ASHEVILLE - Buncombe County — already at the top of the state's list — is nearing its all-time high of religious vaccine exemption rates.

The county Health and Human Services Department said 4.91 percent of area kindergartners had a religious vaccine exemption during the 2016-17 year, meaning they didn't get at least one vaccination required to attend school. That's almost five times higher than North Carolina's 1.1 percent rate, and close to Buncombe's 5 percent rate two years ago.

Some area schools, where parents with similar opinions on vaccinations cluster together, have rates as 20 percent, said Dr. Jennifer Mullendore, medical director of the county Health and Human Services Department.

From 2015: Buncombe has NC's highest vaccine exemption rate

"We believe that everybody wants the best for their kid," she said. "We never think that they're trying to bring harm to their child. But the concerns they have about vaccines may be based on misinformation."

North Carolina allows two types of vaccine exemptions: medical, which requires proof from a properly licensed physician; and religious, which under state law requires a non-verifiable written statement for "bonafide" religious objections.

Mullendore said the county's medical exemptions have remained steady and far below 1 percent. Typically, less than five of the 2,400 kindergartners entering school each year obtain a medical exemptions.

But religious exemptions have gradually increased in number since the 1990s, according to county data. Buncombe's religious exemption rate was 0.62 percent 17 years ago, reaching 3.81 percent by 2010. While it has dropped some years since then, it hasn't been below 3 percent for nearly a decade.

Mullendore said the rise in vaccine exemptions can be seen throughout the U.S., though some states have made moves to tighten their laws. Such bills largely have failed in North Carolina, where religious exemptions are submitted by parents without any required verification from religious leaders and are not submitted to the state for review.

"It appears that people use that when actually what they have is a philosophical exemption," Mullendore said. "We don't allow a philosophical exemption in this state. Some states do."

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Mullendore said it's possible Buncombe's large concentration of naturopathic providers — and supporters of alternative medicine — contributes to the high exemption rates. While the vast majority of parents are vaccinating their children, even seemingly small exemption numbers can be concerning, she said.

The county has seen several chickenpox outbreaks at local schools, she said. Children who have been exposed but cannot prove their immunity, either by lab results or a shot record, could be directed to stay away from school for at least 21 days.

Mullendore said parents should speak to their medical providers and learn the health consequences of skipping vaccinations. Lower immunization rates have helped nearly eradicate vaccine-preventable diseases that once injured, disabled and even killed people, she said.

Parents have 30 days after school starts to turn in immunization records.

"We've become complacent because we have the luxury of being complacent," Mullendore said. "If you go to certain countries in this world, you will see measles and you will see polio. You will see those things. It's a plane ride away."