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Summary of Major Changes in the 2009 Red Book

Major Changes General
Section 1. Active and Passive Immunization
Section 2. Recommendations for Care of Children in Special Clinical Circumstances
Section 3. Summaries of Infectious Diseases
Section 4. Antimicrobial Agents and Related Therapy
Section 5. Antimicrobial Prophylaxis
Appendices

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MAJOR CHANGES: GENERAL

  1. The use of the dash (-) has been eliminated and replaced by the word "through" when referring to inclusive ages (eg, 6 through 12 months of age).

  2. All Web sites and telephone numbers have been updated and verified to be accurate at the time of publication.

  3. References to policy recommendations of the American Academy of Pediatrics, Advisory Committee on Immunization Practices, and other select societies have been updated throughout.

  4. Standardized vaccine abbreviations (www.cdc.gov/vaccines/recs/acip/vac-abbrev.htm) are used throughout.


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SECTION 1. ACTIVE AND PASSIVE IMMUNIZATION

  1. Table 1.1, showing morbidity from 10 vaccine preventable diseases, has been updated to include data from 2007.

  2. The Web site for the interactive catch-up immunization scheduler for children 0 through 6 years of age has been added (www.cdc.gov/vaccines/programs/default.htm#catchup).

  3. Table 1.3 has been updated to include vaccines licensed since publication of the 2006 Red Book, including DTaP-IPV, DTaP-IPV/Hib, HPV, meningococcal conjugate, rotavirus and zoster vaccines. In addition, references to single-antigen measles, mumps, and rubella vaccines have been removed, because these vaccines currently are not produced in the United States.

  4. The table showing recommended storage temperatures of commonly used vaccines has been eliminated and replaced with a Web site where this information can be obtained (www.cdc.gov/vaccines/pubs/downloads/ bk-vac-mgt.pdf).

  5. The 2009 childhood and adolescent immunization schedule has been added (Fig 1.1–1.3), as has the Web site for access to future, updated childhood and adult immunization schedules.

  6. The Combination Vaccines section has been updated, including addition of a table that shows combination vaccines available in the United States, the age group for which they are licensed, and recommendations for use.

  7. The description of the Vaccine Adverse Event Reporting System (VAERS) has been revised.

  8. The vaccine contraindications and precautions section has been revised.

  9. The Common Misconceptions About Immunizations section has been revised to include addition of Table 1.8, which shows common misconceptions about immunizations.

  10. Hepatitis A prophylaxis. The use of hepatitis A vaccine and Immune Globulin for postexposure prophylaxis and for international travel has been updated to reflect current recommendations.

  11. A new section describing Immune Globulin Subcutaneous for children with primary immunodeficiencies has been added.

  12. Pregnancy. Recommendations for dealing with a woman if a dose of human papillomavirus (HPV) vaccine is administered inadvertently during pregnancy have been added.

  13. The definition and management of anaphylaxis has been updated to concur with recommendations of the second National Institutes of Health (NIH)-National Institute of Allergy and Infectious Diseases symposium.

  14. Immunization recommendations for human immunodeficiency virus (HIV)-infected or -exposed children were updated to be consistent with the guidelines of the Centers for Disease Control and Prevention, NIH, and Infectious Diseases Society of America (IDSA) for diagnosis and treatment of opportunistic infections in HIV infected children (MMWR Early Release 2009;58(March 24, 2009):1–207).

  15. The section on American Indian/Alaska Native Children has been updated to reflect changes in vaccine recommendations for these high-risk groups.

  16. The Adolescent and College Populations section has been updated to include all vaccines recommended for adolescents.

  17. The section titled Misconceptions About Vaccine Contraindications has been deleted. Information has been incorporated into the Vaccine Contraindications and Precautions section.


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SECTION 2. RECOMMENDATIONS FOR CARE OF CHILDREN IN SPECIAL CLINICAL CIRCUMSTANCES

  1. Biological Terrorism. The table detailing biological weapons has been removed, and Table 2.1, providing emergency contacts and educational resources, has been updated.

