At the beginning of each school year, the school-nurse coordinator for the 3,000-student Ashland, Oregon, district plans a "parent's night" around the topic of vaccinations for the safety and health of children. That is only the beginning of the school-nurse coordinator's contact with parents who are skeptical about the necessity of immunizations, a routine part of preventative care for most families. While the vaccination-exemption rate for kindergarten students in Oregon is around 4%, in Ashland, about 28% of kindergarten students have exemptions on file, meaning they are missing one or more of the 10 vaccines required by the state for their grade. As the United States prepares for a fall resurgence of H1N1, or swine- flu virus, the role of schools in the public-health effort to prevent illnesses is drawing more attention. A recent National School Boards Association survey of 485 districts found that about three-quarters said they would allow vaccinations to take place in school buildings. Even though vaccines are mandatory for public school attendance, all states permit medical exemptions, with 48 allowing them for religious reasons and 21 for personal beliefs. Each state decides how easy or difficult it will be for a parent to obtain an exemption to a vaccine. A June study in "Pediatrics," the publication of the American Academy of Pediatrics in Elk Grove, Ill., showed that parental refusal of the pertussis, or whooping cough, vaccine was associated with a greater risk of pertussis infections. "This study helps dispel one of the commonly held beliefs among vaccine-refusing parents: that their children are not at risk for vaccine-preventable diseases," according to the study's lead author. In March 2005, a study in the "American Journal of Public Health" explored the school role in implementing school immunization requirements. That survey showed that a child attending a school that had a school nurse on staff was significantly less likely to have an exemption than a school where immunization information was handled by someone other than a nurse.