ASHEVILLE, North Carolina — A chickenpox outbreak at a private school now ranks as North Carolina's largest since a vaccine for the virus became available more than 20 years ago, health officials say.
As of Friday, 36 students at Asheville Waldorf School had contracted the varicella virus, known to most as chickenpox. The school has one of the highest vaccination religious exemption rates in the state.
The viral infection manifests in an itchy rash in most cases and is not typically life-threatening. But the outbreak at Asheville Waldorf should cause concern, said Dr. Jennifer Mullendore of Buncombe County Department of Health and Human Services.
According to the Centers for Disease Control and Prevention, chickenpox is particularly dangerous to infants, pregnant women those with compromised immune systems, such as people who are HIV positive or coming out of cancer treatment.
"People don't think it's a serious disease, and for the majority of people it's not. But it's not that way for everybody," Mullendore said. Two to three out of every 1,000 children infected with chickenpox required care in a hospital, she said.
"To me, that's not a mild disease, and if you're the parent of one of those children, you probably don't think so either," Mullendore said.
Each year, the chickenpox vaccine prevents more than 3.5 million cases of varicella, 9,000 hospitalizations and 100 deaths, the CDC states on its webpage.
That's why health care providers for years have recommended all children medically able, namely those who have healthy immune systems, be vaccinated, Mullendore said.
Those recommendations have by and large have gone unheeded by the parents of Asheville Waldorf's 152 students — 110 of whom have not received the chickenpox vaccine, which was made available in the United States in 1995.
Leading the state in vaccination exemption
North Carolina's Department of Health and Human Services tracks the rate of kindergartners whose parents have claimed a religious exemption, allowing them to forego vaccination.
During the 2017-2018 school year, the last for which data were available, Asheville Waldorf had a higher rate of religious exemptions for vaccination than all but two other schools in the state.
Of the 28 kindergartners who enrolled that year, 19 had an exemption to at least one vaccination required by the state for school entry.
School officials did respond to questions from the Citizen Times Friday. The school enrolls students from nursery age through sixth grade, Mullendore said.
The only two North Carolina schools to top Asheville Waldorf's religious exemption rate were private schools in other counties. Both had 100 percent exemption rate — one had only one kindergarten student, the other had two.
"The thing people need to understand is that when you have pockets of unvaccinated people, they serve as reservoirs for disease," said Susan Sullivan, a nurse with the state DHHS who consults with local health departments about vaccines and preventable diseases.
"It's not just about you"
Buncombe County has long dealt with high vaccination exemption rates, in part from parents who fear vaccines more so than the illnesses they prevent.
"What's the big deal with chickenpox? There is no big deal," said Asheville resident Amy Gordon, whose children were vaccinated for polio and other diseases in the late 1980s, years before the chickenpox vaccine became available.
"If I was a parent with a kid who wasn't vaccinated, I'd want to send my kid to the Waldorf School to get chickenpox," Gordon said.
Had the vaccine been around when her children got their other shots in the late 1980s, Gordon still wouldn't have allowed it, she said.
In the face of overwhelming agreement to the contrary from health care providers and government agencies, such as the United States Centers for Disease Control and Prevention, Gordon and others say that vaccines lead to a host of health issues.
For Sullivan, and countless others in the medical field, the diseases that vaccines prevent are far more concerning, even when they may seem minor.
In the 1980s, Sullivan was working as a nurse in Johns Hopkins oncology unit when she witnessed chickenpox claim the life of an elementary-age girl.
The girl, who Sullivan didn't name, had just finished a leukemia treatment and returned to her home when she came in contact with somebody who had chickenpox.
"Because her immune system was brand spanking new, the disease spread to her internal organs, and she did not survive," Suillivan said. "That was a wake up call to me that this is not a benign childhood illness."
Sullivan and Mullendore, echoing the position of healthcare providers at large, said that vaccination is important for protecting the community at large.
"It's not just about you," Sullivan said. "It's about the people you interact with: Pregnant women, people with AIDS, people finishing chemo. They're a part of our community, too, and we have to do what we can to protect everybody."
Follow Sam DeGrave on Twitter: @sgdegrave