A mumps outbreak has a way of pushing hesitant parents off of the fence when it comes to vaccinating their children, several Northwest Arkansas physicians said.
But several area parents who've chosen not to vaccinate said they're unconcerned by the outbreak of the virus. Mumps causes swollen salivary glands, body aches and other mostly mild or moderate symptoms, but can lead to rare complications such as deafness or brain inflammation, particularly among adults.
Mumps symptoms and complications
The most common symptoms include:
• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite
• Swollen and tender salivary glands under the ears on one or both sides
Symptoms typically appear anywhere from 12 to 25 days after infection. Mumps can also rarely cause more serious complications, particularly among adolescents and adults:
• Inflammation of the testicles in between 3 percent and 10 percent of males who have reached puberty
• Inflammation of the brain (encephalitis) or of the tissue covering the brain and spinal cord (meningitis), inflammation of the ovaries and/or breast tissue, and deafness — all of which typically occurs in less than 1 percent of cases.
Source: Centers for Disease Control and Prevention
The illness appeared to have spread to 89 confirmed or suspected cases around Northwest Arkansas by Friday, nearly all of them in Springdale, according to the Arkansas Department of Health.
"Almost every other patient the last few days" has asked to make sure his vaccinations are up to date, Dr. Virginia McCord, a pediatrician at Northwest Arkansas Pediatric Clinic in north Fayetteville, said Thursday. The clinic offered expedited vaccine sessions a couple nights last week for parents who wanted to get the recommended second vaccine dosage for their preschool-age kids without waiting for a doctor's appointment.
Checking in
The vaccine introduces a weakened version of the virus as a kind of practice run for the body's immune system so it can fend off full-strength exposure later. It prevents the illness in 88 percent of the people who are exposed to the virus after receiving the recommended two doses, according to the federal Centers for Disease Control and Prevention.
One mother was planning to wait until her child was at least 18 months old for the vaccine's first dose instead of the recommended 1 year, but decided to come in anyway, said Dr. Andrew Koehler, one of McCord's colleagues.
"It's a reminder that these diseases do still exist," Koehler said of the outbreak, urging all parents to vaccinate their children if possible. Mumps affected hundreds of thousands of people in the country each year until the vaccine became widespread, according to the centers. The country has seen less than 2,000 cases a year recently.
The clinic won't accept patients whose parents refuse to vaccinate them because some patients undergo major surgeries or have other issues that leave their bodies vulnerable to diseases such as mumps that unvaccinated people are more likely to carry.
The pediatricians are happy to provide vaccines to someone who doesn't have them but wants them, said Dr. Joe Robinson, the clinic's co-founder.
Northwest Health's Dr. Andrew Hamby in Bentonville on Thursday said he'll spend weeks attempting to convince new parents to vaccinate, calling it an "essential part of well-being." If that's unsuccessful, he'll urge them to find another pediatrician.
"It's my best medical advice," he said, so if patients don't trust it, they don't trust him.
Hamby also saw more people checking on their immunizations as well, and he said Thursday he expected even more to come if mumps spread beyond Springdale. The Health Department later that day reported the virus had done so, with two reported cases in Rogers.
"If anybody was on the fence -- 'Well, I'll get them if I need it' -- this usually pushes them off the fence," Hamby said.
Going without
Public school children who go to school where mumps cases are found and haven't been vaccinated have to stay home for at least 26 days as well. Arkansas law allows parents to exempt their children from required vaccines for religious, medical or other reasons, including personal objections to vaccination. About 1,700 people have taken that option in Benton and Washington counties, according to the Department of Health.
The pediatricians said they haven't seen people who had forgone vaccinations but changed their minds because of the outbreak.
"The more that I learn (about mumps) the more that I'm not worried about it," said Eva Charles of Bentonville, whose two sons briefly attended public schools but are now home-schooled and haven't received a vaccine since they reached school age. She said she became concerned about the vaccine's ingredients and side effects after reading the pharmaceutical insert that gives those details.
