In November 2018, a school in Buncombe County saw an outbreak of chickenpox. At least 36 students were infected – making it one of the worst outbreaks in North Carolina since 1995.
The students attended Asheville Waldorf School, a private school with a population of about 150 and one of the highest religious exemption rates for vaccinations in the state. 67.9 percent of kindergarteners in the 2017-2018 school year had these exemptions, the highest in the county. Chapel Hill-Carrboro City Schools had a 98.6 percent vaccination rate for that same year.
The outbreak in Buncombe County isn't the first one the country has seen recently, and as these instances continue, North Carolina health professionals are emphasizing the importance and safety of vaccines against false information.
People have speculated that receiving the flu shot can still make you sick and that the MMR (measles, mumps and rubella) vaccine causes autism. However, this has been refuted by multiple studies.
It is possible North Carolina is now seeing the results of this speculation. In 2016, 35 cases of mumps were reported in the state, a significant increase from a total of four the previous year. In 2017, 92.2 percent of children aged 19-35 months in the state had received the first MMR vaccine dose, a 1 percent decrease from 2016.
“We’re talking about diseases, some diseases that many have never seen because we have been so effective at eradicating diseases through immunization,” said Kelly Kimple, chief of women’s and children’s health for the North Carolina Department of Health and Human Services' public health division.
The N.C. DHHS assesses the number of 2-year-olds in each county who are considered up-to-date on their recommended vaccinations. In 2015, the county average across the state was 70 percent. North Carolina schools are required to submit vaccine coverage reports when children enter kindergarten and 7th grade.
North Carolina law requires children in K-12 schools to have all required vaccinations unless there is a medical or religious exemption. While 17 states allow exemptions for personal or philosophical beliefs, North Carolina does not.
“That law is in place because we know that we have to protect individuals as well as communities against vaccine-preventable diseases,” Kimple said. “And we know that vaccines are safe, they’re effective and really a great public health accomplishment.”
In North Carolina, anyone seeking a religious exemption does not need to fill out an official form. Instead, they just provide a statement of their religious objection to immunization directly to the school. A religious leader is not required to sign it.
"Our job as a school system and as a public service, is to comply with the law," said Lisa Luten, spokesperson for Wake County Public Schools.
Luten said within the school district, the main dialogue surrounding vaccines is to provide resources on what the law requires so parents have the necessary information to enroll their children in school.
Kimple said she can't speculate why vaccination rates may change over time, since some of it may be due to an increase in school reporting. However, she said it is always concerning to see the percentage of unvaccinated people increase.
The science behind vaccines is well-established. Elizabeth Hudgins, director of the North Carolina Pediatric Society, mentioned the concept of herd immunity, which means if a high percentage of people in one area are vaccinated, even people who have compromised immune systems and cannot get a vaccine are more protected because it is more difficult for the disease to spread.
She said having this herd immunity can prevent outbreaks.
With the rapid growth of the internet, people now have access to a large amount of medical information. Yet social media can contribute to the spread of misinformation on scientific topics such as vaccines. In March 2019, Facebook announced it would aim to remove false information about vaccinations from its platform.
Kimple said since people may not have had personal experiences with mostly eradicated diseases, it becomes easier to read anti-vaccine propaganda online and not understand the severe complications that come with that illness.
“I think all of this different information really does create confusion and concern for parents or for other individuals,” she said.
Although measles was eliminated in the United States in 2000, there have been at least 387 cases since Jan. 1, 2019. While there have been some confirmed measles cases in North Carolina, Kimple said these have been generally limited to international travelers who return to the United States.
Health care workers across North Carolina are tasked with addressing concerns or rumors about vaccines. Hudgins said pediatricians are generally very passionate about vaccinations.
“It’s important to note that the vast, vast, majority of parents do vaccinate their children because vaccines are safe and effective,” Hudgins said.
She said she would advise parents to speak with a trusted health care provider if they have any specific concerns about vaccines.
“All of the vaccine-preventable diseases are contagious. Measles is highly contagious,” Hudgins said. “So the more people who are immunized, the more protected you are — not only people who may not be able to get vaccinated because they have a certain condition, but everybody is more protected when more people are immunized.”
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