Chickenpox cases have skyrocketed at a North Carolina school where many families claim religious exemption from vaccines.

The Asheville Waldorf School had 36 infections as of Friday, The Washington Post reported. It is the worst outbreak in the state since the vaccine became available 20 years ago.

“The school follows immunization requirements put in place by the state board of education, but also recognizes that a parent’s decision to immunize their children happens before they enter school,” the school said in a statement to Blue Ridge Public Radio.

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The Asheville Waldorf has one of the highest religious vaccination exemption rates in North Carolina, the Post reports, citing data from the state's Department of Health and Human Services.

As of the 2017-18 school year, 110 of the school's 152 students had not received the vaccine, the Citizen-Times reported.

North Carolina requires that all students receive certain immunizations including chickenpox, but allows for exemptions on religious grounds or at the advice of a physician.

The medical director for Buncombe County, N.C., tied the outbreak to low immunization numbers in a news release.

"We want to be clear: Vaccination is the best protection from chickenpox," she said.

"When we see high numbers of unimmunized children and adults, we know that an illness like chickenpox can spread easily throughout the community — into our playgrounds, grocery stores, and sports teams."

The chickenpox vaccine is 90 percent effective according to the Center for Disease Control and has effectively destroyed a disease which once affected many Americans.

Vaccination is not prohibited by most religions, but many parents in the U.S. have expressed worry about adverse reactions to vaccines due to misinformation spread about their uses.

A poll for Research America in May found that 70 percent say vaccinations for diseases like measles and polio are “very important.” That number was down from the 80 percent in November of 2008 who said the vaccines are crucial.

While there can be some allergic reactions and other issues, the medical community has debunked the vast majority of these fears and the World Health Organization encourages vaccination.