Know What I’m Thankful for This Thanksgiving? Not Getting Chickenpox…

Recently, there’s been an outbreak of a disease not often seen in the news… chickenpox. As of last week, 36 children at a small private school in North Carolina have come down with the disease.

This represents North Carolina’s worst chickenpox outbreak since the vaccine became available more than 2 decades ago. Since its approval in 1995, the vaccine has significantly reduced the number of chickenpox cases – a disease that once affected more than  90% of Americans. Additionally, the site of the outbreak, the Asheville Waldorf School, is a private school where 68% of incoming kindergartners have at least one religious vaccine exemption.

What’s the big deal with chickenpox?

While many know chickenpox as a nuisance disease, for some it is much more serious. Prior to the vaccine, chickenpox caused an estimated 4 million cases, 10,000 hospitalizations, and 100-150 deaths per year in the US. Since the 2 dose schedule was implemented, with one dose at 12-15 months and a second at 4-6 years, the incidence of chickenpox has decreased 9-10 fold.

According to the CDC’s estimates, the chickenpox vaccine has prevented over 80 million cases, 207,000 hospitalizations, and 2,300 deaths since its licensing in 1995.

But why the hasn’t the chickenpox vaccine completely eliminated the disease? The vaccine is ~90% effective. Because two doses don’t guarantee protection, the vaccine requires high levels of population uptake in order to reach herd immunity levels. Unfortunately, chickenpox vaccination is often regarded as ‘optional’, especially with rising anti-vaccine sentiment.

Why was the Asheville Waldorf School so susceptible to an outbreak?

(1) North Carolina is one of 47 states which allows non-medical (i.e. religious) vaccine exemption waivers, with the state statute reading: “if the bona fide religious beliefs of an adult or the parent, guardian or person in loco parentis of a child are contrary to the immunization requirements contained in this Part, the adult or the child shall be exempt from the requirements.”

To obtain an exemption, parents just have to “write a statement of their religious objection to immunization.” It does not need be notarized or signed by a religious leader.

(2) The school has the 3rd highest religious vaccine exemption rate in the state. During the 2017-18 school year, almost 3/4 of students in the school (110 of 152) had not received the chickenpox vaccine.

This outbreak is an example of a dangerous trend of increasing anti-vaccine sentiment. Across the country, the number of non-medical vaccine waivers has quadrupled since 2001. And as of 2017, 47 of 50 states allow religious exemptions to required vaccines. Additionally, religious exemptions pose a particularly serious threat to vaccination, as seen by the large measles outbreak in Rockland County, NY, which has sickened 77 children (and counting).

What this means:

Anti-vaccine messaging, misinformation, and delayed vaccine schedules have been noted as factors in many outbreaks of vaccine-preventable diseases. Chickenpox and measles both spread easily from person to person. As such, these outbreaks pose significant risks not just for the children of parents who choose not to vaccinate, but for those in the community who are pregnant, have immunodeficiencies, serious allergies, or cancer and are unable to get vaccinated.

All in all – the choice to vaccinate is not just an individual one. Personal vaccination decisions have community-wide repercussions. Vaccinate yourself not only for your own protection, but for those who cannot protect themselves and the community as a whole. 


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