  2. Transmitted infections. The Red Cross Web site where blood donor information is available has been added (www.redcross.org, then click Blood services, then Blood Donor eligibility guidelines). In addition, blood screening information has been provided for West Nile virus, bacterial contamination, Trypanosoma cruzi (Chagas disease), and the variant form of Creutzfeldt-Jakob disease (vCJD).

  3. Human Milk, Human Immunodeficiency Virus (HIV). The recommendation for routine screening of pregnant women for HIV as well as an update on prevention of HIV during breastfeeding in resource-limited countries have been added. Guidelines for what to do when a child mistakenly has been fed expressed milk from another mother are provided.

  4. Antimicrobial agents in human milk. The table showing antimicrobial agents taken by mothers that may be cause for concern has been replaced by a Web site that provides current information (www.toxnet.nlm.nih.gov/help/LactMedRecordFormat.htm).

  5. Children in Out-of-Home Child Care. General recommendations for exclusion of children in out-of-home care have been placed into Tables 2.5 and 2.6. Hepatitis A vaccine is recommended for all susceptible close personal contacts of children internationally adopted from a country with high or intermediate hepatitis A endemicity in the first 60 days after arrival in the United States.

  6. School Health. Immunization recommendations for school-aged children and adolescents have been updated. Recommendations for management of infections spread by direct contact, including methicillin-resistant Staphylococcus aureus (MRSA), herpes simplex, Tinea capitis, and scabies, have been updated. Guidelines on control and prevention of MRSA in athletic and other school settings have been added.

  7. Infection Control for Hospitalized Children. The text and Table 2.7 have been updated to include new elements of Standard Precautions.

  8. Sexually Transmitted Infections (STIs) in Adolescents and Children. Recommendations for use of HPV vaccine beginning at the health care visit at 11- through 12-years of age has been added.

  9. Hepatitis and Youth Correctional Settings. Rates of hepatitis A, hepatitis B, and hepatitis C in adolescents in youth correctional settings have been updated.

  10. Medical Evaluation of Internationally Adopted Children. The epidemiology, diagnosis, and prevention aspects of the viral hepatitis section have been revised. Consideration and diagnosis of Chagas disease and Schistosoma infections in children from countries with endemic infection and strongyloidiasis in any child with eosinophilia has been added. A description of the Immigration and Nationality Act and how it relates to adopted children has been added.

  11. Table 2.17, showing approaches to evaluation and immunization of internationally adopted children, has been revised.

  12. Prevention of Mosquitoborne Infections. An update on the use of picaridin and oil of lemon eucalyptus as insect repellents has been added.

  13. Prevention of Illnesses Associated With Recreational Water Use. This section was revised to include updated surveillance data from the CDC report on waterborne diseases associated with recreational water use.

  14. Diseases Transmitted From Animals (Zoonoses) has been added as a new section, which includes tables showing nontraditional pets and animals in public settings and guidelines for prevention of human diseases from exposure to pets, nontraditional pets, and animals in public settings.


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SECTION 3. SUMMARIES OF INFECTIOUS DISEASES

  1. Adenovirus. New methods to detect adenovirus have been added to the "Diagnostic Tests" section. Information about adenovirus serotype 14, an emerging cause of severe pneumonia, has been added.

  2. Amebiasis. The enzyme immunoassay (EIA) test has replaced the indirect hemagglutination test for routine serodiagnosis of amebiasis.

  3. Anthrax. Treatment and prevention sections have been updated to include changes in vaccine administration.

  4. Arboviruses. This chapter has been rewritten. West Nile virus has been moved to form an independent chapter; 2 new tables, one showing clinical manifestations and the other showing genus, geographic location, vectors, and average number of cases for domestic and international arboviral disease, have been created; proposed recommendations for the Japanese encephalitis vaccine being considered by the Food and Drug Administration have been added, as have recommendations from the ACIP statement on Japanese encephalitis.

