Child vaccination rates are declining in several states that had previously led in vaccination efforts, with some areas experiencing outbreaks of diseases such as measles and whooping cough. The decline in vaccination rates is attributed in part to expanded exemptions, although the extent to which this is a national trend is unclear, with some areas reporting steady rates. Reports also suggest that some pediatricians may not be following the recommended vaccination schedule, while others note that enforcement of vaccination policies may be inadequate in certain regions.