One common anti-vax talking point is that kids who are unvaccinated can’t spread disease because they aren’t sick. One lawsuit against New York’s new vaccine law went so far as to say that “there has not been one instance of a child with a religious exemption spreading disease in a school.”

Is that true?

I’m guessing it isn’t, but let’s do a little research…

Are Kids With Religious Exemptions Spreading Disease?

Before I considered the latest measles outbreak in New York and how many of those cases occurred in unvaccinated kids in school with religious exemptions, I found a few other examples.

“During April 4-May 17, 1994, the largest U.S. measles outbreak since 1992 occurred among students in two communities that do not routinely accept vaccination. This report summarizes the investigation of and control measures for this outbreak. The outbreak began in a 14-year-old Christian Science high school student who developed a rash on April 4, 2 weeks after skiing in Colorado where a measles outbreak was occurring. The student lived with her family in a community associated with a Christian Science college in Jersey County, Illinois, and commuted approximately 30 miles to a Christian Science boarding school (kindergarten through grade 12 {K-12}) in St. Louis County, Missouri.”

Outbreak of Measles Among Christian Science Students — Missouri and Illinois, 1994

At least 189 people got measles in these communities during this outbreak, including a student in New York.

“Eighteen prospective students from outside St. Louis County attended a carnival at the boarding school on April 16; eight developed measles after returning home (three to Maine, two to California, and one each to Missouri, New York, and Washington).”

Outbreak of Measles Among Christian Science Students — Missouri and Illinois, 1994

During another measles outbreak among Christian Scientists in 1985 in Illinois, there were at least 136 cases, including 3 deaths.

There were even more deaths during a measles outbreak in Philadelphia in 1991.

“According to Assistant Health Commissioner Robert Sharrar, four victims from Philadelphia – two girls 9 years old and two girls 11 and 13 – were affiliated with the Faith Tabernacle Congregation, which shuns medical treatment. The children, who attended the church’s school, had not been vaccinated. “

Philadelphia’s Measles Death Toll Rises

By the end of the 1991 Philly outbreak, 9 children were dead.

Back to New York, during a 2009 mumps outbreak in New York and New Jersey, even though many were vaccinated, “the outbreak primarily has affected members of a tradition-observant religious community.”

Are there any other examples?

Four children in Florida with a religious exemption developed measles in 2012 and although they didn’t get anyone at school sick, they did likely expose someone at an Orlando-area theme park who did later get sick.

Also in Florida, in 2013, in a charter school where 84% of kids had religious exemptions, 316 students developed pertussis, with attack rates of 57%!

What’s the usual attack rate for pertussis?

In another Florida outbreak in 2013, this one at a preschool, attack rates ranged from 23% for kids who were up-to-date on their pertussis vaccinations to 40% if they had fewer than three doses of a pertussis vaccine.

At the Asheville Waldorf School in North Carolina, at least 36 students got sick with chickenpox in 2018. The school had the highest rate of religious exemptions in the state.

And there was an outbreak in Alaska linked to religious exemptions.

“Among the 30 who were not vaccinated, 24 (80%) were eligible to be vaccinated (i.e., aged ≥ 12 months and born on or after January 1, 1957); of the 24 who were eligible to be vaccinated, all 12 school-aged children had religious exemptions, and two of nine children aged 1–4 years were siblings of these unvaccinated schoolchildren. Although no source case was identified, this outbreak coincided with a measles outbreak associated with the Seattle-Tacoma (Washington) airport, the major airport gateway to Juneau.”

Measles Outbreak Among School-Aged Children — Juneau, Alaska, 1996

Remember the last imported case of vaccine associated paralytic polio?

In 2005, an unvaccinated 22-year-old U.S. college student from Arizona became infected with polio vaccine virus while traveling in Costa Rica in a university-sponsored study-abroad program. She had never been vaccinated because she had a religious exemption.

How about the last cases of wild polio in the United States?

“The 1979 outbreak occurred in unvaccinated Amish persons living in Iowa, Missouri, Pennsylvania, and Wisconsin. Overall, 15 cases of illness caused by wild poliovirus type 1 occurred among U.S. citizens: all 10 paralytic cases occurred among unvaccinated Amish persons; three cases of transient paralysis occurred among unvaccinated Amish persons; and two nonparalytic cases occurred among unvaccinated members of the Mennonite church who were in frequent contact with Amish persons. Epidemiologic and virologic evidence indicated this outbreak resulted from importation of poliovirus from the Netherlands through Canada (Ontario), where outbreaks had occurred during 1978 in members of religious groups with objections to vaccination.”

Poliomyelitis — United States, Canada

It was in 1979.

It was among the Amish and may have been linked to religious exemptions, although many Amish got vaccinated to help eliminate the endemic spread of polio in the United States.

