Non-medical exemptions from childhood vaccinations have been on the rise in the US over the past two decades.[1] Analysis of county-level data showed significant variation in the rates of these exemptions between counties and states.[1] These exemptions increase the risk of disease outbreaks in groups of children with a high concentration of exemptions.[1] "Hot spots" with large numbers of unvaccinated children occur mainly in metropolitan states with benevolent laws.[1] The American Academy of Pediatrics (AAP) supports ending non-medical exemptions for schools and daycares and recognizing only medical exemptions.[2] Only five US states allow exclusively medical exemptions.[2] State mandatory vaccination laws are effective in preventing vaccine-transmitted diseases.[1] It is necessary to continue monitoring to assess changes in vaccination policies.[1]