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Flu deaths continue upward climb
Measles on the rise in state
flu update pic
High immunization rates in California have kept preventable childhood diseases, such as measles, at record lows during the past 20 years. However, there have been 15 confirmed cases of the virus so far this year, while only two cases were reported for the same time frame last year. - photo by Photo Contributed

State health officials have announced another increase in influenza-related deaths, but reported the rate of hospitalizations is at or below normal for this time of year, suggesting the peak may have passed.

While the flu season continues to claim more lives, state officials have a new public health worry as California sees a resurgence of measles.

The number of influenza-related deaths in the state rose to 302, with 24 added in the last week, the California Department of Public Health reported. Six of the 302 are pediatric deaths. There are an additional 19 deaths under investigation, and not yet confirmed.

The 302 confirmed influenza-associated deaths this season have been reported by the following jurisdictions: Alameda (6), Butte (1), Calaveras (2), Contra Costa (6), El Dorado (2), Fresno (21), Glenn (1), Humboldt (1), Imperial (1), Kern (10), Kings (6), Lake (1), Lassen (1), Long Beach (7), Los Angeles (44), Madera (2), Marin (2), Mendocino (4), Merced (5), Monterey (5), Nevada (1), Orange (13), Riverside (13), Sacramento (25), San Bernardino (23), San Diego (25), San Francisco (3), San Joaquin (7), San Luis Obispo (1), San Mateo (6), Santa Barbara (3), Santa Clara (15), Santa Cruz (3), Shasta (3), Siskiyou (2), Solano (3), Sonoma (7), Stanislaus (13), Sutter (1), Tulare (3), Tuolumne (1), and  Ventura (3).

By this time last year, CDPH had received reports of a total of 34 influenza fatalities in persons under 65 years of age and in all of the 2012-13 season, a total of 106 deaths were reported.

“The influenza season continues and it’s not too late for vaccination, which is still the best way to prevent illness and the spread of illness,” said Dr. Ron Chapman, director of the CDPH and state health officer.

The high number of deaths occurring this flu season is attributable to the resurgence of the H1N1 strain, also known as swine flu. The 2009 H1N1 pandemic saw millions of people sickened by the virus worldwide and caused an estimated 150,000 deaths. The H1N1 virus tends to cause more illnesses in children and young adults that it does in older individuals, though all age groups are susceptible.

The great majority of reported influenza deaths in persons under 65 years of age have occurred in people with underlying medical conditions. Outpatient visits continued to decrease and both outpatient visits and hospitalizations are within expected baseline levels for this time of year. The influenza season status was decreased to regional, the CDPH reported.

Those at highest risk — the elderly, pregnant women, infants, or those with other health conditions — who show flu symptoms should contact their physician immediately in order to get the most effective treatment. Symptoms include fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and fatigue.

Influenza vaccine remains available and there is no widespread shortage of anti-virals for treatment. CDPH continues to closely monitor influenza activity statewide and related resources.

The CDPH is also monitoring an increased level of measles in the state. There have been 15 confirmed cases of the virus so far this year, while only two cases were reported for the same time frame last year.

“We are off to a very bad start,” said state epidemiologist Dr. Gil Chavez.

Measles is a highly contagious viral disease that is spread through the air when someone who is ill with the disease coughs or sneezes. Symptoms begin with a fever that lasts for a couple of days, followed by a cough, runny nose, red, watery eyes, and rash. The rash typically appears first on the face, along the hairline, and behind the ears and then affects the rest of the body. Infected people are usually contagious for about eight days: four days before their rash starts and four days after. Complications can include diarrhea, ear infections, and pneumonia and death can occur from severe complications. Infants, pregnant women and immuno-compromised persons are more susceptible to complications from measles. 

“We want to do everything we can to prevent measles cases and we must do everything possible to limit the disease from spreading,” said Chapman. 

The 15 confirmed cases were reported in six counties: Alameda (1), Contra Costa (2), Los Angeles (5), Orange County (3), Riverside (3), and San Mateo (1). For every one person confirmed with the measles virus, health officials must tracks dozens more to verify possible exposure. One of the cases reported in Contra Costa is a UC Berkeley student who contracted the virus while on a trip to the Philippines. While still in the contagious period, the student traveled on the Bay Area Rapid Transit system, possibly exposing hundreds to the virus. The Contra Costa County health department confirmed on Friday that two relatives of the student have now come down with measles. Those two new cases are not part of the state’s official confirmed cases count.

High immunization rates in California have kept preventable childhood diseases, such as measles, at record lows during the past 20 years. Since 2000, when measles was declared eliminated in the United States, the number of cases per year in California has ranged from 4-40 cases. In that time, almost all measles cases in the United States have been linked to travel to areas of the world where measles still circulates. Among the California cases with onset in 2014, three had traveled to the Philippines, where a large outbreak is occurring, and two had traveled to India, where measles is endemic. Two other cases were people linked to individuals who had recently traveled out of the country.

The age range for those 15 confirmed cases went from 5 months to 44 years old.

Of the 15 confirmed cases, 13 were either not vaccinated or were unsure of their vaccination status. Seven of them had parents who chose not to vaccinate them as part of California’s personal belief exemption law, Chavez said.

Children are recommended to get their first dose of MMR (measles, mumps, rubella) vaccine at 12 to 15 months. The second dose of MMR is usually administered before children start kindergarten at 4 to 6 years. Immunized adults do not need boosters. However, anyone born since 1957 who has not had two doses of vaccine may still be vulnerable to measles and should ask their doctor about getting immunized.

“Immunization is the best defense against measles, with 99 percent of persons developing immunity after two doses,” Chapman said. “With an outbreak in the Philippines and measles transmission ongoing in many parts of the world outside of North and South America, we can expect to see more imported cases of this vaccine-preventable disease.”

Imported cases can spread to the community, especially among unvaccinated persons, including infants too young to be vaccinated, Chapman said. Unvaccinated Californians who are traveling outside of North or South America should receive MMR vaccine before they go. Infants who are traveling can be vaccinated as young as six months of age, though they should also have the two standard doses of MMR vaccine after their first birthday.