Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization

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Abstract
Control of vaccine-preventable diseases in the United States has been achieved in part by implementation and enforcement of mandatory vaccination for school entrance in every state.1,2 Despite challenges to immunization laws, the courts have upheld such laws, citing the substantial public health benefit afforded to society by vaccination.3 Yet, to address concerns regarding mandatory vaccination, many states allow personal exemptions from vaccination. Religious exemptions are permitted in 48 states and philosophical exemptions in 15 states.4 Exemptions based on medical grounds are allowed in all states.