Previously controlled vaccine preventable diseases (VPDs) are in resurgence.1,2  To date, there have been 477 confirmed measles cases in the United States in 2014, the most in 18 years. In 2013 there were ∼25 000 pertussis cases in the United States. Vaccine refusal has been associated with outbreaks of invasive Haemophilus influenzae type b disease, varicella, pneumococcal disease, measles, and pertussis.8–12 

Even while national and statewide immunization coverage remain high, rates of parents who refuse vaccines via nonmedical exemptions (NMEs) to school immunization requirements have been increasing.13,14  Furthermore, NMEs cluster geographically,9,10  leading to critical reductions in herd immunity and a perfect storm for sustained transmission, outbreaks, and increased risk of VPDs to both unvaccinated and vaccinated individuals.7,9,10,15,16 

Beyond active refusal, many parents are delaying...

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