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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
Summary of Major Changes in the 2000 Red Book
Major changes in recommendations and information concerning pediatric infectious diseases and immunizations since publication of the 1997 Red Book are listed here to aid physicians and other health care professionals in implementing these changes in their practices. Because the Red Book is divided into 5 major sections plus the appendices, the summary of the changes are grouped accordingly. In addition, on February 17, 2000, the Food and Drug Administration (FDA) approved a license application for pneumococcal 7-valent conjugate vaccine for active immunization of infants and toddlers against invasive disease caused by Streptococcus pneumoniae due to capsular serotypes included in the vaccine, beginning at 2 months of age. Information about recommendations for use of this vaccine will be published in Pediatrics and is available at http://www.aap.org/.
The Visual Red Book on CD-ROM contains more than 640 photographs and source data related to clinical and laboratory manifestations of many infectious diseases. This material will assist pediatricians, family practitioners, nurse practitioners, and other health care professionals caring for children to more expeditiously diagnose and manage these infections. Many of the disease manifestations depicted are now less frequently seen because of the availability and routine use of immunizations in infants, children, and adolescents.
SECTION 1. ACTIVE AND PASSIVE IMMUNIZATION
Prologue. A table of the baseline 20th century annual morbidity, the 1998 morbidity and percentage decrease in 9 diseases with vaccines recommended before 1990 for universal use in children in the United States is given (Table 1.1, p 2).
Sources of Vaccine Information. Information in this section has been updated to include Web sites and fax and telephone numbers where additional information can be obtained (p 2).
Informing Patients and Parents. A table outlining the use of Vaccine Information Statements has been added (Table 1.2, p 5).
Scheduling Immunizations. The year 2000 schedule (Figure 1.1, p 22) for recommended childhood immunizations is given. Changes reflected in this schedule are reviewed in detail in the disease-specific chapters and include exclusive use of acellular pertussis vaccines, an all-inactivated poliovirus (IPV) vaccine schedule, special considerations for the use of hepatitis B vaccine products, and routine use of hepatitis A vaccine in some states and regions. The footnotes in the schedule provide further guidelines. This schedule is revised and published in January of each year in Pediatrics and is available at http://www.aap.org/.
Thimerosal Content of Some Vaccines and Immune Globulin (IG) Preparations (p 36). Information about thimerosal content of vaccines and IG preparations is provided.
Indications for the Use of Immune Globulin Intravenous (IGIV) (Table 1.6, p 45). A table providing the recommendations of the FDA and National Institutes of Health (NIH) for use of IGIV has been added.
Immunocompromised Children (p 56). This section (titled in previous editions, "Immunodeficient and Immunosuppressed Children") has been expanded to include recommendations for immunization of children and adolescents with primary and secondary immune deficiencies.
New Chapters and Sections
SECTION 2. RECOMMENDATIONS FOR CARE OF CHILDREN IN SPECIAL CIRCUMSTANCES
School Health. Recommendations published by the AAP in 1999 for prevention of transmission of human immunodeficiency virus (HIV) and other bloodborne pathogens in the athletic setting are included in this chapter as well as in the HIV chapter (p 325).
Sexually Transmitted Diseases (STDs) in Adolescents and Children (p 138). This chapter has undergone extensive revision to include the 1998 Centers for Disease Control and Prevention (CDC) Guidelines for Treatment of Sexually Transmitted Diseases. Tables and text have been added regarding criteria for adolescents considered at increased risk for contracting an STD, implications of commonly encountered STDs for diagnosing and reporting sexual abuse of infants and prepubescent children, testing children and adolescents for STDs when sexual abuse is suspected or has occurred, and tables giving recommended prophylaxis after sexual victimization of preadolescent children and adolescents has occurred.
New Chapters and Sections
SECTION 3. SUMMARIES OF INFECTIOUS DISEASES
Anthrax (p 168). This chapter has been updated to include revised treatment options for persons infected with susceptible and resistant strains of Bacillus anthracis and to highlight the potential use of this organism as a bioterrorist weapon.
Arbovirus (p 170). Characteristics of the West Nile virus have been added.
Bacterial Vaginosis (p 183). Therapy for females with bacterial vaginosis has been defined by pregnancy status, and treatment options have been revised.