Before that, in 1972, there was an outbreak of paralytic polio at Daycroft, a Chris­tian Science boarding school in Greenwich, Connecticut. At least 12 students, all unvaccinated, were affected in the first polio epidemic in the US in seven years.

Also among the Amish, an outbreak of rubella and congenital rubella syndrome in 1991, including 16 cases in New York.

“The outcome of pregnancy was determined for the 94 Amish mothers who reported illness or had serologic evidence of maternal rubella (Table 1). CRS occurred in 10 infants, all of whom were born to mothers who had histories of rubella-like illness in the first trimester; seven had possible manifestations of CRS; nine were miscarried/stillborn; and 68 infants appeared normal at birth. During the study period, medical personnel identified one additional infant with CRS from Lancaster County whose mother was a conservative Mennonite. “

Congenital Rubella Syndrome Among the Amish — Pennsylvania, 1991-1992

There have also been cases of tetanus among the Amish.

“In 1997 a 12-year-old Amish boy in Pennsylvania contracted tetanus. His medical bills were $600,000. The Amish community refused to apply for Medicaid because of their religious opposition to accepting government assistance and were able to pay only $60,000 of the bill.”

Some Outbreaks of Vaccine-Preventable Disease in Groups with Religious or Philosophical Exemptions to Vaccination

More recently, the measles outbreaks in New York occurred almost exclusively among completely unvaccinated children, including many school aged children.

“Persons who claim exemptions from immunizations for any reason may be at increased risk of contracting a VPD compared with immunized persons. In addition, persons who claim philosophical and/or religious exemptions (exemptors) may create some risk to the community because unvaccinated or undervaccinated persons may be a source of transmission.”

Salmon et al on Health Consequences of Religious and Philosophical Exemptions From Immunization Laws

Remember diphtheria?

You probably think that it has been a long, long time since a child has died from diphtheria in the United States, especially since we have had an effective vaccine for well over one hundred years.

Well, it has been a long time since anyone who was vaccinated has died…

Tragically, in 1982, a 9-year-old girl died after getting diphtheria at a Christian Science camp in Colorado.

Even more recently, an unvaccinated 4-year-old boy died in Massachusetts died with diphtheria. His mother was a Christian Scientist.

It should be very clear that kids with non-medical exemptions, including religious exemptions, are getting sick and are spreading disease.

Increasing in the post-Wakefield era, religious exemptions from immunizations put our kids at risk.

More on Kids With Religious Exemptions Spreading Disease

• Are the Measles Outbreaks in New York a Hoax?
• Why Are You Still Worried About the MMR Vaccine?
• Was the Measles Outbreak in Michigan Caused by Vaccine-Strain Measles?
• What Does the Torah Say About Vaccines?
• A Slice of Pie: MMR Edition
• Some Outbreaks of Vaccine-Preventable Disease in Groups with Religious or Philosophical Exemptions to Vaccination
• MMWR – Notes from the Field: Measles Outbreaks from Imported Cases in Orthodox Jewish Communities — New York and New Jersey, 2018–2019
• MMWR – Outbreak of Measles Among Christian Science Students — Missouri and Illinois, 1994
• MMWR – Measles Outbreak in a Boarding School — Pennsylvania, 2003
• MMWR – Imported Vaccine-Associated Paralytic Poliomyelitis — United States, 2005
• Study – Health Consequences of Religious and Philosophical Exemptions From Immunization Laws
• MMWR – Measles Outbreak in an Unvaccinated Family and a Possibly Associated International Traveler — Orange County, Florida, December 2012–January 2013
• MMWR – Notes from the Field: Outbreak of Pertussis in a School and Religious Community Averse to Health Care and Vaccinations — Columbia County, Florida, 2013
• MMWR – Measles Outbreak Among School-Aged Children — Juneau, Alaska, 1996
• A leader in vaccine exemption, Asheville Waldorf has NC’s worst chickenpox outbreak since ’95
• MMWR – Comparative Mortality of Two College Groups, 1945 – 1983
• MMWR – Poliomyelitis — United States, Canada
• MMWR – Measles outbreaks in religious groups exempt from immunization laws.
• Measles Outbreak In Ohio Leads Amish To Reconsider Vaccines
• MMWR – Pertussis Outbreak in an Amish Community — Kent County, Delaware, September 2004–February 2005
• Study – Haemophilus influenzae Type b Disease Among Amish Children in Pennsylvania: Reasons for Persistent Disease
• MMWR – Congenital Rubella Syndrome Among the Amish — Pennsylvania, 1991-1992
• MMWR – Poliovirus Infections in Four Unvaccinated Children — Minnesota, August–October 2005