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Resurgence of Measles Kills 6 in California


RIVERSIDE — A persistent measles epidemic that has gripped the Southland and other regions of California since late 1987 flared anew in January, claiming six lives and prompting some experts to warn that an end to the outbreak is nowhere in sight.

The surge in measles cases comes after several counties experienced a lull late last year that gave many health officials hope that the stubborn epidemic might be subsiding.

Instead, Los Angeles, Riverside and Fresno counties in January reported their highest monthly total of suspected measles cases since the outbreak began.

And in San Bernardino County, health authorities attributed three deaths to measles last month--only two shy of the five measles-related deaths recorded there during all of last year.

"It's out of control," said Dr. Loring Dales, chief of the immunization unit for the state Department of Health Services. "There is no sure-fire way to control it. And it's showing no indication of going away."

Dales and other measles experts agree that only parents can stop the spread of the disease by ensuring that their children are immunized once they reach the recommended age, which ranges from 12 to 15 months.

The continuing rubeola--or red measles--epidemic is described by state epidemiologists as the worst in California since 1977. It surfaced in August, 1987, and initially was centered in Los Angeles County.

Later, it spread to Orange and San Diego counties, as well as to the Inland Empire. Fresno County's outbreak, which began a year ago, is considered separate and unrelated.

Just two confirmed cases of measles were reported in San Diego County during January, said Dr. Donald Ramras, deputy director of the county Department of Health Services.

However, investigators are reviewing an additional 23 suspected cases "and past experience shows that, when we suspect a case, most of the time it's confirmed," Ramras said.

"It would seem to me that we're seeing the same" upward trend as the rest of Southern California, Ramras said. January's two confirmed and 23 suspected cases are noteworthy because there were no reported cases in December and just eight in November, Ramras said.

Statewide, 3,000 measles cases were reported in 1989, most of them in Southern California. An unusually high proportion of people contracting the viral disease--more than one-third--required hospitalization. Twenty people died.

Toward the end of the year, however, several counties experienced a substantial decline in measles cases.

In October, only 29 cases were reported in Los Angeles County. Nineteen cases were reported in November in San Bernardino County, where 100 new cases a month had been the norm over the summer.

"With that kind of downturn, we thought the worst of it was behind us," said Dr. Gary Euler, chief of immunizations programs for San Bernardino County.

January, however, squelched such optimism. Los Angeles County reported 260 suspected cases of measles for the month. Although that figure may decline as epidemiologists gather details of each case, it marks the highest monthly total since the outbreak began.

Riverside's 103 probable cases in January was also a record for that county.

Orange County appears to be something of an exception. Although the January total of 11 cases was almost triple the four reported in December, epidemiologist Thomas J. Prendergast predicted that the total for 1990 will not reach the 388 cases logged in Orange County last year.

In addition to the deaths of an infant, a toddler and a 22-year-old man last month in San Bernardino County, the epidemic's victims already this year include a 15-year-old girl in Los Angeles County, a 7-month-old baby in Orange County and a toddler in Fresno County.

Dr. William Atkinson, a medical epidemiologist with the Centers for Disease Control in Atlanta, said the January upsurge mirrors a pattern seen in other areas of the country that had experienced brief, misleading lulls in their measles outbreaks.

"This same activity is happening in Milwaukee, Dallas and in parts of Florida," Atkinson said. "We also have new outbreaks all of a sudden in Texas. We don't have a ready explanation, but we are drawing nearer to the traditional measles season of late winter and early spring."

Rubeola is a highly infectious viral disease characterized by a rash that covers the body. Symptoms usually last about 10 days, unlike those of rubella, or German measles, which persist about three days.

The California epidemic has mostly targeted preschool-age children, many of them Latino or black and from low-income, inner-city families.

In Fresno County, 400 cases and two deaths--the most recent occurring Jan. 2--have been recorded since February, 1989.

Recently, the disease has taken a particular toll among Fresno County's sizable community of Southeast Asian Hmong refugees, most of whom live in the city of Fresno.

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