Measles Outbreak Ebbing : Health: Although officials won’t say it’s over, the epidemic is declining in California. New York State’s rate has tripled, however.

A four-year measles epidemic that has preyed mostly on unvaccinated inner-city children, killing scores of youngsters across the country, has ebbed sharply in California and in most other states, health officials said Wednesday.

Though they warned that it is too soon to declare the epidemic in full control, health officials were encouraged by a sharp drop in measles cases--especially in California, the hot spot for the disease a year ago. Last year, there were 12,586 cases in California, compared to 1,810 so far this year.

“My guess is this epidemic is ending,” said Dr. Loring Dales, immunization chief for the California Department of Health Services. “At the state level, we’re way down. We hope it’s over.”

With measles on the decline in California, the worst state now is New York. New York City alone accounts for nearly half the 7,957 U.S. cases reported through Aug. 17, according to the federal Centers for Disease Control. The number of cases in New York is more than triple the number last year.

“We have really, really bad feelings about New York,” said Dr. William Atkinson, head of the measles program at the Centers for Disease Control.

Only nine states have uncovered new measles cases this year. Last year, public health workers were tracking them in every state but North Dakota.

Atkinson said aggressive public immunization programs by state and local health officials contributed to the epidemic’s decline in California.

“They have just done a super job in shooting thousands and thousands of doses of vaccine into kids,” Atkinson said. “The clinics got cranked up, lots of kids got attended to.”

Nature helped, too. Most epidemics die out naturally, just as a brush fire subsides when there is no more fuel to burn. Having measles confers lifelong immunity for most people--they can’t get it and they can’t spread it. So four years into California’s outbreak, there are far fewer people for the virus to infect.

But Atkinson cautioned against complacency, noting that California’s 1,810 cases so far this year are evidence of significant pockets of unimmunized residents, vulnerable to the highly contagious virus.

“Keep in mind that is more than the total number reported for the entire country in 1982,” he said.

California health officials acknowledge that they have an ongoing problem in publicizing the benefits of immunization among groups isolated by language or culture. More than 60% of the measles cases--and of the deaths--in Los Angeles County were among unvaccinated Latino preschoolers, some of whose families may have recently migrated from Latin America. Strict immunization requirements for entry into school have been highly effective in protecting children over the age of 5.

“You get down to a place where people left unimmunized are very, very hard to reach,” said Dr. Shirley Fannin, Los Angeles County’s director of disease control. “They don’t listen to exhortations, they don’t freely come out, you have to entice them.”

But Los Angeles County numbers are down dramatically too, with 751 measles cases as of July 30 compared to 3,535 cases through the same period last year. Overall, there have been more than 7,000 cases recorded in the county and 37 deaths since the epidemic began in late 1987. Two children have died of measles complications in Los Angeles County this year.

Fannin said her staff directed an extraordinary array of special outreach programs, extended the hours at public health centers so working parents could bring in their children for shots, and ran immunization clinics in churches and housing projects.

This campaign was complemented by similar efforts in private health care organizations and hospitals. Flyers alerting families to the measles crisis were sent home with schoolchildren, especially in the hard-hit neighborhoods of East and South Los Angeles, El Monte and Pomona.

Officials in Orange, San Bernardino, Riverside and other counties took similar measures. Orange County health officials administered vaccine in the County Jail; Riverside sent public health nurses bearing vaccine to remote desert ranches whose workers included many migrant families.

“I think we’re on the decline,” said Dr. Hildy Myers, an epidemiologist with the Orange County Health Care Agency, which has recorded 259 measles cases through Tuesday, compared to 616 cases through August of last year. “But we don’t want to send the message out: ‘It’s over and you don’t need to worry about being immunized.’ ”

Indeed, about 600,000 children are born in California each year, not to mention the thousands that enter the state as immigrants.

“That means new (susceptible people) every year,” said Dale, the state immunization chief. Getting infants and toddlers promptly immunized is the only way to keep what the CDC’s Atkinson calls “the tinder of an epidemic” from accumulating.

Officials estimate that some inner-city neighborhoods in California had an immunization rate of less than 50% among preschoolers. Measles requires a 94% immunization rate for certain protection against an epidemic, Fannin said.

At the height of the epidemic last year, the state Legislature responded with emergency appropriations of $8 million to buy vaccine and set up extra inoculation clinics. School nurses were also tapped to immunize children entering kindergarten without proof of vaccination, and alerted health officials to vulnerable younger siblings.

But budget cuts in the Los Angeles Unified School District have ravaged the ranks of school nurses, Fannin said, adding: “I think we are going to rue the day.”

Dale cautioned that emergency state money for the anti-measles campaign ran out June 30. Since then, Orange County officials closed some night and school-based clinics.

In Los Angeles, county supervisors have made an effort to keep extra programs going with a special immunization appropriation of $1.35 million at a time when health programs throughout the county and state are feeling the effects of California’s recent budget problems.

State officials are pinning their hopes on $40 million in additional federal immunization money President Bush has put in his budget proposal for next year.

“California will certainly be eligible,” said John Dunajski, assistant immunization chief for the state.

A Disease on the Decline

Here is a look at the recent incidence of measles: CASES OF MEASLES

COUNTY 1988 1989 1990 JAN.-JULY 1991 Los Angeles 508 1,229 4,549 870 Orange 91 408 725 289 Riverside 35 145 1,122 229 San Bernardino 13 631 1,464 166 San Diego 32 202 1,013 33 Ventura 10 10 58 23 Santa Barbara 0 7 120 0 STATE TOTAL 818 3,083 12,586 1,897 U.S. TOTAL 3,396 18,193 27,785 7,547

DEATHS FROM MEASLES

COUNTY/AREA 1988 1989 1990 JAN.-JULY 1991 Los Angeles 2 13 12 2 Orange 0 0 2 1 Riverside 0 1 4 2 San Bernardino 0 4 8 1 San Diego 0 0 4 0 Ventura 0 0 0 0 Santa Barbara 0 0 0 0 STATE TOTAL 2 20 52 7 U.S. TOTAL 2 41 89 NA

SOURCE: Calif. Dept. of Health Services; Centers for Disease Control

NA indicates not available