Rash of Measles Cases Worries Health Officials : Epidemics: Crisis is blamed on lack of infant immunization. Medical experts now fear outbreaks of other preventable diseases, including polio.

Months later, it was clear the problem had emerged at an ordinary high school basketball game just before Christmas, 1987.

But the true dimensions of the public health crisis weren’t exposed until many months after South Torrance and Bishop Montgomery high schools met in a small gymnasium.

In the weeks after the game, students at both schools reported rashes, high fevers and coughs. Measles.

By spring, 1988, measles cases were reported at other South Bay schools and at Loyola Marymount College. By August, 1988, however, the outbreak wasn’t confined to just high school and college students. It had taken hold in a fragile population: unimmunized children of poor and immigrant families in Southern California.

To public health officials, the shift in measles transmission from teen-agers to babies signaled a crisis.

Minor outbreaks of measles commonly occur in high schools and colleges because the immunizations some teen-agers received as infants failed to confer lasting immunity.

But the reason measles has reached epidemic proportions among infants and toddlers is that infants, particularly among the poor and minorities, simply haven’t been immunized against measles--or other preventable illnesses, health officials say.

Only 70% of California children younger than age 2 are fully immunized, reports Dr. Loring Dales, chief of the immunization unit for the state Department of Health Services in Berkeley. The rate drops to about 50% among the poor and minority groups. An estimated 375,000 California children ages 1 to 4 are not immunized against measles.

The picture is similar nationwide.

According to the U. S. Centers for Disease Control, only 50% to 60% of all children under age 2 have completed the recommended schedule of infant immunizations:

* Four DTP vaccines (for diphtheria, tetanus and pertussis).

* Three oral polio vaccines.

* One shot for measles, mumps and rubella.

* And one shot for Haemophilus influenzae meningitis.

State law requires proof of immunization before children may be enrolled in school or state-licensed day-care facilities. But in many families, that means immunizations are postponed until the child is nearly 5.

The current gap of unimmunized infants and toddlers could fuel epidemics of pertussis (commonly known as whooping cough) and polio in much the same way the measles outbreak erupted, warns James Mize, a public health official with the CDC.

“We know pertussis is on the rise,” he says. “Two-thirds of all cases of pertussis are occurring in children less than 5. We don’t have any cases of wild-virus (not vaccine-induced) polio in the United States right now. But our worst nightmare is to see outbreaks of wild-virus polio in the inner cities.”

Local health officials say they already are struggling to cope with one epidemic.

In the past 15 months, measles has infected more than 4,000 Californians, many of them children. The epidemic has hospitalized nearly 1,000, killed 49 and so depleted the state’s meager health resources that services, in general, are suffering; attempts to control other potential epidemics, such as tuberculosis, have been sidelined.

“It’s almost overwhelming the health-care system,” says Dr. Stephen Waterman, chief of communicable disease control for the county Health Services Department. “We have had to set priorities. And to make one thing a priority you have to make another thing not a priority.”

But health officials agree that unless the numbers of unimmunized children are reduced, highly communicable “Third World” diseases once nearly eradicated in the United States could make a comeback.

Infant immunizations usually require five visits to a doctor’s office or clinic when the child is between 2 months and 18 months of age. Booster shots for some diseases are required when the child enters school.

“We’re dealing with a preventive health service that requires a multitude of visits to the health provider,” the CDC’s Mize says. “We believe the majority of people who don’t get immunized are in lower-socioeconomic groups. Getting these kids immunized is a priority, but it’s not as high a priority as ‘Where am I going to live’ and ‘How can I get other health care for my children?’ ”

In Southern California, the problem appears to be compounded by language barriers and cultural differences. Many parents of unimmunized children are natives of countries where childhood immunizations are unheard of, health officials say. Families may be unable to arrange transportation to health clinics or may fear venturing beyond their neighborhoods.

But public health departments are failing to connect with the growing population of people without regular health care, says Dr. Lester Breslow, director of UCLA’s Health Promotion Center. Breslow is a former director of the state department of public health.

