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Red Book Online subscribers can stay up-to-date with important news and features such as

• Status of Licensure and Recommendations for New Vaccines – New

• Breaking News—Red Book Online Special Alerts (including archives)

♦ Special Alert: HPV Vaccine: AAP Update Posted 7/23/08

Rumors have begun to circulate about the safety of Gardasil® human papillomavirus (HPV) vaccine based on a news story about adverse events being reported. Most adverse events following administration of a vaccine are mild and self limited and include pain and redness at the injection site.

Based on the risk/benefit profile of HPV vaccine, the American Academy of Pediatrics continues to recommend routine HPV vaccination for 11-12 year old girls and catch up vaccination for 13-18 year old girls. As with any vaccine, continuous monitoring for and review of adverse events that occur after HPV vaccine administration, with follow-up as necessary, will assure that our HPV vaccine program is as safe as possible. This monitoring includes physician and parent reports to the VAERS system.

Centers for Disease Control and Prevention and Food and Drug Administration are conducting an ongoing study of VAERS reports describing adverse events following Gardasil.

The CDC-FDA information on Gardasil safety is now posted on the Immunization Safety and FDA CBER Web sites.

Additional information for providers and parents about HPV, HPV vaccine and a summary of Gardasil reports to VAERS can be found at the following websites:

CDC: HPV Vaccination page
CDC: HPV vaccine safety Q and A’s for the public.
CDC: HPV vaccine Q and A for public
Summary of Gardasil reports to VAERS

Go to HPV in Red Book Online.

♦ Special Alert: Measles outbreaks in the United States: Public health preparedness, control and response in healthcare settings and the community Posted 4/16/08

The CDC issued a Health Advisory on April 2, 2008 regarding a measles outbreak in Arizona that was linked to an importation from Switzerland. The first case, with rash onset on February 12, 2008, occurred in an adult visitor from Switzerland who was hospitalized with measles and pneumonia. Through March 31, 2008, nine confirmed cases were reported to the Arizona Department of Health Services.

For the entire health advisory, please click on the CDC link below.

CDC Link
Go to Red Book text:
Section 3, Measles

♦ Special Alert: Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection Posted 2/1/08
CDC is requesting that states report all cases of influenza-related pediatric mortality during the 2007-2008 influenza season. This health advisory contains updated information about influenza and bacterial co-infections in children and provides interim testing and treatment recommendations.

Since 2004, the Influenza-Associated Pediatric Mortality Surveillance System, part of the Nationally Notifiable Disease Surveillance System, has collected information on deaths among children due to laboratory-confirmed influenza, including the presence of other medical conditions and bacterial infections at the time of death. From October 1, 2006 through September 30, 2007, 73 deaths from influenza in children were reported to CDC from 39 state health departments and two city health departments. Data on the presence (or absence) of bacterial co-infections were recorded for 69 of these cases; 30 (44%) had a bacterial co-infection, and 22 (73%) of these 30 were infected with Staphylococcus aureus.

For the entire health advisory, please click on the CDC link below.

CDC Link
Go to Red Book text:
Section 3, Influenza

♦ Special Alert: American Academy of Pediatrics Urges Caution in Use of Over-the-Counter Cough and Cold Medicines Posted 1/24/08
The U.S. Food and Drug Administration issued an advisory strongly recommending that over-the-counter cough and cold medications not be given to infants and children under two years old because of the risk of life-threatening side effects. The American Academy of Pediatrics (AAP) supports this recommendation and urges parents to seek safer ways to soothe infants and young children suffering from colds and coughs.

Studies have shown cough and cold products are ineffective in treating symptoms of children under six years old, and may pose serious risks. A variety of rare, serious health problems have been associated with use of these medications in children, including death, convulsions, rapid heart rates and decreased levels of consciousness. (A review by the U.S. Centers for Disease Control and Prevention of national emergency department visits due to adverse drug events from cough and cold medications will be published in the online version of Pediatrics, Jan. 28.)

