By Chris Adams

Dr. Nathaniel Smith, secretary of health in Arkansas, has been on the front lines of a handful of infectious disease outbreaks – including those involving diseases that were once virtually eradicated in the United States.

In a session with National Press Foundation fellows, Smith detailed how the Arkansas Department of Health handled outbreaks of mumps and hepatitis A, how it is preparing for any potential measles cases, and how exemptions and waivers from vaccinations impact disease rates.

The outbreak of mumps in 2016 was the second largest in the United States since mumps vaccinations started. Before the U.S. mumps vaccination program started in 1967, about 186,000 cases were reported each year, according to the Centers for Disease Control and Prevention. In 1989, the two-dose MMR – measles, mumps, rubella – vaccine was introduced and mumps cases dropped more than 99%.

In recent years, however, they have crept up, including in Arkansas. In all, the state saw 3,000 cases during the outbreak, in 37 of the state’s 75 counties, with a concentration in the northwest corner of the state. They were primarily among immigrants from the Marshall Islands – and primarily among children who had been vaccinated. The state found that giving a third booster dose to children helped restart their protection.

The hepatitis outbreak was in the northeast corner of the state and concentrated among people who had injected drugs. The state has given more than 30,000 vaccinations to people since the beginning of the outbreak.

He also described the process by which people can get exempted from vaccine mandates. Using medical, religious and philosophical justifications, such exemptions have risen dramatically in the past two decades, from a few hundred a year to more than 8,000.

Even when diseases such as measles pop up, some people and communities remain hesitant or hostile to vaccinations.

“Some of the communities that have the lowest vaccination rates – they have reasons that may not be very changeable,” he said.