“If you have a large unimmunized population, as we do among preschool youngsters, then the likelihood of an outbreak is perfectly obvious,” Breslow says. “The people being affected have been neglected. . . . We grossly under-serve the people living in the inner cities of Los Angeles County.”

Under a new nationwide program called the Infant Immunization Initiative, federal health officials aim to raise immunization rates of children younger than age 2 to 90% nationwide by the year 2000. But so far, Mize says, CDC officials have no specific strategies on how to accomplish that goal.

In California, however, the statewide advocacy group Children Now is sponsoring the California Full Immunization Act (SB 2266) to provide funding and program changes needed to improve immunization rates.

The $11.8-million act would provide money for more vaccines, expansion of clinics and training of health department staff.

The California bill is noteworthy because of its commitment to send health professionals into needy neighborhoods, says Kay Johnson, director of the health division for Children’s Defense Fund, a Washington-based advocacy group.

Johnson says public health departments have backed away from aggressive immunization campaigns common in the 1960s and 1970s. In the ‘70s, public health nurses often canvassed door-to-door to immunize children in Chicago housing developments, she says.

“We believe this is a problem related to access to care,” Johnson says. “Families are not resisting. Families are not unaware that they should be immunized. But they are not part of a regular system of care.”

Public health nurses should be dispatched to hard-to-reach communities to enroll families in a long-term system of care, Johnson says. Under this plan, nurses could establish an ongoing relationship with families to encourage future care, she says.

“Even if you get the baby in at 4-months-old, unless that child is in a regular system of care, you literally have to go and find that child again in three months for his next shot,” she says.

Individual communities should devise strategies to reach their unimmunized residents, UCLA’s Breslow says.

For example, officials in the largely Latino city of South El Monte were well aware of their growing population of unimmunized children.

But in November, the city was shocked when a 2-year-old boy died of measles after contracting the illness at a public health clinic where his mother had brought him for other care. “We thought, if he picked it up there, then we have a problem,” says Connie McFall, director of human services for South El Monte.

With the help of a health promotion project run by UCLA, city officials set up special measles immunization clinics beginning in January. They publicized the clinics by printing fliers in Spanish and English and sending them home with school children.

The clinics are held one evening each month from 3 to 7 p.m. at a senior citizens center. Vaccines are available free from the county; volunteer senior citizens help families to register and complete paper work. Volunteer school nurses--who were among the most vocal advocates for the clinic--administer the shots. Children who need other immunizations, such as polio and DTP vaccines, can receive those vaccines as well, McFall says.

Through the clinics, South El Monte officials have learned that many children had not received immunizations because the closest health clinic, in El Monte, was too far away, McFall says.

“We’ll see a woman who doesn’t speak English come in with a stroller and trailing four other children. For her to get the five miles to nearest health clinic is impossible.

“I think it’s time people stop being territorial about what is the health department’s function and what is the city’s function,” McFall says.

“The question is, what is the logical way we can get something done quickly? Had we waited for the health department, with all the county bureaucracy, it would have been another three or four months before kids would have been inoculated against measles.”

The program in South El Monte did not stop the epidemic there, UCLA’s Breslow says: “But at least it showed what people can do to get this (message) out among the people. It would have been good if this had been done all over the county a couple of years ago when the risk was evident.”

Childhood Immunization Schedule Health officials can devises a personal schedule for adults and children who are not immunized at the recommended time. People who have questions regarding immunizations should call their coun1954095208 (The DTP vaccine protects against diphtheria, tetanus and pertussis. MMR protects against measles, mumps and rubella. Hib protects against Haemophilus influenzae meningitis.)

Recommended Age Vaccine 2 months DTP (first dose), polio (first dose) 4 months DTP (second dose), polio (second dose) 6 months DTP (third dose) 12-15 months MMR (first dose),DTP (fourth dose), polio (third dose) 18 months Hib 4-6 years DTP (fifth dose), polio (fourth dose), MMR (second dose) 14-16 years Tetanus and diphtheria booster (repeated every 10 years throughout life.)

Source: Annals of Internal Medicine, July, 1989; Calif. Health Services Department.)