Recent outbreaks of vaccine-preventable diseases and a growing immunization opt-out rate are pushing physician organizations in California and Vermont to seek greater restrictions on exemptions from school-entry immunization requirements.

Every state allows exemptions for children with medical contraindications verified by a physician, and all but two states let parents with religious objections skip immunizing their children.

An additional 20 states allow exemptions based on parents’ philosophical or personal beliefs. Requirements for securing personal-belief exemptions vary by state but are often as easy as signing a form.

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