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 it was 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 only 1,810 so far this year.

In San Diego County, the contrast is even sharper: 18 reported cases so far this year, compared with 985 for all of 1990.

“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 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 they have an ongoing problem in getting the message about the benefits of immunization to groups isolated by language or culture. More than 60 percent of the measles cases--and of deaths--in Los Angeles County were among unvaccinated Latino preschoolers, some of whose families may only have recently migrated from Mexico and 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.”

San Diego County health officials said a public awareness campaign probably accounted for the dramatic drop in cases this year.

“Maybe a lot of the information that went out last year had an impact,” said Sandy Ross, immunization project coordinator for the county Department of Health Services.

Many of the 18 cases this year were imported, she added. “Most were infected outside the county and became ill here,” Ross said. “But that doesn’t mean that we couldn’t have the same problem here. The problem is getting parents to have their children immunized.”

Ross said health officials are worried that a half-page newspaper advertisement that has appeared recently in the San Diego Union and Tribune might cause parents to not immunize their children, thinking that it is not mandatory or medically needed.

The ad, reportedly placed by 17 chiropractors in San Diego County, questions the need of immunizing children against disease. It’s appearance comes just before the beginning of school, when students are usually inoculated, Ross said.

Although San Diego County has not been as hard hit as Los Angeles, the county last year suffered its worst epidemic in the last 20 years, Ross said. San Diego County had three measles-related deaths last year; there were no deaths from measles from 1980-89. No one has died so far this year of the disease.

According to Ross, inner-city communities have the hardest time getting rid of an epidemic. Lack of money or education usually means that parents cannot ensure that their children are properly immunized, she added.

Los Angeles has a higher number of measles cases than San Diego because it “certainly has a larger inner-city neighborhood than we do,” Ross said.

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 in Los Angeles County of measles complications 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 their children in for shots, and ran immunization clinics in churches and housing projects.

This campaign was complimented by similar efforts in private health care organizations and hospitals. Flyers alerting families to the measles crisis were sent home with school children.

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.”’

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