Resurgence of Measles Kills 6 in California

A persistent measles epidemic that has gripped the Southland and other regions of California since late 1987 flared anew in January, claiming six lives and prompting some experts to warn that an end to the outbreak is nowhere in sight.

The surge in measles cases comes after several counties experienced a lull late last year that gave many health officials hope that the stubborn epidemic might be subsiding.

Instead, Los Angeles, Riverside and Fresno counties in January reported their highest monthly total of suspected measles cases since the outbreak began.

And in San Bernardino County, health authorities attributed three deaths to measles last month--only two shy of the five measles-related deaths recorded there during all of last year.

“It’s out of control,” said Dr. Loring Dales, chief of the immunization unit for the state Department of Health Services. “There is no sure-fire way to control it. And it’s showing no indication of going away.”

Dales and other measles experts agree that only parents can stop the spread of the disease by ensuring that their children are immunized once they reach the recommended age, which ranges from 12 to 15 months.

The continuing rubeola--or red measles--epidemic is described by state epidemiologists as the worst in California since 1977. It surfaced in August, 1987, and initially was centered in Los Angeles County.

Disease Spreads

Later, it spread to Orange and San Diego counties, as well as to the Inland Empire. Fresno County’s outbreak, which began a year ago, is considered separate and unrelated.

Statewide, there were 3,000 measles cases reported in 1989, most of them in Southern California. An unusually high proportion of people contracting the viral disease--more than one-third--required hospitalization. Twenty people died.

Toward the end of the year, however, several counties experienced a substantial decline in measles cases.

In October, only 29 cases were reported in Los Angeles County, while San Diego County had none. Nineteen cases were reported in November in San Bernardino County, where 100 new cases a month had been the norm over the summer.

“With that kind of downturn, we thought the worst of it was behind us,” said Dr. Gary Euler, chief of immunizations programs for San Bernardino County.

January, however, squelched such optimism. Los Angeles County reported 260 suspected cases of measles for the month. While that figure may decline as epidemiologists gather details of each case, it marks the highest monthly total since the outbreak began.

Riverside’s 103 probable cases in January was also a record for that county, and San Diego had 23 suspected cases after its quiet December.

Orange County appears to be something of an exception. Although the January total of 11 cases was almost triple the four reported in December, epidemiologist Thomas J. Prendergast predicted that the total for 1990 would not reach the 388 cases logged in Orange County last year.

In addition to the deaths of an infant, a toddler and a 22-year-old man last month in San Bernardino County, the epidemic’s victims already this year include a 15-year-old girl in Los Angeles County, a 7-month-old baby in Orange County and a toddler in Fresno County.

Dr. William Atkinson, a medical epidemiologist with the Centers for Disease Control in Atlanta, said the January upsurge mirrors a pattern seen in other areas of the country that had experienced brief, misleading lulls in their measles outbreaks.

“This same activity is happening in Milwaukee, Dallas and in parts of Florida,” Atkinson said. “We also have new outbreaks all of a sudden in Texas. We don’t have a ready explanation, but we are drawing nearer to the traditional measles season of late winter and early spring.”

Rubeola is a highly infectious viral disease characterized by a rash that covers the body. Symptoms usually last about 10 days, unlike those of rubella, or German measles, which persist about three days.

The California epidemic has mostly targeted preschool-age children, many of them Latino or black and from low-income, inner-city families.

In Fresno County, 400 cases and two deaths--the most recent occurring Jan. 2--have been recorded since February, 1989.

Recently, the disease has taken a particularly heavy toll among Fresno County’s sizable community of Southeast Asian Hmong refugees, most of whom live in the city of Fresno.

“Many of the young Hmong children are not immunized, either because of cultural reasons or lack of education,” said Merelyn Boren, supervising public health nurse for Fresno County. “We’ve focused our outreach efforts on these people, going door-to-door in the apartments.”

Other counties are conducting similar efforts, but experts say that reaching parents of preschool children--the highest-risk group--is difficult because the children are not yet in school.

“This thing is not going to go away until parents get their children immunized,” said Dr. Steve Waterman, chief of communicable diseases for Los Angeles County. “The trouble is, many of these kids are not in day-care centers, are not getting systematic medical care, or have parents who are nervous about coming into our clinics. We just can’t find them.”

Bad Timing

State officials say the timing of the epidemic is particularly distressing because of a financial pinch on California’s immunization program. Dales of the Health Services Department said the state will have 25% less than needed to spend on measles and other vaccinations this year.

“What that could mean is we may have to close down the clinics in September and tell people to come back in 1991,” Dales said. “Considering that the public health program (provides vaccinations for) one-third of the state’s children, that could be a very big problem.”

The funding crunch is all the more lamentable, officials say, because of recent recommendations by the Centers for Disease Control and the American Academy of Pediatrics that children receive a second measles vaccination.

Times staff writers Greg Johnson and Lanie Jones contributed to this story.