County Measles Cases Hit Highest Level in 11 Years

With more than six months left in 1989, Orange County’s measles epidemic already has hit an 11-year high of 280 cases, more than double that of all of 1988, county health officials said Thursday.

So far, the county has not recorded any deaths from the highly contagious disease. “But if it keeps on like this, we’ll see them,” warned county epidemiologist Dr. Thomas J. Prendergast.

The 280 cases reported so far this year were as of June 20. That compares to 109 measles cases in all of last year and only 12 in 1987, according to statistics from the Orange County Health Care Agency. The last severe measles epidemics occurred in 1976 with 443 cases and in 1977 with 397 cases.

More than half of this year’s cases have involved Latino children who had never been vaccinated, and a quarter of those affected were adults, according to Prendergast.

He said he hoped that the epidemic would slow when schools let out for the summer later this month but added that he wasn’t counting on it.

“The problem is: one or two people can infect as many as 20 people. So we can’t be confident it won’t pick up again,” he said.

Prendergast blamed this year’s outbreak on several factors. “A number of Hispanics were not immunized. Some were immunized, but the vaccine has a small failure rate,” he said. “And a few people were immunized with something not as effective as the vaccine we use now. But the main problem is young Hispanics who were not immunized.”

Measles, also known as red measles or rubeola, is considered a highly infectious disease. Symptoms typically begin about 10 days after the virus enters the body and include fever, cough, watery eyes and sensitivity to light.

A rash appears about four days after the first symptoms and lasts five to 10 days. Complications of measles can include ear infections, bronchitis, pneumonia and, in rare cases, encephalitis. The illness is sometimes confused with rubella, or German measles, which also involves a rash but has less severe symptoms.

Around the country, 24 states including California have reported measles outbreaks this year, mostly affecting preschool children, according to the National Centers for Disease Control in Atlanta.

Through June 11, there were 5,569 cases of measles, a 300% increase over the same period last year, CDC public health adviser Dean Mason said.

Hardest hit have been children in the Los Angeles area, where eight have died from complications of measles. Also, nine children died in Houston, one in Illinois and one in Puerto Rico, Mason said.

Although this year’s measles epidemic is severe, still “it’s minuscule to what it was in the pre-vaccine era,” Mason noted. Before a measles vaccine was developed in 1963, typically more than 500,000 people contracted measles in an average year.

Nevertheless measles is still “a lousy, rotten disease,” noted Dr. Adele Hofmann, director of the outpatient clinic at Childrens Hospital of Orange County in Orange.

At least five children were admitted to CHOC with encephalitis that accompanied measles, CHOC officials said.

In addition, so many youngsters with measles were coming to CHOC’s clinic in April and May that “we were having our own epidemic in the waiting room,” Hofmann said.

“We would be having, say, a kid who would be coming in for a burn treatment. And there’d be a kid who’d be coming in with measles, but who didn’t have the rash yet. And he’d expose all the kids who were there.”

Same Problem

UCI Medical Center in Orange had the same problem in the waiting area for its emergency room, doctors there reported. Someone who seemed to have the flu or bronchitis would “come to our front desk and they’d expose a lot of people,” said Dr. Michael Burns, an associate clinical professor of emergency medicine and infectious diseases.

While Burns said he doesn’t know for certain whether other patients caught measles in UCIMC’s emergency room, two physicians and an emergency room technician did catch the disease there.

“The docs got pretty sick, but that’s typical of measles,” Burns said. “You feel like you’re going to die.”

Particularly hard-hit by measles have been young Latinos, many of them from the Santa Ana area, local doctors say. Also, Hofmann said, Samoan children here seem to get especially ill from the measles. “They don’t seem to have a mechanism for handling (it),” she said. “They’re like American Indians, who were decimated by measles. We saw a number of Samoan children who were devastated by measles.”

Have Managed the Risk

Both CHOC and UCIMC believe that they have managed the risk of contracting measles at their hospitals. At CHOC, the hospital has posted signs saying that any child with fever, cough, watery eyes and rash “must report to the nurse’s station immediately” so he can be kept separate from other patients

At UCIMC, emergency room personnel posted a sign in English and Spanish that says, “If you have a rash, do not enter. Please have someone contact the triage nurse.”

In addition, hospital officials sent out “an alert” barring any child under the age of 16 from visiting a patient.

Also, the hospital offered free measles vaccines to any employee under the age of 35 who had not been vaccinated since 1980, Patricia Hamm Hayden, UCIMC’s infection control manager, said.

Despite the latest tally of measles cases, officials at both CHOC and UCIMC said they believe that the epidemic may be waning.

Hofmann said she has been seeing only three to four measles cases a week lately. In April and May, her clinic typically was seeing three to four in a day.

At UCIMC, Burns said he had not seen any measles cases for several weeks.

He’ll Wait and See

Prendergast said he was interested in those accounts but would wait to see whether the numbers “won’t pick up again.”

CHOC’s Hofmann had some advice for parents who might be wondering what to do about immunizing their child. “If your youngster is a year old and has not been immunized, the greatest service you can do is to take him to your physician or health department for immunization,” she said.

“The risks of a measles, mumps or rubella shot are negligible. There’s occasionally fever or a very transient rash, but it’s the safest of all shots we have,” she said, adding that the shots should give a child protection up to 10 years.

Parents should also consider re-immunizing high school and college students, she said.

TIPS ON TREATING MEASLES

When a child appears to have the measles, his or her fever should be managed, according to Adrienne Pederson, head nurse at the outpatient clinic for Childrens Hospital of Orange County. There are no drugs to combat measles once the disease strikes, she said. Here are some things parents should know:

Control fever with a non-aspirin product. Fever could go as high as 103 and the child should be given liquids to help fight dehydration. Fever could last for several days and may be accompanied by vomiting.

Before the rash appears, listen to make sure the cough that usually accompanies the disease in its first few days does not move to the chest area. If it does, that can result in pneumonia.

Watch to make sure that children do not become listless or incoherent. Measles and its fever can result in encephalitis, or inflammation of the brain.

Put children in bed and make them as comfortable as possible. If they complain about light hurting their eyes, the room should be darkened.

Keep children away from other children after measles are suspected. Also, parents of other children who could have been infected with measles should be notified immediately.

COUNTY CASES

Year Number 1989 to date 280 1988 109 1987 12 1986 14 1985 25 1984 7 1983 3 1982 21 1981 14 1980 63 1979 79