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

He is an Israeli traveler, state health officials said, who unknowingly imported measles into Oakland County in early March and provoked what became the biggest measles outbreak. in Michigan in 28 years.

Before visiting a Jewish Orthodox enclave in Southfield and Oak Park, this man had spent some time in New York, where an unrelated measles epidemic was spreading rapidly among largely unvaccinated children and led to to declare state of emergency.

Once in Michigan, the man spent his time in synagogues and Jewish institutions praying and studying every day from March 6 to 13, unaware that he was spreading the virus along the way.

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

It is extremely contagious – nine out of 10 people without immunity who are exposed to it will develop measles. And, at first, the symptoms can notoriously mimic colds and flu.

"I saw three cases (…) of children with measles-like symptoms and a rash," said Dr. Gary Ross, who works in the emergency department at Beaumont Hospital in Dearborn, with patients who He treated during the first week of the year. April. "Since there is an epidemic, we control all of them, they have been tested positive for the flu … (…) Most early colds also look like measles, which is very difficult to identify.

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

Eliav Shoshana, father of six children from Southfield, did not know that the traveler had exposed him to measles at the Yagdil Torah congregation in Southfield on March 9, said his wife, Henny Shoshana.

"My husband was sitting in a synagogue and studying the Torah and praying" that day, said Henny Shoshana. "He realized in retrospect that there was a person there who seemed sick and coughing a lot." He covered his mouth … I'm sure he was horrified when he went he probably did not know that he had measles and it's so contagious that even covering one's mouth can allow some droplets to escape. "

The virus is transmitted by person-to-person contact and also by air, mainly after the infected person coughs or sneezes. It's so contagious that he can live in the air until two hours after the departure of an infected person.

Five days after Eliav Shoshana's exposure to measles, the Michigan Department of Health and Human Services confirmed that the traveler infected with measles had actually made it to the same synagogue where Shoshana had also prayed.

The MDHHS and the Oakland County Health Division sent out alerts to the media and the public on March 14, explaining that the traveler was also infectious when he visited several places nearby, where many Orthodox Jews will buy food and medicine, study and study. to pray – One Stop Kosher Market, Jerusalem Pizza and the Ahavas Olam Torah Center in Southfield, as well as Yeshiva Gedolah of Grand Detroit, the Kollel Institute of Grand Detroit and the Lincoln Liquor & Rx in Oak Park.

The rumor spread quickly, said Rabbi David Shapero, who was also exposed to measles at the Yagdil Torah congregation, but did not contract the virus.

"The communication within the community was close," he said, "and in a few hours each person had received a text message, a voicemail message or an e-mail. .

Rabbi David Shapero, who was also exposed to measles at the congregation Yagdil Torah, did not contract the virus. (Photo: Rabbi David Shapero)

"In our community, there are always things that everyone wants to know, usually it's a happy opportunity – someone is engaged and there will be a reception where everyone should be aware or someone died.In our community, if someone dies in the morning, the funeral will take place this afternoon. one dies in the afternoon, the funeral will be held the next morning. … They use call stations and people have lists and, in a very short time, a phone call The message tells the community that something good has happened and that they should be aware of it or that something is going to be sad … We can have one, two or three calls a day on different topics. "

More: Born between 1957-1989? You can not be protected against the measles epidemic

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It was only the following week that the first symptoms of Eliav Shoshana began to manifest themselves.

Henny Shoshana said that he had a headache on March 19 and that he felt a little dilapidated. But these complaints seemed minor and could be explained by fatigue.

The family was preparing to celebrate Purim, a festive Jewish holiday that includes large group meals, parties and food sharing. She and her husband had slept little in the days leading up to the holidays and some of their children were recently cured of flu and strep throat.

"There was this perfect storm that led to the epidemic in the orthodox Michigan community," said Henny Shoshana. "With the approach of these holidays, which, as you can imagine, require a lot of preparation … people were contagious, but they were not aware that they were sick – completely asymptomatic or perhaps a little under time.

"Because it happened in Purim, the magnitude of the exposure was huge, obviously, it's really the story of what happened here." "

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

"We went to this big party gathering at least 150 people, including infants and pregnant women," she said. "And again, we went not knowing that he was sick at all, and certainly not with measles.That night he came home and it was very clear that he had a fever, so he stayed in bed. "

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

The second wave of measles masked as a flu

As Eliav Shoshana became ill, state health officials and local authorities confirmed the second wave of measles cases.

Four other people contracted measles – all related to the Israeli traveler. Three other people, according to health officials, had suspected cases. A host of new venues have been announced, including not only sites frequented by the Orthodox Jewish community, but also secular sites, such as Kroger, Meijer, Westborn Market, medical buildings, an ABC warehouse and the Lowe's Home Improvement Store, among others.

