Doctors, rabbis worked to uncover source of Oakland County measles

Karen Bouffard
The Detroit News
Oakland County Health Division public health nurse Rebecca Pomaville, left, gives the MMR (measles, mumps, rubella) vaccination to health division secretary Kim McIsaac, right.

Sleuthing by a local emergency doctor helped identify a person believed to be Patient Zero in the measles outbreak that started last month in Oakland County, a crucial step in gaining control of the highly contagious disease.

The outbreak came to the attention of Oakland County Health Department officials in March, when they received a call from an Oak Park physician who was worried that a patient he'd sent home with a prescription might have the measles.

The patient was an Orthodox Jewish Israeli man who had traveled to Detroit to raise funds for charities in Israel. Health officials jumped on the case.

Measles is known to spread in close-knit communities. They'd just dealt with an outbreak among members of one Oakland County Orthodox Jewish family in October, which was quickly contained. But an outbreak among New York City's Orthodox Jewish community was still underway.

Oakland County health officials called Dr. Steve McGraw, the county's medical director for EMS. He's worked for years with Detroit-area Hatzalah, a group of volunteer medics who provide emergency services in the area's Orthodox neighborhoods. 

"We had a guy that didn’t speak English and the SIM card in his cell phone wasn’t working; it was one of these disposable Walmart cell phones," McGraw recalled Tuesday. "He raises money for charities in Israel, and he was meeting families and going to various synagogues three times a day."

McGraw solicited the help of rabbis from synagogues across the region who mobilized to find the man. He was finally located at a local house for traveling rabbis.

"I sat down with him, and I can’t speak Hebrew, so one of the rabbis was translating for me," McGraw said of Rabbi Daniel Arm, a coordinator with the Tzedakah Enhancement Project, which assists Jewish charities across the region.

Until that moment, McGraw and health officials believed the man had come to Detroit directly from Israel. The doctor was stunned to learn the traveler had been in the United States since November.

"I said, What do you mean, November? I knew that if he’d been in Detroit since November, he wouldn’t have contracted measles," McGraw recalled. 

"He said, 'Well, I’ve only been in Detroit one day. I’ve been spending my time in Brooklyn.' And I was like, now that makes sense, because I remembered there had been a brewing outbreak in Brooklyn."

Through translated interviews, McGraw was able to trace the man's movements across Metro Detroit's Jewish community. 

According to the Jewish News, he made visits to Ahavas Olam Torah Center in Southfield, Congregation Ahavas Yisroel in Oak Park, Congregation Yagdil Torah in Southfield, Dovid ben Nuchim-Aish Kodesh in Oak Park, Jerusalem Pizza in Southfield, Kollel Institute of Greater Detroit in Oak Park, Mikveh Israel in Oak Park, One Stop Kosher Market in Southfield, Yeshiva Gedolah of Greater Detroit in Oak Park, and Lincoln Liquor & Rx in Oak Park.

According to McGraw, the traveler's symptoms had started while en route from New York to Detroit, with a fever and a cough. He saw the doctor who prescribed the traveler antibiotics. The man eventually came down with a small rash near his hairline so he contacted the doctor again. That's what prompted the doctor to reach out to the health department. 

"It starts pretty consistently, you feel really sick for four or five days. The virus all that time is dividing inside. You get this fever, cough, a really bad sore throat and this conjunctivitis, oozy eyes," McGraw said. "All that looks like the flu.

"The hallmark is about the fifth day or so, you get this rash right at the hairline. You can feel it. It descends the face down to the shoulders and the neck. It’s like if somebody poured a can of red-dotted paint over you, and it’s running down to your waist."

The problem is, the patient is contagious the entire time, even before the rash appears, according to McGraw. And measles is far more contagious than the flu. 

The health department attempted to reach out to the traveler but the man's cellphone wasn't working, prompting the manhunt.

Blood tests confirmed on March 14 that the man had measles, and testing matched his strain of the virus to the New York City outbreak, according to health officials.

McGraw noted the traveler was extremely cooperative after learning he had measles and stayed indoors to keep from exposing anyone else.

But to stop the spread, Oakland County health officials blasted the community about the need to vaccinate, said Leigh-Anne Stafford, health officer for the Oakland County Health Division.

The department sent nurses into peoples' homes to administer vaccinations and treat people with symptoms. They also set up sites where people could be vaccinated without exposing others. 

"There were a couple of testing sites, so if somebody was concerned we had an area where people could go and be tested," Stafford said. "If they had questions, they could pull up in their car, and we had people to help them."  

The department has administered 2,500 vaccinations since March 14, compared with perhaps a couple of hundred in that time period for previous years, she added. 

Since the start of the Oakland County outbreak, health officials have confirmed one case of the New York strain in Wayne County. A different strain was identified in a measles case recently confirmed in Washtenaw County. 

Last week, authorities reported the number of measles cases in southeast Michigan outbreak has fallen to 39 from 41 after further testing of two cases. 

Michigan's measles outbreak coincides with others reported across the country, including New York, California, Illinois, Texas and Washington, according to officials.

The outbreak is the largest in nearly three decades, health officials said.

McGraw, chairman of the emergency departments at Ascension Providence Hospital in  Southfield and Novi, said he's grateful for the support of Metro Detroit's Orthodox community, which worked to quickly bring the outbreak under control by making sure everyone was vaccinated. 

The Council of Orthodox Rabbis of Greater Detroit issued a statement on March 20, saying it was a religious "obligation for every member of our community to be properly and fully vaccinated."

"Ignoring or undermining this policy of universal vaccination endangers the community," the council wrote.

McGraw said most of the Oakland County cases were identified in adults. 

"In the New York case, there was a significant percentage of them that were children that had not been vaccinated. We didn’t see that in the Detroit case at all," he said. "We saw some kids get sick, but they were in the same house with an adult who got it first.

"There really isn’t any strength to an anti-vaccination movement in Detroit at all in the Orthodox community," he added. "Their rate of vaccination is about the same as everyone else in Oakland County."

Twitter: @kbouffardDN