Vaccine exemptions up in NWA amid nation's measles outbreak

Nearly 1,500 schoolchildren in region claim exemptions

Northwest Arkansas has more unvaccinated schoolchildren than any other region in the state, which several health care providers said could raise the risk for an outbreak of an otherwise preventable disease.

The debate over whether vaccinations are safe and necessary has again moved to the nation's center stage as a measles outbreak that began in California affects more than 120 people from Canada to Mexico, according to the Centers for Disease Control and Prevention and news reports.

Measles virus

Health officials report an outbreak of measles this year that began in California has spread to several state and to two other countries. Measles is one of the most infectious diseases, because it’s spread in the air, can persist for long times outside of the body and other factors, said Dr. Jennifer Dillaha with the Arkansas Health Department.

• Type: Virus spread by coughs and sneezes

• Symptoms: A high fever, cough and watery or red eyes; a few days later, a rash of red spots can spread across the body. Symptoms typically appear one or two weeks after infection.

• Complications: Can cause ear infections or diarrhea. One out of a thousand infected children can develop severe encephalitis that can cause deafness or brain damage; one or two out of a thousand could die.

• Vaccine: Prevented with measles, mumps and rubella (MMR) vaccine in at least two doses.

Source: Centers for Disease Control and Prevention

Effectiveness and safety

Researchers say vaccines are effective at preventing disease and keep a large majority of recipients from getting either seriously ill or ill at all. Still, few are 100 percent effective, according to the Centers for Disease Control and Prevention. The measles vaccine is nearly 100 percent effective after two doses and lasts a lifetime. Pertussis, or whooping cough, vaccines are at least 70 percent effective over the first several years but fade over time, making booster shots necessary. High immunization rates help protect those whose vaccination is less effective.

“I don’t think there’s any medication that’s ever been devised by humans that’s 100 percent effective,” said Dr. Jennifer Dillaha with the state Department of Health. Vaccines also bring a chance for side effects, usually mild, like redness at the shot area or a fever, but rarely serious. Vaccines are safer than their diseases, doctors said.

Source: Staff report

Parents of almost 600 public school children in Washington County and almost 900 in Benton County have exempted them from at least one vaccine because of medical, religious or philosophical reasons, according to the Arkansas Department of Health.

No other counties come close. Pulaski County, with about twice Washington County's population, is home to 261 exempted public school kids. About 4,200 K-12 students have exemptions statewide.

Measles hasn't been reported in Arkansas since 2012, but the outbreak and the number of exemptions have state officials on the lookout. One person with measles can infect 90 percent of the people around them who aren't immunized, while nearly all who get the vaccine are protected, according to the CDC.

"It is very concerning," said Dr. Jennifer Dillaha, the health department's medical director of immunizations. "My concern is that it would be easy for measles to circulate in Arkansas."

Still, the exemptions show many parents have concerns, even fears, about vaccination.

"I would hate to be a parent having a baby in this time, because you get conflicting views on this subject," said Rebecca Powers, a Bentonville Public Schools board member who has exemptions for her kids. "In general, I don't think that there's enough evidence to force people to get vaccines."

Divisive Medicine

Vaccines give the body's immune system a leg up on disease essentially by giving it practice. They carry fragments of a virus, for example, or a mix of weakened or dead bacteria that won't mount a full-fledged attack. The vaccine prompts a full response from blood cells that fight infection, which can then recognize the germs and quash the real disease before it begins.

Widespread vaccination began centuries ago, when researchers noticed farmers exposed to mild cowpox were immune to the similar but far deadlier smallpox virus, according to the National Institutes of Health. Whooping cough, polio, measles -- the annual number of cases plummeted after vaccines were developed. Measles was declared eradicated in the U.S. in 2000 and has returned.

Dr. Orrin Davis with the Northwest Arkansas Pediatric Clinic in Fayetteville called vaccination the greatest medical advance in history.

"I'm just going to use your body against getting an infection," Davis said. "How beautiful is that?"

