Diseases Once Rare in Children’s Hospitals Return as Vaccination Rates Decline Nationwide
Doctors across the United States say they are treating children for illnesses that routine vaccinations once made increasingly uncommon, raising concerns that years of declining immunization rates are beginning to reverse decades of public health progress.
Pediatricians have described seeing more cases of whooping cough, rotavirus infections, bacterial pneumonia, and other potentially life-threatening illnesses that vaccines have long helped suppress. Some physicians reported treating conditions they rarely encountered during their careers, while others said growing vaccine hesitancy is changing the way emergency rooms and hospitals care for children.
The reports come as measles outbreaks continue to spread across multiple states and vaccination coverage remains below federal public health targets.
Johns Hopkins University’s International Vaccine Access Center reported 2,077 confirmed measles cases nationwide as of May 29. Researchers warned that outbreaks reported across the country have raised concerns about continued transmission, additional hospitalizations and deaths, and the possible loss of the nation’s measles elimination status.
Public health experts have long viewed measles as a warning sign because of its ability to spread rapidly through communities with lower vaccination coverage. The New York Times reported that physicians increasingly fear the resurgence of measles may be followed by the return of other vaccine-preventable diseases.
Doctors say that it is already happening.
Dr. Meghan Hofto, a pediatric hospitalist at the University of Alabama at Birmingham, said she has already treated roughly as many children with rotavirus this year as she saw during the previous decade. Rotavirus once caused tens of thousands of hospitalizations annually before vaccines sharply reduced its spread. None of the children she treated this year had been vaccinated.
Hofto also described caring for infants with pertussis, commonly known as whooping cough, who appeared stable before suddenly struggling to breathe.
“It’s hard to know when they’re safe to go home,” Hofto told the Times.
The rise in whooping cough cases has been particularly striking. More than 28,000 cases were reported nationwide last year, compared with approximately 7,000 in 2023, according to figures cited by The Times. Many of the affected infants were too young to receive vaccinations themselves and relied on broader community protection to reduce their exposure.
Other doctors described similarly troubling cases.
Dr. Jessica Kirk, a pediatric hospitalist in Alabama, recently treated an unvaccinated toddler hospitalized with pneumonia caused by simultaneous infections of Haemophilus influenzae and Streptococcus pneumoniae. Vaccines exist to protect against both illnesses. The child required oxygen and antibiotics to recover.
According to numerous doctors, infections caused by H. influenzae and S. pneumoniae can lead to sepsis, meningitis, and severe pneumonia. Some emergency room physicians reported performing spinal taps and other invasive testing on unvaccinated children with high fevers because they could no longer safely assume protection from diseases that had become uncommon during the vaccine era.
Researchers at Johns Hopkins have been tracking vaccination trends nationwide and found continuing signs of vulnerability.
The International Vaccine Access Center has launched a national monitoring project examining childhood immunization coverage, exemption policies, and legislation affecting vaccine access across all 50 states and the District of Columbia. The effort was created to provide policymakers with data on childhood vaccination rates and factors affecting immunization uptake.
At the same time, vaccine policy has become increasingly contentious in state legislatures.
Johns Hopkins researchers reported that lawmakers across the country continue to introduce bills affecting childhood vaccination requirements, vaccine access, and non-medical exemptions. Researchers also noted that state policies governing exemptions remain a significant factor in vaccination coverage and disease transmission risks.
Another recent initiative, the Vaccine Policy Atlas developed by American Families for Vaccines and Johns Hopkins’ International Vaccine Access Center, was created to help states understand how their laws interact with federal vaccine recommendations and how changes in federal advisory processes could affect vaccine access. The Atlas notes that states differ significantly in how vaccine requirements are written into law and how they incorporate recommendations from federal health authorities.
Physicians have said vaccine skepticism has expanded beyond childhood immunizations.
Several reported seeing more adults refuse tetanus shots after injuries such as dog bites or cuts from contaminated objects. One physician recalled patients rejecting tetanus vaccinations because they distrusted pharmaceutical companies or believed doctors were financially rewarded for administering vaccines.
Doctors also reported growing resistance to other preventive treatments. Researchers found that some patients have refused blood transfusions because donors may have received vaccines, while some parents have rejected vitamin K injections for newborns. Five physicians reported they had seen brain or abdominal hemorrhages in infants whose parents declined vitamin K treatment, including one child who died and another who suffered partial paralysis.
Health officials continue to stress that vaccination remains the most effective defense against measles and many other preventable diseases. Johns Hopkins researchers noted that unvaccinated individuals or those with unknown vaccination status account for nearly all measles cases reported during the current outbreaks. Two doses of the measles vaccine are estimated to provide 97% protection.
For doctors confronting the return of illnesses that vaccines once pushed to the margins of American medicine, the challenge is becoming increasingly personal.
“It just feels like you’re a tiny little boat with a giant tidal wave coming at you,” Dr. Erin Charles, a regional pediatric hospitalist at Seattle Children’s Hospital, told reporters. “And you might convince one family here and there.”
Doctors interviewed said illnesses that now appear sporadically could become much more common if vaccination rates continue to decline. Dr. Taylor Rosenbaum, a pediatric hospitalist in Miami, said younger physicians may soon find themselves learning how to treat diseases that vaccines once made uncommon.
“For many such illnesses, it’s going to be probably a low uptick,” Rosenbaum said. “Until it’s very fast.”
