Doctors across the United States say they are treating children for illnesses that routine vaccinations once made increasingly uncommon, raising new concerns as childhood immunization rates remain below public health targets and measles outbreaks continue to spread nationwide.
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 years of practice, while others said growing vaccine hesitancy is changing the way emergency rooms and hospitals care for children.
In D.C., new data from the Johns Hopkins Bloomberg School of Public Health show childhood vaccination rates remain below federal goals for several key immunizations, even as the District has avoided the measles outbreaks seen elsewhere in the country.
Several doctors said the return of vaccine-preventable illnesses is no longer a theoretical concern.
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 combined. Rotavirus once caused tens of thousands of hospitalizations annually before vaccines dramatically reduced its spread. None of the children she treated this year had been vaccinated.
Hofto also described treating infants suffering from 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 New York Times.
Another physician, Dr. Jessica Kirk of 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, but vaccination rates have declined in recent years. The child required oxygen and antibiotics to recover.
Public health experts have long viewed measles as an early warning signal because of how quickly it spreads when vaccination coverage weakens. The Times reported that physicians increasingly fear the resurgence of measles may foreshadow the return of additional diseases once kept under control through routine immunization.
Those concerns are playing out against the backdrop of a large national measles outbreak.
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 multiple states have raised concerns about continued transmission, additional hospitalizations and deaths, and the possible loss of the nation’s measles elimination status.
The Johns Hopkins tracker notes that measles is highly contagious and can lead to pneumonia, encephalitis, hospitalization and death. Researchers stated that maintaining high vaccination rates remains the most effective way to prevent outbreaks and protect individuals who cannot receive vaccines because of age or medical conditions.
“Most people who are vaccinated with MMR or MMRV will be protected for life,” according to the Centers for Disease Control. “Vaccines and high rates of vaccination have made these diseases much less common in the United States, compared to the period before these vaccines were available.”
Vaccinations Among Children in the District
D.C. has not reported a measles case this year. Still, Johns Hopkins researchers found several indicators that public health officials continue to monitor closely.
Among kindergarten students in the District, 93% completed the measles, mumps and rubella vaccine series during the 2024-25 school year. That rate is similar to the national average but remains below the Healthy People 2030 target of 95%, the level public health officials generally consider necessary to provide strong community protection against measles outbreaks.
Maryland and Virginia each reported 96% coverage.
The District’s numbers reveal a mixed picture.
MMR coverage among kindergarten students has steadily increased over the last five years, climbing from 79% during the 2020-21 school year to 93% in 2024-25. Yet vaccination coverage among younger children has moved in the opposite direction. Johns Hopkins reported that only 63% of District 2-year-olds received all four recommended doses of the DTaP vaccine in 2024, down from 76% the year before and well below the Healthy People 2030 goal of 90%. DTaP protects children against diphtheria, tetanus and pertussis.
The report also found that the District’s non-medical exemption rate increased slightly during the most recent school year. D.C. allows religious exemptions but does not permit personal or philosophical exemptions. The non-medical exemption rate among kindergartners stood at 2.5%, below the national median of 4%. Researchers noted that higher exemption rates have been linked to increased disease transmission.
Johns Hopkins researchers pointed to another notable finding. The District spends approximately $1,084 per person on public health, compared with a national average of $124 per capita. Even with that level of investment, childhood vaccination coverage remains below federal goals for several vaccines.
D.C. also does not participate in a universal vaccine purchasing program, under which states buy recommended vaccines for all children regardless of insurance status. Public health advocates have argued such programs can reduce disparities and improve vaccine access.
District lawmakers have continued to revisit immunization policy.
The Immunization of School Students Amendment Act of 2023 requires schools and child development facilities to provide annual immunization information to families, notify parents when students are missing required vaccinations, provide information about where immunizations can be obtained, and establish timelines for compliance. The law also requires healthcare professionals to electronically submit immunization certifications to public health authorities.
Johns Hopkins identified two additional measures currently before the D.C. Council. Bill B26-0606 would protect physicians from liability claims arising from vaccine administration, while Bill B26-0414 would permit providers to administer immunizations recommended by organizations such as the American Academy of Pediatrics, not solely those tied to federal recommendations.
The policy discussion is taking place nationally as states examine how vaccine laws interact with federal recommendations. The Vaccine Policy Atlas, developed by American Families for Vaccines and Johns Hopkins’ International Vaccine Access Center, was created to help policymakers understand how state laws incorporate federal immunization guidance and how changes in federal advisory processes could affect vaccine access.
Researchers also noted the financial costs associated with outbreaks. According to the Johns Hopkins District brief, a single measles case triggers public health response activities that cost an average of $224,000. Each additional measles case adds roughly $16,000 in response costs.
Physicians working on the front lines say the numbers tell only part of the story.
“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 The New York Times. “And you might convince one family here and there.”
Doctors say illnesses that now appear sporadically could become far more common if vaccination rates continue to fall.
Dr. Taylor Rosenbaum, a pediatric hospitalist in Miami, said younger physicians may soon find themselves learning how to treat diseases vaccines once pushed to the margins of American medicine.
“For many such illnesses, it’s going to be probably a low uptick,” Rosenbaum said. “Until it’s very fast.”
