Thursday, February 02, 2017

TOP STORY >> Mumps tied to vaccine decline

Leader editor

Cabot schools are likely to have more cases of mumps after a Cabot Middle School North staff member recently came down with the viral disease, which is easily preventable with the use of vaccines.

There are 2,642 cases of mumps in Arkansas right now, according to the state Health Department. An acceptable rate is a mere three or four cases. The outbreak began in northwest Arkansas last August and has since spread to much of the state. 

It’s not surprising given Arkansas has one of the lowest vaccination rates in the country and one of the highest rates of mumps, a nasty illness that can cause glandular and testicular swelling, and in rare cases sterility and even death.

The disease is on the rise here and across the country due to a decline in vaccination rates as more and more parents are choosing to forgo vaccines for their children. It is an alarming trend that is driving outbreaks of mumps and other diseases that had been virtually eradicated.
Parents here, and in many other states, can choose not to have their children vaccinated based on religious or philosophical reasons. Medical exemptions are also given with a doctor’s approval.
Local school districts and the Health Department track the number of students exempted from getting vaccines. Statewide, there were 6,362 exemptions during the 2015-2016 school year, including medical, religious and philosophical waivers. 
The Cabot School District has 100 exemptions currently with a student body of 10,617. Of Cabot’s waivers, 68 were philosophical, 26 were religious and six were medical.
The Pulaski County Special School District, the only other district to compare to Cabot’s in size, reports only 83 exemptions out of 12,846 students. Out of PCSSD’s exemptions, 28 are for medical reasons, 12 are on religious grounds and 43 are philosophical.
The Jacksonville-North Pulaski School District has 14 such exemptions for its 3,933 students. Six were religious, five were philosophical and one was medical.
The Beebe School District has 25 exemptions – 11 for religious reasons, 13 are philosophical and one medical – with a 3,255 student body.
The Lonoke School District has 17 vaccine waivers – nine were for medical reasons, six were philosophical and two were religious exemptions. Its enrollment is 1,755.
These numbers may seem relatively low, but they can have dramatic public-health consequences.
Both vaccinated and unvaccinated people can spread mumps and often with few symptoms or none at all. Generally mumps is accompanied by flu-like symptoms. 
In schools where mumps outbreaks occur, the Health Department requires unvaccinated students to stay home from school for 26 days until the virus subsides.
In Cabot’s recent case, the school employee was determined not to have been in enough contact with students to warrant that, but the next case could be different.
“Mumps is pretty infectious, so it is not unlikely that there will be more cases in the Cabot area. However, it is hard to predict what areas may see many cases and which ones will only have a few cases. Since the beginning of the outbreak, a large majority of cases have been in northwest Arkansas in Washington, Benton and Madison counties. There have been spillover cases into other counties, but cases are still concentrated in the northwest corner,” said Meg Mirivel, the Health Department’s public information officer.
“Throughout this outbreak, 90 percent to 95 percent of school-aged children and 30 percent to 40 percent of adults involved in the outbreak have been fully immunized,” Mirivel said.
That is no reason to avoid vaccinations, she said.
“The vaccine is not perfect. Two doses of the MMR shot are about 88 percent effective at preventing the mumps. That means that if you have 100 people who are fully vaccinated, 88 of them will be fully protected. The remaining 12 will still be vulnerable to mumps. If it were not for the vaccine, however, we would be seeing many, many more cases of the mumps,” Mirivel said.
Those who have been vaccinated, but still contract mumps, generally show mild symptoms.
“We have only seen a few cases with complications, like swelling of the brain or testicles. Normally, we would expect to see many more persons with complications. This tells us that even though some vaccinated individuals are still getting the mumps, they are experiencing mild disease. The vaccine remains the best protection we have against the mumps,” Mirivel said. 
The state Health Department advises two doses of MMR vaccine, which inoculates against mumps, measles and rubella. It has been available since 1971.
Despite the advice from experts, vaccination rates are dropping due to the public’s misconception that vaccines are dangerous and cause autism, a developmental disorder.
Eighteen states, including Arkansas, allow religious and philosophical exemptions, while 28 others allow vaccine waivers for religious reasons.
Meanwhile, California, responding to a spate of outbreaks, has done away with all but medical exemptions and is beginning to see a decline in mumps. Mississippi and West Virginia have also done away with all but medical exemptions and have some of the fewest mumps cases in the nation.
About five years ago, there were only a few hundred cases in the country, said Oklahoma state Sen. Ervin Yen (R-Oklahoma City), who is a cardiac anesthesiologist.
Yen introduced a bill last year to do away with religious and philosophical exemptions, which would have brought Oklahoma in line with Mississippi, West Virginia and California. It was defeated in committee, but he plans to introduce a similar measure that would allow religious exemptions but not philosophical ones.
“This is a disease we can get rid of. There’s no correlation—autism and vaccination—none,” Yen said.
He noted  Oklahoma’s vaccination rate is about 90 percent. Arkansas’ is about the same, according to the Centers for Disease Control and Prevention. That may seem like a lot, but it’s the other 10 percent that’s troubling.
By comparison, Mississippi’s vaccination rate is 99 percent. That’s the best in the nation.
“The more people you have vaccinated the less of the diseases you will see. Bottom line is the benefits far outweigh the risks. Our U.S. Constitution is quite clear: Life trumps everything else including religion,” Yen said.
State Rep. Karilyn Brown (R-Sherwood), just a few weeks before Cabot’s mumps case was reported, had introduced a bill in the House to do away with religious and philosophical exemptions. After fierce resistance from opponents of vaccines, she pulled the bill.   
“The response to my filing the bill to eliminate the religious and philosophical objections to vaccinations was met with overwhelming opposition. It was quite unpleasant and shocking. In fact, several of my colleagues told me they could not vote for removing a parent’s choice with regard to vaccinations,” Brown said.

Brown is considering reintroducing a bill to prohibit vaccine waivers.

“I do believe that religious and philosophical exemptions may be a luxury we cannot afford to continue to allow. I would have to look at the ‘research’ the anti-vaxers sent to me as well as the information from others who have been combating the vocal opposition before running a bill similar to the one I pre-filed for this session, and I would have to believe I would have public support before running that gauntlet again,” she said.

“I may look into doing a poll to find out how Arkansans feel about the exemptions. Just knowing that we have way more cases of mumps than we would ordinarily be expected to have is alarming. The questions that trouble me are 1) What outbreak are we going to have next? And 2) how long will this mumps epidemic continue? 3) Will it just wear itself out or keep on spreading beyond Arkansas’ borders? 4) When are we going to have an avoidable death?” Brown said.  

She pointed out that almost all of the children in northwest Arkansas who contracted the mumps were actually vaccinated.
According to the state Health Department, Brown said, “those who oppose vaccinations tend to cluster in communities, thereby, making that community more vulnerable.”
“The belief that vaccines cause autism has been debunked; however, many people of above-average education are still opposed to mandatory vaccinations. And there are still many others who wholeheartedly support vaccinations,” she said.

That type of clustering does seem to appear in affluent areas. In the Pulaski County Special School District, Maumelle High School and Maumelle Middle School each report 10 students, Sylvan Hills High has 15, while College Station, Harris and Cato elementary schools have none.
Area school districts do not provide any vaccines. They refer students who are seeking vaccinations to primary-care doctors or to county health units.
The state Health Department operates health clinics in Cabot at 118 S. First St., which can be called 501-843-7561; in Lonoke at 306 N. Center St., 501-676-2268; and in Jacksonville at 3000 N. First St., 501- 982-7477.