Asheville chickenpox outbreak revives debate about religious exemptions to vaccines

At least three dozen students at an Asheville private school have come down with the chickenpox in what state health officials are calling the worst outbreak of the disease since a vaccine was introduced in 1995.

The outbreak at Asheville Waldorf School has reignited controversy about the North Carolina law that allows parents to exempt their children from receiving mandatory vaccines based on their religious beliefs. Students may also be exempted for medical reasons.

To claim the religious exemption, a parent may write a statement “of the bona fide religious beliefs and opposition to the immunization requirements” and give it to their child’s school in place of an immunization record.

In 2015, lawmakers proposed a bill that would have all but eliminated that provision. Protesters picketed the General Assembly, calling the bill draconian and “medical terrorism,” The Charlotte Observer reported. Lawmakers promptly withdrew the bill.

Use of the religious exemption continued to climb. Between the 2012-13 and 2016-17 school years, the number of kindergarteners excused from immunizations for faith reasons more than doubled, The News & Observer has reported.

The most recent data from the North Carolina Department of Health and Human Services show that about 1.2 percent of the kids who entered kindergarten in North Carolina last year had parents who claimed a religious exemption, up slightly from 1.1 percent the year before.

Children who don’t get vaccinated are not evenly distributed across the state. One especially notable cluster of unvaccinated children go to the Asheville Waldorf School, the site of the chickenpox outbreak. At the start of the last school year, 68 percent of kindergarteners were excused from getting required shots on religious grounds.

That’s an exemption rate far above any other school with 20 or more kindergarteners. The next highest rate was at ArtSpace Charter School in Swannanoa, about 10 miles away. There, 31 percent of kindergarteners got a religious exemption.

Faith-based exemptions are particularly widespread in Buncombe County, where Asheville is located. State data show that 5.7 percent of the county’s 2,542 kindergarteners in the county had parents who excused their children on religious grounds.

That’s the highest rate of any North Carolina county, but other western counties had elevated rates. In both Transylvania (total kindergarten population 278) and Watauga (total kindergarten population 361) counties, 4.7 percent of kindergarteners had a religious exemption.

In North Carolina’s two most populated counties, the rates are lower: 1.2 percent in Wake, of 13,572 kindergarteners; and 1.9 percent of Mecklenburg’s 13,095 kindergarteners.

Health officials emphasize that vaccinations protect more than just the individual children who get the shots.

“Immunization is something we do that is good for society,” Dr. David Weber, professor of medicine and pediatrics as well as epidemiology at UNC, told The News & Observer last year. “There is a small risk to it, because nothing in life is completely risk-free. But we do it because it benefits all of us.”

If enough people have been vaccinated, an isolated case will not turn into an full-scale outbreak. That’s the concept of “herd immunity”: Even people who aren’t vaccinated are more protected because they aren’t exposed to the disease. The vaccination rate needed to achieve that protection varies by illness, but is generally between 80 and 90 percent.

Contrary to scientific evidence, some parents have come to believe that vaccines cause more serious health issues than they’re meant to cure. The source of much of their skepticism is a 1998 study that purported to show a link between vaccines and autism. The results had been falsified, the study was retracted and scores of studies since have shown no such link. But the conspiracy theory lives on with the help of advocacy groups and supportive statements by President Trump, The Washington Post has reported.

Some parents also believe that chickenpox is not as scary a threat as measles, for example. A hefty share of Facebook comments on the Asheville Citizen-Times article in which the recent outbreak was first reported reflect this attitude. Several commenters remembered when parents had “chickenpox parties” to intentionally expose their kids to the disease, which once affected 90 percent of Americans.

The Centers for Disease Control and Prevention warn that chickenpox is serious, “even life-threatening, especially for babies, adolescents, adults, pregnant women and people with weakened immune systems.” A person can spread the disease for up to two days before the blister-like, itchy rash appears, usually on the stomach, back and face.

The CDC says the vaccine is about 90 percent effective, preventing some millions of cases of the chickenpox, thousands of hospitalizations and more than 100 deaths each year. But the vaccine hasn’t eliminated the varicella zoster virus, which causes chickenpox.

North Carolina first required kindergarteners to receive the varicella vaccine in 2001. A second dose was required in 2015, and the state has carefully tracked all outbreaks since.

In 2016, five outbreaks affected 20 people, including a 7-month-old baby. In 2017, an outbreak at a private school affected nine children between the ages of 7 and 10, data provided by the North Carolina Department of Health and Human Services show.

In response to the Asheville chickenpox outbreak, Dr. Jennifer Mullendore, the Buncombe County medical director, issued an unequivocal statement: “We want to be clear: vaccination is the best protection from chickenpox,” she said.

“When we see high numbers of unimmunized children and adults, we know that an illness like chickenpox can spread easily throughout the community — into our playgrounds, grocery stores, and sports teams.”

The school also issued a statement:

“At the Asheville Waldorf School our students’ overall health is always a priority and concern. Like all public and private schools in NC, our school strictly follows immunization requirements put in place by the North Carolina State Board of Education. As an associate member of the Association of Waldorf Schools of North American and like all other Waldorf Schools, we are compliant with national, state and local laws. We also recognize that a parent’s decision to immunize their children happens before they enter school. At Asheville Waldorf School we support our families, we love our students, we love our city and we are grateful that our community is strong during challenging times.”

Parents of children at the school have challenged a county quarantine order, the Asheville Citizen-Times reported.

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Carli Brosseau is a reporter at The News & Observer who often analyzes databases as part of her work. She attended the University of North Carolina at Chapel Hill.