For the full announcement and related information, please visit Treating Coughs and Colds on the AAP Web site.

Go to Red Book text:
Section 3, Rhinovirus Infections
Section 2, Isolation Precautions

♦ Special Alert: Yellow Fever Vaccine Shortage Posted 1/22/08
The Centers for Disease Control and Prevention (CDC) has recently become aware of a temporary shortage of single-dose vials of YF-VAX®, the only yellow fever vaccine marketed in the United States. The 5-dose vials of YF-VAX® continue to be available in sufficient supply.

According to the manufacturer, sanofi pasteur, there is no shortage of the vaccine itself, but there is a temporary issue related to the specialized production equipment necessary to insert the vaccine into single-dose vials. Delays occurred when the supplier of this equipment went out of business, making it necessary to validate a new supplier. This issue has been rectified, and the single-dose vials are expected to be back in stock in March 2008.

To view the full announcement, please click on the CDC link below.

OUTBREAK NOTICE: Yellow Fever Alert for Brazil

CDC Link
Go to Red Book text:
Section 1, International Travel
Section 3, Arboviruses

♦ Special Alert: Recommendations for Influenza Vaccine, 2007-2008 Posted 1/16/08
The American Academy of Pediatrics (AAP) recommends annual influenza immunization for all children with high-risk conditions who are 6 months and older; all healthy children ages 6 through 59 months; all household contacts and out-of-home caregivers of children who have high-risk conditions and/or healthy children younger than 5 years; and all health care professionals.

The purpose of this statement is to update the current recommendations for routine use of influenza vaccine in children, which were originally published in a condensed version in April 2007. New information includes (1) harmonization of the recommendation of the AAP and the Centers for Disease Control and Prevention that children younger than 9 years receive two doses of influenza vaccine in their second season of immunization if they received only one dose in the previous seaon; and (2) further details on the administration of live-attenuated influenza vaccine (LAIV), including the recommendation for the use of LAIV in children as young as 2 years.

To view this statement as a PDF, please click here.
2008 Immunization Schedule for Ages 0-6 [PDF] | 2008 Immuninization Schedule for Ages 7-18 [PDF]
Go to Red Book text:
Section 1, Sources of Vaccine Information

♦ Special Alert: New 2008 Recommended Childhood and Adolescent Immunization Schedules Posted 1/2/08
The annual recommended immunization schedules for children and adolescents in the United States for January–December 2008 were approved by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians. There are three schedules: one for children 0 to 6 years of age, one for those 7 to 18 years of age, and a catch-up immunization schedule for those who start late or fall behind. These schedules reflect current recommendations for use of vaccines licensed by the US Food and Drug Administration and include the following changes from last year:


• A single dose of pneumococcal conjugate vaccine is recommended for all healthy children 24 to 59 months of age who are incompletely immunized.
  
• The lower age limit for use of live-attenuated influenza vaccine in healthy children has been reduced from 5 years of age to 2 years of age. Live-attenuated influenza vaccine is now available in a liquid formulation that is stable at refrigerator temperatures. The time interval for administration of the second dose of live-attenuated nasal influenza vaccine (when a second dose is indicated) has been reduced from 6 to 4 weeks.
  
• A single dose of quadrivalent meningococcal conjugate vaccine is now recommended for all adolescents 11 to 18 years of age if not previously administered. For children 2 to 10 years of age at increased risk of meningococcal infection, as defined in the 2006 Red Book, 1 quadrivalent meningococcal conjugate vaccine is recommended and preferred over quadrivalent meningococcal polysaccharide vaccine.

Throughout 2008, any applicable updates to potential vaccine licensures and recommendations will be posted on the Red Book Online table "Status of Licensure and Recommendations for New Vaccines."

