Vaccination update and the unvaccinated child

Current Recommendations
Under Health Secretary Robert F. Kennedy Jr., the Centers for Disease Control and Prevention (CDC) has altered longstanding recommendations about immunizing children against vaccine-preventable illnesses. CDC has removed immunizations against six diseases from its list of routine childhood vaccinations, reducing the number of diseases that all children are advised to be vaccinated against to 11, down from 17.

The C.D.C. still recommends that all children get vaccinated against:

• Diphtheria, tetanus and whooping cough, which are combined into one vaccine
• Measles, mumps and rubella, also combined into one MMR vaccine
• Polio
• Haemophilus influenzae type b
• Pneumococcal conjugate
• Chickenpox
• Human papillomavirus, but only one dose instead of multiple shots.

The agency no longer recommends that all children receive vaccines against six illnesses, which can be deadly:

• Hepatitis A
• Hepatitis B
• Influenza
• Meningitis
• Respiratory syncytial virus
• Rotavirus

Instead, for most of these six diseases, it recommends that “high risk” children get vaccinated and that parents of other children consult a health care provider about whether the vaccines are appropriate within a framework called shared clinical decision making. This has left many parents feeling uncertain about their ability to contribute to a decision about vaccination because they lack the knowledge and expertise in the science of medicine and are worried about the information purveyed by anti-vax advocates. As a result, some parents are switching to pediatricians who will continue the long-established schedule of vaccinations for babies and children. And many parents and their physicians are abandoning the CDC. as a source of information in favor of the American Academy of Pediatrics broader vaccine schedule, available at: (https://downloads.aap.org/AAP/PDF/AAP-Immunization-Schedule.pdf)

Although vaccines are still available and broadly covered by insurance, the U.S. government’s policy shifts are likely to accelerate an ongoing decline in childhood vaccination rates and an increase in infections. These changes include Secretary Kennedy’s recent appointment of a doctor to head an influential vaccine advisory panel who has suggested that vaccines against measles and polio should be optional. And in September 2025, Florida announced it would become the first state to end all vaccine requirements, including the slate of childhood immunizations that has been required nationwide for decades.

The chances of contracting childhood diseases prevented by vaccination still remains low in most of the U.S., but high national average rates mask far more precipitous drops in some states, counties and school districts. In those areas, falling vaccination rates are creating new pockets of students no longer protected by herd immunity, the range considered high enough to stop an outbreak among those who are unvaccinated. For example, if 95% of children receive the MMR vaccine, this would stop measles spreading completely. However, measles, mumps and rubella can quickly spread again if fewer than 90% of people are vaccinated as is the case in some communities. The result has been the loss of the “eradicated” status for measles in the U.S. and a surge in both measles and whooping cough in some places. For a community, an outbreak can be extremely disruptive. For children, measles and other once-common childhood diseaseshospitalization and life-threatening complications.

The benefits and risks of vaccination, they:

• help to protect both parents and children from many serious and potentially deadly diseases
• protect other people in your family and community – by helping to stop diseases spreading to people who cannot have vaccines, such as babies too young to be vaccinated and those who are too ill to be vaccinated
• undergo rigorous safety testing before being introduced – they're also constantly monitored for side effects after being introduced.
• sometimes cause mild short-term side effects, for example feeling a bit unwell and having a sore arm for 2 or 3 days or feeling tired, having a headache, mild fever, or flu-like symptoms
• It's rare for anyone to have a serious allergic reaction to a vaccination. If this does happen, it usually happens within minutes.
• The person who vaccinates you or your child will be trained to deal with allergic reactions and treat them immediately. With prompt treatment, you or your child will make a good recovery.
• reduce the incidence of, or if enough people are vaccinated even eliminate some diseases.

Vaccines are safe they:

• do not overload or weaken the immune system – it's safe to give children and adults several vaccines at a time and this reduces the number of injections needed
• do not contain mercury (thiomersal)
• do not contain any ingredients that cause harm – only ingredients essential to making them safer and more effective and only in very small amounts
• do not cause autism – studies have found no evidence of a link between the MMR vaccine and autism
•  are thoroughly tested and monitored to make sure they will not cause harm.

Why vaccines are important

• Vaccination is one of the most important things that can be done to protect adults and children against ill health. They prevent millions of deaths worldwide every year.
• Since vaccines were introduced, in many countries, diseases like polio and tetanus that used to kill or disable millions of people are either gone or are now very rarely seen. And smallpox has been completely eradicated in all countries.
• Other diseases like measles and diphtheria have reduced to a very low number of cases each year since vaccines were introduced. These cases are often related to travel.
• However, if people stop having vaccines, it's possible for infectious diseases to quickly spread again.
• The World Health Organization (WHO) has listed vaccine hesitancy as one of the biggest threats to global health.
• Everyone should be up to date with their routine vaccinations to give them the best protection.

