With Michigan in the midst of its largest measles outbreak in nearly three decades, Abram Wagner isn't surprised almost all of the cases have been reported in Oakland County.

State health officials this week reported the number of confirmed cases had risen to 34, the most since 1991. The breakdown: 33 cases in Oakland County and one in Wayne County.

Wagner, a professor in the department of epidemiology at the University of Michigan, cited a Baylor University study that showed Oakland County had a large population of unvaccinated kindergarten students.

“Scientists had predicted that Oakland County would be at high risk for a measles outbreak,” he said. “... Scientists from Baylor College of Medicine found that Oakland County had the fifth largest number of vaccination exemptions in the country. So this outbreak was, sadly, predicted.”

State and county health officials said the outbreak started March 13 when measles was confirmed in a traveler from Israel who had stopped in New York before coming to Michigan. The state's outbreak is among several reported across the country, including in New York, California, Illinois, Texas and Washington.

State and county health officials say getting the MMR vaccine (for measles, mumps and rubella) is the best way to protect against measles, and they are ramping up efforts to persuade people to get the shot.

The Oakland County Health Division issued news releases and information sheets, with versions translated into Spanish, Arabic and Hebrew, and conducted special measles vaccine clinics at its Southfield office and at Young Israel of Oak Park.

More than 2,000 people had been vaccinated as of April 1, and efforts continue, said Leigh-Anne Stafford, health officer for the Oakland County Health Division.

“We are recommending everyone — no matter their age — to check their immunization status,” Stafford said. “Unvaccinated individuals need to get vaccinated."

There are exceptions — including pregnant women and people with compromised immune systems — and people should consult the vaccine provider before getting the shot.

Also, you're considered protected if you have written documentation of at least one dose of a measles-containing vaccine for preschool-age children and low-risk adults, or two doses for school-age children and high-risk adults, including college students, health care personnel, and international travelers.

Others who don't need to be vaccinated are those with laboratory evidence of immunity, laboratory confirmation of measles or a birth date before 1957.

Diamond Wilford of Oak Park took her 1-year-old daughter, Tiffany, to a county health clinic in Southfield for vaccination last week.

“This outbreak is scary — you hear about possible exposure at this school or that store,” Wilford said. “She’s not in day care yet, and I don’t believe she has been exposed, but I want to protect her.

“She cried (when she got the shot), but I think it's harder on the parent than on the child,” said Wilford, who said she has had conversations with neighbors who are anti-vaccination.

“I don’t tell them how to care for their child and don’t want them trying to tell me,” she said. “But the general advice is an immunized child is not only being protected but also others.”

Measles is spread by direct person-to-person contact and through the air. Symptoms include high fever (may spike to over 104 degrees; cough; runny nose; red, watery eyes; tiny white spots on the inner cheeks, gums and roof of mouth two to three days after symptoms start, and a red, raised, blotchy rash that usually starts on the face and spreads to the trunk, arms and legs within three to five days.

Severe and potentially deadly complications include pneumonia and encephalitis (swelling of the brain), according to the federal Centers for Disease Control.

“The MMR vaccine is very safe and effective," Stafford said. "Most people who get MMR vaccine do not experience any serious reactions. Getting the MMR vaccine is much safer than getting measles.”

According to the CDC, one dose of measles vaccine is about 93 percent effective at preventing measles when exposed to the virus and two doses are about 97 percent effective.

Avraham “Avi” Cohen can testify that the vaccine isn't 100 percent effective.

Cohen, 23, of Oak Park received the MMR vaccine when he was 2 and again at age 5, said his wife, Debbie Cohen. “He does have written proof,” she said. “But he still got the measles."

Debbie Cohen said her husband, who was too sick to be interviewed, noticed his first symptoms the week of March 17 and thought he had caught something from his 2-year-old son. The Cohens also have a 2-month-old boy.

“Our older son had been exposed to someone who had measles the prior week, so I took him to the doctor, who came out to the car, swabbed him and the following Tuesday, the results came back negative,” Debbie Cohen said.

