Children should receive a second dose of the vaccine against measles, mumps, and rubella upon entering school to supplement the measles vaccine first administered at age 15 months, the federal Centers for Disease Control has recommended.
The recommendation follows a “rather extraordinary” year of measles outbreaks, primarily among preschool-aged children and college students, according to William Atkinson, a medical epidemiologist with the c.d.c.'s division of immunization.
A total of 16,236 cases of measles were reported in 1989, compared with 4,866 during the previous year, ac4cording to the c.d.c. It was the largest number of reported cases since 1978. In addition, 42 people died from measles, the most since 1972.
The c.d.c.'s recommendation had been expected by the medical community. Last summer, the American Academy of Pediatrics also recommended that children receive two doses of the vaccine.
But while states are “highly supportive” of the recommendation on medical grounds, most do not have enough money to provide a second round of measles vaccination to children who receive medical care through public-health clinics, said Valerie White, a legislative associate with the Association of State and Territorial Health Officials.
California, which reported more than 3,000 cases of measles and 17 deaths in 1989, is facing “a catastrophic vaccine funding shortfall,” said Loring Dales, chief of the immunization unit of the California Department of Health Services.
The state, which provides vaccinations for about one-third of the state’s children in public clinics, is $3.6 million short of the $15.5 million needed to administer all of the childhood vaccines in 1990, he said.
A second dose of the measles vaccine is “out of the question,” Dr. Dales said.
“We cannot start on that, because we would run out even sooner and not be able to give many children the first dose,” he said.
Texas, which also reported a large number of measles cases last year, is facing a similar funding shortfall, Dr. Dales added.
The cost of the measles vaccination has skyrocketed since 1988 to about $27 a dose, Dr. Dales noted, primarily because of lawsuits over damage caused by the vaccines.
The increased cost has prompted more Californians to use public-health clinics rather than private physicians for the vaccinations, he said.
Because the measles rate is high among high-school and college-age students, the American Academy of Pediatrics suggested that the second dose of measles vaccination be administered before students enter middle school or junior-high school.
Dr. Atkinson said the c.d.c. recommended that the second dose be given as students enter kindergarten or the 1st grade because states already monitor children enrolling in school to ensure that they have received other childhood vaccines.
Requiring a second measles vaccination at a later time would require setting up new monitoring systems and add to the vaccination’s cost, he noted.
The c.d.c.'s recommendation, published in the Dec. 29, 1989, Morbidity and Mortality Weekly Report, is not binding on the states. However, Dr. Atkinson said he expected “most states” to take some action to require the second dose of the vaccine.
New York State will require a second dose of vaccine beginning next year, he said. In addition, Illinois and Oregon are considering requiring second doses.
The approximately 200 measles outbreaks reported in 1989 struck the approximately 5 percent of the population for whom the measles vaccination was ineffective, Dr. Atkinson noted.
The largest outbreaks were among preschool-aged children in inner-city neighborhoods in Houston, Los Angeles, and Chicago, he said. Smaller outbreaks were reported on college campuses throughout the country. The largest of the college outbreaks were at Kent State University in Ohio and Texas Tech University, he said.
