1989 — Measles (resurgence), CDC reports 17,850 cases in 47 States and DC –45-62

— ~62  Hinman, et al. “Acute Measles Mortality in the United States, 1987-2002.” JID, V189.[1]

—   49  NIP[2] surveillance (1987-2002), in Hinman.[3]

—   47  Blanchard tally of State breakouts below.

—   45  Los Angeles Times. “Measles Outbreak Plagues 23 States; Funds Run Short.” 4-14-1990.

—   45  McClatchy. “Measles is a leading killer of children…” Orange County Register, 4-1-1990.

—   42  Big Spring Herald, TX. “Crossroads counties miss measles epidemic.” 12-31-1989, 1-2.[4]

—   41  CDC. “Current Trends Measles – United States, 1989 and First 20 Weeks 1990.” MMWR.

—   40  NCHS[5] multiple-cause mortality database (1987-1999), in Hinman.[6]

 

California                  (22)

— 22  LA and San Bernardino Counties.[7]

–17  Los Angeles Co. AP. “Measles reaches epidemic….” Ukiah Daily Journal, 4-1-1990, A10.

—  5  San Bernardino Co. AP. “Measles reaches epidemic…” Ukiah Daily Journal, 4-1-1990, A10

— 20  Jacobs. “Immunizations save kids’ lives.” Chronicle-Telegram, Elyria, 10-14-1990, A-5.[8]

— 17  CDC. “Current Trends Measles – United States, 1989 and First 20 Weeks 1990.” MMWR.

 

District of Columbia (  1)

 

Illinois                        (12)

–12  Daily Herald (Dave Urbanek). “Chicago staves off measles epidemic.” 3-26-1991, p. 4.[9]

–11  CDC. “Current Trends Measles – United States, 1989 and First 20 Weeks 1990.” MMWR.

–10  Chicago and Cook County

—  8  Chicago area; seven had not been vaccinated.[10]

—  2  Cook County. The Star, Orland Park, IL. “Fewer measles cases…” 12-6-1990, p. 6.

 

Missouri                     (  1)

— 1  CDC. “Current Trends Measles – United States, 1989 and First 20 Weeks 1990.” MMWR.

 

Texas                          (10)

–10  CDC. “Current Trends Measles – United States, 1989 and First 20 Weeks 1990.” MMWR.

–10  Houston area, Oct 1988-Dec 1989. Big Spring Herald, TX. “Crossroads…” 12-31-1989, 1.

—  6  Bentsen. “U.S. must improve child health care.” Kerrville Daily Times TX. 1-18-1990, 5A.[11]

 

Wisconsin                  (  1)

— 1  CDC. “Current Trends Measles – United States, 1989 and First 20 Weeks 1990.” MMWR.

 

Narrative Information

 

CDC: “As of May 11, 1990, local and state health departments reported a provisional total of 17,850 measles cases for 1989 — a 423% increase over the 3411 cases reported for 1988 (Figure 1). Forty-one measles-associated deaths have been reported for 1989. Forty-seven states and the District of Columbia reported cases, compared with 36 states that reported cases during 1988. The overall incidence rate in 1989 was 7.3 cases per 100,000 population–more than five times the rate of 1.4 per 100,000 for 1988.

 

“Twenty-three states reported at least 100 cases each. Four states reported greater than 2500 cases each, accounting for 12,127 (67.9%) of the total reported cases: Illinois (3232), Texas (3201), California (3053), and Ohio (2641). Incidence rates of greater than 10.0 per 100,000 population occurred in Illinois (27.8), Ohio (24.3), Texas (19.0), Wisconsin (16.7), Missouri (13.1), and California (10.8).

 

“A total of 16,734 (93.7%) cases met the clinical case definition for measles,** and 4420 (24.8%) were serologically confirmed. Importations from other countries accounted for 321 (1.8%) cases; an additional 222 (1.2%) cases were epidemiologically linked to imported cases.

 

“Children less than 5 years of age accounted for 36.7% of measles cases, compared with 28.7% of cases in 1988… The estimated incidence rates for all age groups were higher in 1989 than in 1988. The largest increases in incidence rates were among adults aged 25-29 years (+600%) and children aged less than 1 year (+592%) and 1-4 years (+562%). The highest incidence rate was among children less than 1 year of age (51.9 per 100,000).