2008 Immunization Schedule for Ages 0-6 [PDF] | 2008 Immuninization Schedule for Ages 7-18 [PDF] | 2008 Catch-Up Immunization Schedule for Persons Aged 4 Months-18 Years Who Start Late or Who Are More Than 1 Month Behind [PDF]
Go to Red Book text:
Section 1, Scheduling Immunizations

♦ Special Alert: Hib Booster Doses Suspended Due to Shortage of Hib Vaccines Posted 12/20/07
The recent suspension of production by Merck & Co., Inc. of PedvaxHIB® and COMVAX® and Merck's subsequent voluntary recall of certain lots of both vaccines on December 13th have led to a significant disruption in the supply of Haemophilus influenzae type b (Hib) containing vaccines. The Centers for Disease Control and Prevention (CDC) is making some Hib vaccine available from its stockpile and sanofi pasteur is increasing production of its licensed Hib vaccine, ActHIB®, to attempt to meet the current demand for Hib vaccine in the United States. However, a significant temporary shortage of Hib containing vaccines is now expected. AAP has been working with the CDC and other stakeholders to develop an interim strategy to best meet the needs of children during the shortage. A CDC Dispatch published today in Morbidity and Mortality Weekly Report provides additional details on the expected shortage and interim recommendations.

In brief, recommendations include:

1. Temporary deferral of the routine Hib vaccine booster dose administered at 12-15 months of age except for children who are at increased risk for invasive Hib disease, as described below. A register and tracking system should be developed to facilitate recalling these children when vaccine supply improves.
   
2. Children at increased risk for invasive Hib disease should continue to receive the recommended booster dose of Hib vaccine at 12-15 months of age. Children at increased risk include: American Indian and Alaskan Native children (AI/AN), and children with sickle cell disease, HIV infection, anatomic or functional asplenia, malignancies or other immunocompromising conditions. Any Hib containing vaccine licensed for use at 12-15 months of age (PedvaxHIB®, ActHIB® or TriHIBit®) can be administered. TriHIBit® is only licensed to be administered at the 12-15 month of age visit.
   
3. The primary series for all children should be completed on schedule with 2 doses of a PRP-OMP containing Hib conjugate vaccine (PedvaxHIB® or COMVAX®) given at 2 and 4 months of age or 3 doses of a PRP-T containing conjugate vaccine (ActHIB®) given at 2, 4 and 6 months of age.
   
4. Hib vaccines are considered interchangeable for primary immunization. Therefore, either vaccine can be used to complete the primary series. However, if only one of the two first doses given at 2 and 4 months of age was a PRP-OMP containing vaccine, a total of three doses of Hib containing vaccine is needed to complete the primary series.
   
5. Physicians who serve predominantly AI/AN populations should attempt to give a PRP-OMP containing vaccine as the first dose because of the high risk of invasive Hib disease at an early age in this population and the more rapid protective antibody response seen with PRP-OMP. The CDC will prioritize distribution of remaining stocks of PRP-OMP containing vaccines for use in AI/AN children living in predominantly AI/AN communities.
   
6. The appropriate number and timing of doses of Hib vaccine for children who are behind schedule is available in the 2006 Red Book (pages 28-32) and online at Red Book Online.
   
7. All isolates of H. influenzae from sterile sites should be serotyped and cases promptly reported to your state health department.
   
8. To allow maximum distribution of available Hib vaccine, physicians should order only the number of doses of vaccine required to meet their needs for the next 4 weeks.

CDC Link
Go to Red Book text:
Section 3, Haemophilus influenzae Infections

♦ Special Alert: Botulism Outbreak Associated with Canned Chili Investigated by CDC Posted 7/25/07
As of July 21, 2007, four cases of botulism (two from Indiana and two from Texas) were reported to CDC. All four persons reportedly consumed Castleberry's brand Hot Dog Chili Sauce Original. After being notified of the outbreak by the FDA, the company that manufacturers the Castleberry's brand hot dog chili sauce and other products, issued a voluntary recall.

Click here for the full article.

