A statewide outbreak of measles that has been traced to a wrestler at Oakland Mills High School has prompted screenings and re-inoculations at area middle and high schools.
Approximately 110 cases, including 20 in Howard County, have been reported in the state since the initial outbreak began and are all linked to the athlete, said officials at the Maryland Department of Health. Statewide cases reported in seven of the 11 years since 1981 were well under 20 per year.
Two weeks after the senior developed symptoms in late February, students at 12 schools in five counties came down with measles.
TheDepartment of Health said many students were initially exposed to the virus at two wrestling matches, the latter a statewide tournament.
They are also "fairly certain" that the wrestler's exposure is traceable to the measles outbreak last December in Philadelphia that resulted in 10 deaths, said R. Barry Trostel, chief of the state's immunization division.
Health officials are trying to control the spread by setting up on-site clinics at any school where a case is reported and at any school associated with it to reinoculate the entire student body.
Even with efforts to enforce inoculation of all preschoolers and reinoculate 12-year-olds, it will probably be another three to four years before the state will be protected against another outbreak, said Edward Hirshorn, assistant chief of the state immunizationdivision.
"So, potentially, we can have this again next year," hesaid.
Besides Oakland Mills, cases were reported at three other area schools in March but only two were confirmed, one at Hammond HighSchool and one at Clemens Crossing Elementary School.
Although nonew outbreaks have been reported in Howard County, county health officials said outbreaks continue throughout the state.
As part of a stepped-up re-immunization campaign aimed at 12-year-olds that began just prior to the outbreak, the federal government provided the statehealth department with 50,000 doses of the measles-mumps-rubeola vaccines for all 24 school systems, with 1,500 allotted to Howard County.
Since the outbreak, an additional 20,000 doses were rushed to the state.
Trostel explained that children should be inoculated withthe vaccination at 15 months of age. But prior to 1976, children were being inoculated as early as 9 and 12 months, which proved to be ineffective.
For that reason, many teen-agers are particularly susceptible to the virus. The American Academy of Pediatrics recommended that all 12-year-olds be reinoculated, although "technically," said Trostel, all children inoculated before 1976 should receive a second vaccination.
"We'd prefer to save it for those who cannot pay, but we'll re-immunize anyone," said Dr. Cynthia Lipsitz, director of the Howard County Bureau of Personal Health, Department of Health.
The county health department responded to the Oakland Mills outbreak by sending home letters forbidding children to attend school if they werenot reinoculated or do not obtain signed parental consent permittingthe health department to reinoculate them at school.
But 113 of the 1,100 students did not bring home the letters and as a result, were sent home.
"The next day we found only 76 either had to be re-vaccinated, have their blood tested or, for medical or religious reasons, were exempted from the inoculations and had to stay home for two weeks until after the onset of the rash in the last case," Lipsitz said.
Students whose blood tests positive for measles antibodies are not required to be reinoculated. Eighteen students remained out of school until the exclusion was lifted on March 26.
"Ideally, even ifthere is one case in a school, we require re-immunization," Lipsitz said.
But with all the spread cases and limited resources, health officials could only recommend it for Hammond and Clemens Crossing.
"We looked at each situation separately and assessed the risk," sheadded.
Sue Ann Tabler, principal of Oakland Mills High School, was at a meeting during the outbreak and returned when the clinic was closing down. "Our only concerns now are the incoming ninth-graders. People didn't suspect the inoculations wouldn't hold."
The cost of an inoculation by a personal physician is about $45, said Lipsitz. "We don't have infinite resources, but if a doctor recommends immunization and the individual can't pay for it, we'll fill in the gaps."
WHAT EXACTLY IS MEASLES?
Measles is caused by a virus. It is very infectious and is spread person-to-person through breathing. In fact, even in an area as large as a gymnasium, a person with measles could infect someone at the opposite end of the room, say health officials.
Measles is characterized by cold-like symptoms that may last 3-4 days and include fever, cough, runny nose and watery eyes.
Usually, not always, a rash then develops -- first on the face, then on the chest and back. By the third day, it spreads to the arms and legs. Measles usually lasts about a week or more.
Measles can cause serious complications on occasion and it can be a life-threatening illness. Sufferers may experience middle-ear complications, hearing loss or encephalitis.
Since 1976, the recommended age for inoculation is 15 months. Those who were inoculated before that age may not be immune and should be reinoculated.
SOURCE: The Maryland Department of Health and Mental Hygiene