Chlamydia trachomatis (p 208). Prophylactic antibodies are no longer routinely recommended for asymptomatic infants born to mothers known to have untreated chlamydial infections. Information is given on the increased risk of developing infantile hypertrophic pyloric stenosis for infants less than 6 weeks of age who are given oral erythromycin for chlamydia, pertussis, or ureaplasma.
Hepatitis A (p 280). New data about the epidemiology of hepatitis A; information about the effectiveness of community-based hepatitis A immunization programs; and recommendations for the routine immunization of children in states, counties, and communities with elevated rates of hepatitis A virus infection are given.
Hepatitis B (p 289). Hepatitis B vaccine dosages, formulations, and immunization schedules; and schedules and vaccine formulations for immunization of premature infants have been updated. Additional information concerns the comprehensive immunization strategy of the CDC to eliminate transmission of hepatitis B in the United States.
Hepatitis C (p 302). The guidelines for preventing hepatitis C virus transmission have been revised. Interferon-
in combination with ribavirin is a new treatment option for chronic hepatitis C virus infection in adolescents and adults. Herpes Simplex Virus (p 309). Therapeutic options for different HSV infections have been expanded to include valaciclovir, famciclovir, and penciclovir (also see Table 4.8, "Antiviral Drugs for Non-HIV Infections," p 675).
Human Herpesvirus 6 (Including Roseola) and 7. This chapter now includes herpesvirus 7.
Human Immunodeficiency Virus Infection (p 325). This chapter has been extensively revised to include the following: (1) an update of the epidemiology of HIV infections; (2) addition of a table (p 332) listing diagnostic tests for HIV infection; (3) revision of the surveillance case definition for HIV infection according to the 1999 CDC recommendations (Table 3.23, p 326); (4) updated guidelines on antiretroviral therapy (see Tables 4.9, p 678; 4.10, p 683; and 4.11, p 687), including Table 4.12 (p 692) showing considerations for changing antiretroviral therapy; (5) Web sites where current drugs and treatment recommendations can be found; and (6) guidelines for use of varicella and hepatitis A vaccines in HIV-infected children in the United States. The section entitled "Reduction of Perinatal HIV transmission" has been expanded and guidelines for postexposure prophylaxis for possible sexual or other nonoccupational exposure to HIV has been updated. Recommendations for the prevention of opportunistic infections in children with AIDS have been revised in accordance with the 1999 USPHS/IDSA Guidelines for Prevention of Opportunistic Infections in Persons Infected With HIV. Characteristics of antiretroviral drugs are given in tables in Section 4.
Influenza (p 351). Indications for antiviral therapy with a neuraminidase inhibitor for treatment of influenza A and B infections in adolescents and adults are provided.
Listeria monocytogenes Infections. Dietary recommendations for persons at high risk of listeriosis are given in Table 3.33 (p 374).
Lyme Disease (p 374). Current recommendations for the use of Lyme disease vaccine are included.
Meningococcal Infections. A change concerns the need to inform and educate college students and parents about the risk of meningococcal disease and possible benefit of immunization (p 396).
Pelvic Inflammatory Disease (PID). Recommendations for treatment of PID have been updated to be consistent with the 1998 CDC Guidelines for Treatment of Sexually Transmitted Diseases.
Pertussis. The list of licensed DTaP products has been expanded to include all FDA-approved preparations (Table 3.43, p 441). Only acellular pertussis vaccines given as DTaP are recommended for the pertussis immunization series in theUnited States. The association between orally administered erythromycin for treatment or prevention of pertussis in infants less than 6 weeks of age and infantile hypertrophic pyloric stenosis has been included.
Pneumocystis carinii (p 460). Recommendations concerning therapy and prevention have been updated and are consistent with the 1999 USPHS/ IDSA Guidelines for Prevention of Opportunistic Infections in Persons Infected With HIV.
Poliovirus Infections. The AAP now recommends a 4 dose all-IPV schedule for routine immunization of all infants and children in the United States (p 465).
Rabies (p 475). New information includes an update on the epidemiology of rabies and anti-rabies biologics in the United States (Table 3.48, p 477) and recommendations regarding an observation period for domestic ferrets, and the recommendation for local administration of Rabies Immune Globulin.
