Summary of Major Changes in the 1994 Red Book: Report of the Committee on Infectious Diseases

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1000 PEDIATRICS Vol. 93 No. 6 June 1994

Summary

of Major

Changes

in the

1994

Red

Book:

Report

of the

Committee

on Infectious

Diseases

Georges Peter, MD*

The 1994 edition of the Red Book was recently

pub-lished by the American Academy of Pediatrics (AAP),

providing the most recent recommendations and

guidelines for prevention, control, and treatment of infectious diseases in infants and children.’ These rec-ommendations and guidelines are based on

informa-tion available through 1993 and replace those given in the 1991 Red Book. To aid physicians and other health care professionals in assimilating new recommenda-tions and information into their practices, a summary of major changes is given in the Red Book. This sum-mary, with minor changes, is reprinted here. Subse-quent recommendations of the AAP are published as

Committee statements in AAP News and Pediatrics. In

keeping with the current 3-year intervals between editions of the Red Book, the next edition is anticipated no later than 1997.

Major changes in recommendations and related

in-formation in the 1994 Red Book are summarized as

follows:

1. Immunization recommendations. The schedules

for routine immunization, including changes in recommendations for Haemophilus influenzae type b, hepatitis B, measles, and oral polio vaccines

have been revised. In view of the increasing

com-AIDS, amantadine, antibacterial drugs, antimicrobial drugs, antiparasitic

drugs, antiviral drags, arboviruses, Arcanobacterium haemolyticum infection, astroviruses, bacterial meningitis, bacterial vaccines, bacterial vaginosis,

breast-feeding, catscratch disease, child care (out-of-home), Chiamydia tra-chomatis infection, congenital syphilis, croup, day care, dexamethasone, DTPvaccine, Escherichia coliOl57:H7, EsCherichia coli diarrhea, foreign travel, gonococcal infection, group A streptococcal infection, group B streptococcal infection, Haemophilus influenza infection, Haemophilus influenza vaccines, Hantavirus infection, hemorrhagic fevers, hemolytic uremic syndrome, hepatitis B, hepatitis Bvaccine, herpes simplex infection, HIV infection,

human herpesvirus-6 infection, human milk, immune globulin, immunization ofpreterm infants, immunization recommendations, immunizations, influ-enza, influenza vaccine, intravenous immune glObulin (1GW), Japanese en-cephalitis, Kawasaki disease, measles, measles vaccine, MMR vaccine, ml-crosporidiosis, Mycobacterium avium complex (MAC), parainfluenza virus

infection, pediculosis, pelvic inflammatory disease, pertussis, pertussis vac-cisc, Pneumocystis carinii infection, poliovirus vaccine, respiratory syncytial virus infection, ribavirin, rimantadine, roseola, sexually transrnifted

dis-eases, Standardsfor Pediatric Immunization Practices, syphilis, tuberculin skin testing, tuberculosis, tuberculosis drug therapy, Ureaplasma urealyticum in-fection, vaccine adverse events, vaccine contraindications, vaccines, vaccine

storage, vaccine injury compensation, varicella-zoster immune globulin

(VZIG), varicella-zoster infection, viral vaccines.

From the *Coft on Infectious Diseases of the American Academy of Pediatrics.

Received for publication Jan 12, 1994; accepted Jan 19, 1994.

Reprint requests to (G.P.) American Academy of Pediatrics, Publications Department, 141 Northwest Point Blvd, P0 Box 927, Elk Grove Village, IL 009V.

PEDIATRICS (ISSN 0031 4005). Copyright C 1994 by the American Aced-erny of Pediatrics.

plexity of the immunization recommendations

for infants and children, particular attention should be given to the comments and footnotes

in these schedules. In addition, because

licen-sure of new vaccines and revised recommenda-tions after publication of the Red Book will result in continuing changes, the Committee antici-pates the publication of an updated immuniza-tion schedule each year in the interval before the next edition of the Red Book is published. 2. Guidelines on active immunization.

Recommen-dations on vaccine handling and storage, assess-ment of immunizations received in foreign countries in fuffilling vaccination requirements in the United States, interchangeabifity of vac-cine products, vaccine injury compensation, and

reporting vaccine-preventable diseases have

been either revised or added.

