There's concern diseases like measles could spread to the islands. Part of the worry comes from the latest data that shows the percentage of kids not vaccinated in Hawaii's schools. 

State law requires all students from kindergarten to 12th grade to meet immunization requirements to go to school. That includes vaccines and shots like Polio and Measles, Mumps and Rubella. But some health officials are worried about those who are exempt because of religious or medical reasons.

"It's something we've been monitoring for some time and we're continuing to monitor the numbers of those who've been requesting religious exemption is suddenly rising, especially in the past decade," Dr. Sarah Park, Hawaii State Epidemiologist, said.  

The data from the department got figures from 409 schools in the state. Haleakala Waldorf School on Maui tops the list with the most un-vaccinated kids by percentage at 52.7 percent. Some say the consequences of not vaccinating goes beyond the classroom. 

"Folks who say it's their choice. Well, you live in this community, our community and your choice to not be vaccinated impacts the health of everyone around you," Park said. 

Nine out of the top 10 schools with the highest percentage of un-vaccinated kids are on neighbor islands.

"There are a lot of schools that opened up in rural areas and in areas where it was most needy, far away from the closest hospital or convenience stores. Those might be contributing factors but we'd really need to look into the data," Sione Thompson, executive director, Hawaii State Public Charter School Commission, said.

To improve vaccination rates and prevent outbreak, Park wants to spread the word through educational resources for parents and the community. 

"We need to make sure we can reach out to the community and make sure where we can to offer education, resources and not just for our community but to our healthcare providers to help them to talk to their patients," Park said. 

It's a partnership some educators agree with. 

"I have full confidence that as we look into this and if there's resources that we need to better provide to our communities. I'm very very happy to obliged," Thompson said. 

You can see the full exemption list here.