How vaccines work

• Vaccines induce the body’s immune system to create antibodies that protect you from diseases.
• It's much safer for your immune system to learn this through vaccination than by catching the diseases and treating them.
• Once your immune system knows how to fight a disease, it can often provide life-long protection.

Herd immunity

• Having a vaccine also benefits your whole community through herd immunity. Herd immunity gives protection to vulnerable people such as newborn babies, elderly people and those who are too sick to be vaccinated.
• If enough people are vaccinated, it's harder for the disease to spread to those people who cannot have vaccines. For example, people who are ill or have a weakened immune system.

Those who cannot safely receive vaccines include:

• People who've had a serious allergic reaction (anaphylaxis) to a previous dose of the vaccine
• People who've had a serious allergic reaction to ingredients in the vaccine
• People without a fully-working immune system, including those without a working spleen
• People on chemotherapy treatment whose immune system is weakened
• People with HIV
• Newborn babies who are too young to be vaccinated
• Elderly people
• Many of those who are very ill in hospital.

For these people, herd immunity is a vital way of protecting them against life-threatening disease.

Health safety for the unvaccinated child––understand the risks
Unvaccinated children are more likely to catch and spread diseases that can cause complications like pneumonia, brain swelling, deafness, paralysis, or even death. They can also infect babies too young for vaccines, people with weakened immune systems, and the elderly. An unvaccinated child can still be kept as healthy as possible, but they remain at higher risk for serious, preventable infections such as measles, pertussis (whooping cough), chickenpox, and meningitis. The safest long‑term strategy is to follow the routine childhood‑vaccine schedule; if there are good reasons for not doing that that, the focus should be on minimizing exposure, optimizing general health, and having a clear plan with your pediatrician.

Keeping an unvaccinated child as safe as possible from infections requires extra layers of prevention and vigilance. While vaccination is the most effective protection, here are practical steps that can significantly reduce risk.

Reduce exposure to infections

• Limit time in crowded indoor spaces (day care, travel, malls, busy waiting rooms, large parties), especially during outbreaks of measles, flu, or RSV. In general, out of doors activities are much safer.
• Avoid contact with anyone who is sick or has recently been around someone with a contagious illness (even “just a cold”}; ask caregivers, visitors, and family members about their health before close contact.
• If there is a local outbreak of a vaccine‑preventable disease (for example measles), follow public‑health guidance on staying home from school, daycare, or group activities.

Strengthen general health and hygiene

• Teach and practice frequent hand‑washing with soap and water (wash for at least 20 seconds), especially before eating, after using the bathroom, and after being in public places.
• Use alcohol-based sanitizer when soap isn’t available
• Ensure the child eats a balanced diet, gets enough sleep, and has regular physical activity to support immune function.
• Keep up with routine well‑child visits so your pediatrician can monitor growth, development, and catch problems early.

Respiratory protection

• Teach the child to cover coughs and sneezes (elbow or tissue)
• Use masks in high-risk indoor settings, especially during outbreaks
• Ensure good ventilation at home (open windows, air purifiers if possible)

Maintain a clean environment

• Regularly disinfect high-touch surfaces (doorknobs, toys, phones)
• Avoid sharing cups, utensils, or toothbrushes
• Wash toys and bedding frequently

Protect the child’s “circle” of contacts

• Make sure parents, siblings, grandparents, and regular caregivers are up to date on their own vaccines (flu, COVID‑19, MMR, Tdap, etc.), creating a “cocoon” of protection around the unvaccinated child.
• Avoid having sick adults or older children kiss the child on the face or share cups, utensils, or pacifiers.
• Ask visitors to stay away if they are ill or recently exposed to infections.

Stay informed

• Be aware of outbreaks in your area (measles, whooping cough, flu, etc.)
• Follow public health guidance closely
• Maintain a good relationship with a pediatrician who knows your child’s vaccination status.

Have a clear medical plan

• Tell every health‑care provider that your child is unvaccinated so they can consider vaccine‑preventable diseases sooner and take extra infection‑control precautions.
• Know the warning signs (high fever, stiff neck, trouble breathing, rash, persistent vomiting, or extreme lethargy) and seek urgent care if they appear.
• Discuss with your pediatrician whether and when catch‑up vaccination might be appropriate, because many vaccine‑preventable diseases have no cure, only supportive treatment. Share the child’s age and which vaccines they’ve missed with their doctor to devise a tailored set of practical steps.

Important note: Keeping an unvaccinated child as safe as possible from infections requires extra layers of prevention and vigilance. Even with these measures, unvaccinated children remain at higher risk for serious infections. If circumstances allow, discussing and implementing vaccination options for an unvaccinated child (including delayed or selective schedules) with a trusted healthcare professional can help reduce risk further.

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