiflu and Augmentin for the strep, and that was that,” she said — until the next morning.
“He woke up about 11 in the morning, and one of the kids says, ‘Oh, you have something on your forehead,’ ” Henny Shoshana said. “He had a very mild rash that was starting to break out. … And I’m saying to myself, there is no way he has flu, strep and measles. There’s no way.”
They thought he might be having an allergic reaction to the antibiotic. But because March 23 was a Saturday, a holy day in the Orthodox Jewish community called Shabbat, when no work is to be done, no phone calls are made and the Internet is not used, Eliav Shoshana walked to the home of his neighbor, a medical resident, to ask whether he ought to be concerned.
“And he’s like, there’s no way this is the measles. This is for sure a classic allergic reaction rash to your Augmentin,” Henny Shoshana said. “He was like, take some Benadryl and don’t take Augmentin for now.”
Though they weren’t concerned about measles, they were worried that Eliav Shoshana wasn’t getting the antibiotics he needed to treat the strep throat. So later that evening, he went to the synagogue near their home because he knew his internal medicine doctor prays there. He’d hoped his doctor would send a new prescription to the pharmacy once Shabbat was over.
“He happened to be feeling a little bit better at that point, so he was thinking let me just go there, find him and tell him,” his wife said.
More:Measles outbreak in Michigan: This is who’s most vulnerable
And as the Shoshanas came to realize the virus had come to roost in their home, the number of cases within the community continued to grow as well. By March 25, the state DHHS confirmed 18 cases. The following day, the tally was up to 22, including a person from Wayne County.
All were tied to that initial traveler who brought the first case to Michigan.
Missing shot records cause confusion
“The quick spread of the virus,” said Lynn Sutfin, a spokeswoman for the state DHHS, “had more to do with how many places he visited, the number of people exposed initially (the couple weeks before Purim), and subsequent exposure of close/household contacts to confirmed cases.
“The other thing that played a role in this is the number of individuals who were susceptible to measles. Unfortunately, there were many adults who thought they were immune to measles but ultimately were susceptible.”
The Council of Orthodox Rabbis of Greater Detroit issued a statement March 22, urging all members of the community to get vaccinated:
“In light of the recent spread of measles in our community, each and every individual is halachically obligated to take the necessary precautions to protect one’s self and family, and prevent the spread of the disease to others,” the letter said.
“It’s troubling to hear that perception, and … we unfortunately could see this story brewing,” he said.
“Let’s set the record straight. The reality is that the Council of Orthodox Rabbis of Greater Detroit, which is sort of the umbrella for all of the orthodox synagogues and rabbis, they put out a very clear, unequivocal statement that families are obligated to vaccinate their children and that community members who are not vaccinated are obligated by Jewish law … to go and get vaccinated and if you are showing any symptoms of the measles, you are forbidden in their viewpoint from engaging in the community.
“In Judaism, protecting life and the preservation of life supersedes every other precept and commandment. You can break the rules of the Sabbath to save a life. There is just nothing more important than that. And so the perception that the Jewish community would be the ones perpetrating this intentionally is factually incorrect and you know, for many members of our community, it’s causing great anxiety because frankly it’s offensive.”
Kurzmann said people have wrongly made parallels linking the measles outbreak in Michigan’s Orthodox Jewish community to the one in Rockland County, New York, where the vast majority of the 180 people who have been infected with measles (as of April 11) are unvaccinated children.
In Michigan, state health officials say, the majority of measles cases are in adults. And six of the now 39 cases here involve people who have proof they’ve received the age-appropriate doses of the MMR vaccine; the remaining 33 have either undocumented vaccine status, like Eliav Shoshana, or are unvaccinated.
“That’s a different story altogether,” he said. “They are apples and oranges and I think sometimes people lump them together. …The Orthodox community of Detroit … at the highest level is committed to dealing with this issue, and hopefully the measles can be eradicated again.”
Michigan’s outbreak now includes people ranging in age from 8 months old to 63 years old, including a student at Derby Middle School in Birmingham. Sutfin said that so far, none of the people in Michigan who have contracted measles have been hospitalized or had severe complications of the disease, which can include deafness, pneumonia, encephalitis, permanent brain damage and death.