  5. Candidiasis. This chapter has been updated to include use of newer antifungal agents in children, including newborn infants and to reflect clinical practice guidelines from the Infectious Diseases Society of America.

  6. Clostridium difficile. A previously uncommon, fluoroquinolone-resistant strain of C difficile with variation in toxin genes has emerged. Initial therapy of children with severe disease attributable to C difficile has been updated.

  7. Cytomegalovirus. This chapter has been updated extensively to include outcomes following congenital infection, the role of maternal reinfection as the cause of some cases of congenital infection, diagnostic approaches in congenital infection, treatment options for congenitally infected infants with symptomatic cytomegalovirus (CMV) disease, treatment options for perinatally acquired CMV infection in very preterm infants, new recommendations for treatment and prophylaxis of CMV in HIV-infected patients, and specific details for preparing human milk to prevent perinatal transmission in at-risk preterm infants.

  8. Ehrlichia and Anaplasma Infections. Previously referred to collectively as ehrlichiosis, ehrlichiosis and anaplasmosis now are used to describe infections caused by Ehrlichia and Anaplasma species, respectively.

  9. Enteroviruses. The classification system for human enteroviruses (HEVs) into HEV A, HEV B, HEV C, and HEV D has been included. Diagnostic tests available have been updated.

  10. Epstein-Barr Virus Infections. A figure showing the evolution of development of antibodies to Epstein Barr virus antigens has been added.

  11. Fusobacterium infections, including Lemierre Disease has been added as a new chapter.

  12. Gonococcal Infections. Because of an increase in resistance of Neisseria gonorrhoeae to fluoroquinolones, these drugs no longer are recommended to treat gonorrhea. An extended-spectrum cephalosporin is recommended as initial therapy for children, adolescents, and adults for treatment of gonorrhea. Tables 3.7 and 3.8 clarify treatment recommendations.

  13. Haemophilus influenzae Infections. The text and Table 3.10, describing Haemophilus influenzae type b (Hib)-containing vaccines licensed for use in the United States, have been updated to include DTaP-IPV/Hib. Information has been added about interim recommendations for use of Hib conjugate vaccines during a Hib vaccine shortage and the importance of completing the primary Hib immunization series.

  14. Hepatitis A. The text and Table 3.13 have been updated to include changes in recommendations for use of hepatitis A vaccine for both postexposure prophylaxis and for international travelers journeying to countries with endemic hepatitis A infection. In addition, the alternative dose of the combined hepatitis A-hepatitis B vaccine has been added.

  15. Hepatitis B. The text and Table 3.17 have been updated to include recommended uses of hepatitis B-containing vaccines. Two new tables have been added. One shows the estimated HBsAg prevalence by regions of the world, and the second provides categories of adults at high risk recommended to receive hepatitis B vaccine.

  16. Herpes Simplex. The chapter has been revised significantly to include risks of neonatal herpes following exposure during delivery; the diagnostic workup of an infant suspected of having neonatal herpes; the care of newborn infants whose mothers have active genital lesions; and the care of newborn infants whose mothers have a history of genital herpes but no active genital lesions at delivery.

  17. Histoplasmosis has been updated to include recommendations from the Infectious Diseases Society of America.

  18. Human Bocavirus, a cause of respiratory tract diseases in children, has been added as a new chapter.

  19. Human Immunodeficiency Virus Infection. This chapter has been updated extensively to include information on new guidelines from CDC/NIH/IDSA on prevention and treatment of opportunistic infections (OIs), changes in occurrence of OIs, expanded description of HIV-1 and HIV-2 epidemiology, including transmission, and new information on diagnosis, treatment, and control measures.

  20. Human Papillomaviruses. Diagnostic methods and prevention, including use of the US Food and Drug Administration (FDA)-licensed and -submitted vaccines to prevent HPV infections, have been added.

