Tag: chickenpox outbreaks

Are Kids With Religious Exemptions Spreading Disease?

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.”

Did Assemblymember Colton look for evidence?

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.

11 kids got paralytic polio at a Christian Science school in 1972.

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.

We should have acted in 2007, instead of waiting for more and more kids to get sick in outbreaks, as non-medical exemptions to continued to increase.
We should have acted in 2007, instead of waiting for more and more kids to get sick in outbreaks, as non-medical exemptions to continued to increase.

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

More on Kids With Religious Exemptions Spreading Disease

About That Chickenpox Outbreak in New York

Anti-vax folks really seem to be excited about a new case of chickenpox at a school in New York.

There is a case of chickenpox at a school in New York.
Made my day?

A case that wasn’t report until after they implemented new rules that eliminated religious vaccine exemptions.

About That Chickenpox Outbreak in New York

So does this chickenpox pox case or outbreak in New York somehow mean that their plan isn’t working?

Of course not!

For one thing, it is only one case.

Remember that chickenpox outbreak in Kentucky last Spring? At least 32 kids ended up getting chickenpox!

That shouldn’t happen at this school in New York, as there hopefully aren’t even 32 unvaccinated kids left to get sick. There might be though…

Wait, how could there be 32 unvaccinated kids if they have eliminated non-medical exemptions?

Well, since the law just went into effect at the start of this school year, kids likely haven’t had time to get fully vaccinated.

Wait, what?

Children who are not fully immunized can continue to attend school if they are in the process of completing the ACIP catch-up schedule or if they are otherwise exempt from immunization requirements. A school shall not refuse to admit a child based on immunization requirements, if that child is “in process.”

New York School Immunization Q&A

Also, for some reason, “students entering grades 5, 11 and12 for the 2018-19 school year are only required to have received one dose of varicella vaccine.”

Remember, to be considered fully vaccinated against chickenpox, kids should have two doses of the chickenpox vaccine.

So it should be easy to see that there may be students in New York schools who are only partially vaccinated.

What else?

The deadline for kids to get vaccinated was September 17 and the vaccine takes at least two weeks to work.

The case was reported on October 18.

Add in the 10 to 21 day incubation period and it is very possible that this was a student who was initially unvaccinated and developed chickenpox before his vaccine had time to work!

Whaddya know!!

Are there any other possibilities?

Could it simply be a student with breakthrough chickenpox? A child who was vaccinated, but developed chickenpox anyway?


While the chickenpox is said to be 100% effective at preventing severe cases of chickenpox, you can still sometimes get milder, breakthrough infections, even after two doses.

Or the case could be in a teacher or other school worker.

What about shedding?

While the chickenpox vaccine is said to rarely cause a rash, it typically occurs at the site of injection, so it is unlikely that it would be confused with a full blown case of chickenpox. And this rash rarely gets others sick.

The bottom line though is that with fewer fully unvaccinated students in school now, this is unlikely to develop into a big outbreak.

More on Chickenpox Outbreaks

Can Schools Remove Unvaccinated Kids?

Why do parents think that their intentionally unvaccinated kids can not or will not be removed from school?

This school in Michigan was right to send unvaccinated kids home during a chickenpox outbreak.
This school in Michigan was right to send unvaccinated kids home during a chickenpox outbreak.

After all, when available, part of their choice when signing their child’s immunization waiver is to accept that their child could be excluded from school “as a disease control measure.”

Keeping unvaccinated kids out of school during an outbreak is the only way to keep more kids from getting sick. It is not a form of discrimination or segregation.

Well, I guess accept is a strong word…

Can Schools Remove Unvaccinated Kids?

Why is this coming up again?

“Last week, Marysville High School forcibly removed over 37 students from the high school due to an alleged outbreak of chicken pox, which consisted of two students.”

Parent: School wrong to remove unvaccinated students

Why send unvaccinated kids home when someone at the school has chickenpox?

Once upon a time, with no treatment or vaccine, families would just be quarantined when they had chicken pox.
Once upon a time, with no treatment or vaccine, families would just be quarantined when they had chicken pox. Photo by Howard Liberman.

Because chickenpox is very contagious!

