All affected children are students at Asheville Waldorf School, according to a statement from the Health and Human Services Department of Buncombe County, where the school is located.
North Carolina law requires all students to get certain vaccinations, including the one for chicken pox, before they start school. But the state also allows for medical and religious exemptions from the required shots.
Buncombe County medical director Dr. Jennifer Mullendore told CNN that, last year, the kindergarten class at Asheville Waldorf School had the highest percentage of religious exemptions in the county and one of the highest in the state. (Data from the 2018-2019 school year have not yet been gathered, she added.)
Mullendore told CNN that the outbreak "demonstrates what happens when we have a population that is not immunized, that has not gotten the vaccine. It offers an opportunity for the infection to get into that community and spread easily."
And it's possible the outbreak may worsen.
"The size of this outbreak and the fact that this school continues to have a large number of unvaccinated students makes it very likely there will be continued spread of chickenpox within the school," Mullendore told the New York Times.
INSIDER reached out to the school on Wednesday, but it was closed for Thanksgiving and not able to provide a comment.
Chicken pox is caused by the varicella-zoster virus. Its symptoms include an itchy, blister-like rash, fever, and tiredness. The Centers for Disease Control and Prevention (CDC) describes it as "very contagious." The disease spreads primarily through touching or breathing in virus particles that come from chicken pox blisters.
Though complications are not common in healthy people who get chicken pox, they can happen.
Some possible complications include bacterial skin infections, pneumonia, infection or inflammation of the brain, blood stream infections, bleeding problems, and dehydration, according to the CDC. In certain cases, chickenpox may cause death.
"It is important to understand that even healthy children and adults may develop serious complications from varicella," Dr. Mullendore told the New York Times.
Infants, teenagers, adults, pregnant women, and people whose immune systems are compromised by illness or medication may be at higher risk for these serious issues, the CDC website said.
Two doses of the chicken pox vaccine are about 90% effective at preventing the disease, according to the CDC. If a vaccinated person does get the disease, it's usually milder with fewer blisters and minimal fever.
Getting vaccinated also helps protect others who may be at higher risk for chicken pox and its possible complications, including those with weakened immune systems and pregnant women.
"We want to be clear: vaccination is the best protection from chickenpox," Mullendore said in the Buncombe County statement. "When we see high numbers of unimmunized children and adults, we know that an illness like chickenpox can spread easily throughout the community — into our playgrounds, grocery stores, and sports teams."
The CDC recommends the chicken pox vaccine for kids, adolescents, and adults. Children should get two doses of the vaccine, according to the CDC: The first at 12 to 15 months old and the second at 4 to 6 years old.
While this cluster of chicken pox cases is limited in scope, a number of recent outbreaks of measles — a disease that's also preventable with a vaccine — show how illnesses can spread in communities with low vaccination rates.
Measles was declared eliminated in the US in 2000, but outbreaks have continued since then.
In November, 17 children in New York City came down with measles. City health officials said the virus spread in schools with unvaccinated or incompletely vaccinated children. Last year, 75 people came down with measles in a Minnesota Somali-American community with "poor vaccination coverage," according to the CDC. And in 2014, the US saw 23 measles outbreaks, including one that sickened 383 people primairly in unvaccinated Amish communities.
Currently, the US has very low rates of vaccine-preventable diseases, according to the CDC. But there's some research to suggest more parents are opting not to vaccinate their children as the anti-vaccine movement continues. A study published earlier this year in the journal PLOS One found that, since 2009, there has been an increase in kindergarteners with non-medical vaccine exemptions in 12 of the 18 US states that allow these exemptions.
"As larger unvaccinated populations grow ... the potential for vaccine-preventable disease outbreaks grows," the authors of the PLOS One Study said in a statement.
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