CDC Link
Go to Red Book text:
Section 3, Botulism and Infant Botulism

♦ Special Alert: AAP Publishes First-Ever Red Book^® Atlas of Pediatric Infectious Diseases Posted 5/22/07
Based on key content from the Red Book, and featuring over 500 full color images never before available in print, the new Red Book Atlas of Pediatric Infectious Diseases (hardcover, 415 pages) from the American Academy of Pediatrics provides efficient, illustrated, and trustworthy clinical guidance on more than 100 pediatric infectious diseases. For more information, visit the AAP Bookstore or view the Red Book Atlas flyer (PDF) via the links below.

AAP Bookstore link | Red Book Atlas flyer (PDF)

♦ Special Alert: AAP Guidance Regarding Expected MMRV Supply Difficulties Posted 5/11/07
Merck & Co., Inc. has notified the American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) that, based on current market demand, the company projects the existing supply of ProQuad is likely to be depleted by July 2007. Once depleted, ProQuad is not expected to be available at least for the remainder of 2007. Vaccine providers should begin transitioning from ProQuad to MMR and Varivax according to their current supply of vaccine.

In its April issue, AAP News reported that Merck (Whitehouse Station, N.J.) had temporarily suspended production of bulk varicella, which is used in the preparation of its three varicella-containing vaccines, due to lower than expected yields in recent production lots. Varicella bulk is stored frozen until it is needed in the final preparation phase of each varicella-containing vaccine. Thus, the lower virus yield in the production of bulk varicella zoster virus (VZV) does not affect the quality of any of Merck’s VZV-containing vaccines currently on the market, nor does it affect any lots of vaccine manufactured and ready for release to the market. Production of VZV bulk will remain suspended until Merck identifies the cause of the lower-than-expected virus yield.

To conserve existing bulk, Merck prioritized continued production of Varivax and the newly licensed zoster vaccine (Zostavax) over ProQuad, since production of Varivax requires less bulk varicella than does production of ProQuad. Zostavax is licensed for use in adults age 60 and older, and should never be administered to children.

Merck said it foresees no problems in meeting an increased demand for Varivax and MMR while ProQuad is unavailable. Further information is available in the CDC’s Morbidity and Mortality Weekly Report.

Supplies of Varivax are expected to be adequate for implementation of the new recommendation from the Academy and the CDC that a second dose of varicella vaccine routinely be administered to all children and adolescents without evidence of immunity to varicella-zoster virus. Although the Academy recommends that the second dose of varicella-containing vaccine be administered routinely at 4-6 years of age, during the ProQuad shortage physicians who wish to reduce the number of injections at the 4-6 year old visit may routinely give the second dose of Varivax prior to this age, as long as the first and second doses are separated by at least 28 days (and preferably by at least three months). Full recommendations on use of varicella vaccine in pediatric patients are available online on Red Book Online, and will be published in the July issue of Pediatrics.

Questions about the supply of these Merck products can be addressed by contacting Merck’s National Service Center at 1-800-637-2590.

AAP Policy Statement (PDF) | Red Book Online Vaccine Status Table
Go to Red Book text:
Section 3, Varicella-Zoster Infections

♦ Special Alert: CDC Updates Recommendations for Treatment of Gonococcal Infections Posted 4/25/07
The Centers for Disease Control and Prevention (CDC) has updated its sexually transmitted diseases treatment guidelines and "no longer recommends the use of fluoroquinolones for the treatment of gonococcal infections and associated conditions such as pelvic inflammatory disease (PID)." Click here for the full MMWR article.

CDC Link
Go to Red Book text:
Section 3, Gonococcal Infections
Section 3, Pelvic Inflammatory Disease

♦ Special Alert: AAP Recommends Universal Immunization for Hepatitis A Posted 4/11/07
In a new 2007 policy statement, the American Academy of Pediatrics has recommended that all children should receive hepatitis A vaccine at 1 year of age (12–23 months) as a 2-dose regimen. The 2-dose series should be administered at least 6 months apart.