Vaccines commonly contain chemicals such as formaldehyde to prevent contamination, aluminum gels or salts to prompt a more lasting response to the vaccine, and animal proteins, which can be left over from the manufacturing process, according to the disease control centers.
The measles-mumps-rubella vaccine's side effects can range from a mild rash in one in 20 people to severe allergic reactions in less than one in 1 million, according to the centers, which say the vaccines' safety is extensively tested. Charles said one of her sons began experiencing food allergies and eczema shortly after his early vaccines and she wasn't convinced by vaccine safety testing, which is done by the manufacturers under federal supervision.
"I would rather deal with those illnesses than with the potential to have brain inflammation from the shot or death from the shot," said Charles, referring to possible side effects of vaccines. The federal centers say those side effects are so rare they can't definitively be tied to the vaccines themselves.
"I don't know -- is my child going to be the one?" Charles asked.
Deedra Haslip in Russellville said her perspective on vaccines changed in much the same way after a flu vaccine caused a severe allergic reaction for her years ago. She now has multiple sclerosis and said her doctor linked it to her reaction to the vaccine.
The National Multiple Sclerosis Society cites many studies on its webpage that show no link between vaccinations and developing multiple sclerosis, including a 2003 study by the National Immunization Program for the Centers for Disease Control and Prevention.
Haslip credited advances in technology and sanitation with declining rates of diseases targeted by vaccines, declines health officials credit to the spread of vaccination, and said she won't be immunizing her 2-year-old daughter.
"There's so much fear-mongering around these diseases," Haslip said.
She said she sees vaccines as unnecessary meddling with the body's immunity but acknowledged some diseases targeted by vaccines can cause harm or even death. "I'm not saying that's OK. But rather than allowing nature to work, we interfere with that."
Greg Johnson of Gentry, who doesn't vaccinate his two children, said parents should be able to decide after being given all of the information about vaccines. His children are home-schooled, but spend time with other kids in church and sports.
Johnson pointed to the state policy that allows the exempt children to return to school immediately after receiving the vaccine even though it typically takes days or weeks to be fully effective. He said the mixed signals made him trust the authorities' information that much less.
"It's just a natural sickness kids get, so personally I'm not super concerned about it at all," he added of the outbreak.
'Obvious benefit'
Dr. Gary Wheeler, chief medical officer for the state Health Department, called the school policy "a compromise between practicality and science." With mumps, a vaccine shortly after exposure can soften the disease's impact, and full immunity comes quickly if someone is simply behind on the recommended second dose.
The lag time remains for those who haven't gotten the first dose, but "we think that we can live with that," Wheeler said. Public school students don't seem to have spread the virus to each other while at school, he said last week.
Wheeler said he respected parents' right to decide their children's vaccinations, but said vaccines do much more good than harm despite occasional side effects. No one has ever been known to spread the disease after being vaccinated, Wheeler said, citing the American Academy of Pediatrics.
"They are highly safe and highly effective," he said of vaccines. "The number is very, very small for anything serious."
Dr. Dirk Haselow, the department's state epidemiologist, said the department's policies and recommendations will shift depending on the situation at hand.
For instance, take a school where a single student shows likely symptoms of mumps but then tests negative for the virus. False negatives can happen if the test isn't done within a narrow time frame, so health officials will look to the student's recent history for any possible contact with other mumps cases. If that contact's there, the student will be considered to have mumps, and students in the same school who aren't vaccinated must stay home.
If there's no contact, the negative test can be accepted, and unvaccinated students could return.
Thousands of Arkansas public school students fall within the 12 percent who don't get the benefit of immunity after being vaccinated. Most of the cases so far have been people who were vaccinated, Haselow said.
The department's considering providing third doses of the vaccine to specific groups that are close to the mumps cases, which should shrink the effectiveness gap, Haselow said. And even though two doses aren't 100 percent effective, people who don't get them are nine times more likely to catch the virus.
"Of those who do get mumps (after vaccination), it's usually shorter in duration, milder in terms of pain and harder to transmit to others," he said. "It's still a very obvious benefit."
NW News on 09/11/2016