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California lawmakers on Monday sent the governor a contentious bill that would impose one of the strictest school vaccination laws in the U.S. after a series of emotionally charged debates that followed a measles outbreak.

The state Senate reaffirmed the bill striking California’s personal belief exemption for immunizations. Mississippi and West Virginia are the only two states with such strict requirements in place. If the bill becomes law, medical exemptions would still be granted to children with serious health issues.

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