3. Standards for Pediatric Immunization Practices.

These standards, as recommended by the

Na-tional Vaccine Advisory Committee, approved

by the United States Public Health Service and

endorsed by the AAP in 1993, are published in

their entirety to enhance the delivery of immu-rnzations of children.

4. Immunization in special circumstances.

Recom-mendations for hepatitis B immunization of

pre-term infants and those for immunization for for-eign travel have been revised.

5. Children in out-of-home child care. The

recom-mendations are similar to those in the previous edition of the Red Book, but the chapter has been revised to include the latest information

concern-ing infectious diseases in child care.

6. Sexually transmitted diseases. New guidelines for

preventing these diseases in adolescents and

young adults have been added.

7. Arboviruses. The revised recommendations of

the Centers for Disease Control and Prevention (CDC) for usage of the Japanese encephalitis

vac-cine (which was licensed in the United States in 1992) are summarized.

8. Chiamydia trachomatis infection. The recommen-dations on the treatment of C trachomatis infection have been revised, including guidelines for treat-ing infants born to mothers with a previously un-treated C trachomatis infection.

9. Cat scratch disease. New information on the eti-ology and diagnostic tests for this disease are given.

10. Escherichia coli diarrhea. Recent information on E

coli 0157:H7 as well as that for other E coli

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ARTICLES 1001

genic strains and the complication from E coli

0157:H7 infection of hemolytic uremic syndrome

are summarized.

I 1. Gonococcal infection and pelvic inflammatory

disease. Recommendations on treatment have been revised.

12. Haemophilus influenzae infection. The 1993 AAP

recommendations on vaccination and related

is-sues, including recently licensed conjugate

vac-cines, immunization schedules at different ages

and in different circumstances, and rifampin

chemoprophylaxis, are given. In addition,

up-dated recommendations on the usage of two of

the recently licensed conjugates with DiP vac-cine are given.

13. Hemorrhagic fevers caused by Bunyavirus, in-cluding Hantavirus. Information on Hantavirus infection and the resulting epidemic in the south-western United States in 1993 are provided. 14. Hepatitis B. In addition to the 1992 AAP

recom-mendations on universal hepatitis B immuniza-tion, new recommendations on the immunization of preterm infants, clarification of the recommen-dations for immunization of preadolescents and adolescents, and guidelines on the immunization schedule in different circumstances, such as

lapsed immunization and the flexibility in

sched-ule, are given in detail.

15. Herpes simplex virus infection. The

recommen-dations on the treatment of infants exposed to

herpes simplex virus (HSV) during delivery have been revised. The changes, while not major, re-flect new epidemiologic findings and other

infor-mation on HSV infection. Recommendations for

antiviral therapy of HSV infection have been up-dated. Guidelines for preventing transmission of HSV infection in athletic competition involving close contact, such as wresthng, are provided.

16. HN infection and AIDS. Changes include the

re-vised CDC survefflance definition for AIDS,

guidelines for diagnosing HIV infection in the

first 6 to 18 months of life for infants born to HIV-infected mothers, antiviral therapy recommenda-tions, indications for intravenous immune

globu-ha (1GW), and the recommendations of the AAP

Task Force on Pediatric AIDS (now termed the

Provisional Committee on Pediatric AIDS) as

published in their statements on perinatal HIV serological tests, adolescent education, school at-tendance and education, child care, and foster

care. Related information on preventing and

treatingPneumocystis

cariniipneumoniaandMyco-bacterium avium complex (MAC) infection in HIV-infected patients is given in the specific chapters on these infections. Because the guidelines on the treatment of children with suspected or proven HP/ infection are complex and evolving, physi-cians should review these chapters for further information.

17. Human herpesvirus-6 (roseola). Because the etiol-ogy of roseola, human herpesvirus-6 (HHV-6), has been identified, the title of this chapter has been

changed and information on HHV-6 infections is

given.

