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Locals weigh in on cause of November Asheville chickenpox outbreak

Brandon Paykamian • Dec 1, 2018 at 5:18 PM

In November, at least three dozen students at the Asheville Waldorf School in North Carolina contracted chickenpox, renewing a local debate about vaccination exemptions after the outbreak made national news. 

Health officials in North Carolina and beyond believe the outbreak was connected to these exemptions. Buncombe County leads the state in religious vaccination exemptions for kindergarteners entering schools at 5.7 percent.

Like other outbreaks connected to the anti-vaccine movement — including a rise in American cases of mumps cited by the Centers for Disease Control and Prevention and measles outbreaks in Indiana that peaked in 2012 — Dr. Reid Blackwelder, an East Tennessee State University professor and chairman of family medicine, said it’s likely part of the problem was the assumption unvaccinated children are safe due to “herd immunity.”

“People often claim they do not need to vaccinate their child because of the principle of ‘herd immunity.’ If most people in a group are immunized, that protects those who are not from infection. This obviously does not work when most of the people in a population are not vaccinated, such as in the school in Asheville,” he pointed out. “In that setting, an infection can spread rapidly and widely, and goes from the school to homes and broader communities where many people are potentially exposed.”

Blackwelder emphasized the importance of getting children vaccinated for chickenpox and stressed the public health dangers that come with not getting the vaccine. 

“In terms of chickenpox, the vaccine is safe and definitely works to prevent infection. While chickenpox is usually self-limited, it can be deadly. Three to four children out of 1,000 are hospitalized each year,” he said. “However, it is especially deadly to those people who have compromised immune systems, such as people with HIV or are on chemotherapy, as well as to pregnant woman and very young infants.

“Another benefit of the chickenpox vaccine is that it has definitely been shown to decrease the rate of shingles, as well as the debilitating complication of post-herpetic neuralgia — nerve pain that frequently complicates recovery from shingles.”

Tennessee Department of Health Regional Director David Kirschke weighed in on why he thinks the anti-vaccine movement has taken a hold in recent years, and why it has become a western phenomenon. According to Kirschke, many in the U.S. and the west simply haven’t witnessed the effects of many dangerous diseases like polio, measles, and other diseases more prevalent in the early 20th century and previously.

“Vaccines have become a victim of their success. They’ve worked so long that some people forget about how dangerous these diseases can be, especially in children. They’ve become complacent,” he said, adding that he believes the public needs to be more educated on the seriousness of diseases like measles, a highly contagious respiratory infection.

But the anti-vaccination movement isn’t always driven by religious exemptions; it is also part of a widespread misconception that there is a strong correlation between vaccines and autism. 

Courtney Johnson, the founder of the ETSU Neurodiversity Club, said much of this hysteria is driven by problematic anti-autism attitudes. She said there seems to be an attitude among some that the risk of contracting deadly diseases is a preferable choice compared to having an autistic child.

“The movement preys upon families looking for any possible cause or way to ‘cure’ the autism because they feel overwhelmed with the negative rhetoric and trying to cope in a world that sees autistic people as broken and burdens. To these people who take advantage, we’re byproducts of an environmental toxin, a heavy burden, a broken excuse of a human being. We’re an epidemic and a problem child,” she said. “It all stems from this culture of anger and negativity toward autism — which eventually ends up being aimed at us autistic people.

“I lost my autistic baby brother this past September, and I can assure people from firsthand experience that the death of a child is so much worse and painful than autism.”

However, Blackwelder said some initial concerns about vaccines are rational, pointing to past problems with other vaccines that had to be corrected after further studies. But when weighing the risks and benefits of vaccines, Blackwelder said the choice is clear.

“Almost anything that has a potential benefit also has potential consequences. For example, the oral polio vaccine used decades ago was indeed a source of polio, especially in immuno-compromised people in the U.S. After studies showed that relationship, the vaccine was changed to prevent such spread. The same thing happened with pertussis,” he said. “One known complication was minimized when the vaccine was changed, again, based on good science. The appropriate concerns about preservatives led to the removal of things like mercury from vaccines, even though the amount of such substances was less than found in some foods.

“From a public health perspective, the key is to ensure that the benefits outweigh the risks for any kind of treatment or process. Relying on good science helps direct good choices and in developing safe and sensible processes like vaccination programs,” he continued. “Chickenpox can be deadly, especially to our friends and family whose immune systems don't work.

“The bottom line is that vaccinations are safe for the vast majority of children.”

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