Maryn McKenna writes in Annals of Emergency Medicine that the impressive recent success of rotavirus and pneumococcus vaccines has caused emergency room doctors to ask “Where have the kids gone?”
The benefits of such sharp changes in incidence include not only reduced burden of disease but reduced health care utilization and cost; one 2007 study found that, thanks to Prevnar, annual hospitalization and ambulatory expenditures for children younger than 2 years shrank 45% between 1999 and 2004, from $688.2 million to $376.7 million.3 There are more subtle effects as well, some as simple as reducing the stress on a child and his parents because less blood work means fewer needle sticks during an ED stay.
Interestingly, McKenna found physicians worrying that colleagues who entered the profession after these vaccines hit the market would be underexposed to cases of the now widely prevented diseases, and may thus find it difficult to recognize them if or when they do occur.
Physicians who have been in the specialty long enough to have experienced the introduction of Hib vaccine in the mid 1980s, with its extraordinary suppression of bacterial meningitis, and the subsequent introduction of Prevnar, caution that success brings its own risks as well. The lower the incidence of a disease, the less likely younger physicians are to experience it in their training — and thus the more careful medicine must be to make sure certain procedures are still taught.