Measles Epidemic Flares Up in Southland : Disease: L.A. County and Inland Empire report more cases already this year than in all of 1989. And the outbreak appears to be spreading.

The measles epidemic that has plagued Southern California since late 1987 has dramatically worsened, with Los Angeles County and the Inland Empire, the hardest-hit areas, reporting many more cases during the first three months of 1990 than in all of 1989.

Dramatic increases in measles cases have also been registered throughout the Central Valley and in San Diego County, and a measles outbreak has developed in Alameda County in the San Francisco Bay Area.

“Children are getting ill, going to the hospital and dying,” said Dr. Loring Dales, chief of the immunization unit for the state Department of Health Services in Berkeley. “We are really stunned by not only the amount of illness but also the severity. . . . (It is) the kind of thing you would see in Calcutta.”

Most of the current cases are occurring in pre-school-age children who have never been immunized against measles. Health officials speculate that these toddlers may be especially vulnerable to the disease. Previous epidemics have largely affected school-age children or young adults.

Statewide, between a quarter and a third of measles victims have required hospitalization, primarily for pneumonia or dehydration. About one in 200 of the afflicted individuals have died, compared to the historical pattern in the United States of one death for every 1,000 to 3,000 measles cases.

“We feel like we’re under siege,” said Dr. Gary Euler, chief of immunization programs in San Bernardino County, where health officials have documented 910 cases and five deaths already this year, compared to 650 cases and five deaths during all of 1989. San Bernardino officials believe the county’s rate of new cases is the highest in the state, possibly in the nation.

Measles cases this month “have been coming in so fast you can’t keep the log up,” said Orange County epidemiologist Thomas J. Prendergast.

As of Thursday, 1,411 measles cases and six measles deaths had been reported to Los Angeles County health officials, compared to 1,202 cases and 17 deaths last year. The incomplete March case total of 661 is already the highest monthly total in 13 years.

Dr. Shirley L. Fannin of the Los Angeles County Department of Health Services said the epidemic in the county “clearly exceeds” the last major epidemic in 1976 and 1977. “We are really into a major surge. . . . It is hop, skipping and jumping from population to population and infecting the susceptibles,” she said.

Statewide, reported cases are “running way ahead” of 1989, when 3,048 measles cases were reported, Dales said. If current trends continue, he said, it is “possible” that the 1990 case total will surpass the 9,000 reported in 1977.

Particularly hard hit are Latino, Asian and Pacific Islander ethnic minorities and children of all racial and ethnic groups in low-income communities.

Some measles victims who go to hospitals are unwittingly helping spread the disease, especially in emergency rooms where sick people often face long waits before receiving care. In Los Angeles County, at least 69 adult health care workers have developed measles, and one-third of them have been hospitalized.

Last Tuesday, Dr. Kenneth W. Kizer, the state health director, told the Assembly Health Committee that an additional $8.8 million is needed this year to combat the epidemic, including money for more immunization clinics, programs and vaccine doses.

Los Angeles County is planning to open some public health clinics in the evening hours and is seeking assistance from the U.S. Centers for Disease Control.

Other counties are planning to extend hours of existing clinics or organize special outreach clinics in shopping centers, churches, large apartment complexes and community centers. Educational messages about the measles epidemic and the importance of immunization are being sent out in many languages with welfare checks and Medi-Cal mailings.

Some hospitals in San Diego County are warning potentially infected individuals not to mingle with others seeking treatment and are advising parents to leave their other children at home when they bring a child in for treatment.

Measles, or rubeola, is a highly contagious viral disease that causes high fever and a severe rash. It is spread through the air by infected individuals. Measles most commonly occurs in the winter and spring, but during epidemics a substantial number of cases occur throughout the year.

To prevent the disease, a first dose of measles vaccine is recommended for children at between 12 and 15 months and a second dose at 4 to 6 years. But the vaccine is not foolproof; between 5% and 10% of recipients fail to achieve immunity after one dose of the vaccine.

More than 90% of school-age children have been immunized against measles, primarily because of intensive public health efforts over the last 15 years. Such immunization is required as a condition of attending public and private schools, as well as state-licensed day-care centers.

But surveys around the state show that only about 70% of all children--and only 50% of many ethnic minorities--have been immunized against measles by their second birthday, according to Dales. He estimated that a minimum of 375,000 California children between ages 1 and 4 have not been immunized against measles. Until these children are immunized, they remain at high risk of contracting the disease.

Measles outbreaks are now blossoming in San Diego County, across the San Joaquin Valley and in Alameda County. Alameda County, for example, had 30 measles cases in all of 1989 but has recorded more than 150 cases already this year, Dales said. Cases in San Diego County have increased from 191 in 1988 to 467 so far this year.

Public health officials lack an effective mechanism for targeting toddlers, many of whom are cared for at home or in unlicensed day-care centers. Unless parents bring their children to a physician’s office or public health clinic for immunization, they are likely to remain unprotected until they enter school.

“There is a huge gap, the toddler gap, that we have never been able to close,” Dales said. “Parents are good at bringing in their children for their shots during the first six months of life, but then it falls off.”

Public health officials are uncertain why the rate of measles complications and deaths has increased. But Dales suggested that toddlers may be more susceptible than older children to the disease, which can also include ear infections and brain damage. Another possibility is that a higher percentage of severe cases, rather than mild ones, are being reported to county health departments.

“It looks like the same virus as in prior epidemics,” Dales said. “We are sending virus isolates to the Centers for Disease Control. So far nothing unusual has cropped up in the analyses.”

Measles immunization is given as part of a vaccine against measles, mumps and rubella, or “German measles.” A dose of the vaccine costs about $27, but is generally available without charge at public health clinics.

Nationally, there were about 16,000 measles cases in the United States in 1989, compared to about 3,000 in 1988. The largest concentrations of cases were in Texas, California, Illinois and Ohio.

Times staff writers Lanie Jones in Orange County, Jenifer Warren in Riverside, Jerry Gillam in Sacramento, Greg Johnson in San Diego and Joanna Miller in Ventura contributed to this story.

MEASLES IN CALIFORNIA The persistent measles epidemic is dramatically worse, with more cases of the highly contagious viral infection reported in Fresno, Los Angeles, Riverside, San Bernardino and San Diego counties during the first three months of 1990 than in all of 1989. If current trends continue, the measles epidemic may surpass the one in 1977, when 9,000 cases were reported statewide.

1989 JANUARY-MARCH 1990 CASES DEATHS CASES DEATHS California 3,048 25 N/A 24* Fresno County 327 1 332 8 Los Angeles County 1,202 17 1,411 6 Orange County 388 0 204* 2 Riverside County 166 2 512 2 San Bernardino County 650 5 910 5 San Diego County 191 0 467* 0 Ventura County 8 0 2 0

* Includes cases under investigation. SOURCES: County health departments, state Department of Health Services. MEASLES CASES IN LOS ANGELES 1987: 126 cases 1988: 565 cases 1989: 1,202 cases 1990: 1,411 cases January: 258 cases February: 492 cases March: 661 cases SOURCE: Los Angeles County Department of Health Services