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Summary of Major Changes in the 2003 Red Book
Several changes in the 2003 Red Book affect all sections of this edition. Side bar indicators have been added to facilitate easy access to the specific sections; an expanded number of Web site addresses and references to recommendations of the Committee on Infectious Diseases (COID), Committee on Pediatric AIDS, and other committees of the American Academy of Pediatrics (AAP) as well as the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) have been included; and for all tables, footnote designators have been changed from symbols to numbers for easier reference. Terms have been updated and standardized throughout the Red Book, including changing hand washing to hand hygiene, adverse reactions to adverse events, Mantoux and PPD (purified protein derivative) to tuberculin skin test, nosocomial to health care-associated, hepatitis B carrier to chronic hepatitis B virus infection; and strict isolation precautions to specific terms (contact precautions, droplet precautions, and airborne precautions). Several name changes of organisms have been incorporated throughout the book, including:
Pneumocystis carinii to Pneumocystis jiroveci
Tinea versicolor to Pityriasis versicolor
Norwalk virus to norovirus
Ehrlichia phagocytophila to Anaplasma phagocytophila
Chlamydia (Chlamydophila) pneumoniae
Chlamydia (Chlamydophila) psittaci
SECTION 1. ACTIVE AND PASSIVE IMMUNIZATION
Prologue. Table 1.1 was updated to include the 2001 morbidity and percentage decrease for 9 diseases with vaccines recommended before 1990 for universal use in children in the United States.
Sources of Vaccine Information. The number of sources is expanded, and Web site addresses are provided for most sources.
Vaccines Produced and/or Licensed in the United States. Table 1.3 ( p 8) lists vaccines produced and/or licensed in the United States and includes a Web site for the US Food and Drug Administration that is updated regularly. Additions since 2000 include hepatitis A-hepatitis B combination vaccine, conjugated pneumococcal vaccine, another diphtheria and tetanus toxoids and acellular pertussis (DTaP) preparation, a DTaP-inactivated poliovirushepatitis B combined vaccine, and smallpox vaccine. Several vaccines that no longer are available in the United States have been removed from the table.
Vaccine Handling and Storage. Information on appropriate handling and storage of all vaccines ( Table 1.4, p 11) is updated.
Needle Length. Recommendations were altered to be consistent with ACIP recommendations and modified for use in preterm infants who have a small muscle mass ( pp 18–19).
Immunization Scheduler. A Web link to an immunization scheduler for parents, physicians, and other health care professionals is provided ( p 22).
Scheduling Immunizations. The 2003 schedule ( Figure 1.1, p 24) for recommended childhood and adolescent immunizations is given, and the name of the figure is changed to "Childhood and Adolescent Immunization Schedule." A Web link to the new adult immunization schedule is provided.
Catch-up Immunization Schedules for Children and Adolescents Who Start Late or Who Are >1 Month Behind have been reformatted for easier use ( Table 1.6, p 26).
2003 Standards for Child and Adolescent Immunization Practices ( p 50) has been added (also see Appendix II, p 795).
Internet Resources for Immunization Information. Twenty-eight resources for information including Web sites have been added ( p 52).
Preterm and Low Birth Weight Infants ( p 66) is updated to include recommendations in the AAP statement titled "Immunization of Preterm and Low Birth Weight Infants."
Required or Recommended Travel-Related Immunizations ( p 95). Adverse events associated with yellow fever vaccine have been added (also see Arboviruses, p 199).
New Chapters, Sections, and Tables:
Guidelines for Spacing Live and Inactivated Antigens ( Table 1.5, p 23)
Minimum Ages and Minimum Intervals Between Vaccine Doses ( Table 1.7, p 29)
Vaccine Shortages ( p 37)
Institute of Medicine Immunization Safety Review Committee ( p 38)
The Brighton Collaboration ( p 40)
Clinical Immunization Safety Assessment Network (CISA) ( p 41)
Vaccine Identification Standards Initiative (VISI) ( p 43)
American Indian/Alaska Native Children ( p 84)
SECTION 2. RECOMMENDATIONS FOR CARE OF CHILDREN IN SPECIAL CIRCUMSTANCES
Biological Terrorism. This chapter has been revised to include only biological agents, with update of the existing 2 tables and addition of Table 2.3 ( p 105), which provides emergency contact and educational information.
Blood Safety ( p 106) has been updated to include current information on blood screening measures, potential transfusion-transmitted agents, and improvements in blood safety.
Human Milk ( p 117). This chapter has been revised to include the current recommendations from the AAP statement on breastfeeding and the use of human milk.
Children in Out-of-Home Child Care ( p 123). This chapter has been revised to include the AAP/American Public Health Association National Health and Safety Performance Standards.
Infection Control for Hospitalized Children ( p 146) and Infection Control in Physicians’ Offices ( p 155) provide hand hygiene recommendations from the HICPAC/SHEA/APIC/ADSA Hand Hygiene Task Force, including efficacy of alcohol-based hand rubs.
