New docs get schooled in old diseases as vax rates fall

• Lingering vaccine hesitancy and distrust of the medical establishment stoked by Health Secretary Robert F. Kennedy Jr. are leading some health systems to add training on old scourges that were practically wiped out by immunization campaigns and increased surveillance.

"You're taught these things in medical school, and you're taught from a very academic perspective with the sense of measles was eradicated in 2000," said Nicholas Cozzi, EMS medical director at Rush.

• "Now we're having a resurgence, the highest in 25 years, and you might have not reviewed that since the first year of medical school," he added. "It's a new paradigm and a new normal that we have to adapt to."

The big picture: The focus is particularly acute on childhood illnesses such as measles, chicken pox, invasive strep pneumoniae and pertussis, experts told Axios.

• Polio and diphtheria, covered by the DTap vaccine, are also a concern. An unvaccinated 10-year-old boy died in Germany after contracting diphtheria, once the leading cause of premature death of children.
• Rubella — a less easily transmitted infection covered by the MMR vaccine — can also be a threat, because of the way it can infect a fetus during pregnancy, said Catherine Troisi, professor at UTHealth Houston School of Public Health and chair-elect of the International Network of Epidemiology in Policy.
• Vaccination rates for U.S. kindergartners were down slightly in 2023-24 for the DTap, polio, chickenpox and MMR shots, according to CDC data.

Zoom in: Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, said rotavirus is another old disease that's being introduced to younger doctors.

• "That virus dominated my residency [in the 1970s]. We had 400 kids admitted every winter," Offit said. That was before a vaccine was licensed in 2006 and virtually eliminated 70,000 hospitalizations with severe diarrhea annually, he added.
• "Now it's the rare child who ever gets admitted. Most pediatric residents have never seen a case of rotavirus-induced dehydration in the hospital," he said.

Between the lines: Incidents such as the measles outbreak in Texas and Kennedy's recent changes to federal vaccine policy are heightening vigilance and forcing updates to physician training.

• It will likely take time for medical schools and residency programs to formally change their training, Troisi pointed out.
• Medical professionals are being advised to stay current on public health advisories, ask patients about travel histories and be on guard for less likely conditions that may present as more common ailments.

They may also have to brush up on best practices for spinal taps in infants and toddlers, an invasive diagnostic tool that is seldom used today but can quickly turn up telltale signs such as inflamed membranes, said Adrianna Cadilla, a pediatric infectious diseases specialist at Nemours Children's Health in Orlando.

• "When I trained, I would hear my attendings tell us about how often they had to do lumbar punctures because that was when Hemophilus influenza type B was running rampant," Cadilla said. "I only got to do probably one every ER shift, but that was a lot in comparison to now."
• The hospital is using simulations to get medical students and residents more experienced in doing spinal tap on infants and wriggling older children, she said.

What to watch: New outbreaks could force more on-the-fly adjustments, especially in areas with low vaccination rates and the prospect of fewer recommended childhood immunizations.

• Artificial intelligence is an emerging as a valuable tool in more quickly recognizing the medical conditions that may be of greater concern, Cozzi said. "That's a game changer," he said.