A North Carolina school with a large anti-vaccine community is at the heart of the state's largest chickenpox outbreak in decades, officials say.
On Friday 36 students at Asheville Waldorf School were diagnosed with the disease, the Asheville Citizen-Times newspaper reported.
The school has one of the state's highest rates of religious exemption, allowing students to skip vaccination.
US health officials say vaccinating is far safer than getting chickenpox.
"This is the biggest chickenpox outbreak state health officials are aware of since the vaccine became available," a North Carolina Department of Health spokesman told the BBC in an emailed statement.
Out of the Waldorf School's 152 students, 110 have not received the vaccine for the varicella virus, known to most as chickenpox, the Citizen-Times found.
And 67.9% of the school's kindergarten students had religious immunisation exemptions on file in the 2017-2018 school year, according to state data.
At least it is "only" chickenpox. which (usually) isn't serious in children. There is a whole raft of far more serious diseases that children are susceptible to if they are not routinely vaccinated. Is it time to implement some kind of punitive measures on parents that refuse to have their children vaccinated? Does the Anti-Vaxxer movement pose a threat to public health at large? Is there any way to educate parents to dispel the myths surrounding vaccinations?
I hope that this acts as a wake-up call to the parents whose children are involved in this outbreak. It is unfortunate, but I believe that their children being affected by the diseases that the vaccinations are supposed to protect against is one of the only ways that these parents will actually learn, such is the intractability of their opinions.
I'm actually on the fence regarding punitive measures against the parents. On the one hand I believe that the risk to public health is serious enough to warrant routine vaccination, but I cannot imagine any measures taken against the parents that wouldn't indirectly affect the child in some way. And the thought of children being dragged off to be vaccinated against their parents' will just comes across as abhorrent.