  21. The Influenza chapter has been updated to include information about the etiology and epidemiology of avian influenza and pediatric influenza; antiviral drug resistance, including oseltamivir resistance; and current immunization recommendations, including immunization of children from 6 months through 18 years of age.

  22. Kawasaki Disease. This chapter has been updated to include an algorithm from the American Heart Association for evaluation of patients with suspected incomplete disease.

  23. Malaria. Patterns of resistance of drugs used to treat malaria have been updated with concomitant updates to the treatment and chemoprophylaxis sections.

  24. Measles. The epidemiology section has been updated, recommendations of the World Health Organization for use of vitamin A for all children with acute measles have been added, information about measles-mumps-rubella-varicella (MMRV) vaccine has been included, and an update on the lack of production of single-antigen measles vaccine in the United States has been added.

  25. Meningococcal Infections. Use of meningococcal conjugate vaccine (MCV4) has been updated to reflect recommendations for use in people 11 through 18 years of age, and a recommendation not to use MCV4 routinely in children 2 through 10 years of age (only for high risk) has been added. The report of resistance to ciprofloxacin used for chemoprophylaxis has been added.

  26. Mumps. The epidemiology section, including the increase in cases in 2006, and the diagnostic section have been updated, and recommendations for 2 doses of mumps-containing vaccine (measles-mumps-rubella [MMR]) have been emphasized. Lack of monovalent mumps vaccine, which currently is not produced in the United States, has been added.

  27. The Pediculosis Capitis chapter has been updated to be consistent with the forthcoming AAP statement on head lice.

  28. Pelvic Inflammatory Disease. Because of resistance, fluoroquinolones no longer are recommended to treat N gonorrhoeae. Reference to recommendations for partner-services for programs for HIV infection, syphilis, gonorrhea, and chlamydia have been added.

  29. The Pertussis chapter has been updated to clarify recommendations for Tdap use in the text, and Table 3.47 shows special situation recommendations for use of Tdap in adolescents. Information about additional pertussis-containing vaccines (Tdap, DTaP-IPV/Hib, and DTaP-IPV), addition of all pertussis-containing vaccines to Table 3.45, and tables showing contraindications and precautions of DTaP (Table 3.46) and Tdap (Table 3.48) have been added.

  30. Pneumococcal Infections. The epidemiology of pneumococcal disease since licensure of the heptavalent pneumococcal conjugate (PCV7) vaccine has been updated, including addition of children with cochlear implants in the high-risk category. Additional updates include immunization recommendations for children 24 through 59 months of age who are not completely immunized, high-risk children 10 years of age and younger, and American Indian/Alaska native children 24 through 59 months of age. Case reporting criteria have been updated, as have high-risk criteria for invasive pneumococcal infection. The new Clinical Laboratory Standards Institute (CLSI) definitions of in vitro susceptibility have been added to Table 3.50.

  31. Pneumocystis jirovecii Infections. This chapter has been updated to conform with "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children" published by the CDC/NIH/IDSA.

  32. The Polyomaviruses (BK virus and JC virus) chapter is new to this edition.

  33. Rabies. This chapter has been updated to include current information on epidemiology, recommendations for rabies preexposure and postexposure prophylaxis, and information regarding treatment considerations for human rabies patients.

  34. Respiratory Syncytial Virus. This chapter has been updated to include new information on epidemiology, diagnostic testing, management of infected children, and infection-control measures. New recommendations are provided for the number of doses of palivizumab as well as new eligibility criteria for prophylaxis of high-risk groups.

  35. Rickettsial Diseases. The section dealing with other spotted fever infections has been updated to include epidemiologically distinct but clinically similar tickborne infections.

  36. Rotavirus. This chapter has been updated to include recommendations for use of the 2 FDA-licensed rotavirus vaccines in infants in the United States.

  37. Rubella. Monovalent rubella vaccine currently is not produced in the United States. Rubella immunization recommendations have been adjusted to reflect this.

  38. The Sporotrichosis chapter has been updated to include recommendations in the Infectious Diseases Society of America guidelines.