AAP Policy Statement (PDF) | Red Book Online Vaccine Status Table
Go to Red Book text:
Section 3, Hepatitis A

♦ Special Alert: Two Doses of Varicella Vaccine Now Recommended By AAP Posted 4/11/07
In a new 2007 policy statement, the American Academy of Pediatrics has published its recommendation of a 2-dose varicella immunization strategy. Children 12 months through 12 years of age should receive two 0.5 ml doses of varicella vaccine, separated by at least 3 months. Children 13 years of age or older without evidence of immunity, should receive two 0.5 ml doses of varicella vaccine separated by at least 28 days.

AAP Policy Statement (PDF) | Red Book Online Vaccine Status Table
Go to Red Book text:
Section 3, Varicella-Zoster Infections

♦ Special Alert: Important Red Book Erratum Posted for Cryptococcus neoformans Infections Posted 4/11/07
An important new erratum for the 2006 Red Book has been posted on Red Book Online for the Cryptococcus neoformans Infections (Cryptococcosis) section. On page 270 of the 2006 Red Book, under the Treatment heading, in the third sentence, the dosage of fluconazole should be changed from 100 mg/kg per day to 10 mg/kg per day.

View Errata | Go to Red Book text: Cryptococcus neoformans Infections (Cryptococcosis)

♦ Special Alert: 2007 Childhood and Adolescent Immunization Schedules Released Posted 1/2/07
The American Academy of Pediatrics (AAP) has issued the recommended 2007 childhood and adolescent immunization schedules for the United States. The schedules represent joint recommendations from the AAP, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians (AAFP).

The 2007 schedules reflect several major changes including the following:

• The division of the recommendations into 2 separate schedules: one for children 0 to 6 years of age and one for those 7 to 18 years of age.
• The addition of oral live rotavirus vaccine for routine administration to all infants at ages 2, 4, and 6 months of age.
• Routine administration of a second dose of varicella vaccine at 4 to 6 years of age.
• The addition of human papillomavirus vaccine for girls 11 to 12 years of age, with catch-up immunization of girls 13 to 18 years of age. This vaccine, administered intramuscularly in a 3-dose series at 0, 2, and 6 months, prevents most cases of cervical cancer and genital warts.
• The age range for routine annual administration of influenza vaccine has been expanded to children aged 6 to 59 months and close contacts of children aged 0 to 59 months.

Throughout 2007, any applicable updates to potential vaccine licensures and recommendations will be posted on the Red Book Online table "Status of Licensure and Recommendations for New Vaccines" at http://www.aapredbook.org/vaccstatus.shtml.

2007 Immunization Schedule for Ages 0-6 [PDF] | 2007 Immunization Schedule for Ages 7-18 [PDF] | Go to Red Book text | Red Book Online Vaccine Status Table

♦ Special Alert: AAP Releases Recommendations for Rotavirus Vaccination Posted 11/2/06
The AAP now recommends routine immunization of infants with three doses of pentavalent rotavirus vaccine administered orally at 2, 4 and 6 months of age. The first dose should be given between 6 to 12 weeks of age; vaccination should not be initiated for infants older than 12 weeks of age. Subsequent doses should be administered at 4 to 10 week intervals and all three doses of vaccine should be administered by 32 weeks of age.

AAP Policy Statement (PDF) | Red Book Online Vaccine Status Table
Go to Red Book text:
Section 3, Rotavirus Infections

♦ Special Alert: MCV4 Supply Update: AAP and CDC Recommends Resuming Meningococcal Vaccination to Persons Aged 11-12 Years Posted 11/2/06
In May 2006, the American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) recommended deferral of meningococcal polysaccharide-protein conjugate (MCV4) vaccination in 11-12 year-olds in response to vaccine supply limitations. Vaccine manufacturer sanofi pasteur reports that limitations in MCV4 supply have now been resolved. Therefore, the AAP and the CDC encourage resuming routine vaccination of ALL recommended groups, including 11-12 year-olds, 15 year-olds (at high school entry) if not previously vaccinated with MCV4, college freshmen living in dormitories if not previously vaccinated with MCV4 and others at increased risk for meningococcal disease. When possible, providers who deferred vaccination of 11-12 year-olds should recall those patients for MCV4 vaccination.

