JACKSONVILLE, Fla. – As the number of measles cases in the United States hits the highest levels in two decades, the number of parents choosing to not vaccinate their children against the measles and other diseases is getting more attention.

In Florida, a single piece of paper – the religious exemption form – can allow a parent to opt their child out of vaccinations.

According to the Duval County Health Department, an average of 96% to 98% of students here get all of the required vaccinations. But, the department has seen an increase in the number of parents requesting a religious exemption for their children. Dr. Pauline Rolle, the interim director of the Duval County Health Department, said the number of local families filing for that exemption is still below the national average.

SEE THE NUMBERS: County-by-county | School-by-school

News4Jax requested records from the state detailing immunization statistics for public and charter schools throughout Florida. Each school year, the state collects data on kindergarten and seventh-grade students, assessing the number of students who are immunized, or have a religious or medical exemption. We noticed numerous schools throughout Northeast Florida with rates of religious exemptions higher than the statewide rate for public schools: 2.6% for kindergartners, and 1.5% for seventh-grade students.

Top ten area schools with the highest rates of religious exemptions

We went to one St. Johns County school with a higher-than-average vaccination rate, Valley Ridge Academy in the Nocatee area. At that school, just over 5.5% of kindergarten students are covered by a religious exemption. Most parents were not comfortable publicly voicing their opinions about vaccines, but one mother did agree to speak, if she didn’t identify herself.

“Vaccinations are very touchy,” the mother said. “People have very strong opinions on it one way or the other, even on blogs it blows up whenever the topic comes up."

The mother’s three children have all had their shots, but she has family members who don’t vaccinate. She remembers a time three years ago when her twin girls were babies and she was worried about their health in a public space.

“I was concerned because there was an outbreak at one of the theme parks and my girls were that age where they hadn't been vaccinated so there was a concern,” the mom said.

That mother’s concern is one thing that worries doctors as well, when the choice to not vaccinate exposes other vulnerable kids to disease.

“Over the years we have depended on the community to look out for those folks by getting vaccinated, and one thing about herd immunity, if you have enough people getting vaccinated in the community that provides some level of immunity,” Rolle said.

County-by-county exemption rates

Among Northeast Florida counties, Flagler County had the highest rate of religious exemptions among kindergartners for the 2018-2019 school year, at 4.8%. At the opposite end was Union County, where 0.9% of the kindergartners had the exemption. Statewide, Sarasota County had the highest rate at 8.1%.

Among seventh grade students, Columbia County was highest, with a 3.6% religious exemption rate. At the other end of the scale, Bradford County had no seventh-grade students covered by a religious exemption. As with kindergartners, Sarasota County had the highest rate in the state for seventh-grade students with a religious exemption, at 4.8%.

Click here to view an interactive map of countywide immunization data

It's not recommended for children to get the MMR vaccine, which protects against measles, mumps and rubella until they’re 1 year old, and there's a segment of the population that can’t get vaccinated for medical reasons. These groups rely on the masses to get their vaccines to protect those who can't. Rolle said people have forgotten what the dangers of disease look like.

“Most people are not concerned until it directly affects them, and so when we start to see that happen we'll see people start to get their children vaccinated, and themselves for that matter,” Rolle said.

In most states, parents are able to file for a religious exemption from immunization. In Florida, it’s a simple one-page form, requiring basic information about your child, a parent or guardian’s signature and a visit to the health department for another signature.

“Every parent has a right to make a decision for their child to get them vaccinated. So we don't ask questions in regards to that,” Rolle said. “A parent comes in and says they want a religious exemption we give it to them. We offer them on a walk-in basis and by appointment.”

Rolle said that after a parent files for the religious exemption, the health department is unable to track whether the child ever gets vaccinated. Parents might allow some vaccinations, or space them out, but that information is not required to be reported. Rolle said that can be frustrating.

“It can be, in terms of tracking potential disease outbreaks,” said Rolle. “If we could have 100% data on who's truly unvaccinated and who's not then it makes it easier to determine where we need to focus our efforts.”

Making vaccines available for families

Rolle said the goal is to educate parents about vaccinations so they're not avoiding them because they're scared, misinformed or think they're unaffordable. Vaccinations are available at local health departments for free. You can contact your local health department for more information:

Immunization data for Northeast Florida public & charter schools:

Search by district or school name in the box below and click the plus sign in the table to see more details about a school: