Deadly Bacterial Infection Breaks Out in L.A. County

Los Angeles County is experiencing a dramatic outbreak--not seen since the 1960s--of a deadly bacterial infection that causes spinal meningitis and a related blood disease.

Since December, there have been 120 cases reported, including 26 deaths, according to Dr. Shirley L. Fannin, associate deputy director of communicable disease control for the county Department of Health Services.

The cases of meningococcal infections include an apparent cluster at the Los Angeles Central Jail, where about a dozen inmates have required hospitalization, according to Dr. Peter Heseltine of the County-USC Medical Center.

In recent years, only about 60 cases have been reported annually in the county, the majority of them during the winter months.

With the possible exception of the jail, almost all the cases have apparently been unrelated, according to health officials, who said new reports of the disease are still being received. Fannin said meningococcal infections typically trail off by the end of March, but she added, “We don’t have any way to absolutely predict. . . .”

One possible explanation for the outbreak is a shift in the strain of bacteria, which has been detected in the county over the last several years. As a result, more people may be susceptible to the new strain.

But for reasons that are not yet clear, other Southern California counties, including Orange, San Diego, Riverside and Ventura, have not experienced an increased number of cases.

Los Angeles health officials first noticed a disproportionate number of meningococcal infections among Central Jail inmates last summer, said Dr. Steve Waterman, chief of acute communicate diseases for the county. “The crowded conditions are ideal for transmitting the infection,” Waterman said. “There is no question there is a problem in the jail.”

Among the public at large, health officials became aware of the “significantly higher number of cases” after receiving 22 case reports in December, compared to 10 in December of 1985, according to Fannin.

In January, when 68 cases were diagnosed, the health department sent a letter to all physicians in the county, advising them to be vigilant for early signs of the infection in their patients, such as a characteristic rash, Fannin said. An additional 30 cases were reported in February.

But Fannin said the health department “rejected” the idea of a public warning about the outbreak because there is “nothing an individual could do to prevent the disease.”

“When you make a public announcement you have to have a clear message that the public can take an action on,” she said.

Meningococcal disease, which can infect the blood stream or the membrane surrounding the brain and spinal cord, is spread through the air and by close contact, sometimes causing epidemics in military barracks, for example. It strikes mostly children between 3 months of age and adolescence--as has been the pattern in the current outbreak.

The infections are caused by the bacteria Neisseria meningitidis. In the winter, about one out of every four people carry the bacteria in their noses or throat, according to Fannin. But most do not become ill, although they can transmit the infection to others.

The vast majority of patients who become ill only have mild symptoms--similar to a cold or the flu. They recover without treatment.

But while the life-threatening form of the disease is rare, it can be devastating when it occurs. Within hours an infected individual can suddenly develop a characteristic rash, severe fever, headache and weakness. Occasionally, less than 10 hours elapse from the onset of such symptoms to death.

Even when treated promptly with antibiotics, between 10% and 20% of severe cases are fatal.

At the Central Jail, officials have discussed the possibility of taking special steps to curb meningococcal infections that are sometimes used in epidemic situations, such as immunizations or the widespread use of antibiotics to decrease the number of inmates carrying the bacteria, Waterman said. The advantages and disadvantages of recommending such steps are still being studied.

About 2,500 cases of meningococcal disease occurred in the United States in 1986, including 356 in California. In Los Angeles County, the record number of cases in the last 30 years occurred in 1966, when 199 meningococcal infections were diagnosed.