Every few weeks we experience the resurgence of some infectious disease that had previously been under control through vaccinations. The cause of this can be attributed to the anti-vaccine sentiment. This "movement" has increased in communities and has allowed viruses to cross a threshold and be delivered through susceptible hosts (i.e., unvaccinated individuals). The latest infectious disease to benefit from this vicious cycle is chickenpox, which, in North Carolina has been causing the highest number of cases on record since the introduction of the vaccine.
This recent outbreak is centered at the Asheville Waldorf School, a private school in Asheville, N.C. recognized for possessing one of the highest religious vaccination exemption rates in the state. Nearly three quarters of the students at this school — which has become a viral exchange center — are not vaccinated against chickenpox, making this 38-case outbreak unequivocally preventable and predictable.
A risky right of passage
Chickenpox (varicella) is not benign. Before the introduction of the vaccine in 1995 about 4 million cases of chickenpox occurred each year with over 10,000 requiring hospitalization; 100 to 150 people died each year. This is not a mild illness and while the death toll may not have been as high as measles or influenza, it was greater than zero. Furthermore, the economic impact of 13,000 hospitalizations and 4 million cases each year was substantial. I contracted chickenpox in the eighth grade, in the pre-vaccine era and do not rank it amongst my most idyllic childhood memories.
Far from being a microbe deserving of parties, which are de facto ritualistic ceremonies to sacrifice children to the virus, chickenpox is something that should be avoided. The illness begins with fever and fatigue and following these symptoms, the characteristic blistery rash develops. This is the point where most people’s knowledge of chickenpox stops. However, there is much more to know.
Many people are not aware that chickenpox is an important cause of strokes; can cause pneumonia; lead to severe secondary bacterial skin infections and are the necessary precursor infection for shingles, a painful and often debilitating reactivation of the virus in older age groups.
Shingles is also associated with heart attacks and strokes. Chickenpox in pregnant women can be particularly dangerous as higher rates of pneumonia and death occur. Neonatal varicella — which can be deadly — can also develop after infections that arise near delivery. These complications are impossible to forget if one has ever witnessed them.
The power of vaccination
As a child, I vividly recall successive rows of desks in my classroom becoming empty as the virus stalked the school. Chickenpox was so successful at finding new victims because it is a highly contagious virus that spreads through the airborne route, even before the rash appears. A virus that spreads via breathing is very formidable and nothing short of vaccine can really impact transmission.
The highly effective and safe vaccine — administered in two doses alongside the MMR at age 12-15 months and at 4-6 years — is responsible for making a near ubiquitous suffering experience 9-10 times rarer than it was in the pre-vaccine era.
Most people are able to receive the vaccine (pregnant women and the immunocompromised being two notable exemptions), but nationally only about 90 percent of children are vaccinated against varicella. Unvaccinated pockets, such as the gaping one that exists in Asheville, act as kindling for outbreaks.
Antiviral therapies such as: valacyclovir and acyclovir; and antibody VariZIG, are available, but prevention by vaccination in those who can receive the vaccine should be the goal.
Reason and science vs. primitivism
This outbreak illustrates just how the anti-vaccine movement threatens the health security of the nation. Religious exemptions, which exist in almost all states, by definition seek to place supernatural considerations and faith above those of science and medicine. As such, they represent a return of dark ages primitivism.
Schools, whose mission it is to guide developing minds, should set an example of what it means to adhere to facts and logic by forbidding vaccine exemptions that are not based on demonstrable medical necessity. As civilization advances, childhood becomes even more full of true idyllic experiences as what were once dismal challenges continue to evaporate. Chickenpox was a dismal challenge, and it is totally avoidable in 2018.
Amesh A. Adalja M.D. is a board-certified infectious disease physician, is a senior scholar at the Johns Hopkins Center for Health Security. Follow him on Twitter: @AmeshAA.