 

“A total of 248 outbreaks, each involving from five to 2440 persons, accounted for 79.4% of the cases. Outbreaks were classified based on the age group with the most cases. Fifty-six outbreaks involved predominantly preschool-aged (less than 5 years of age) children, 170 involved predominantly school-aged (5-19 years) persons, and 22 involved predominantly post-school-aged (greater than or equal to 20 years) persons. Outbreaks involving predominantly preschool-aged children accounted for 8007 (44.9%) cases; outbreaks involving predominantly school-aged persons, 5662 (31.7%); and outbreaks involving predominantly post-school-aged persons, 508 (2.8%).

 

“Twenty-five outbreaks involved greater than or equal to 100 cases each and accounted for 60% of the cases reported for 1989; nine were outbreaks involving predominantly preschool-aged children and ranged from 105 to 2440 cases. The largest outbreaks involving predominantly preschool-aged children occurred in Los Angeles (2440 cases), Chicago (2178 cases), and Houston (1434 cases) and accounted for 33.9% of all cases reported for 1989. Sixteen outbreaks involving predominantly school-aged children, ranging from 100 to 437 cases, accounted for 3277 (18.4%) cases….

 

“A provisional total of 41 measles-associated deaths were reported, for a case-fatality rate of 2.3 deaths per 1000 reported cases. Deaths were reported from five states (California (17), Illinois (11), Texas (10), and Missouri and Wisconsin (one each)) and the District of Columbia (one), and occurred primarily in outbreaks among preschool-aged children. Twenty-nine (70.7%) deaths occurred among children less than 5 years of age, including nine (22.0%) less than 12 months of age; two deaths were in 11-year-olds. Twenty-nine (93.5%) of these 31 children were unvaccinated. Two children, one of whom had been vaccinated, had serious underlying disease (one case each of leukemia and congenital neurologic defects). The remaining 10 deaths occurred in adults aged 19-33 years. Nine of these patients were unvaccinated. Three had underlying medical conditions (one each with leukemia, scleroderma (not on steroids), and diabetes mellitus). Most deaths were attributed to pneumonia.

 

“Vaccination Status. Of reported patients, 7149 (40.1%) were known to have been vaccinated on or after their first birthday (Table 2). Approximately 79% of appropriately vaccinated persons with measles were 5-19 years of age. The remaining 10,654 (59.7%) persons with measles were unvaccinated or inadequately vaccinated (i.e., vaccinated before their first birthday). Of these persons, routine vaccination was indicated for 6073 (57.0% (34.0% of total)). Almost 40% of these vaccine-eligible persons were children 16 months to 4 years of age. Measles occurred in 3699 (20.7%) persons for whom routine vaccination was not indicated; 3203 (17.9% of total) children were less than 16 months of age. Eight hundred eighty-two (4.9%) were unvaccinated for other reasons….

 

“Editorial Note: The provisional total of 17,850 measles cases reported in 1989 is the largest number reported since 1978. This marked increase in disease incidence has continued through early 1990….

 

“In addition to the increased incidence of measles in all age groups during 1989-1990, the age distribution of cases has changed from that observed in previous years. From 1988 to 1989 the proportion of patients less than 5 years of age increased from 28.6% to 36.7%. For the first 20 weeks of 1990, 42.3% of patients were in this age group. In comparison, a median of 28.5% of patients reported during 1980-1988 were in this age group. Conversely, the proportion of school-aged persons with measles decreased. During 1980-1988, a median of 53.3% of reported cases were in persons 5-19 years of age, compared with 46.4% in 1989; more than half of the patients in this age group were 15-19 years old. In the prevaccine era, greater than 50% of reported measles patients were 5-9 years old; in 1989-1990, this age group represented approximately 10% of total measles cases.

 

“As in 1988, primarily two types of outbreaks occurred in 1989: those among unvaccinated preschool-aged children and those among highly vaccinated ( greater than 90%) school- and college-aged populations. During 1985-1988, most cases were reported from outbreaks involving predominantly school-aged children; a median of 47 outbreaks involving predominantly school-aged children occurred annually, accounting for a median of 51% of all reported measles cases. Also during this period, a median of eight outbreaks involving predominantly preschool-aged children occurred annually, accounting for a median of 20% of reported cases (3). Although the number and size of both types of outbreaks increased in 1989, the relative impact of these outbreaks changed. In 1989, 45% of all cases were reported from outbreaks involving predominantly preschool-aged children, while only 32% occurred in outbreaks involving predominantly school-aged children.