18. Influenza. Vaccine recommendations have been

expanded to indude possible indications for healthy children and timing of vaccination in ste-roid recipients, such as children with asthma. Rec-ommendations for antiviral therapy and

chemo-prophylaxis have been revised to include

rimantadine, which was approved by the Food

and Drug Administration in 1993. Current dosage guidelines for this drug and its analogue, aman-tadine, are given.

19. Kawasaki disease. The recommendations on

treatment, induding guidelines on the usage of

1GW, have been updated.

20. Measles. Revisions include the recommended age of 12 to 15 months for the first dose of MMR

vac-cine, timing of routine immunization of children

who recently received immune globulin, and

in-dications for vitamin A in patients with measles. 21. Parainfluenza virus infection. Treatment

recom-mendations for children with croup have been

ex-panded to include racemic epinephrine and dexa-methasone.

22. Pediculosis. The Committee’s guidelines on treat-ment and prevention have been clarified.

23. Pertussis. Major changes include the previously

issued AAP statement giving recommendations for using the acellular pertussis vaccine, ie, DTaP, and delineation of the precautions and contrain-dications to pertussis vaccination. A high-pitched cry after pertussis vaccination is no longer con-sidered a precaution or contraindication to fur-ther pertussis immunization.

24. Poliovirus infection. The recommended age for the third dose of OPV in the routine childhood

immunization schedule has been changed from

15 to 18 months to 6 to 18 months of age. 25. Group A streptococcal infections. The indications

for oral cephalosporins in the treatment of group A streptococcal pharyngitis have been revised.

The section on diagnostic tests has been updated.

New information on the streptococcal toxic shock

syndrome is given.

26. Group B streptococcal infections. The 1992 AAP

guidelines on the chemoprophylaxis of group B

streptococcal infections are listed.

27. Syphilis. Guidelines for the treatment of infants with possible congenital syphilis have been re-vised in an attempt to darify the AAP’s recom-mendations.

28. Tuberculosis. The recently published AAP

recom-mendations on tuberculin skin testing, including indications, specific tests, and interpretation of the Mantoux test, are given. New treatment rec-ommendations, including the indications for

four-drug therapy, have been made. In view of

the complexities of treating patients with possible or proven tuberculosis, physicians caring for chil-dren with tuberculosis should review this chapter in detail.

29. Varicella-zoster infection. Changes indude the

1993 AAl’ recommendations for oral acydovir in

children with varicella, and guidelines on infec-tion control after hospital exposures. In addition,

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1002 MAJOR CHANGES IN THE 1994 RED BOOK

varicella-zoster immune globulin (VZIG) is no

longer routinely recommended for healthy,

susceptible adults exposed to a person with

varicella.

30. Dexamethasone therapy for bacterial meningitis in infants and children. The earlier Committee statement (see 1991 Red Book) has been revised.

Although the recommendations are similar to

those in the earlier statement, physicians should

review the recommendations to make informed

decisions about using dexamethasone in infants and children with bacterial meningitis.

31. Ribavirin therapy of respiratory syncytial virus

infection. The 1993 AAP statement is reprinted.

32. New chapters. The following have been added:

. Human milk. This chapter summarizes guidelines and recommendations on infectious disease issues in treating infants who are receiving human milk. Many

of the recommendations

are also given

in the

disease-specific chapters in Section 3. . Arcanobacterium haemolyticum infection

. Astroviruses

. Bacterial vaginosis

. Microsporidiosis

. Ureaplasma urealyticum infection

33. Antimicrobial tables. The tables on drug dosages and recommendations, induding those for para-sitic, fungal, and viral infections, have been updated.

Every effort has been made to identify major

changes to aid physicians in rapidly assimilating

new guidelines and recommendations in the Red

Book for the care of their patients. However, because no list is complete, physicians are urged to review relevant chapters and sections. In addition, during

the preparation of each edition, the entire book is

reviewed and revised. Hence, this edition has a con-siderable amount of new information to assist phy-sicians in the diagnosis, treatment, and prevention of pediatric infectious diseases.

REFERENCE

1. American Academy of Pediatrics Peter G, ed. 1994 Red Bc*ik Report of

the Committee on Infectious Diseases. 23rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 1994

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1994;93;1000

Pediatrics

Georges Peter

Infectious Diseases

1994 Red Book: Report of the Committee on