A stubborn measles outbreak that has plagued much of Southern California for two years has flared this summer in the Inland Empire, causing two deaths and prompting concern that the disease could spread still faster with the start of the school year next month.
Hardest hit by the rubeola, or "10-day measles," epidemic has been San Bernardino County, where more than 500 cases have been reported since October.
The epidemic has swept through three San Bernardino County jails as well as the California Institution for Men in Chino, claiming the lives of two inmates and prompting mass inoculations of those who work and are housed in the detention facilities.
Gary Euler, a county epidemiologist tracking the outbreak, said the disease has struck residents in 18 widely scattered cities, from San Bernardino to Big Bear, and has so far defied efforts to stop its spread.
While San Bernardino recorded about 32 cases annually over the last decade, the county has been struck by an average of 100 new cases a month since June. An unusually high rate of one in three patients has required hospitalization.
"We're doing what we can to get people immunized, but so far we don't have a handle on it," Euler said. "I don't think anyone has the answer as to why this has just taken off here."
The Southland epidemic surfaced in August, 1987, and was initially centered in Los Angeles County. Since then, it has fanned out to include the Inland Empire as well as Orange and San Diego counties.
More than 2,000 cases have been recorded so far, with the majority occurring in 1989. Eleven deaths--nine in Los Angeles County spread over two years and two in San Bernardino since June--have been definitively linked to the epidemic, while at least six other fatalities may be related, health authorities say.
In Riverside County, 93 people have contracted measles since the first reported case in April. After a jail inmate came down with the disease and quickly infected two others, officials launched a mandatory immunization program, inoculating 1,500 inmates and staff members. Transfers within the jail system were also limited in order to reduce exposure to the highly contagious rubeola virus.
County epidemiologist Randy Regester said Riverside's outbreak was initially concentrated in the region's eastern reaches, near Indio, but quickly spread west. He said public health nurses have interviewed all of the victims and have alerted anyone with whom they had contact.
"We've been real aggressive on the case investigation end of things in hopes of keeping control of it," Regester said.
Orange County health authorities say the measles outbreak there is the worst in 11 years. Dr. L. Rex Ehling, a county health officer, said 307 cases have been reported in 1989, about triple the number recorded the previous year. Ehling also said one death had been linked to the outbreak, but he could provide no details and state officials could not confirm the report.
70 People Ill
Unlike San Bernardino, Orange County has seen the measles rate dip since its peak in May, a month in which more than 70 people became ill.
The same is true in Los Angeles County. In mid-spring, more than 100 cases monthly were the norm, but this summer, only about 40 new victims have been stricken each month.
The spread of the disease also has slowed in San Diego County. The outbreak peaked there in early spring but has faded almost completely, with fewer than a dozen cases in July. In all, there have been about 160 measles victims in San Diego in 1989, more than double the number in 1988.
Rubeola, or red measles, is a highly infectious viral disease characterized by a rash that covers the body. Its symptoms typically last 10 days, unlike those of rubella, or German measles, which persist about three days.
Dr. Loring Dales, chief of the immunization unit for the state Department of Health Services, said the Southland epidemic is the most serious to strike California since 1977 and resembles those that have hit New York, Newark, N.J., and Miami in recent years.
Most of the victims have been preschool-aged children in poor, inner-city neighborhoods, where public education about immunization is often deficient. Children under age 3 are particularly vulnerable to the high fever and bronchial infection associated with the disease.
"This has been a very difficult outbreak to contain," Dales said, noting that the cases have been geographically diffuse. "It's not like we can target one area and go door to door."
The disease has also caused an abnormally high number of fatalities and has brought unusually severe symptoms, with 20% of the victims suffering pneumonia and the same ratio requiring hospitalization. Typically, 5% of measles victims need hospital care.
Nationwide, more cases of measles have been reported this year than in any year since 1980, according to the national Centers for Disease Control. Chicago and Houston are waging particularly tough battles against the virus, with 4,000 cases and six deaths between them in the past year.
Although rubeola usually attacks elementary schoolchildren, one-fourth of the San Bernardino County victims have been adults. Many of these have been jail inmates.
While 85% to 90% of the young adult population is immune to measles, "when you have barracks-type living, like in a jail, measles will find the 10% to 15% who aren't protected," said Dales of the state health agency.
In San Bernardino County, Euler said officials instituted a mandatory inoculation program in the jails and there have been no new cases since immunizations were halted last week. There was one case at the county's Juvenile Hall two weeks ago, however, so authorities immunized nearly all of the 340 youths at that facility.
With the first day of school not far off, health officials face a new challenge: "You couldn't dream up a better way to spread measles than a school setting, with all those kids mixing all the time," Dales said.
Barbara Cole, supervising public health nurse for Riverside County, said the Health Department will offer low-cost vaccinations at a special back-to-school clinic.
In San Bernardino County, where outbreaks occurred at 46 schools, any student lacking proper immunization records will be barred from school, Euler said.