On the morning of March 22, Henny Shoshana stated that her husband "felt very seized, with fever, he was sore, tired and he noticed … that his throat hurt a bit."

That day, Henny Shoshana said that the family had received a message from Hatzalah, a volunteer emergency medical intervention group serving the Jewish community of Oak Park, Huntington Woods and Southfield. It was urging people to get vaccinated if it was possible that they were exposed to measles.

The Oakland County Health Division had extended hours of service for its vaccination clinic and Hatzalah informed the community that receiving a MMR vaccine within 72 hours of exposure to measles can prevent or limit the severity of the infection. The immunoglobulin, a blood product with antibodies that can help protect against the virus, was also available at the clinic for people who could not be vaccinated, such as infants, pregnant women and people whose immune system was compromised.

The Shoshanas were sure to have been vaccinated in their childhood and did not think that Eliav Shoshana could have caught the virus.

"The classic symptoms of measles are fever, rashes, and … runny nose, sneezing, coughing, and conjunctivitis." All he had was a fever, Henny said. Shoshana. But they were worried about their 3-year-old son, who had been vaccinated for the first time with a 12-month MMR vaccine. he was still too young to have received his second dose, which, according to the CDC, should be administered between 4 and 6 years of age. The Shoshanas agreed to take their son to a vaccination clinic later that week, she said.

That day, her husband went to an emergency treatment center where he got a positive result for both strep throat and influenza A.

"Her doctor prescribed Tamiflu and Augmentin for the treatment of strep throat, and that's all," she said – until the next morning.

"He woke up around eleven in the morning and one of the kids said," Oh, you have something on the front, "said Henny Shoshana. "He had a very mild skin rash that was starting to break out … And I say to myself, he has no way to get the flu, strep, or measles. It is not possible."

They thought that he could have an allergic reaction to the antibiotic. But as March 23 was a Saturday, a holy day in the Orthodox Jewish community called Shabbat, no work is done, no phone calls are made and the Internet is not used, Eliav Shoshana went to her home. neighbor, a resident doctor, to ask whether he should be concerned or not.

"And he says to himself, there's no way that it's measles – it's a classic allergic reaction to your Augmentin," Henny Shoshana said. "It was like, take Benadryl and do not take Augmentin for the moment."

Although they were not worried about measles, they feared that Eliav Shoshana was not getting the antibiotics he needed to treat strep throat. So, later in the evening, he went to the synagogue near their home because he knew that his internal medicine doctor was praying there. He had hoped that his doctor would send a new prescription to the pharmacy once the Shabbat was over.

"He felt a little better then, so he was thinking of letting me go, find him and tell him," his wife said.

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

It is at this moment that the first core of doubt in their minds has taken root: could Eliav Shoshana also have measles?

"The doctor, looking at this in this context, is like," Oh my God. "Then he said," No, it can not be. It's impossible for it to be measles. You have the flu. You have strep infection. This is simply not possible. But you know, let's make sure. After the end of Shabbat, be careful, re-check and get a cotton swab to exclude it, "said Henny Shoshana.

"My husband, hearing this, turns around and goes home, it was like there was a chance that it was measles, I will go home."

From that moment, the rash of Eliav Shoshana advanced as a classic case of measles. He had characteristic white Koplik spots in the mouth.

"The rashes have spread from behind the ears and on the forehead," said Henny Shoshana, "then along his arms and trunk in classic progression … … so we said, OK, forget that. It's measles.Then we spent the next 24 hours calling everyone we knew who might have been exposed to say that he had measles.

"It's important to educate the public, people need to know if you just have a fever, in the context of this epidemic, you have to be careful, pay attention and make sure you do not transmit it. think you have measles and can go out and infect more people. "

More: How 2 children in Michigan were tested positive for measles, but did not have the disease

More: Measles outbreak in Michigan: it's who is most vulnerable

And when the Shoshanas realized that the virus had settled in their homes, the number of cases in the community also continued to increase. On March 25, the DHHS confirmed 18 cases. The next day the count rose to 22, including a Wayne County person.

All were related to this first traveler who brought the first case to Michigan.

Missing fire recordings are confusing

"The rapid spread of the virus," said Lynn Sutfin, a DHHS spokeswoman, "had more to do with the number of places that he visited, the number of people initially exposed (the few weeks preceding Purim), and subsequent exposure of close / family contacts with confirmed cases.

"The other factor that played a role in this situation is the number of people susceptible to measles.Unfortunately, many adults thought they were immunized against measles, but were ultimately sensitive."

On March 22, the Council of Orthodox Rabbis of the Grand Detroit issued a statement urging all members of the community to be vaccinated:

"In light of the recent spread of measles in our community, every individual is required to take the necessary precautions to protect themselves and their family, as well as to prevent the spread of the disease to others," says the letter.