  39. Staphylococcal Infections. The toxic shock chapter has been deleted, and updated information on staphylococcal toxic shock syndrome has been added to this chapter. In addition, current information on the epidemiology, diagnosis, treatment, and prevention of MRSA has been added. An algorithm for initial management of skin and soft tissue infections caused by S aureus has been added.

  40. Group A Streptococcal Infections. This chapter has been updated to include information about toxic shock syndrome attributable to group A streptococcal infections, current American Heart Association guidelines for prevention of bacterial endocarditis, and a table showing the Jones criteria for rheumatic fever.

  41. Syphilis. An algorithm for evaluation and treatment of infants born to mothers with reactive serologic tests for syphilis has been added, and the text has been updated.

  42. Tuberculosis. The approach to patients with multiple drug-resistant and extensively drug-resistant tuberculosis, use of interferon-gamma release assays for diagnosis, and infection attributable to Mycobacterium bovis have been added.

  43. Diseases Caused by Nontuberculous Mycobacteria. Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases have been updated to follow guidelines of the American Thoracic Society/IDSA. A table providing criteria for discontinuing and restarting prophylaxis for Mycobacterium avium complex in HIV-infected children has been added.

  44. Varicella-Zoster Infections. This chapter has been updated to include recommendations for a routine 2-dose varicella immunization program; a second-dose catch-up varicella immunization program; routine immunization for all healthy people 13 years of age or older without evidence of varicella immunity; prenatal assessment and postpartum immunization; expanding the use of varicella vaccines in HIV-infected children; establishing middle school, high school, and college entry immunization requirements; and criteria for and evidence of immunity to varicella.

  45. Toxic Shock Syndrome. This chapter has been eliminated, and the information has been placed in the Staphylococcal Infections and Group A Streptococcal Infections chapters.


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SECTION 4. ANTIMICROBIAL AGENTS AND RELATED THERAPY

  1. A section on antimicrobial agents used in adults for serious infections and their potential use in children has been added.

  2. Drug Interactions. The section on drug interactions has been reduced, including elimination of the accompanying table, which has been replaced with a Web site where information can be obtained (www.fda.gov/cder/drug/drugInteractions/default.htm).

  3. Tables of antibacterial (Tables 4.1 and 4.2), antifungal (Tables 4.5– 4.7), antiviral (Table 4.8), and other agents recommended to treat sexually transmitted infections (Table 4.3) have been updated.

  4. The Drugs for Parasitic Infections tables, reproduced with permission from The Medical Letter, have been updated to the most recent versions.


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SECTION 5. ANTIMICROBIAL PROPHYLAXIS

  1. Antimicrobial Prophylaxis. Table 5.1, showing site, exposed host, and vulnerable host categories where antimicrobial chemoprophylaxis is most likely to be successful, has been added.

  2. Prevention of Bacterial Endocarditis. The American Heart Association guidelines for prevention of infective endocarditis have been included. Antimicrobial prophylaxis for dental procedures now is recommended only for patients at highest risk of severe consequences from endocarditis who are undergoing the highest-risk procedures. Drug regimens are provided in Table 5.3.

  3. Prevention of Neonatal Ophthalmia. Silver nitrate no longer is recommended for prophylaxis of ocular gonorrheal infection.


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APPENDICES

  1. Appendix I has been updated to include recent contact information of organizations that are listed.

  2. Appendix IV: The National Childhood Vaccine Injury Act reporting and compensation table has been updated to include vaccines licensed and added to the table since the last edition.

  3. Appendix VI: Contraindications and precautions of vaccines licensed since the last edition have been added.

  4. Appendix IX: Newly recognized vehicles of foodborne disease associated with causative agents and additional classical syndromes of foodborne diseases have been added.

  5. New Appendices. Two new appendices have been added. One (Appendix II) shows dates of vaccines licensed by the FDA, and the other (Appendix III) shows Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9) codes for administering licensed vaccines in the United States.


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