Measles Cases Spur Vaccine Reminder

Southern California health officials are crossing their fingers in hopes that four recent cases of measles--three in Los Angeles County and one in Orange County--don’t spark outbreaks of the rare but potentially serious childhood disease.

At the same time, they’re using the cases to remind parents about the potential consequences of not vaccinating their children. Investigators have determined that two of the three Los Angeles children who became ill should have been vaccinated but weren’t. The third was too young.

“In some ways, we’ve been victims of our own success” with public health campaigns to wipe out measles, said Dr. Jay M. Lieberman, director of pediatric infectious diseases at Miller Children’s Hospital in Long Beach, where the three youngsters were treated.

About 90% of preschoolers and 95% of school-age youngsters have received one or both recommended measles inoculations. The first is given between the ages of 19 and 35 months, the second at 4 or 5. California requires the shots for kindergarten admission.

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Many Americans have forgotten how devastating measles can be, Lieberman said, and young doctors may have never even seen a case.

Yet because measles still kills a million children a year in developing countries, according to the World Health Organization, state and federal health officials watch for any signs the disease is gaining domestic toeholds.

Vaccination gaps remain among residents who never developed natural immunity from contracting measles, never got the vaccine or were among the unlucky 5% the vaccine failed to protect. Their vulnerability worries Lieberman.

“Whether [the latest group of cases] is a little blip and will go away or represents the first signs of measles reemerging remains to be seen,” Lieberman said. “I’d be shocked if there weren’t more cases.”

It is a particularly sneaky illness because it has a long incubation period, anywhere from five to 21 days after exposure. Also, it’s easily spread when an infected person coughs or sneezes, releasing tiny, highly infectious droplets into the air.

The disease typically begins with a runny nose, cough, conjunctivitis (pink eye with a discharge) and fever of 103 to 105 degrees--symptoms that can easily be mistaken for other maladies. After three or four days, a characteristic red rash sets in, beginning on the face and eventually covering the body. Measles is generally contagious about four days before and four days after the rash appears.

Rare but potentially deadly complications include pneumonia and encephalitis, seen most often in infants and the elderly.

Southern California’s latest measles patients have recovered, but health officials have alerted local hospitals and doctors to be on the lookout for more cases, especially among people who came into contact with the recovered patients.

Doctors at Miller Children’s Hospital nearly missed measles in the first two kids, 19-month-old and 3-year-old siblings from Hawaiian Gardens, treating them for fevers, rashes and diarrhea before blood tests detected the problem, Lieberman said. The third child, a 9-month-old girl from Long Beach, came in a few days later.

Investigators determined that the infant was exposed when her mother dropped her at the home of the Hawaiian Gardens children for a couple of days. They’re unsure how the siblings were exposed.

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Orange County health officials determined that a woman in her 40s was infected by a relative visiting from Nevada. The California relative became ill June 4, the same day she attended a concert with 2,000 others at the Orange County Performing Arts Center.

Health investigators are tracing all the contacts the sick people had and now suspect that a Long Beach hospital clerk may be infected; the clerk began showing signs of a rash and fever last week.

Although deaths from measles are rare in this country, the last major outbreak, in 1989-’91, caused 150 deaths among the 55,000 reported cases. Los Angeles was hit particularly hard.

In the last couple of years, the U.S. has averaged about 100 cases annually but no deaths, said Dr. Walter Orenstein, director of the National Immunization Program at the federal Centers for Disease Control and Prevention in Atlanta. About a third of the cases come from Americans traveling abroad who bring the illness home or from unvaccinated foreign visitors.

California had 17 cases last year, including one in L.A. County and four in Orange County. This year, there have been 12, including the L.A. and Orange county cases, said Dr. Natalie Smith, immunization branch chief for the state’s Department of Health Services.