The measles epidemic in San Diego County has worsened dramatically recently, leading public health officials to believe that more cases will be reported during the first three months of 1990 than in all of 1982, when the previous record for reported cases was set.
Since early January, 49 confirmed cases of measles and 418 probable cases--most of which will eventually be confirmed--were reported in the county, officials said. San Diego reported 191 measles cases during 1989 and 451 during 1982.
The epidemic that began sweeping through Southern California in late 1987 has hit hardest in Los Angeles County and the Inland Empire, where health officials have already reported 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 an 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.”
The majority of the current cases are occurring in preschool-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.
More than half of San Diego County’s confirmed and probable cases during the past three months have involved preschoolers.
“That’s an age group of kids who should be immunized at 15 months,” said Sandy Ross, immunization project coordinator for the county Department of Health Services. “But many of the kids in this outbreak were eligible for vaccinations they have not gotten.”
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 have died, contrasted with the historical pattern in the United States of one death for every 1,000 to 3,000 cases.
While local hospitalization figures are not yet available, “one out of every four people with measles was hospitalized during 1989,” Ross said. “That’s a lot of people who were ill enough to require hospitalization.”
“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 so far this year, contrasted with 650 cases and five deaths during 1989. Officials there believe the county’s rate of new cases is the highest in the state and possibly 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.
San Diego has yet to record its first measles-related death during the current outbreak. However, local hospitals have reported several serious cases, including one death that might eventually be linked to measles.
Hector Lopez, a 10-year-old fourth-grader at Sunset View Elementary School in Point Loma, died Feb. 23, several days after being hospitalized. The county coroner’s office has yet to determine if he died of measles, but the disease has been diagnosed in other members of the boy’s family.
Doctors at Children’s Hospital are now caring for a 1-year-old who was admitted to the hospital 68 days ago after being found to have measles. The prognosis is “not good” for the infant, who is on life-support systems, hospital spokesman Mark Morelli said Friday.
As of Thursday, 1,407 measles cases and six measles deaths had been reported to Los Angeles County health officials, contrasted with 1,202 cases and 17 deaths in 1989. The incomplete March case total of 661 is already the highest monthly report of cases in 13 years.
Dr. Shirley L. Fannin of the Los Angeles County Department of Health Services said the epidemic there “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, said Dales of the state’s immunization unit in Berkeley. If trends continue, he said, it is possible that the 1990 case total will surpass the 9,000 cases reported in 1977.
Previous epidemics have largely affected school-age children or young adults. But the majority of the current cases are occurring in preschool-age children who have never been immunized against measles, according to Fannin.
Particularly hard-hit are Latino, Asian and Pacific Islands ethnic minorities, and children of all racial and ethnic groups in low-income communities.
Doctors are also treating an unknown number of measles victims at hospital emergency rooms, said Ross of the San Diego County health department. “A lot of people go to emergency rooms just to be diagnosed. Others are sick enough to need (intravenous) fluids to rehydrate them so they don’t have to be hospitalized.”
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. “The longer the infectious person is there, the greater the opportunity to spread it to other people,” Ross said.
Some San Diego County hospitals evidently have posted signs at emergency room entrances, warning infected people not to mingle with others who are seeking treatment, Ross said. UC San Diego Medical Center has posted warning signs at doors leading to wards that house highly susceptible patients such as pregnant women and infants.
And emergency room nurses are now advising parents to leave their other children at home when they bring an injured or ill child in for treatment. “That’s difficult to do, but when they bring the 10-year-old in for treatment of a soccer injury, they might expose their small baby who’s not yet eligible for a vaccination,” Ross said.
On Tuesday, Dr. Kenneth W. Kizer, the state health director, told the Assembly Health Committee that $8.8 million more is needed this year to combat the epidemic, including funds for more immunization clinics, programs and vaccine.
Los Angeles County is planning evening hours for some public health clinics and is seeking assistance from the U. S. Centers for Disease Control.
Other counties are planning to extend hours of existing clinics or are organizing special outreach clinics in shopping centers, churches, large apartment complexes and community centers. Educational messages about the epidemic and the importance of immunization are being sent out in various languages with welfare checks and Medi-Cal mailings.
Measles, or rubeola, is a highly contagious viral disease that causes high fevers and a severe rash. It is spread by direct contact with the respiratory secretions of 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 vaccine is recommended for all children between 12 and 15 months old, 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 past 15 years. Such immunization is required as a condition of attending both 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 if they are exposed to infected individuals.
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 to parents at public health clinics.
The San Diego County health department has historically provided vaccines for needy children at 15 months of age. But, because of federal budget cuts, “we don’t even know if we’ll have vaccines available in September, when the anticipated supply will run out,” Ross said. “We’re really in limbo right now.”
Also, the county does not have vaccine available for the second shot that is being recommended by the Centers for Disease Control.
Times staff writers Lanie Jones in Orange County, Jenifer Warren in Riverside, Jerry Gillam in Sacramento and Joanna Miller in Ventura contributed to this story.