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.

Orange County recorded its first death of a county resident--a 7-month-old baby boy from complications of the disease--in January, although the total number of new cases reported for the first month of 1990 did not alarm officials. Last month, 11 county residents had contracted the viral disease and another 25 were suspected.

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.”

But Orange County is faring well in the epidemic compared to other regions, county officials said. Orange County epidemiologist Thomas J. Prendergast stressed Thursday that measles cases this year probably will fall well below last year’s total of 388.

“We may wind up with 15 or 16 (measles) cases in a month, but we probably won’t get 80” as San Bernardino County did in January, Prendergast said.

Orange County recorded 109 measles cases in 1988, contrasted with only 12 measles cases in all of 1987.

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.

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. Numbers peaked in Orange County in April, when 93 cases were reported, but then the cases declined. Only 21 confirmed and six unconfirmed cases were counted in the last three months of the year.

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.

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.”

High risk communities, including Latino neighborhoods in central Orange County, “have had enough natural disease transmission” already so that “most people are immune”--either because they’ve had the disease recently or been vaccinated, Dr. Prendergast said.

In addition, county clinics and local pediatricians are continuing a concerted effort to immunize children early--at 12 months rather than the previously recommended age of 15 months--to increase protection during this statewide measles outbreak.

Prendergast noted that Orange County was still “getting introductions” of measles from neighboring counties and from Mexico. Last month, for instance, there were several clusters of cases involving someone who had contracted measles in Mexico, then infected Orange County residents. In addition, seven of the January cases involved members of a church group that opposes immunization.

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.”

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