Last month, a traveler who raised money for charity in Brooklyn's ultra-Orthodox Jewish communities drove through the night to Detroit – his next gathering ended. He felt sick on the road and saw a doctor when he got there. But the doctor, who had never seen measles, misdiagnoses human fever and coughs like bronchitis.
Over the next two weeks, the traveler Michigan's Patient Zero will spread the highly contagious respiratory virus to 39 people he stayed in private homes, the synagogue attended daily and acted on the cash markets. His case offers a precautionary story of how easily one of the most infectious pathogens on the planet spreads in close communities – especially those whose members live, work, and socialize outside of the ordinary.
"Each of our cases has had a link to the original case," said Leigh-Anne Stafford, health officer for Oakland County, a Detroit suburb where everything but one case was reported.
Over the past five years, 75 percent of measles cases reported to the Centers for Disease Control and Prevention occurred in various insular societies, including Amish in Ohio, the Somali community in Minnesota, Eastern European groups in the Pacific, and the ultra-Orthodox Jewish community in New York. .
In the current outbreak, the new York infection has spread through patient zero and other travelers to predominantly ultra-orthodox communities in Westchester and Rockland counties in New York; Oakland County, Michigan and Baltimore County, Maryland. On Friday, Connecticut officials said an adult-contrasted measles visited Brooklyn at the end of March. New Jersey officials are investigating possible links between 11 cases in the Ocean County area and those in New York.
"What is similar to all these communities is that they live close to each other and spend much of their time interacting with each other," said Daniel Salmon, professor of international health at Johns Hopkins Bloomberg School of Public Health and head of school. institute for vaccine safety. "It's so important. Fairs don't care about what your cultural heritage is."
Many of these communities are cautious of government, avoiding television and the Internet, and are often dependent on their own doctors for care. has sometimes gained a foothold and discouraged parents from fully vaccinating their children.
The traveler had come from Israel in November November to Brooklyn, the epicenter of a measles outbreak, and stopped for about two months before moving on to the Detroit area in early March, said Russell Faust, Oakland County's healthcare professional. The man who does not identify health personnel in Michigan told them that he was visiting ultra-Orthodox communities in the United States to raise money for charity.
Fever and cough after his arrival, he saw a doctor who wrote antibiotics.
When the man called back to complain about a rash the next day, the doctor thought he had an allergic reaction. But after the doctor believed more about it, he was worried about the possibility of measles and decided to leave a voicemail to the health department with the man's cell phone number. Health officials jumped on the case – but could not reach the man because of a problem with their cell phone.
They turned to Steve McGraw, director of Oakland Emergency Medical Services, and a long-time member of the Detroit area of Hatzalah, the Orthodox community's emergency medical response group, a completely voluntary effort with deep ties to many families. McGraw warned rabbinical leaders, then jumped into his car and drove to the area that the traveler would stay to look for a man's rental car, a blue sedan, and knew it would stand out among the minivans used by almost all families.  Hatzalah members and rabbinical leaders were also mobilized to look for the traveler who lived in a neighborhood guesthouse. When they found him a few hours later, the traveler was stunned. He told McGraw and Rabbi who found him to be wrong because he thought he had had measles.
"There is only one disease, and you have it," said McGraw, saying that a rabbi was translated into Hebrew. "He put his head down and was very emotional. I could tell from the look of his face that he was devastated. He did the math in his head," counts all the people he had been in contact with, McGraw says. "
The journey showed Hundreds of contacts with members of the community that health care companies needed to trace, having stayed mostly in private homes in the Oak Park and Southfield areas, having visited synagogues three times a day to pray and study and frequent cousins and pizzerias, including 30 places on One week.
"This guy walked around the whole community and was infected," McGraw said. "We knew we had a very large exposure." Measles virus is so contagious that if an unvaccinated person goes through a room up to two hours after someone with measles has left, there is a 90 percent chance that the unvaccinated person becomes ill. a days after the tantalum rash, since measles is so contagious, at least 96 percent or more of a community must be vaccinated to prevent the risk of outbreaks.
On March 13, blood samples confirmed the traveler's measles. The strain matched the genetic fingerprint of New York City outbreaks, McGraw said. On the same day, the public health authorities drew attention.
To get information out to the ultra-orthodox community, health officials used their internal messaging system called a call post. Recorded voice messages call on about 1200 mobile phones. McGraw recorded a message that rabbinical leaders approved for delivery, the first of several to provide information on the disease and vaccination clinics.
Over the next few weeks, Janet Snider, a pediatrician for many ultra-orthodox families and Gedalya Cooper, an emergency medical doctor, both members of Hatzalah, visited people in their homes to diagnose and test them for measles.
The Orthodox Rabbinical Council of Greater Detroit issued an exhaustive statement saying that Jewish law was obliged by every member of the community to be "properly and fully vaccinated" according to the CDC. The Agency recommends that children receive two doses of measles, kotz and rats (MMR), starting from the first dose of 12 to 15 months and the second dose at 4 to 6 years.
"To protect and protect every individual in the wider community, every individual, family, and institution must take the necessary precautions against anyone who chooses not to be vaccinated," said the statement.
Hatzalah and Rabbinical leaders helped the health ward establish Three clinics in one synagogue, immunizing nearly 1,000 people in a week, in early April, have given more than 2,100 vaccinations, vaccine impact does not seem to be a major factor in the Oakland County cluster, officials said.
In Michigan, it seems close co-operation between health care providers and the religious community at least have controlled disease spread, which can cause serious complications including deafness, pneumonia, brain injury and death.
Now, with 555 measles cases in 20 states – the highest in five years – see other places on that model Hatzalah groups in other parts of the country reach out to the camp n members for advice on increasing vaccination in the ultra-orthodox community, Faust said.
Oakland County had something else to do for it: The show's outbreak usually starts with children. But Patient Zero had spent most of his time with adults, and most of the 39 cases are in adults. Many adults who became ill thought they were immune because some had been told that they had the disease as a child or were vaccinated.
"There is a fair number of non-immunized or under-immunized adults," says Faust, physician. Some of the infected adults were also born before 1957, when most caught measles and are considered to have natural immunity.
Officials said the risk remains high for those who are not vaccinated or vaccinated and who travel to communities here or abroad where measles falls.
Holes in vaccination tires have led to 20-year high measles cases in Europe. Major outbreaks also occur in parts of the Middle East, Southeast Asia and Japan. More than 1,200 people have died in Madagascar. With spring and summer holidays, travelers visiting European countries with outbreaks, such as France and Italy, are approaching a much greater chance of getting infections back to "islands or pockets of vulnerability," said Saad Omer, an infectious disease expert at Emory University.
"Measles is a very irreconcilable disease," he said. "Although most are vaccinated, this number may not be high enough."
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