The Grand Detroit Orthodox Rabbi Council issued the statement on March 22 calling on community members to be vaccinated against measles, mumps and rubella to prevent the spread of measles. (Photo: Council of Orthodox Rabbis of the Great Straits)

"Because of the outbreak, the Michigan Department of Health has issued updated immunization guidelines and all members of the community must follow them to make sure they are fully immunized. you have symptoms of measles … stay at home and immediately contact your health care provider for instructions.It is absolutely forbidden for anyone with symptoms to go out (even to Shul), and to get out of bed. expose others and put them in danger. "

These guidelines encouraged people to check their immunization status.

"It is assumed that anyone born before 1957 was suffering from measles because the disease was very common at that time," said Leigh-Anne Stafford, spokesman for the Oakland County Health Division. "But it is possible that people have not had it, which makes them vulnerable now.We recommend to everyone, regardless of age, to check their immunization status.If you do not have any 39, registering two measles vaccines documented by a doctor or Michigan Care Improvement Registry (MCIR), not knowing if you have been vaccinated, or if you have ever had measles, contact your health care provider for know how to get vaccinated. "

In response, members of the Orthodox Jewish community rallied en masse to get vaccinated.

In just three days – March 22-24 – the health division administered 970 MMR vaccines. She has also managed a remote clinic in Young Israel of Oak Park to make vaccination even more accessible to the community.

"In a week, the health department has administered more than 2,000 vaccines, not to mention the hundreds of vaccines administered in many private doctors' offices," said Dr. Janet Snider, pediatrician at Bingham Farms. "These were given to babies, toddlers and adults who could not find documentation on their vaccines, who had only one vaccine or who had non-immune status.

"Their leadership in this epidemic is surpassed only by the kindness they have shown to the community, community activists, rabbis, doctors and volunteers have all joined the Ministry of Health. as part of a unified effort to stop this highly contagious disease and prevent it in the future ".

Henny Shoshana and her 3-year-old son were among those who lined up on March 24 to get vaccinated. Although she was certain to have received two doses of the vaccine in her youth, like her husband, she had no evidence of her vaccinations. To be very careful, she received another vaccine. They also quarantined themselves, fearing to expose anyone to the virus for up to 21 days.

Meanwhile, the number of cases in Michigan has continued to grow. As of April 1, the state had confirmed 30 cases. As of April 2, there were 34. As of April 5, the number has increased to 39.

As the news spread about the epidemic, Henny Shoshana discovered that there were other members of the close-knit community who, like her husband, had also caught the measles whereas they were confident of having been vaccinated in their childhood. Nor did they have evidence that public health officials needed to count them among the vaccinated because their documents had not been kept since childhood and the doctors' offices that had administered their vaccines. decades earlier had been closed for a long time.

A community victim of a false narrative

Public health officials should classify people like Eliav Shoshana in the measles epidemic as those who are not vaccinated or whose MMR vaccine status is unknown or unconfirmed due to lack of documentation.

Henny Shoshana began to worry about the possibility of creating a false narrative about the Orthodox Jewish community and giving people the impression of being anti-vaxxers.

"I have friends who said they went out into the community and people looked at them with suspicion," she said. "I think it's important to say that the Orthodox Jewish community is not very clearly opposed to vaccination and that it's about people who, to their knowledge, their parents have followed the protocol of their generation.

"In fact, the Torah, which is like the Bible of the Orthodox, as well as our rabbis and our religious leaders, are not only anti-vaccination, they are actually very supportive of vaccination," she said. "It's essentially considered a religious requirement." There is a Hebrew quote from the Bible that says it is our responsibility to protect and protect our health because our bodies are gifts from God.

This is a misconception that also worries David Kurzmann, executive director of Jewish Community Relations Council Detroit Metro / AJC.

"It is disturbing to hear this perception and … we have unfortunately been able to see this story get ready," he said.

"The reality is that the Council of Orthodox Rabbis of the Great Straits, which is in a way the umbrella of all orthodox synagogues and rabbis, has issued a very clear and unequivocal statement that families are obliged to Immunize Jewish law requires their children and unvaccinated community members to be vaccinated If you have symptoms of measles, their views prohibit you from engaging in the community.

"In Judaism, protecting and preserving life prevails over all other precepts and orders.You can break the rules of the Sabbath to save a life.Nothing is more important than that.And the perception that the Jewish community would be the ones who commit it intentionally are factually incorrect and you know, for many members of our community, this creates great anxiety because, frankly, it's offensive. "

Kurzmann said that people had mismanaged a parallel between the measles epidemic in the Orthodox Jewish community of Michigan and that of Rockland County, New York State, where the vast majority of the 180 people infected with measles (as of April 11) are unvaccinated children.