Dr. Ross, the Beaumont emergency department doctor, said if it hadn’t been for the quick action of the state and Oakland County health officials and the Orthodox Jewish community’s effective communication network that warned people to look for symptoms, to stay home if symptoms develop, and to get vaccinated, the Michigan outbreak would likely be far worse.
“People have been taking it seriously enough and the outbreak has been slowing down from first exposure,” he said. “As a community, we don’t want people getting sick within or outside the community because of us.”
Henny Shoshana said she’s grateful that she and their children were spared from the measles, and that her husband has since recovered.
“My husband is doing well now,” she said. “He’s still weak, but we are just so grateful. … We are counting our blessings.”
Michigan’s measles outbreak, she said, could continue to worsen, but she’s hopeful it won’t.
“We can hope. For the most part, I think that what’s working to our advantage is that there is a good network, and people want to do the right thing and be safe,” she said.
If you or someone you know lives in Michigan and has the measles, contact Kristen Jordan Shamus: 313-222-5997 or [email protected] Follow her on Twitter @kristenshamus.
New, unrelated measles case comes to Michigan from Germany
Another traveler — this one from Germany — came to Michigan with the measles in early April, health officials said Friday, potentially exposing people to the virus on campus at the University of Michigan in Ann Arbor, at Detroit Metro Airport and several restaurants, bars and drugstores.
This person hadn’t had any recent vaccinations, according to the Washtenaw County Health Department, and it is not known whether the individual was vaccinated for measles as a child. This case is not tied to the earlier Michigan measles outbreak involving a traveler from Israel.
Others may have been exposed to measles during the following dates, times and locations.
- University of Michigan Intramural Sports Building, 606 E Hoover Ave., Ann Arbor, 11 a.m.-3 p.m.
- Lucky’s Market, 1919 S Industrial Highway, Ann Arbor,1-4 p.m.
- Lan City Hand Pulled Noodle, 2612 Washtenaw Ave., Ypsilanti, 6-10 p.m.
- Whole Foods, 3135 Washtenaw Ave., Ann Arbor, 8 -11 p.m.
- University of Michigan Intramural Sports Building, 606 E. Hoover Ave., Ann Arbor, 10 a.m.-2 p.m.
- University of Michigan North Quad Complex, 105 S. State St., Ann Arbor, 8:30-11:30 a.m.
- NeoPapalis, 500 E. William St., Ann Arbor, 9-11 p.m.
- University of Michigan Intramural Sports Building, 606 E Hoover Ave., Ann Arbor, 4-7 p.m.
- Mani Osteria and Bar, 341 E. Liberty St., Ann Arbor, 11 a.m.-2 p.m.
- Encore Records, 417 E. Liberty St., Ann Arbor, noon-3 p.m.
- University of Michigan Angell Hall Courtyard Computing Site (The Fishbowl), 435 State St., Ann Arbor 1-6 p.m. on April 4, 1 to 6 p.m. and April 5, 4 to 10:30 p.m.
- University of Michigan Angell Hall Courtyard Computing Site (The Fishbowl), 435 State St., Ann Arbor, 4-10:30 p.m.
- Jolly Pumpkin Café & Brewery, 311 S. Main St., Ann Arbor, 12:30-4:30 p.m.
- Blank Slate Creamery, 300 W. Liberty St., Ann Arbor, 2:30-6 p.m.
- Asian Legend, 516 E. William St., Ann Arbor, 8:30-10:30 p.m.
- Walgreens Pharmacy, 317 S. State St., Ann Arbor, 9:30 p.m.-midnight.
- CVS Pharmacy, 209 S. State St., Ann Arbor, 9:30 p.m.-midnight.
- Lucky’s Market, 1919 S. Industrial Highway, Ann Arbor, 1:30-4:30 p.m.
- CVS Pharmacy, 1700 S. Industrial Highway, Ann Arbor, 10 a.m.-Noon.
- Woodbury Gardens Apartments leasing office and clubhouse, 1245 Astor Ave., Ann Arbor, 11 a.m.-1:30 p.m.
- Michigan Flyer-AirRide, 3:15 to 6 p.m.
- Detroit Metro Airport’s McNamara Terminal, 3:55-7:30 p.m.
— Kristen Jordan Shamus
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