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Axios
2 days ago
- Health
- Axios
New docs get schooled in old diseases as vax rates fall
Rush University Medical Center in Chicago is adding a new twist to its curriculum for medical students and residents, using AI tools and learning modules to teach how to more quickly identify measles rashes on different skin tones. Why it matters: It's another reminder that diseases once thought to have been eradicated are showing up with increased frequency in clinics and ERs, posing challenges for younger physicians and health workers who thought they were relegated to history. 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.
Yahoo
27-02-2025
- Health
- Yahoo
At the center of Texas measles outbreak, a by-the-numbers look at high rates of vaccine exemptions
Texas officials announced the first measles death in the U.S. in a decade Wednesday, a grim milestone in the ongoing outbreak ravishing Texas and nearby New Mexico. The death, which occurred in a school-age child, is the first of its kind since 2015, according to the U.S. Centers for Disease Control and Prevention. In a statement, Lubbock city and Texas health officials confirmed the hospitalized patient was unvaccinated. While Health and Human Services Secretary Robert F. Kennedy Jr. said two deaths have been reported in the outbreak in a Cabinet meeting Wednesday, local authorities and the U.S. Centers for Disease Control (CDC) have confirmed only one death. As of Thursday, the HHS has said only one death occurred. The Texas Department of State Health Services announced Tuesday that confirmed infections were up to 124, mostly in children. All but five cases were in unvaccinated people or people with unknown vaccination status, and most occurred in far West Texas in Gaines County. Here's a look at the area and what the data shows so far about how measles is spreading. In the U.S., all states require students to have a certain set of childhood vaccines before entering school. The typical vaccine course for a school-age child includes the MMR (measles, mumps, rubella) vaccine, DTap (diphtheria, tetanus, pertussis) vaccine, Hib (H. influenza) vaccine and vaccines for polio, chickenpox, flu, hepatitis A and B, rotavirus, pneumococcal and sometimes RSV or COVID. Requirements vary by state. If a parent cannot or does not want to vaccinate their child against these diseases, they can submit a request for an exemption, usually on the grounds of medical need or religious and personal beliefs. Different states allow different kinds of exemptions. In Texas, state law allows exemptions in three cases: If a healthcare provider determines that it is not safe for a student to get a certain vaccine, the student is in the U.S. military or the student has a religious or personal belief that goes against getting immunized. If it is found medically dangerous for a student to have an immunization, this is called a medical exemption. If the exemption is granted based on religious or personal belief, it is called a conscientious exemption. Nationwide, childhood immunization rates against serious diseases like measles are declining as more parents request non-medical exemptions from recommended vaccinations, according to the CDC. The epicenter of the outbreak, Gaines County, Texas, encapsulates 10 cities, towns and census-designated locations and had a population of about 22,523 in 2023, according to U.S. Census data. At the seat of the county is Seminole, a small city with a population of roughly 7,231. The same data shows that 31.4% of the population is under 18, the prime population most heavily impacted by measles. Gaines, which has three school districts that are all public, has an abnormally high conscientious vaccine exemption rate of 13.6% in grades K-12, one of the highest in Texas, 2023-2024 state health data shows. This is more than five times the statewide average of 2.5%. Two other counties, Crosby and Bell, had even higher rates in 2023-2024 at 23.7% and 18.8%, respectively. Of the school districts located in Gaines County, the Seminole Independent School District, which includes three elementary schools, a junior high school and a high school, had the second-highest conscientious exemption rate at 13.82%, followed by Seagraves Independent School District with just a 1.87% exemption rate. The Loop Independent School District, which serves a small student population of 157 K-12, had a 47.95% non-medical exemption rate in 2023-2024 of 47.95%, the highest known number of any public school in Texas. When looking over four years of data, the uptick in non-health-related vaccine exemptions at Loop is a snapshot of a larger, statewide trend. The increase was strong and steady, starting at 16.11% in the 2019-2020 school year and jumping up to 34.39% in 2022-2023 before reaching its current total. According to CDC data that surveyed 92.4% of Texas kindergarten students in the 2023-2024 school season, 94.3% of students had two doses of the MMR vaccines - just short of the 95% needed for herd immunity. Of all incoming kindergartners surveyed statewide the same year, 3.9% claimed a vaccine exemption of any kind, a 0.4% increase from the previous year. Herd immunity means enough people in a population are immune to a disease, often through vaccination, that it becomes very difficult for the infection to spread. This protects those who are not yet immune, such as children who are too young to receive vaccines or those with compromised immune systems. While Gaines and Texas at large have followed the nationwide trend of plummeting vaccination rates, the county has another, population-specific factor that contributes to its high exemption status. The area has a large population of Mennonites, a Christian religious-cultural group established during the protestant reform. Sometimes erroneously mistaken for the Amish due to their cultural practices, the close-knit, under-vaccinated Mennonite community in the area often opts to homeschool children or send them to private schools. According to the Texas State Historical Association, two groups of Mennonites purchased land in Gaines and Andrews counties near Seminole in the late 1970s, an area they picked partially thanks to the less dense population, large swathes of land and private schools that are not heavily regulated. Lara Anton, a spokesperson for Texas' health department, previously told USA TODAY the outbreak was concentrated in this community thanks to "under vaccination." She likewise pointed to access issues, saying the highly rural nature of the region means people have to travel at least 30 to 40 miles to get preventative care, including vaccinations. The outbreak, though centralized in Texas, has since spread to multiple other states, though no deaths have yet been reported elsewhere. Nationwide, vaccination rates are down and exemption rates are up, having seen an especially large jump after 2020, which is likely tied to COVID-19 vaccines. Another piece of the puzzle is a growing anti-vaccine movement, which has been bolstered by the confirmation of RFK Jr., who has a history of speaking out against vaccines, as health secretary. Despite RFK Jr. saying he isn't anti-vaccine during confirmation hearings, he has in the past falsely linked vaccines to autism and urged parents to not vaccinate their children. undefined Exemption rates are not the only factor in the spread of contagious diseases like measles. Exemptions often occur in pockets or are concentrated in certain areas or communities. In areas like Gaines, where school districts and communities with high exemption rates are clustered together and contain a high concentration of the people most susceptible to infection, such as children under 18, the spread is more likely to occur. Access to resources is also a factor - the area in which the outbreak started in Texas is rural and its residents are required to travel further to gain access to immunizations and healthcare once they do become ill. More states are hitting a threshold of under 95% for the MMR vaccine specifically, which is required for herd immunity. With measles holding the distinction of being one of the most contagious diseases of all infectious diseases, according to the CDC, the decline in protective vaccines could spell trouble for states across the U.S. It is so contagious, in fact, that 90% of unvaccinated people who are exposed end up contracting it and one in five of those people end up hospitalized, according to the CDC. It primarily infects children, a population in which it can become exceptionally deadly. And, due to its nature, it's likely actual infection rates are much higher than confirmed cases. Even with only one confirmed death thus far, death ratio compared to the state's 124 known cases is much higher than would be expected, Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, told USA TODAY earlier Wednesday. 'It makes you wonder if it really is 124 cases, or if it is a much larger number of cases.' Texas health officials are working with counties across the state to hold vaccine drives and encourage higher rates of public vaccination. But experts have warned that once measles starts spreading, it can be hard to stop. Contributing: Sara Chernikoff, Eduardo Cuevas, Janet Loehrke, USA TODAY This article originally appeared on USA TODAY: How the Texas measles outbreak began, spread: See graphics