For every case of chickenpox, up to 12 others who are not immune will catch it, which used to lead to large outbreaks in the pre-vaccine era.

“Homecoming events are happening all week long. The school has barred any Marysville student who cannot provide immunity status from attending these week long events including the homecoming parade and the homecoming dance. This group of banned students consists of band members, cheerleaders, and football players. HOWEVER, the school is allowing students from other school districts to attend without checking immunity or vaccination status of the visiting student.”

Parent: School wrong to remove unvaccinated students

To be clear, any of the kids with non-medical exemptions could have gone back to school if they had just gotten a chickenpox vaccine. It was their parent’s choice to avoid vaccinating and protecting them and that is what is keeping them out of school.

Why allow students from other school districts to visit the school?

Those students, even if they are unvaccinated, would not have already been exposed to the Marysville kids with chickenpox! They aren’t a risk to keep the outbreak going.

That is unlike the unvaccinated kids at Marysville High School. They could have already been exposed and could come down with chickenpox anytime over the 10 to 21 days following that exposure. If they stayed in school, they could then expose others, especially as you can be contagious even before you know that you have chickenpox.

“The Marysville School District released the private health, educational, and personal records of these students to the health department without parental consent. This is a clear violation of federal law.”

Parent: School wrong to remove unvaccinated students

And while the Family Educational Rights and Privacy Act (FERPA) does protect student privacy, there are exceptions for health or safety emergencies, including “the outbreak of an epidemic disease.”

As St. Claire County has a high rate of vaccine exemptions, it is not surprising that they are being so pro-active in trying to prevent the outbreak from growing.

“According to Michigan state law, there are three ways to provide immunity to a school. One, is a vaccination record. Two, is a titers blood test that shows immunity. Three, is an affidavit signed by a parent, guardian, or doctor that states the child has had the chicken pox. Despite the fact that at least one parent submitted an affidavit, the school has admitted they will not follow state law, but instead continue based on what the heath department recommends.”

Parent: School wrong to remove unvaccinated students

What about the idea that the school should have accepted the parents affidavit that their child is immune to chickenpox?

“(4) When a local health officer confirms or reasonably suspects that a student or individual attending school or a group program has a communicable disease, the health officer may, as a disease control measure, exclude from attendance any individuals lacking documentation of immunity or otherwise considered susceptible to the disease until such time as the health officer deems there to be no likely further risk of disease spread.”

MDHHS Communicable and Related Diseases Administrative Rules

Because chickenpox is now becoming more and more uncommon, many states are requiring titers to confirm immunity if a child is unvaccinated.

So what happens next?

When an intentionally unvaccinated Kentucky teen was banned from school during a chickenpox outbreak his family sued. They lost and he ended up getting chickenpox! Although he is now at increased risk to get shingles, he didn’t expose anyone else at his school.

We will see what happens in Michigan…

Parents of children affected by the quarantine and removed from school did choose. Their choice was to leave their kids unvaccinated and unprotected.
Parents of children affected by the quarantine and removed from school did choose. Their choice was to leave their kids unvaccinated and unprotected. Hopefully no one at their protest gets exposed to chickenpox.

Unless there is a new case, there is less than a week left to go and of the original 37 students, only 14 students are still being quarantined.

More on Removing Unvaccinated Kids from School

Quarantines for Vaccine Preventable Diseases

The “quarantine of susceptible contacts without presumptive evidence of immunity” is a key tool that health experts use to control outbreaks of vaccine-preventable diseases.

Quarantines were routine in the pre-vaccine era.
Quarantines were routine in the pre-vaccine era.

Once upon a time, it was the only tool.

Quarantines for Vaccine Preventable Diseases

Some examples of quarantine periods include:

In addition to susceptible contacts, during an outbreak, even those who aren’t contacts are sometimes put under quarantine, or at least restricted from going to school.

At least they are if they aren’t naturally immune or haven’t been vaccinated. This is especially common during outbreaks of measles or chicken pox, in which case the quarantine may last much longer than 21 days.

In general, unvaccinated kids will have to stay out of school for at least 21 days after the last case could have been contagious and exposed others.

More on Quarantines for Vaccine Preventable Diseases