under the microscope
under the microscope
By Rodney Rohde, PhD, MS, SM( ASCP) CM, SVCM, MBCM, FACSc
Will Physicians and Medical Laboratory Professionals Be Prepared to Diagnose the Return of Vaccine- Preventable Infections?
The recent resurgence of vaccine-preventable infections like measles, pertussis, mumps, and even threats of polio returning to pockets of the United States raises a critical question: Are we ready to diagnose these diseases when they reappear? This isn’ t a theoretical exercise. The world has witnessed measles outbreaks after years of elimination, pertussis clusters despite vaccine availability, and environmental detections of poliovirus in wastewater.
These trends are a stark reminder that pathogens once considered“ under control” can re-emerge when immunization coverage falters, global travel persists, and diagnostic readiness lags.
At the heart of preparedness are two interconnected groups of professionals – physicians, who are the clinical front line, and medical laboratory professionals, who perform the essential work of identifying and confirming infections. Both communities must be equipped with the knowledge, tools, and systems necessary to recognize and respond swiftly when these diseases return.
A Changing Clinical Landscape
For decades, many clinicians in the United States rarely saw cases of measles or polio. Generation after generation of physicians trained and practiced in settings where these diseases were“ out of sight.” But absence of disease does not equal absence of risk. The risk has increased as vaccine hesitancy, misinformation, and gaps in immunization coverage have undermined herd immunity— the community shield that protects vulnerable people and keeps outbreaks limited.
Today’ s physician must have a renewed awareness that classic pediatric infectious diseases are not relics of the past. Cough with paroxysms and post-tussive vomiting should trigger thoughts of pertussis. A febrile rash with Koplik spots in a traveler should raise alarm bells for measles. Acute onset of high fevers and severe muscle stiffness in an unimmunized child could signify polio or other enterovirus infection.
Diagnosis begins with clinical suspicion— and that requires training, visibility, and experience. Medical schools and residency programs must reinvigorate infectious disease curricula with content that bridges historical knowledge with modern practice. Continuing medical education( CME) programs should emphasize recognition of vaccine-preventable diseases( VPDs) in both typical and atypical presentations.
Diagnostic Laboratories: Tools, Training, and Turnaround
Physicians rely on laboratory confirmation to confidently diagnose VPDs. Yet diagnostic readiness in laboratories varies across the country. Laboratories must maintain capacity for testing that goes beyond routine panels. Too many labs have eliminated specialized assays, particularly for rare diseases, because of financial and workflow pressures. This limits local ability to rapidly detect cases and creates dependence on public health or reference laboratories— with added days of delay.
To address this gap, laboratories must invest in capable molecular platforms, maintain reagents for targeted PCRs, and ensure staff are trained to run and interpret specialized assays. Quality assurance programs should include proficiency testing for VPDs and regular competency assessments.
Illustration of the measles virus. Courtesy of the CDC
Moreover, laboratory professionals must understand when to escalate testing – especially for notifiable diseases. For example, a respiratory panel that detects Bordetella pertussis requires prompt public health notification. A suspected measles case mandates immediate serology and PCR, coordinated swiftly with public health partners.
Public Health Integration: Diagnosis Is More Than a Result
Preparedness isn’ t just about detection; it’ s about integration with public health systems. Rapid reporting of confirmed or suspected VPDs enables contact tracing, outbreak mitigation, and immunization campaigns. The laboratory diagnosis becomes actionable only when it triggers public health response.
Physicians and laboratory professionals need clear understanding of reporting requirements and established communication channels. Electronic health records should be configured for prompt alerts to health departments. Laboratories should have protocols for immediate notification of results that signal public health risk.
Diagnostic Stewardship and Recognition Bias In a clinical era dominated by broad syndromic panels and rapid multiplex tests, there is a risk of diagnostic complacency. If measles or mumps isn’ t included in a standard panel, clinicians may overlook targeted testing. Diagnostic stewardship— the practice of thoughtfully choosing which tests to order based on clinical judgment— must evolve to include VPDs in differential diagnoses, especially in high-risk contexts like travel, low-immunization communities, or daycare exposures.
This requires collaboration: physicians must communicate clinical suspicion clearly to laboratories, and laboratory professionals must be willing to engage, ask questions, and recommend additional testing when appropriate.
Education, Simulation, and Preparedness Exercises
Real readiness comes from practice. Healthcare systems should integrate simulation exercises that include identification of VPDs. These drills can test the entire chain— from patient presentation
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• www. healthcarehygienemagazine. com • march-april 2026