{'fraction_non_alphanumeric': 0.0180623973727422, 'fraction_numerical': 0.021346469622331693, 'mean_word_length': 5.251282051282051, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Mandatory Immunization Laws and the Role of Medical, Religious and Philosophical Exemptions

Background Immunizations are among the successful public health interventions in preventing morbidity, mortality and health care costs. One of the strategies used in the US to control vaccinepreventable diseases (VPDs) has been state laws mandating vaccination for school entrance. There are no federal laws mandating vaccinations. All laws requiring vaccination are and always have been at the state or local level. Massachusetts passed the first immunization law in the US in 1809, requiring smallpox vaccination. 1 Over time, many other jurisdictions and states enacted similar laws. Twenty states required immunization against certain diseases for school entrance in 1963. In 1970, 29 states had such laws. A landmark study by Robbins, et al, in 1969 demonstrated that states with laws covering the total school population and that actively enforce such laws were correlated with lower rates of measles. 2 This study prompted attention to be paid not only to the existence and nature of school immunization requirements, but additionally the importance of enforcement. By 1980, all 50 states had school immunization laws.