Measles Epidemic Ebbing in California : Health: Rate falls sharply in nation, but officials won’t say 4-year outbreak is over yet. New York cases have tripled.

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. Orange County reported 707 cases last year compared to 259 cases reported here through Tuesday.

“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 health officials warn that like a wildfire still not entirely under control, the measles epidemic could come roaring back.

“I think we’re on the decline. But we don’t want to send the message out: ‘It’s over and you don’t need to worry about being immunized,’ ” said Dr. Hildy Myers, an epidemiologist with the Orange County Health Care Agency.

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

California health officials acknowledge that they have an ongoing problem in publicizing the benefits of immunization among groups isolated by language or culture. In Orange County, 50% of last year’s cases were Latinos, although in the last six months, 74% of measles victims were Anglo. The deaths here have included two Latino infants, a Latino 2-year-old and, this year, an Anglo man in his mid-30s.

In Los Angeles County, more than 60% of the measles cases--and of the deaths--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 effective in protecting children over the age of 5.

But Myers said some adults who were vaccinated may not have been protected, perhaps because they did not develop measles antibodies after receiving the vaccine or because the vaccine may have failed when it was stored improperly.

“There is a group of about 5% (of the population) who don’t respond even after the first shot,” Myers explained. “And that’s a major reason for the recommendation for a second dose” of vaccine. Still, she and other local health officials believe their immunization drives get much of the credit for the decline in measles cases.

“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.

Health officials remain concerned about the 600,000 children 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. In Orange County, the rate of unimmunized children is probably about 40%, said Dr. Gerald Wagner, medical director of the county’s immunization program. 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. Also, because of county budget constraints this year, 20 of 78 Orange County “well baby” clinics that have offered immunizations are recommended for closure Oct 1.

Myers expressed concern about the closings. “In my mind it is always very shortsighted to cut vaccination services--a very cost-effective service,” she said. If children don’t get vaccinated until age 5, when they start school, “a whole group of people is going all these years unprotected. And it sets us up for another epidemic.”

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.

End of an Epidemic?

Now in its fourth year, the measles epidemic may be ending in Orange County, as indicated by a sharp drop in reported cases. Number of Cases/Monthly Aug. 1990: 51 Aug. 1991: 1 Number of Cases/Yearly 1988: 109 1989: 395 1990: 707 1991: 259 Source: Orange County Health Care Agency