She said their son had an ear infection and was running a fever.

“My husband, meanwhile, had a cough, runny nose, and a little fever, so we figured it probably was the flu," she said. “So he began taking regular Motrin and Dayquil, nothing special.”

The following Friday, she said she took their son to the doctor to check on his ears.

“As we were leaving the doctor’s office, my husband called to say he had a rash all over his body,” she said. “So I told my son’s doctor and he suggested I call the Oakland County Health Department and follow their instructions.”

She said a doctor and nurse from the health division visited their home and administered booster shots to her parents and older son, and swabbed the entire family to determine whether they had measles.

Several days later, her husband’s test results returned positive for measles. By then, he had experienced a severe headache and a fever that spiked past 105 degrees.

Cohen said she called one of the hospitals because her husband “felt like he was being burned alive. They asked what painkillers I was giving him and I told them, but they talked me out of coming to the hospital.”

“We should have gone in,” she said. “They were scared of exposure, obviously.”

She said her husband’s temperature eventually came down and he started feeling better.

Health officials have identified at least 110 locations of potential measles exposure between March 14 and April 1 in Oak Park, Southfield, Berkley, Royal Oak, West Bloomfield, Pontiac, Bloomfield Hills, Farmington Hills, Novi and Wixom.

The list, compiled by health officials based on interviews, includes synagogues, schools, office buildings, hospitals and urgent care facilities, a funeral home, a liquor store and pharmacies, Lowe's and Home Depot stores, Aldi, Kroger and Meijer grocery stores, a car wash and even the Oakland County Circuit Court building.

Wagner said Metro Detroiters should be on “high alert.”

“Measles is highly contagious and can spread quickly in areas with low vaccination coverage,” the UM professor said. “Measles causes unnecessary suffering in children, and it is extremely expensive to control. The state will probably spend around $5,000-$10,000 per case in controlling the outbreak.”

While Macomb County has recorded no measles cases, the county health department sent out an advisory last week that one of the originally confirmed infected persons had visited a Bank of America on Romeo Plank Road in Macomb Township between noon and 2 p.m. on March 19. Persons who had been in the bank that day were advised they may have been exposed to the virus.

“So far, we fortunately have not had one confirmed case (of measles) here,” said Dr. Kevin Lokar, medical director for the Macomb County Health Department. “We have had a number of people come in for vaccinations since last month, but they were motivated because of the media attention that has been given to the outbreak.”

Bill Ridella, county health officer, said workers have vaccinated 227 people since March.

“That’s 52 percent higher than the same period one year earlier,” Ridella said. “This is a serious disease and has to be treated seriously. The public education programs appear to be working.”

mmartindale@detroitnews.com

(248) 338-0319

Where to get vaccinated

Oakland County

Health Division offices are open Monday, 8:30 a.m.- 6:00 p.m. and Tuesday-Friday, 8:30 a.m.- 5:00 p.m. at 1200 N. Telegraph Road, Building 34 East, Pontiac, and 27725 Greenfield Road, Southfield. Call 800-848-5533 for more information.

Wayne County

Walk-in vaccination at 33030 Van Born Road, Wayne, on Monday, Tuesday, Thursday and Friday, 8-11 a.m. and 12:30-4 p.m. and on Wednesday, 11 a.m.-2 p.m. and 3:30-7 p.m. Call 734-727-7101 for more information.

Macomb County

Vaccination clinic at 43525 Elizabeth Road, Mount Clemens, is open 8:30 a.m.-4:30 p.m. Monday and Thursday and 8:30 a.m.-6:30 p.m. Wednesday. Call (586) 469-5235 for more information.

What to do if you think you are infected

--Call your doctor and let him or her know about your symptoms. Your doctor can make special arrangements to evaluate you, if needed, without putting other patients and medical office staff at risk.

--If you have measles, stay home for four days after developing the rash.

--Cover your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in the trash can. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands.

--Wash your hands often with soap and water.

-- Avoid sharing drinks or eating utensils.

-- Disinfect frequently touched surfaces, such as toys, doorknobs, tables, counters.

