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April 19, 2019

Finding 'patient zero': How one man unknowingly spread measles to 39 people—and how officials tracked him down

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    In March, a man travelled from Brooklyn to Michigan to visit people in ultra-Orthodox Jewish communities to raise money for charity—but unbeknownst to him he'd contracted measles and became Michigan's "patient zero" in an ongoing measles outbreak.

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    How this traveler became 'patient zero'

    The man, whom officials have not publicly identified, in November traveled from Israel to Brooklyn, where a major measles outbreak is ongoing that has affected the ultra-Orthodox Jewish community. Officials believe the man, who was visiting ultra-Orthodox communities in the United States to raise money for charity, likely caught the virus during his two-month stay in Brooklyn.

    However, his symptoms did not manifest until early March, as he travelled to Detroit to continue his fundraising effort. He began to feel feverish and was coughing, but a doctor initially misdiagnosed him with bronchitis and prescribed him antibiotics.

    The next day, the man called the doctor, complaining of a rash. The doctor believed the man was experiencing an allergic reaction. But he later grew concerned that the man had measles and decided to contact the county health department.

    Officials immediately began searching for the traveler, but the man was not following a set itinerary and did not have a working cellphone. So public health officials contacted Steve McGraw, Oakland County's medical director for EMS, and a member of the Detroit-area Hatzalah, the emergency medical response group for the ultra-Orthodox Jewish community, to track the man down. McGraw sent alert to rabbinical leaders in the community and within hours the team had located the traveler.

    McGraw informed the traveler that medical professionals believed he had measles. "He put his head down and was very emotional," McGraw said. "I could tell from the look on his face that he was devastated. He was doing the math in his head," figuring out how many people he had been in contact with.

    It turned out, the traveler had met with hundreds of community members, staying in private homes, visiting synagogues three times a day, and frequenting kosher markets and pizza parlors. "This guy was walking around all over the community and contagious," McGraw said. "We knew we had a really significant exposure."

    How local health officials and religious leaders responded

    McGraw and local health officials quickly mobilized to warn the ultra-Orthodox Jewish community.

    They used an internal messaging system, known as a calling post, to send out voice messages recorded by McGraw and approved by rabbinical leaders on about 1,200 cellphones that informed people about the disease and vaccination clinics set up throughout the area. For example, health officials, the Hatzalah and rabbinical leaders worked together to set up three vaccination clinics at one synagogue.

    The Council of Orthodox Rabbis of Greater Detroit also issued a statement saying Jewish law required everyone in the community to be "properly and fully vaccinated," according to CDC. "In order to protect and safeguard each and every individual within the larger community, every individual, family, and institution must take the necessary precautions against anyone who chooses not to be vaccinated," the letter stated.

    According to the Post, nearly 1,000 people were immunized at the synagogue in one week. That number surpassed 2,100 vaccinations by early April.

    Over the course of the next few weeks, two members of Hatzalah, Janet Snider, a pediatrician within the ultra-Orthodox community, and Gedalya Cooper, an emergency medical doctor, began visiting people who'd come into contact with the traveler to test them for the measles.

    Despite those efforts, so far 39 people have been diagnosed with measles connected to the traveler. According to the Post, many of those infected believed they were immune to the virus because they'd been told they had it in childhood or had been vaccinated.  

    Why measles spreads in small communities

    Michigan is one of 20 states where there have been confirmed cases of measles this year, and data suggest the virus hits communities where there are larger numbers of unvaccinated and under-vaccinated individuals the hardest.

    According to the Post, 75% of the measles cases reported to CDC over the past five years occurred in small communities, like the Amish in Ohio, the Somali community in Minnesota, and the ultra-Orthodox Jewish community in New York.

    Measles is extremely infectious—so much so that if an unvaccinated person walks into a room up to two hours after someone with the virus has left, they have a 90% chance of getting sick, according to the Washington Post. People with the virus are contagious for four days before and four days after they see the rash commonly associated with the disease. In order to properly prevent an outbreak, at least 96% of a community needs to be vaccinated against the virus.

    According to Daniel Salmon, a professor of international health at the Johns Hopkins Bloomberg School of Public Health and the director of the school's Institute for Vaccine Safety, "What's similar about all of these communities is that they live in proximity to each other and spend a lot of their time interacting with each other" (Sun, Washington Post, 4/16; Bouffard, The Detroit News, 4/16; Keneally, ABC News, 4/17).

    Editor's note: This story was updated on June 3, 2019. An earlier version of this story inaccurately indicated that the patient had measles as a child and then contracted the disease again as an adult. In fact, medical experts say that a childhood case of measles conveys immunity for life.

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