 

“The 41 deaths in 1989 are the largest number reported in one year since 1971, when 90 deaths and 75,290 measles cases were reported. Measles-associated deaths were primarily occurring among unvaccinated preschool-aged children and adults–groups known to be at increased risk for both complications of measles and death. Reasons for the apparent increase in the case-fatality rate are unclear but may include the higher proportion of cases occurring among younger age groups; underreporting of less severe cases, particularly in the large outbreaks involving predominantly preschool-aged children; and potential undiagnosed underlying disease in these persons.

 

“The increase in unvaccinated persons with measles reported for 1989 primarily reflected the increasing number of cases reported among unvaccinated inner-city preschool-aged children; to a lesser extent, this trend reflected an increase in cases among children younger than the recommended age for vaccination and among persons with religious or philosophic exemptions to vaccination (5,6). Prevention of outbreaks among preschool-aged children will require intensive efforts to increase age-appropriate vaccination levels in inner-city preschool-aged children and to decrease the age of vaccination to 12 months in some high-risk areas.

 

“In addition to the increase in cases among unvaccinated persons, a large number of cases were reported among persons who were appropriately vaccinated. Approximately 2%-5% of persons who receive a single dose of measles vaccine at greater than or equal to 15 months of age will not develop protective immunity (i.e., vaccine failure). If measles virus circulates at relatively low levels, as occurred from 1981 through 1988, then the risk of measles among persons who fail to respond to a single dose of vaccine will be small and these persons will accumulate in the population. Consequently, when measles virus is introduced into environments where large numbers of vaccinated persons congregate (e.g., schools or colleges), the relatively few susceptible persons may be sufficient to sustain transmission and outbreaks may occur. In order to reduce this pool of susceptible persons resulting from vaccine failure, the Immunization Practices Advisory Committee (ACIP) has recommended a second dose of vaccine for groups of persons at high risk for measles, including new entrants to schools and colleges and other institutions for post-high school education (7). If fully implemented, this strategy should eventually eliminate measles outbreaks in these settings. In the meantime, aggressive outbreak control in school-based outbreaks with revaccination of persons at risk will continue to be necessary.” (CDC. “Current Trends Measles – [US]…” MMWR, 39/21, 6-1-1990.)

 

April 14, 1990, LA Times: “The measles outbreak now plaguing California is part of a larger, two-year epidemic that health officials say is sweeping the nation, causing thousands of cases of illness and scores of deaths. From Maine to Texas, Alaska to Florida, there have been serious measles outbreaks in at least 23 states this year, and the number of reported cases is running about 70% ahead of last year at this time, health officials said. For 1989, the Centers for Disease Control in Atlanta reported 17,800 measles cases and 45 deaths….”

 

Texas

 

Bentsen: “According to the Texas Department of Health, last year in one Texas city six children died from the measles, a preventable disease. That’s startling when you consider that it had been 17 years since measles claimed more than five years in Texas, and eight years since any children in our state had died from the disease.”

 

Big Spring Herald: “….There have been 3,119 confirmed cases of red measles this year in about 95 counties of Texas, Hodgson said.[12] The Houston area accounts for about half of those cases, he said, although Dallas has had the most recent outbreak, with about 250 cases. Since October 1988, when the outbreak began in the Houston area, 10 of the measles cases have been fatal. None of the fatalities occurred in West Texas….

 

“The number of red measles cases reported in Texas this year was the most in the state since 1971, when there were 9,585 cases. There were 286 red measles cases in Texas last year.

 

“Nationwide, there have been 42 deaths among 14,714 reported measles cases this year, according to the Associated Press. Measles has claimed more lives in 1989 – mainly among unvaccinated preschoolers and school children whose shots didn’t work – than in any year since 1971, federal health officials say.” (Big Spring Herald (John McMillan), TX. “Crossroads counties miss measles epidemic.” 12-31-1989, pp. 1-2.)

 

Sources

 

ABC 7, Chicago, Eyewitness News (Ben Bradley). “Measles Outbreak: 1989/1990 Outbreak, Today Compared.” 2-9-2015. Accessed 5-5-2016 at: http://abc7chicago.com/health/measles-outbreak-1989-1990-outbreak-today-compared/510538/

 

Associated Press, Yakima, WA. “5 more measles cases reported in Yakima County.” Walla Walla Union-Bulletin, 4-1-1990, 5. Accessed 5-4-2016 at: http://newspaperarchive.com/us/washington/walla-walla/walla-walla-union-bulletin/1990/04-01/page-5?tag

 

