Outbreaks linked to declining vaccination rates are threatening to overwhelm hospital emergency departments — most of which aren't fully prepared to treat sick kids.

Why it matters: More than 35 million children are taken to emergency rooms each year, but most go to local hospitals that see fewer than 10 children a day.

• Only about 17% of hospitals met standards for high pediatric readiness in the most recent national study of nearly 5,000 emergency departments.

Driving the news: Medical groups including the American Academy of Pediatrics and American College of Emergency Physicians today released updated guidelines for pediatric emergency care.

• The groups say the recommendations could save an additional 2,100 lives annually if adopted.

"When families see a large sign that says 'emergency,' there is an assumption that they can handle any emergency," said University of Texas pediatrics associate professor Katherine Remick, a lead author of the new standards.

• But emergency rooms that are behind the times "will struggle to be able to effectively care for those most critical children," she told Axios.

Between the lines: The revised standards come after studies showed hospital pediatric readiness stagnated from 2013 to 2021.

• There's also been a steady decline in pediatric inpatient services and consolidation of pediatric admissions in urban hospitals over the past decade that's resulting in longer travel distances for these services.
• Children's health has declined overall in the U.S. over the past 17 years as these trends have taken hold.

Zoom in: The new recommendations say emergency departments should periodically assess all staff members' knowledge of child-specific emergency care, keep a portable pediatric resuscitation cart ready and come up with a triage system specific to kids.

• ERs should also appoint nurse and physician pediatric care coordinators.
• That recommendation has been made before — and 42% of emergency rooms met the guidelines in 2013. But that dropped to less than 30% during the COVID-19 pandemic, per the technical report accompanying the updated recommendations.

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Congressional negotiators early Tuesday released a bipartisan health care package that revives major parts of the legislative deal that was torpedoed in late 2024 by Elon Musk and then President-elect Trump.

Why it matters: The agreement includes long-stalled priorities like an overhaul of pharmacy benefit manager business practices and new controls on how hospitals bill for outpatient services.

• The package does not include an extension of enhanced Affordable Care Act subsidies, which Democrats want but has hit resistance from GOP leadership.

What's inside: The package includes renewals for expiring health care programs covering community health center funding and Medicare flexibilities to pay for telehealth.

• It includes language aimed at lowering drug prices that would no longer base PBMs' compensation on the price of a drug in Medicare Part D, which critics have said discourages the use of cheaper treatments when available.
• Another provision would take a preliminary step to addressing Medicare hospital spending, by requiring hospital outpatient departments to have unique identifier numbers in an effort to prevent overbilling.

If the package is not derailed, the deal would be brought up for a vote along with the next government spending package later this month.

• The health care funding bill also released Tuesday includes $48.7 billion for the National Institutes of Health, a small increase that rejects the deep cuts proposed in President Trump's budget request.

President Trump unexpectedly waded into the Louisiana Senate race over the weekend and endorsed a prospective GOP primary challenger to Senate health committee chair Bill Cassidy.

Why it matters: Trump's announcement on Truth Social could complicate Cassidy's relationship with the administration, which has grown testy since he supplied a key vote to confirm Health Secretary Robert F. Kennedy Jr. and shepherded other important health nominations.

• Cassidy would play a key role in any forthcoming debate over a new package of health care measures dubbed the Great Healthcare Plan that Trump is pressing Congress to pass.

Driving the news: Trump told Rep. Julia Letlow (R-La.) in March that he would support her if she decided to challenge Cassidy, but that he would lie low to avoid clashing with physician-lawmaker, the New York Times reported.

• Letlow, who hasn't yet committed to the race, posted on X that she was honored by the endorsement and that the Senate seat "belongs to the people of Louisiana, because we deserve conservative leadership that will not waver."
• Cassidy responded with his own X post, saying he's running as a principled conservative who gets things done. "If Congresswoman Letlow decides to run I am confident I will win," he wrote.
• MAHA PAC, a group aligned with Kennedy, pledged $1 million to support a challenge to Cassidy, MS NOW reported.

Cassidy worked hard to mend relations with Trump after voting to convict him in his second impeachment trial. Senate Majority Leader John Thune (R-S.D.) had pushed Trump to support Cassidy, noting possible consequences for key votes the rest of this year, the Times reported.

Kids' flu shots are lagging compared with last year, even amid what's shaping up to be a historically nasty influenza season tied to the so-called "super flu."

Why it matters: Childhood flu vaccination has been trending downward for the past several seasons.

Driving the news: Uptake among kids aged 6 months to 17 years is down 1.5 percentage points nationally as of Jan. 3 compared with the same time last year, per the CDC's latest data.

By the numbers: Oklahoma (+31 percentage points), South Carolina (+14.6) and Delaware (+12.6) are among the handful of states notably outperforming last season's childhood flu vaccination rates as of Jan. 3.

• Rates are notably down compared with last season so far in Rhode Island (-16pp), Tennessee (-14.4) and Massachusetts (-10.7).

The Trump administration recently changed its flu shot recommendations for kids, part of a broader overhaul of the childhood vaccination schedule.

• Instead of recommending the flu shot for all kids, it's now advising parents to consult with their doctors first.

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