While the nightmare of confinement within a restrictive sect in West Texas may be over for more than 400 children in Texas, the outside world may present them with unique health threats.
A dozen of the children have already been identified as being infected with chickenpox, and experts fear that the outbreak could be seen by the sect's members as an ominous result of being removed from their cloistered world and complicate efforts to care for these children.
"I guarantee you that the chickenpox outbreak will be perceived by the group as a sign of wickedness in the outside world," noted Christopher D. Bader, an associate professor of sociology at Baylor University in Waco, Texas, who studies fringe religious groups. "Every event that happens in [extreme religious sect members'] lives is seen in a religious worldview."
According to the Texas Department of Family and Protective Services, a team of medical professionals comprising 25 mental health professionals, four doctors and 10 nurses are providing care for the children, and 14 more doctors and medical assistants will be arriving soon.
The children were rescued this week from the Yearning for Zion Ranch in the Texas town of Eldorado. They are currently being housed in a shelter in San Angelo, Texas.
"As far as here, overall, the health of the women and children appears at least superficially to be good," says Doug McBride, a spokesperson for the Texas Department of State Health Services, which is in charge of medical care for the children including behavioral health, as well as many of the public health aspects of their sheltering. "My understanding is that there was a physician that was a part of that ranch."
He says that for now, most of the ailments are nothing out of the norm — a few cases of upper respiratory infection and some minor gastrointestinal ailments. He says that the 12 children who are suspected to have chickenpox are being separated from the others to reduce the risk of the disease spreading.
State health experts and infectious disease physicians agree that those with chickenpox were likely infected 10 to 20 days ago — at least a week before they were rescued.
"This belies the notion that you can have kids live in a bubble and protect them from germs and infection," said Dr. William Schaffner, professor and chairman of the Department of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn. "Obviously the chickenpox virus made its way into the compound."
Lack of Vaccinations the Real Threat
While the chickenpox outbreak may be holding the attention of those involved, it turns out that the children may be vulnerable to other, more pressing health threats through a general lack of immunizations.
"We're assuming that none of these children have been vaccinated," McBride notes.
Schaffner says this lack of proper immunization must be dealt with effectively, as these children will be vulnerable to certain infections when they join the rest of society. The good news, he says, is that the high immunization rate among other children in the United States means that the chances of these children acquiring these infections in the near future is limited. But in the longer term, a real health threat exists.
"There is not any doubt that unless these children grow up and remain in this sort of 'bubble' of a community, there would be some risk for these children, as they get older, to acquire these illnesses," Schaffner says. "If they left the compound or went outside the U.S., obviously there would be a risk."
For now, the biggest threat to these unvaccinated children is that of tetanus infection.
"If any child injures themselves and gets a cut or a scratch or other injury, there is always the risk of tetanus complicating that injury," Schaffner says. "The health care providers need to be reminded that the child has not been previously vaccinated."
Protecting the Children's Health
Despite the potential threat from lack of vaccination, health officials have not yet decided whether or not to start immunizing the children.
"The idea of vaccination is under consideration, McBride says, adding that to his knowledge, none of the children are legally exempt from getting the full complement of vaccinations.
But if and when such an effort does begin, Schaffner says that the children will likely be subject to a series of "catch-up" immunizations to help protect them against disease.
"It would be a period of weeks, and in some cases months, before all of these children could be protected ideally with vaccines," he says.
For tetanus, for example, a child receiving his or her first shot today would receive a second dose in about a month. The third and final dose would then be given six months to a year later. Only after that last dose would a child be fully protected.
But there are several diseases against which the children need to be vaccinated. And presenting these already traumatized children with a battery of several shots all at once could be a challenge, according to reports from some relief workers.
"I don't know what they've been told about us, but it's not good," Barbara Arendt, a volunteer who helped receive the children at the Baptist Church at El Dorado, told ABC News. "My understanding is that they are told we are from the devil."
Schaffner says the key to bridging these fears is education and understanding.
"These kids are going through a substantial culture shock," he says. "This has to be done with support, comfort, loving care and reassurance that this is what these kids need. You really have to impress upon a child that this is a good thing, that it will protect you and make you stronger."
And according to McBride, the substantial efforts to provide these children with health care are going smoothly so far.
"I think they're overall receptive to the medical care," he says. "In general they have been very grateful for the care, and I don't know of any real problems."