How Oakland Co.’s Orthodox Jewish enclave became epicenter for measles

It was a traveler from Israel, state health officials say, who unknowingly brought the measles to Oakland County in early March, and sparked what has become the largest measles outbreak in Michigan in 28 years.

Before he came to visit an Orthodox Jewish enclave in Southfield and Oak Park, the man spent some time in New York, where an unrelated and fast-spreading measles outbreak among mostly unvaccinated children led the mayor last week to declare a state of emergency.   

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.

“In our community, there are things all the time that happen that everybody wants to know about. Usually, it’s a happy occasion — someone got engaged and there’s going to be a reception someplace that everybody should know about or somebody died. In our community, if someone dies in the morning, the funeral will be that afternoon. If someone dies in the afternoon, the funeral is the next morning. … They use calling posts, and people have lists, and within a very short amount of time a calling post goes out to the community that something good has happened and they should be mindful of it or something sad has happened. … We can get one or two or three calling posts a day on various subjects.”

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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.”

Measles’ second wave masked as flu

As Eliav Shoshana grew sick, state and local health officials confirmed the second wave of measles cases.

Four additional people had measles infections — all tied to the traveler from Israel. Three more people, health officials said, had suspected cases. A host of new exposure locations were announced that included not only sites frequented by the Orthodox Jewish community, but secular ones, too, such as Kroger, Meijer, Westborn Market, medical buildings, an ABC Warehouse and Lowe’s Home Improvement Store, among others. 

By the morning of March 22, Henny Shoshana said her husband “felt very flu-like, with fever; he was achy, tired, and he did notice … that his throat was hurting a little.”

That day, Henny Shoshana said the family got a message from Hatzalah, a volunteer emergency medical response group that serves the Jewish community in Oak Park, Huntington Woods and Southfield. It was urging people to get vaccinated if there was any possibility they may have been exposed to measles.

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.

That’s when the first kernel of doubt in their minds took root: Could Eliav Shoshana have the measles, too?

“The doctor, looking at it in that context, is like, ‘Oh my gosh.’ Then he was like, ‘No. It can’t be. There’s no way this is the measles. You have flu. You have strep. There’s just no way. But you know, let’s make sure. After Shabbat is over, let’s just be on the safe side, double check and get a swab to rule it out,’ ” Henny Shoshana said.

“My husband, hearing that, turns around and goes home. He was like if there’s any chance that this is the measles, I am going to go home.”

From that point on, Eliav Shoshana’s rash advanced like a classic case of the measles. He had characteristic white Koplik spots inside his mouth. 

“The rash spread from behind the ears and on the forehead,” Henny Shoshana said, “and down his arms and down his trunk in classic progression. … So we said, OK, forget it. This is the measles. Then we spent the next 24 hours calling everyone we knew who might have been exposed to say he has the measles.

“This is important for public awareness: People need to know if you just have fever alone, in the context of this outbreak, you need to pay attention and be careful and make sure you’re not spreading it. You might not think you have the measles and may go out and infect more people.”

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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. 

“Due to the outbreak, the Michigan Department of Health has issued updated vaccination guidelines. Every member of the community should follow those guidelines to ensure that they are fully vaccinated. If you are experiencing any symptoms of the measles … you are halachically required to stay home and immediately contact your health care provider for further instructions. It is absolutely forbidden for anyone experiencing symptoms to go out (even to Shul), and expose others and place them at risk.”

Those guidelines urged people to check their immunization status.

“It is assumed anyone born before 1957 had the measles as the disease was very common at that time,” said Leigh-Anne Stafford, a spokeswoman for the Oakland County Health Division. “But it is possible that individuals did not have it, making them vulnerable to it now. We are recommending everyone — no matter their age — to check their immunization status. If you do not have a record of two documented measles (MMR) vaccines from a doctor or Michigan Care Improvement Registry (MCIR), unsure if you have been vaccinated, or unsure if you have had measles in the past, contact your health care provider about getting vaccinated.”

In response, members of the Orthodox Jewish community turned out in droves for vaccines.

In just three days — from March 22-24 — the health division administered 970 MMR vaccinations. It also operated a remote clinic at Young Israel of Oak Park synagogue to make immunizations even more accessible to the community.

“In one week, the health department gave over 2,000 vaccines, not including hundreds of vaccines given in many private doctors’ offices,” said Dr. Janet Snider, a Bingham Farms pediatrician. “These were given to babies, young children and adults who could not find documentation of their vaccines, had only a single vaccine, or had non-immune status. 

“Their leadership in this outbreak is only surpassed by the kindness that they have shown to the community. Community activists, rabbis, doctors, and volunteers have all banded together with the health department in a major unified effort to stop this highly contagious disease and to prevent it in the future.”

Henny Shoshana and her 3-year-old son were among those to line up March 24 to get their shots. Even though she was certain she’d had two doses of the vaccine in her youth, like her husband, she had no proof of her immunizations. To be extra cautious, she got another vaccine. They quarantined themselves, too, wary of potentially exposing anyone else to the virus until 21 days had passed. 

Meanwhile, the number of Michigan cases continued to grow. By April 1, the state had confirmed 30 cases. By April 2, there were 34. By April 5, the count rose to 39. 

As news spread about the outbreak, Henny Shoshana discovered that there were others in the tight-knit community who, like her husband, also contracted measles despite being confident that they were vaccinated as children. They didn’t have the proof public health officials needed to count them among the vaccinated, either, because documents weren’t kept from their childhood years, and the doctor’s offices that would have administered their vaccines decades earlier had long been closed. 

A community victimized by false narrative 

Public health officials are required to classify people like Eliav Shoshana in the measles outbreak as being among those in a category of people who are either unvaccinated or have unknown/unconfirmed MMR vaccine status because they lack documentation.

Henny Shoshana grew concerned that might be creating a false narrative about the Orthodox Jewish community, and leave people with the impression that they are anti-vaxxers.

“I’ve had friends who’ve said they’ve gone out into the community, and people have looked at them warily,” she said. “I think it’s important to say the Orthodox Jewish community are not, very clearly, people who are opposed to vaccinations, and these are people who, to their knowledge, their parents followed the protocol for their generation.

“In fact, the Torah, which is like the Bible of the Orthodox, and our rabbis and our religious leaders not only are they not anti-vaccination, they are in fact very pro-vaccination,” she said. “It’s considered a religious requirement, essentially. … There’s a Hebrew quote from the Bible that says that it is incumbent upon us to guard and safeguard our health because our bodies are gifts from God.” 

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

“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 kshamus@freepress.com. 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.

April 1

  • 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.

April 2

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

April 3

  • 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.

April 4

  • 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.

April 5

  • 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.

April 6

  • 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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