Associated Press, Los Angeles. “Measles reaches epidemic level.” Ukiah Daily Journal, 4-1-1990, A10. Accessed 5-4-2016 at: http://newspaperarchive.com/us/california/ukiah/ukiah-daily-journal/1990/04-01/page-10?tag

 

Bentsen, Lloyd (US Senator from Texas). “U.S. must improve child health care.” Kerrville Daily Times, TX. 1-18-1990, 5A. Accessed 5-5-2016 at: http://newspaperarchive.com/us/texas/kerrville/kerrville-daily-times/1990/02-18/page-5?tag

 

Big Spring Herald (John McMillan), TX. “Crossroads counties miss measles epidemic.” 12-31-1989, pp. 1-2. Accessed 6-16-2016 at: http://newspaperarchive.com/us/Texas/Big-Spring/big-spring-herald/1989/12-31?tag

 

Centers for Disease Control and Prevention. “Current Trends Measles – United States, 1989 and First 20 Weeks 1990.” MMWR (Morbidity and Mortality Weekly Report), Vol. 39, No. 21, 6-1-1990, pp. 353-355, 361-363. Accessed 6-16-2016 at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00001632.htm

 

Daily Herald (Dave Urbanek), Arlington Heights, IL. “Chicago staves off measles epidemic.” 3-26-1991, p. 4. Accessed 5-6-2016 at: http://newspaperarchive.com/us/illinois/arlington-heights/daily-herald-suburban-chicago/1991/03-26/page-112?tag

 

Hinman, Alan R., et al. “Acute Measles Mortality in the United States, 1987-2002.” Journal of Infectious Diseases, Vol. 189 (Supplement 1), 2004, pp. S69-S77. Accessed 5-2-2016 at: http://jid.oxfordjournals.org/content/189/Supplement_1/S69.long

 

Jacobs, Joanne. “Immunizations save kids’ lives.” Chronicle-Telegram, Elyria, OH, 10-14-1990, p. A-5. Accessed 5-4-2016 at: http://newspaperarchive.com/us/ohio/elyria/elyria-chronicle-telegram/1990/10-14/page-45?tag

 

Los Angeles Times (Ron Harris) “Measles Outbreak Plagues 23 States; Funds Run Short.” 4-14-1990. Accessed 5-5-2016 at: http://articles.latimes.com/1990-04-14/news/mn-967_1_nation-s-measles-outbreak

 

McClatchy News Service/David Schrleberg. “Measles is a leading killer of children in Latin America.” Orange County Register, Santa Ana, CA. 4-1-1990, A24. Accessed 5-4-2016 at: http://newspaperarchive.com/us/california/santa-ana/santa-ana-orange-county-register/1990/04-01/page-24?tag

 

The Star, Orland Park, IL. “Fewer measles cases spotted, but officials still concerned.” 12-6-1990, p. 6. Accessed 5-3-2016 at: http://newspaperarchive.com/us/illinois/orland-park/orland-park-star/1990/12-06/page-6?tag

 

 

 

 

 

[1] From Table “Acute Measles Mortality in the United States, 1987-2002.” The horizontal bar representing mortality requires interpretation in that the measurement is in the tens. Thus the bar is somewhat above 60. Could be 63. Whether 62 or 63 this bar represents the Hinman, et al. “Capture-recapture estimate” explained in the article.

[2] National Immunization Program, U.S. Centers for Disease Control and Prevention.

[3] From Table “Acute Measles Mortality in the United States, 1987-2002.”

[4] “Nationwide, there have been 42 deaths among 14,714 reported measles cases this year, according to the Associated Press.”

[5] National Center for Health Statistics, U.S. Centers for Disease Control and Prevention.

[6] From Table “Acute Measles Mortality in the United States, 1987-2002.”

[7] Associated Press, Los Angeles. “Measles reaches epidemic level.” Ukiah Daily Journal, 4-1-1990, A10.

[8] Notes there were no deaths from measles in California from 1982 to 1987, and then 2 in 1988.

[9] “Although the number of reported measles cases is on the rise in several cities across the country, the Chicago area so far is not heading for a repeat of the 1989 measles epidemic that claimed 12 lives, state officials said Monday.”

[10] ABC 7, Chicago, Eyewitness News (Ben Bradley). “Measles Outbreak: 1989/1990 Outbreak, Today Compared.” 2-9-2015.

[11] Bentsen noted this was for one city.

[12] Wes Hodgson, Texas Department of Health epidemiology coordinator for the health immunization division.