Unvaccinated Children in Pediatric Care: To Accept or Not?

A pregnant woman at 35 weeks’ gestation with her second child seeks to register her children as new patients. However, the couple refuses the measles, mumps, and rubella (MMR) vaccine due to concerns about a possible link to autism. This raises the question of whether a pediatric practice should accept them despite their unvaccinated status or require proof of immunization before registration. Experts argue differently.

The parents express a fundamentally critical attitude toward vaccinations. Their older daughter has received two doses of vaccines against hepatitis B, diphtheria, tetanus, pertussis, and Haemophilus influenzae type B but has not been vaccinated against pneumococcus, polio, influenza, or COVID-19. The same approach is to be followed for their second child. Efforts to convince the parents of the importance of the MMR vaccine in protecting both their children and the broader community have been unsuccessful.

Pediatricians often face the dilemma of whether to accept unvaccinated children into their practice or require proof of MMR vaccination before enrollment. In an article published in The New England Journal of Medicine, Ann Cheung, MD, from the Department of Family Medicine and Community Health at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin, and colleagues explored this complex issue.

Practices Reject Unvaccinated Children

Sean T. O’Leary, MD, MPH, from the University of Colorado Denver, emphasized that patient refusal must always be carefully considered from a legal, moral, and ethical standpoint. Despite this, about half of pediatric practices in the United States refuse to accept children whose parents decline the MMR vaccine. However, it remains uncertain whether this policy increases vaccination rates in these children.

O’Leary advocated for accepting unvaccinated children into the practice. He argued that the child is not responsible for the parents’ decisions and may receive suboptimal medical care elsewhere if turned away. There was also a risk that the family might seek care from physicians who opposed vaccination entirely. By keeping these children in the practice, pediatricians have opportunities to educate parents and potentially encourage them to accept other routine vaccinations — and, with enough trust, perhaps even the MMR vaccine.

According to O’Leary, many justifications for rejecting unvaccinated children do not hold up under scrutiny. Some argue that allowing unvaccinated children into a pediatric practice increases the risk of disease transmission to others. However, due to herd immunity, the likelihood of measles transmission in a medical office is considered very low. Additionally, practices could isolate unvaccinated children in a separate waiting area, similar to measures used during the COVID-19 pandemic.

Vaccination Rates

Jonathan L. Temte, MD, PhD, from the University of Wisconsin, took the opposite stance, arguing that children should only be accepted once they receive the MMR vaccine. He pointed to the Centers for Disease Control and Prevention, which declared measles eliminated in the United States as a direct result of high vaccination rates.

At the time, nearly 1 million children worldwide died of measles annually due to lack of vaccine access. However, in 2012, the United States acknowledged that measles elimination had failed, as the disease became endemic again. The resurgence was linked to gaps in vaccination coverage, particularly among school-aged children in some states, which allowed endemic transmission after cases were imported from abroad.

Vaccine Safety

Temte emphasized that MMR vaccines are both safe and highly effective, and concerns that they contribute to neurologic developmental disorders such as autism have been thoroughly debunked. In contrast, measles has a high morbidity and mortality rate, and infection can erase immune memory for other pathogens, increasing susceptibility to secondary infections.

Another major concern is the financial burden of measles treatment, which can place a strain on healthcare systems. While measles incidence remains low, the disease is highly contagious and spreads through aerosol transmission, making it impossible to fully eliminate the risk of exposure in a waiting room. This poses a significant threat to unvaccinated infants and immunocompromised children, who rely on pediatric clinics as safe environments.

For Temte, refusing to accept unvaccinated children is an ethical obligation — a necessary measure to protect vulnerable patients and uphold public health standards.

This story was translated from Coliquio using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.