In Michigan, according to public health officials, the majority of measles cases are in adults. And six of the 39 cases now involve people who have evidence that they have received age-appropriate MMR vaccine doses; the remaining 33 have either undocumented vaccine status, such as Eliav Shoshana, or are unvaccinated.

"It's a different story," he said. "These are apples and oranges and I think sometimes people gather them.The Orthodox community of Detroit … at the highest level is determined to address this problem and hope that measles can be eradicated again."

The Michigan epidemic now affects people aged 8 months to 63, including a student at Derby Middle School in Birmingham. Sutfin said that to date, none of the people with measles in Michigan have been hospitalized or have suffered any serious complications, which may include deafness, pneumonia, encephalitis, permanent brain damage and death. .

Dr. Ross, a physician from the Beaumont Emergency Department, said that without the swift intervention of the state and Oakland County health authorities, as well as the effective communication network of the Orthodox Jewish community, it was recommended to people to look for symptoms, to stay at home if these symptoms manifested developing, and to get vaccinated, the Michigan epidemic would probably be much worse.

"People are taking it seriously enough and the epidemic has slowed since the first exposure," he said. "As a community, we do not want people to get sick inside or outside the community because of us."

Henny Shoshana said she was grateful that measles had spared her mother and children and that her husband has since been healed.

"My husband is fine now," she said. "He is still weak, but we are very grateful, we are counting on our blessings."

According to her, the Michigan measles outbreak could continue to worsen, but she hopes this will not be the case.

"We can hope, and overall, I think what works to our advantage is that there is a good network and people want to do the right thing and be safe," she said. declared.

If you or anyone around you lives in Michigan and has measles, contact Kristen Jordan Shamus at 313-222-5997 or at [email protected] Follow her on Twitter @ Kristenshamus.

A new case of unrelated measles comes from Germany to Michigan

Another traveler, German, arrived in Michigan with the measles virus in early April, health officials said Friday, potentially exposing people to the virus on the campus of the University of Michigan at Ann Arbor. Detroit airport and in several restaurants, bars and pharmacies.

According to the Washtenaw County Health Department, this person had not been vaccinated recently and it is not known if she was vaccinated against measles as a child. This case is unrelated to the measles epidemic in Michigan, which involved an Israeli traveler.

Others may have been exposed to measles on the following dates, times, and locations.

April first

  • Intramural sports building of the University of Michigan, 606 E Hoover Ave., Ann Arbor, from 11:00 to 15:00.
  • Lucky's Market, 1919 S Industrial Highway, Ann Arbor, 1 pm-4pm.

April 2

  • Hand-drawn noodles from Lan City, 2612 Washtenaw Ave., Ypsilanti, 6am to 10am.
  • Whole Foods, 3135 Washtenaw Ave., Ann Arbor, from 8 am to 11 am

April 3

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

April 4th

  • Intramural Sports Building of the University of Michigan, 606 E Hoover Ave., Ann Arbor, from 4pm to 7pm.
  • Mani Osteria and Bar, 341 Liberty Street, Ann Arbor, from 11am to 2pm.
  • Encore Records, 417 St. Liberty St., Ann Arbor, noon to 3 pm
  • University of Michigan, computer site of Angell Hall Courtyard (The Fishbowl), 435 State St., Ann Arbor, from 1 pm to 6 pm April 4th, from 1pm to 6pm and April 5th from 4pm to 10.30pm.

April 5

  • University of Michigan, computer site of Angell Hall Courtyard (The Fishbowl), 435 State St., Ann Arbor, from 4 pm to 10:30 am
  • Jolly Pumpkin Coffee & Brewery, 311 S. Main St., Ann Arbor, 12:30 to 4:30 pm
  • Slate Blank Creamery, 300 W. Liberty St., Ann Arbor, 2:30 pm to 6 pm
  • Asian Legend, 516 E. William Street, Ann Arbor, 8:30 pm to 30:30 pm
  • Walgreens Pharmacy, 317 St. S. St., Ann Arbor, from 9:30 pm to midnight.
  • CVS pharmacy, 209 S. State St., Ann Arbor, from 9:30 pm to midnight.

April 6

  • Lucky's Market, 1919 Industrial Road, Ann Arbor, 1:30 pm to 4:30 pm
  • CVS pharmacy, industrial road of 1700 S., Ann Arbor, 10h-noon.
  • Woodbury Gardens Apartments, office and clubhouse rental, 1245 Astor Ave., Ann Arbor, from 11 am to 1:30 pm
  • Michigan Flyer-AirRide, 3:15 to 6:00 pm
  • McNamara Terminal at the Detroit Metropolitan Airport, from 15:55 to 19:30.

– Kristen Jordan Shamus

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