Respiratory Syncytial Virus (p 483). Recommendations for the use of palivizumab, a humanized mouse monoclonal antibody given intramuscularly, are included.
Staphylococcal Infections (p 514). Changes include new information about coagulase-negative staphylococci and methods of transmission of both susceptible and resistant S aureus and coagulase negative staphylococci. Table 3.51 (p 520) gives the recommendations for detecting and preventing spread of S aureus with reduced susceptibility to vancomycin. Table 3.52 (p 521) gives current antibiotic choices for bacteremia and other serious staphylococcal infections.
Non-Group A or B Streptococcal and Enterococcal Infections. A new drug combination of quinupristin/dalfopristin for treatment of vancomycin-resistant Enterococcus faecium is now available.
Syphilis. Table 3.57 (p 556) gives the current recommended therapy for syphilis and is consistent with the 1998 CDC Guidelines for Treatment of Sexually Transmitted Diseases.
Tuberculosis. The definition section of this chapter has been expanded (p 593) and the treatment section has been updated.
Diseases Caused By Non-Tuberculous Mycobacteria. The chemoprophylaxis (p 617) section has been updated to include the 1999 USPHS/IDSA Guidelines for Prevention of Opportunistic Infections in Persons Infected With HIV. Table 3.71 (p 616) gives current recommendations for therapy.
Varicella-Zoster Infections. New recommendations include use of the varicella vaccine following exposure, use of vaccine for outbreak control, use of the vaccine for some children infected with HIV, immunization of adults and adolescents at high risk for exposure and new data about storage and administration of varicella vaccine. The advantages and disadvantages of the various diagnostic tests for VZ infections are listed in Table 3.72 (p 627). Treatment options with famciclovir and valaciclovir have been added.
New Chapters
Burkholderia Infections (p 194)
Cyclospora (p 226)
Fungal Diseases (p 249)
Hantavirus Cardiopulmonary Syndrome (p 272)
Hepatitis G (p 308)
Human Herpesvirus 8 (p 324)
Prion Diseases (p 471)
Toxic Shock Syndrome (p 576). This chapter gives information and management guidelines for both staphylococcal and streptococcal toxic shock syndrome.
SECTION 4. ANTIMICROBIAL AGENTS AND RELATED THERAPY
The following tables have been updated:
The section entitled "Antifungal Drugs for Systemic Fungal Infections" (p 668) is updated to include information about all classes of antifungal agents.
New Chapters and Sections
Judicious Use of Antimicrobial Agents (p 647)
Characteristics of Antiretroviral Drugs: Nucleoside Analogue Reverse Transcriptase Inhibitors (Table 4.9, p 678)
Characteristics of Antiretroviral Drugs: Nonnucleoside Reverse Transcriptase Inhibitors (Table 4.10, p 683)
Characteristics of Antiretroviral Drugs: Protease Inhibitors (Table 4.11, p 687)
Considerations for Changing Antiretroviral Therapy (Table 4.12, p 692)
SECTION 5. ANTIMICROBIAL PROPHYLAXIS
Prevention of Bacterial Endocarditis (p 735). The recommendations for prevention of bacterial endocarditis have been updated according to the most recent (1997) recommendations from the American Heart Association
APPENDICES
Appendix I, "Directory of Services" (p 743), has been updated to include fax numbers and Web sites, as well as international telephone numbers of contact organizations.
Appendix VIII, "Nationally Notifiable Infectious Diseases in the United States" (p 777), now includes cyclosporiasis, ehrlichiosis, and varicella deaths.
Appendix VI, "Potentially Contaminated Food Products" (p 770), is a new table.
No list is likely to be complete, and the designation of a change as major can be arbitrary. Therefore, physicians and other health care professionals are urged to review relevant chapters, tables, figures, and sections in the Red Book. In addition, since preparation of each edition involved extensive review of the entire book, a considerable amount of new information is included in many chapters and sections, and a number of new tables have been added to aid health care professionals. Throughout the Red Book, references to policy statements of the American Academy of Pediatrics, publications of the Advisory Committee on Immunization Practices, and Web site addresses have been provided to facilitate acquisition of source data and access to new information.
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