CDC Link | AAP Policy Statement | Red Book Online Vaccine Status Table
Go to Red Book text:
Section 3, Meningococcal Infections

♦ Special Alert: Novartis Recalls Select Lots of Fluvirin Influenza Vaccine Posted 11/2/06
Novartis (formerly Chiron) has posted a recall of two lots of Fluvirin influenza vaccine distributed in October 2006. Please see AAP News for more details about lot numbers and the recall notice.

AAP News article | Red Book Online Influenza Resource Page
Go to Red Book text:
Section 3, Influenza

♦ Special Alert: CDC Update on Guillain-Barré Syndrome (GBS) and Menactra Meningococcal Vaccine Posted 10/20/06
The CDC has published an update in MMWR with more information about a possible connection between Menactra vaccine and Guillain-Barré Syndrome (GBS). Through September 2006, there have been a total of 17 cases of GBS among recipients of Menactra (MCV4). It remains unclear if this rate is higher than the rate in the adolescent population overall. An ongoing known risk for serious meningococcal disease exists. Therefore, the CDC and AAP are continuing to recommend routine vaccination of adolescents, college freshman living in dormitories, and other populations at increased risk of meningitis. As noted in the Meningococcal Infections (Control Measures) section of the 2006 Red Book, MCV4 should not be given to adolescents or adults with a history of GBS. The AAP has posted information, including speaking points for pediatricians, on the AAP Member Center.

MMWR Article | AAP Member Center Link
Red Book Online resources:
Section 3, Meningococcal Infections | Section 1, Vaccine Safety and Contraindications | Patient Education Brochures (Infectious Disease Resources)

♦ Special Alert: AAP Addresses Influenza Vaccine Distribution Issues Posted 10/13/06
Many pediatricians have expressed concerns over a limited supply of influenza vaccine for the Fall 2006 influenza vaccination season, particularly due to distribution delays of FluZone manufactured by sanofi pasteur. The AAP has posted a letter from AAP president Jay E. Berkelhamer, MD, FAAP, to its members, which outlines the steps the AAP is taking to address the situation and communicate the issue to the general public. The AAP Member Center contains a collection of documents for members, including template letters and office posters for communicating the delays to patients.

AAP Member Center Link | Red Book Online Influenza Resource Page
Go to Red Book text:
Section 3, Influenza

♦ Special Alert: New 2006 Red Book Text and Images Launched on Red Book Online Posted 7/31/06
The full text of the 2006 Red Book and over 2,000 full-color images have been launched on the Red Book Online Web site. In addition to the new Red Book content and images, Red Book Online has added several dynamic new features to the site, including e-mail-a-friend links, extracts, and PowerPoint downloads for visual images. More details about these useful new features will be outlined in future Red Book Online e-mail alerts.

Key 2006 Red Book links:
Summary of Major Changes in the 2006 Red Book
Full text of the 2006 Red Book
Visual Library
Red Book Archives (2000 and 2003 editions)

♦ Special Alert: AAP Develops New Influenza Resource Page for Health Care Professionals on Red Book Online Posted 5/25/06
The American Academy of Pediatrics Committee on Infectious Diseases (sometimes referred to as the "Red Book Committee") has developed a brand new Red Book Online Influenza Resource Page for health care professionals at www.aapredbook.org/flu. This resource page is a comprehensive list of influenza resources to serve as a centralized point of reference for vaccine, prevention, treatment, reimbursement, policies, news, and other information pertaining to seasonal, avian, and pandemic influenza. This resource page is openly accessible to all visitors of the Red Book Online site, and will be updated periodically with important new information and links.

Red Book Online Influenza Resource Page
Other Red Book Online Resource Pages:
Red Book Online Vaccine Status Table

Vaccine Shortage Updates

Featured Resources from the American Academy of Pediatrics

Comprehensive online infectious disease resource.

Pediatric practice management information, tools, and resources.

Complete library of AAP patient education handouts.

Online home of the AAP Pediatric Coding NewsletterTM.

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