Summary of Major Changes in the 2021 Red Book
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2021. "Summary of Major Changes in the 2021 Red Book", Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics, David W. Kimberlin, MD, FAAP, Elizabeth D. Barnett, MD, FAAP, Ruth Lynfield, MD, FAAP, Mark H. Sawyer, MD, FAAP
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Major Changes: General
All chapters in the last edition of the Red Book were assessed for relevance in the dynamic environment that is the practice of pediatric medicine today. The School Health chapter was noted to have significant overlap with the Children in Out-of-Home Child Care chapter, so they were merged in the 2021 edition into a single chapter titled Children in Group Child Care and Schools. In addition, the Vaccine Injury Table appendix was deleted. Two chapters have been added to the 2021 edition: Pseudomonas aeruginosa Infections and a new Systems-based Treatment Table that is designed to aid in initial antibiotic selections by clinical condition, before the specific pathogen is known.
The 2018 Red Book had 9% fewer chapters compared with the 2015 edition, and yet the total book was 60 pages longer. As we started work on the 2021 Red Book, we therefore identified the 31 chapters that were 10 pages or longer in the 2018 edition, and made a targeted effort to trim them so that all relevant information could more easily and quickly be located. Although some of these 31 chapters (eg, the antibiotic or antiparasitic tables) could not be truncated, we overall achieved our goal by decreasing the 2021 Red Book by 41 pages compared with the 2018 edition.
Every chapter in the 2021 Red Book has been modified since the last edition. The listing below outlines the more major changes throughout the 2021 edition.
To ensure that the information presented in the Red Book is based on the most accurate and up-to-date scientific data, the primary reviewers of each Red Book chapter were selected for their specific academic expertise in each particular area. In this edition of the Red Book, 32% of the primary reviewers were new for their assigned chapters. This ensures that the Red Book content is viewed with fresh eyes with each publication cycle.
Throughout the Red Book, the number of websites where additional current and future information can be obtained has been updated. All websites are in bold type for ease of reference, and all have been verified for accuracy and accessibility.
Reference to evidence-based policy recommendations from the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and other select professional organizations have been updated throughout the Red Book.
Standardized approaches to disease prevention through immunizations, antimicrobial prophylaxis, and infection-control practices have been updated throughout the Red Book.
Policy updates released after publication of this edition of the Red Book will be posted on Red Book Online.
Appropriate chapters throughout the Red Book have been updated to be consistent with 2021 AAP and CDC vaccine recommendations, CDC recommendations for immunization of health care personnel, and drug recommendations from 2021 Nelson’s Pediatric Antimicrobial Therapy.1
Several tables and figures have been added for ease of information retrieval.
Active and Passive Immunization
Internet resources for vaccine information have been updated in Sources of Information About Immunization.
The CDC’s new “Vaccinate with Confidence” program, launched in 2019, has been added to the Discussing Vaccines With Patients and Parents chapter.
The table on “Vaccines Approved for Immunization and Distributed in the United States and Their Routes of Administration” in the Active Immunization chapter has been updated to include the newly approved dengue vaccine.
The Vaccine Ingredients chapter has been restructured to more clearly delineate the excipients that may be present in vaccines.
Information on vaccine transport has been expanded in Vaccine Handling and Storage.
In the Vaccine Administration chapter, information on needle length and site of injection for intramuscularly administered vaccines is provided by age group.
Sequence and interval between PCV13 and PPSV23 has been added to the section on administration of multiple vaccines in the Timing of Vaccines and the Immunization Schedule chapter.
A link to the CDC’s General Best Practice Guidelines for Immunization document has been added to Minimum Ages and Minimum Intervals Between Vaccine Doses.
In the Interchangeability of Vaccine Products chapter, clarification has been added that if different brands of a particular vaccine require a different number of doses for series completion and a provider mixes brands in the primary series, then the higher number of doses is recommended for series completion.
Data have been updated on the small increased risk of febrile seizure when IIV and PCV13 are administered simultaneously in the chapter on Simultaneous Administration of Multiple Vaccines.
The new hexavalent vaccine to prevent diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, and invasive disease due to Haemophilus influenzae type b, Vaxelis, has been added to the table in the Combination Vaccines chapter.
A link to the recommended intervals between vaccine doses has been added to enhance discussion of Lapsed Immunizations.
In the Unknown or Uncertain Immunization Status chapter, a statement has been added that serologic testing may not satisfy some school immunization requirements.
Table 1.11 (Recommended Intervals Between Receipt of Blood Products and Administration of MMR, Varicella, or MMRV Vaccines) has been significantly revised in the chapter on Active Immunization of People Who Recently Received Immune Globulin and Other Blood Products.
The listing of the National Academy of Medicine’s causality conclusions regarding evidence for a causal relationship between the specific vaccines and other adverse event has been expanded in the National Academy of Medicine Reviews of Adverse Events After Immunization chapter.
The Vaccine Adverse Event Reporting System chapter has updated information on reporting of adverse events.
The description of the FDA’s active postmarket surveillance system, the Biologics Effectiveness and Safety (BEST) Initiative, has been updated in the chapter FDA CBER Sentinel Program.