Sexually Transmitted Diseases in Adolescents and Children ( p 157). This chapter has undergone extensive revision to include the 2002 CDC sexually transmitted diseases treatment guidelines. Chapters dealing with specific organisms associated with sexually transmitted diseases also have been updated.
Medical Evaluation of Internationally Adopted Children. This chapter has been updated to provide guidelines for evaluation of immunization status of internationally adopted children. Table 2.17 ( p 175) has been expanded and Table 2.18 ( p 179) has been added.
New Section:
Hepatitis and Youth in Corrections Settings ( p 167) consolidates old and new recommendations for preventing and controlling infections with hepatitis viruses in corrections settings.
SECTION 3. SUMMARIES OF INFECTIOUS DISEASES
Anthrax ( p 196). This chapter has been updated to include revised treatment and prevention options highlighting the potential use of this organism as a bioterrorist agent.
Arboviruses ( p 199). The chapter has been restructured, and information about West Nile virus has been expanded. Current information about the yellow fever vaccine has been added.
Bacterial Vaginosis ( p 214). Diagnosis and treatment options have been updated to be consistent with the 2002 CDC sexually transmitted diseases treatment guidelines.
Chlamydia trachomatis ( p 238). An update on laboratory diagnostic tests for C trachomatis is included.
Cryptosporidiosis ( p 255). Nitazoxanide has been licensed for treatment of children with cryptosporidiosis and giardiasis.
Cytomegalovirus Infections ( p 259). Treatment of cytomegalovirus infection has been updated.
Gonococcal Infections ( p 285). Update on laboratory screening methods to detect Neisseria gonorrhoeae is included, and recommendations for treatment are consistent with the 2002 CDC sexually transmitted diseases treatment guidelines.
Helicobacer pylori Infections ( p 304). Seven-day therapy including rabeprazole has been added.
Hepatitis A ( p 309). Table 3.15 ( p 314) has been updated to include the hepatitis A-hepatitis B combination vaccine.
Hepatitis B ( p 318). Information about new vaccine combinations (hepatitis A-hepatitis B and DTaP-hepatitis B-IPV) is included. Table 3.17 ( p 325) has been updated to include all vaccines that contain hepatitis B. Table 3.18 ( p 328), which summarizes hepatitis B immunoprophylaxis for preterm and low birth weight infants, has been added.
Hepatitis C ( p 336). Laboratory testing and therapy for hepatitis C virus infection have been updated.
Human Immunodeficiency Virus Infection ( p 360). Recommendations for prevention of opportunistic infections in children with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome have been revised in accordance with the 2002 US Public Health Service/Infectious Diseases Society of America guidelines for prevention of opportunistic infections among HIV-infected persons. Recommendations for using antiretroviral agents among adolescents has been revised according to the 2002 CDC guidelines for using antiretroviral agents among HIV infected adults and adolescents. Web sites where current drugs and treatment recommendations can be found have been added, and the tables in Section 4 showing characteristics of antiretroviral drugs have been updated.
Influenza ( p 382). Updates are provided on the virus, protective immunity, disease burden in children, diagnostic assays, and vaccines. Table 3.29 ( p 385) has been added to summarize various aspects of antiviral drugs. Dosages for therapy or prevention of influenza with antiviral drugs has been moved to the Antiviral Drugs for Non-Human Immunodeficiency Virus Infections table in Section 4 (p 729).
Kawasaki syndrome ( p 392). Reference to Kawasaki disease has been changed to Kawasaki syndrome, and a paragraph on incomplete cases has been added.
Malaria ( p 414). Updates on malaria-endemic areas, location of resistant strains, and recommended therapy and prophylaxis are given.
Meningococcal Infections ( p 430). Prophylactic antimicrobial therapy, college requirements for immunization, and air travel as a risk factor have been added. The reimmunization section has been updated.
Human Papillomavirus ( p 448). Section on clinical manifestations attributable to human papillomaviruses has been expanded. Diagnosis and therapy have been updated and are consistent with the 2002 CDC sexually transmitted diseases treatment guidelines.
Parainfluenza Viral Infections ( p 454). The epidemiology and diagnostic tests sections of this chapter have been revised.
Parasitic Diseases ( p 456). Raccoon roundworm (Baylisascaris procyonis) has been added to Table 3.38 ( p 457).
Parvovirus B19 ( p 459). Table 3.39 ( p 460), showing clinical manifestations of human parvovirus B19 infection, has been added.
Pediculosis Capitis ( p 463). This chapter includes information contained in the AAP clinical report on head lice.
Pelvic Inflammatory Disease ( p 468). Recommendations for treatment of pelvic inflammatory disease have been updated to be consistent with the 2002 CDC sexually transmitted diseases treatment guidelines.
Pertussis ( p 472). The list of DTaP vaccine products has been updated to include all FDA-licensed preparations ( Table 3.42, p 477). The use of DTaP-hepatitis B-IPV combination vaccine is included.
Pneumococcal Infections ( p 490). Information showing susceptibility to penicillin, cefotaxime, and ceftriaxone has been added. Table 3.43 ( p 492), showing children at high and moderate risk of invasive pneumococcal disease, and Tables 3.46 ( p 497) and 3.47 ( p 498), providing recommendations for immunization with PCV7, are included.
