All 50 states require vaccination for public-school attendance, permitting exemptions for medical reasons. All except Mississippi and West Virginia allow religious exemptions, and 20 states let parents skip their students' shots for "philosophical" reasons—often a firmly held belief that vaccines are ineffective or harmful. An Associated Press reporter found the rate of vaccine exemptions has increased in the past five years in over half the states, with exemption rates in some counties higher than 20 percent

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