Vaccines have come under increasing fire in the past decade or two, starting with a faulty study in the 1990s that claimed to connect vaccination to causing autism. The study has been retracted and repeatedly debunked in much larger surveys. Despite this, parents' alarm stuck around and continues to grow.

"It has sort of waxed and waned," Davis said, saying first autism, then vaccine chemicals were the chief concern. He urged parents with concerns to talk with their family doctors. "It's our new normal."

The 1,500 exempted students in Northwest Arkansas are a small proportion of the 80,000 who go to school in both counties. But state exemptions for daycare, K-12 and college students have grown more than 1,000 percent in the past 15 years, said Kelly Krell, health department spokeswoman. Arkansas 3-year-olds are less likely to have all of their vaccinations than in any other state, according to the CDC.

Krell pointed to a 2003 law adding the philosophical exemption. Before then, children needed to belong to an explicitly anti-vaccine religion or have some medical reason not to get them, such as an allergy or weakened immune system.

"A philosophical exemption means you just do not want the vaccine for whatever reasons," Krell said. Philosophical exemptions now outnumber the others 2-1.

Powers, the Bentonville school board member, has five kids, four still in public school. All were up to date on vaccinations until this school year, she said.

Powers changed her approach after the state last year began requiring a second chicken pox, or varicella, vaccine for her middle-schooler, Canaan Brown. She said she researched vaccines online and came to believe they were less effective than claimed and potentially dangerous.

"This is the stopping point for me," she said. "It was a whole shift for our family at that time, and that hasn't changed."

Canaan was suspended from school for 21 days last fall after another student on his bus caught the chicken pox. State law requires students without a certain vaccination to stay home when they could be exposed to the disease.

The rule aims to keep unvaccinated kids safe, but Powers said it felt more like a punishment, with too little help for Canaan to keep up with his school work.

"They need to have a plan on how to help him," she said. "I've been called all kinds of names. It's been kind of painful."

State Sen. Bart Hester, R-Cave Springs, said his four children had gotten all recommended vaccinations, but he shared Powers' opinion of mandating them.

"At the end of the day, parents should have the ultimate choice," Hester said, noting non-vaccinating parents must agree to the state's conditions. "I feel like vaccinations make us safer, but I would never want to require a parent to do that."

The Results

More unvaccinated people can mean more infectious diseases, Krell said. Chicken pox has flared up in Northwest Arkansas a few times, she said, and whooping cough has soared statewide. Less than 100 whooping cough cases in Arkansas in 2004 became almost 500 in 2013.

Each unvaccinated child is a potential foothold for whooping cough, measles or another disease targeted by vaccines to spread to others, Davis and his colleagues said, particularly when more and more aren't vaccinated. The pediatric clinic turns away parents who refuse every vaccine, partly for its patients' safety.

Vaccines' success against potentially fatal measles or other illness has given today's parents the luxury of thinking they aren't necessary or helpful, said Dr. Dan Rasmussen, another pediatrician at the Fayetteville clinic.

"The more people that don't immunize, that luxury disappears," he said, adding interest in measles vaccines among parents coming to the clinic has surged. "You lose sight of the fact that this is a very devastating illness."

With almost 400 exemptions, Bentonville has the most of the area's four major school districts, said Paul Stolt, spokesman. Springdale has the fewest with a few dozen, said Kathy Launder, nursing coordinator.

"We've not had any issues with that," she said, but she remains concerned the kids who can't get vaccinated because of health concerns could suffer as a result. "If we were to have an outbreak, then I'm concerned about those kids because that's a huge health issue for them, and it can be life threatening."

Melissa Thomas, nursing director for Fayetteville Schools, said she was less worried. The district had two cases of chicken pox last year and both were very mild reactions to the booster shot, she said, adding thousands of students get the shot without a reaction. Seven unvaccinated students were sent home for the 21-day period.

"I don't have a concern because the plan the Arkansas Department of Health has in place is an effective plan," Thomas said. "In the past, we have responded quickly when we are notified a student has a reportable disease."

Dan Holtmeyer can be reached at dholtmeyer@nwadg.com and on Twitter @NWADanH.

NW News on 02/16/2015

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