A single case of the mumps in a Gilbert school means 19 unvaccinated children have been removed from their classes for nearly a month, the Maricopa County Department of Public Health announced this week.
In Arizona, schools cannot turn away children who do not have their vaccines. But their parents or guardians are required to file an exemption that - at present time - must be signed by the responsible adult. When they take that action, they risk being pulled out of school when a rare, highly contagious disease - like mumps - appears, said Dr. Bob England, director of the county's health department.
In the case at Higley Elementary School, the unvaccinated children will miss 26 days of school, as long as there is not another mumps case reported. If there is, that 26-day-period could start all over, England said.
"We hate to do this. I hate to kick kids out of school. School is important," England said. "But every time a parent signs an exemption and chooses not to vaccinate their child, they've got to know this is possible."
The county health department sent home a note with parents informing them of the mumps case in a fourth-grader at the school. Mumps causes swelling in the salivary glands, loss of appetite and fatigue. It can be contracted through contact with body fluid from the mouth, nose or throat, such as through sneezing or coughing. It is a virus that may be treated with viral antibiotics.
Since 2001, there have only been 19 reported cases of mumps in Maricopa County. Most children are vaccinated against the disease, with a dose given between 12 months and 15 months as part of the MMR shot (measles, mumps and rubella) and a second dose given between 4 and 6 years old, according to the Centers for Disease Control and Prevention.
Adults born prior to 1957 are likely immune to the disease because it was so prevalent, England said. But younger adults who only have had one dose of the vaccine may be at risk.
Vaccine exemptions are not the norm in most Maricopa County schools. But how many families have those exemptions - for personal or religious reasons - differs among campuses.
A recent report by the state Department of Health Services shows schools in Maricopa County vary widely on the number of kindergarten students who were in compliance for the MMR (measles, mumps and rubella) vaccine when they started classes in August 2010. In most cases, more than 98 percent of the students in each of the 630 schools are in compliance, according to the data. A number of schools have students 100 percent in compliance.
But in some cases, that figure plummets to 73 percent. At least one school - a private Phoenix campus - was at 52 percent.
England said this presents problems not only for the children not vaccinated, but for their classmates.
"It matters whether people around you have been vaccinated. It matters at least as much as it matters whether you've been vaccinated. No vaccine is perfect. Even people who have been vaccinated can contract diseases if they're exposed to them. The key is to never be exposed," England said. "That's how we've made all those previously common childhood diseases so rare. It's not that the vaccine is so perfect. It's that you get enough people vaccinated that when one person comes in with a disease that germ has a hard time finding another person to jump to."
England calls it the "herd" effect.
But for many reasons, including medical ones, some parents choose not to vaccinate. Some cite religions or personal preference. Some cite concerns about vaccines themselves.
Parents who do choose to file an exemption may have an extra step in the process in the future.
Rep. Cecil Ash, R-Mesa, is proposing a law that would require a health professional's signature on the exemption forms, as well as the parents. HB 2846 would also require that parents get the exemption form signed by a health provider annually.
Dr. David M Curran, MD, chairman of the department of pediatric medicine at Cardon Children's Medical Center in Mesa, said the bill would not impact doctors a great deal.
"We already do everything the bill proposes. In 2002, the American Academy of Pediatrics recommended all family pediatricians and family practitioners that give vaccines document the family refusals to vaccinate," Curran said. "The idea behind that form is to demonstrate the importance we as pediatricians place upon vaccines."
Curran said health providers talk to the families about the risks, as well. To put it into focus, Curran pointed to the current measles outbreak in Indiana.
Indiana health authorities have reported 10 confirmed cases of the measles in the last week. The index case - the first person identified as having the disease - attended activities at the Super Bowl village in Indianapolis a few days before the game.
According to news reports, all the cases have been found in unvaccinated adults.
Measles is a contagious respiratory disease that, like mumps, is spread through coughing and sneezing and other contact with body fluid from the mouth, nose and throat.
In most years, the United States sees fewer than 50 cases of the disease, according to the CDC website.
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