Pneumocystis jiroveci ( p 500). The name Pneumocystis carinii has been changed to P jiroveci, although the term PCP will continue to be used for Pneumocystis pneumonia. Recommendations concerning therapy and prevention have been updated and are consistent with the 2002 US Public Health Service/Infectious Diseases Society of America guidelines for prevention of opportunistic infections among HIV-infected persons.
Q Fever ( p 512). Diagnostic criteria required to confirm a case of Q fever have been added.
Respiratory Syncytial Virus ( p 523). Recommendations for use of palivizumab in 32- to 35-week-old infants have been clarified, and recommendations for infants and young children with hemodynamically significant congenital heart disease have been added to be consistent with the AAP statement on respiratory syncytial virus infection.
Rubella ( p 536). The recommended time to wait to become pregnant after rubella immunization has been decreased from 3 months to 28 days.
Salmonella Infections ( p 541). Table 3.52 ( p 543), showing the nomenclature for Salmonella organisms, is included. The only typhoid vaccine available in the United States for children 6 months to 2 years of age no longer is manufactured ( Table 3.53, p 546).
Staphylococcal Infections ( p 561). Information about vancomycin-resistant Staphylococcus aureus has been added. Antimicrobial therapy for bacteremia and other serious S aureus infections has been updated ( Table 3.55, p 568).
Group B Streptococcal Infections ( p 584). Recommendations for prevention of perinatal group B streptococcal disease have been updated and are consistent with the 2002 CDC guidelines for prevention of group B streptococcal disease.
Non-Group A or B Streptococcal and Enterococcal Infectious ( p 591). This chapter has been updated to reflect current nomenclature, clinical manifestations, diagnosis, and therapy.
Syphilis ( p 595). Table 3.60 ( p 604) shows the recommended therapy for syphilis and is consistent with the 2002 CDC sexually transmitted diseases treatment guidelines.
Tetanus ( p 611). The total number of doses of diphtheria and tetanus toxoids has been changed from "should not exceed 6 before the fourth birthday" to "should not exceed 6 before the seventh birthday."
Tuberculosis ( p 642). This chapter has been updated to be consistent with the ATS/CDC tuberculosis statement.
Diseases Caused by Nontuberculous Mycobacteria ( p 661). This chapter has been updated to include current clinical syndromes and their causes, diagnosis, and treatment.
New chapters and tables:
SECTION 4. ANTIMICROBIAL AGENTS AND RELATED THERAPY
The following have been updated:
Tables of Antibacterial Drug Dosages ( Tables 4.1 and 4.2, pp 700–712)
Sexually Transmitted Diseases ( Table 4.3, pp 713–718). This table includes recommendations from the 2002 CDC sexually transmitted diseases treatment guidelines.
Antifungal Drugs for System Fungal Infections ( pp 719–721): caspofungin and voriconazole have been added.
Antiviral Drugs for Non-Human Immunodeficiency Virus Infections ( Table 4.8, pp 729–732).
Tables 4.13 and 4.14 ( pp 744–770), Drugs for Parasitic Infections, reflect the 2002 Medical Letter on Drugs and Therapeutics recommendations.
Antiretroviral Therapy
Tables listing nucleoside/nucleotide reverse transcriptase inhibitors ( Table 4.9, pp 733–735), nonnucleoside reverse transcriptase inhibitors ( Table 4.10, pp 736–737), and protease inhibitors ( Table 4.11, pp 738-740) have been updated and simplified.
The table listing considerations for changing antiretroviral therapy has been deleted.
Table 4.12 ( pp 741–743), showing common class adverse events and drug interactions, has been added.
APPENDICES
Appendix I. Directory of Services ( p 789) has been updated to include current contact information.
Appendix II. Standards for Child and Adolescent Immunization Practices ( p 795) has been updated to be consistent with the 2003 Standards.
Appendix III. Guide to Contraindications and Precautions to Immunizations, 2003 ( p 798) is a separate table that has been updated to include hepatitis A, influenza, and pneumococcal vaccines. Latex allergy as a general precaution is added, immunodeficient household contacts and breastfeeding are added under not a contraindication, and administration guidelines for measles-mumps-rubella vaccine and tuberculin skin testing are clarified.
Appendix IV. National Vaccine Injury Act Reporting and Compensation Table ( p 802) has been updated.
Appendix VII. Prevention of Disease From Potentially Contaminated Food Products ( p 814). Information describing food irradiation and shigatoxin producing Escherichia coli infections has been added.
Appendix IX. Nationally Notifiable Infectious Diseases in the United States ( p 822) now includes Powassan and West Nile virus encephalitis, shiga-toxin producing E coli, non-O157:H7 E coli, giardiasis, listeriosis, Q fever, Streptococcus pneumoniae, invasive diseases in children 5 years of age or younger, and tularemia.
OTHER: SARS
Information about severe acute respiratory syndrome (SARS) is not included but may be found at www.cdc.gov/ or www.who.int/en/.
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