In addition to a continuing measles outbreak, another whooping cough outbreak has hit the Amish community in Cattaraugus County, where at least 42 people have contracted the disease in the last four weeks.
About 2,000 Amish live in the county, mainly in the towns of Conewango and Leon.
They last experienced a whooping cough outbreak in 1988 that lasted from September to December, striking 74 children and killing a 3 1/2 -year-old boy. And two months ago, the community experienced a measles outbreak that has hit 138 people and continues to spread.
"We have a large group of unimmunized people who are sitting ducks for outbreaks of disease," said Dr. James Garvey, the county's health commissioner. "Many of the susceptible children will get sick. Then it will be quiet again for a number of years until we reach that critical mass where another large group of unimmunized children develops."
The last measles outbreak was in 1974, when an 8-year-old boy died and an estimated 100 people came down with the disease.
As a result, Garvey said, the Amish community has about 900 people at greatest risk of contracting measles. This figure is based on the approximately 60 births a year since the last outbreak and includes unvaccinated children without immunity to the disease.
Health officials expect the outbreaks to continue because of the large number of unvaccinated children in the community and a limited number of ways to stop people from transmitting the virus to one another.
Many of the Amish in the Conewango Valley -- one of the most conservative and non-conformist Amish communities in the United States and the largest in New York -- have refused to use the vaccine that prevents the disease. Their decision is consistent with their choice to resist telephones, electricity and automobiles.
"There's been some use of the vaccine, but not a lot," Garvey said. "There's also resistance to the idea of scheduling one large clinic for this problem. We end up having to go door to door, which strains our staff."
The measles outbreak has put four people into the hospital and has spread outside the Amish community into the general population. Garvey said health authorities two weeks ago revaccinated 900 non-Amish students and staff at schools in the Village of Cattaraugus, where one student and three preschoolers have contracted the disease.
There have been no official reports of whooping cough in areas outside the Amish community. Another outbreak of whooping cough struck 216 Amish children in 1982 in the same rural community.
Whooping cough, or pertussis, affects mainly infants. An outburst of coughing, often ending in a characteristic "whoop" as breath is drawn in, is the main symptom of the illness, which may last for weeks and can have serious complications.
Garvey said the measles outbreak was not unusual considering the nationwide experience with the disease in the last year. More measles cases were reported in the United States in 1989 than in any year since 1978.
The National Centers for Disease Control reported 14,714 cases of measles by the end of December. It is the highest total since 26,871 cases in 1978. There were 2,726 cases in 1988, and as few as 1,497 cases in 1983.
The nationwide measles outbreaks in 1989 involved previously vaccinated school-age children and college students, as well as unvaccinated preschoolers in predominantly black and Hispanic inner-city neighborhoods, according to the Centers for Disease Control.
"This is the classic time of year for disease outbreaks," Garvey said. "We're just going to have to wait them out. They should fade away as better weather approaches."
Measles is a contagious viral illness that causes a characteristic rash and a fever. It primarily strikes children but may occur among adults. The most common complications are ear and chest infections. The disease also can cause rare but serious complications. One attack of measles usually confers lifelong immunity.
To reduce measles cases related to vaccine failure, physicians' groups recently have recommended a routine two-dose -- instead of one dose -- measles vaccine schedule.