Information about funding and award distribution of the Vaccine Injury Compensation Program has been added to the Vaccine Injury Compensation chapter.
Immune Globulin Intramuscular recommendations for hepatitis A prophylaxis have been updated.
In the Immune Globulin Intravenous chapter, high-titer polyclonal RSV IGIV preparation has been added, the impact on IGIV on ESR has been added, and availability of an anti-IgA assay has been updated.
Utility of Immune Globulin Subcutaneous for immunomodulation in autoimmune neurologic conditions has been added.
Administration of rotavirus vaccine to patients while still in the NICU has been added to Immunization in Special Clinical Circumstances.
Discussion of live vaccines and pregnancy, including cholera vaccine, has been expanded in the Immunization in Pregnancy chapter.
In the chapter on Immunization and Other Considerations in Immunocompromised Children, the timing of immunization following resolution of severe immunization has been added. Meningococcal booster dose information for some immunocompromising conditions has been added. Use of penicillin or amoxicillin prophylaxis “can be considered” for duration of eculizumab treatment and until immune competence has returned. And MenQuadfi (meningococcal groups A, C, Y, W conjugate vaccine [Sanofi Pasteur Inc]) has been added.
The small increased risk of febrile seizure when IIV and PCV13 or when IIV and DTaP are administered simultaneously has been added to the Immunization in Children With a Personal or Family History of Seizures chapter.
The CDC link with guidance on vaccinating people with increased bleeding risk has been added to the Immunization in Children With Chronic Diseases chapter.
The new PRP-OMP containing hexavalent combination vaccine (DTaP-IPV-Hib-HepB) has been added to the chapter on Immunization in American Indian/Alaska Native Children and Adolescents.
In Immunization in Health Care Personnel, Heplisav-B has been added, and a distinction has been made between numbers of doses for it versus Engerix-B or Recombivax HB.
The new dengue vaccine is mentioned in the International Travel chapter. Catch-up HepA administration has been added. The option of Heplisav-B for adults is included. Information on yellow fever vaccine has been expanded in the text. And MenQuadfi (meningococcal groups A, C, Y, W conjugate vaccine [Sanofi Pasteur Inc]) has been added.
Recommendations for Care of Children in Special Clinical Circumstances
The human milk chapter has been retitled as Breastfeeding and Human Milk. Specific infections during which breastfeeding is not advised have been added. Information on Ebola and breastfeeding has been added. Information on cholera vaccine and breastfeeding has been added.
The School Health chapter and the Children in Out-of-Home Child Care chapter have been merged into the new Children in Group Child Care and Schools chapter. Content has been harmonized with the American Academy of Pediatrics’ “Purple Book” (Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 5th ed. Aronson SS, Shope TR, eds. Itasca, IL: American Academy of Pediatrics; 2019).
Respiratory hygiene and cough etiquette have been added to the Standard Precautions section of the Infection Control and Prevention for Hospitalized Children chapter, and the chapter has been shortened.
CDC guidance on the appropriate use of serologic testing for assessing immunity has been added to the Infection Control and Prevention in Ambulatory Settings chapter.
The chapter on Sexually Transmitted Infections in Adolescents and Children has been restructured and shortened. It also has been harmonized with the CDC 2021 Sexually Transmitted Infections Treatment Guidelines.
Hepatitis C testing and malaria screening recommendations for international adoptees have been updated in the Medical Evaluation for Infectious Diseases for Internationally Adopted, Refugee, and Immigrant Children chapter.
Data on infection risks from discarded needles have been updated in the Injuries From Discarded Needles in the Community chapter.
Factors increasing risk for penetrating trauma to the cranium have been added to the Bite Wounds chapter.
Discussion of dengue prevention has been expanded in the Prevention of Mosquitoborne and Tickborne Infections chapter, and recommendations for use of insect repellents have been updated.
In Prevention of Illnesses Associated With Recreational Water Use, incidence data on infections associated with recreational water use have been updated. Information on cyanobacteria has been added. Recommendations on when not to swim in lakes, rivers, and oceans has been added.
Summaries of Infectious Diseases
Actinomycosis disease in people receiving biologic response modifiers has been added. The list of alternative antibiotics that can be used has been narrowed.
Treatment options for Adenovirus Infections are discussed in greater detail.
Molecular diagnostics for intestinal Amebiasis have been expanded. Dientamoeba fragilis epidemiology, diagnosis, and treatment has been added to the chapter.
The sequence of diagnostic testing for Amebic Meningoencephalitis and Keratitis is provided in greater detail. Miltefosine availability has been updated. Sappinia has been removed from the discussion.
The clinical manifestations of Anthrax have been expanded.
Heartland virus has been added to the Arboviruses chapter, and Toscana virus has been removed. Dengue and yellow fever vaccine availabilities have been updated. Dosing in adults and booster dose in children for Japanese encephalitis vaccine has been added.
Treatment options for Arcanobacterium haemolyticum Infections are discussed in greater detail.
Test of cure assessments of stool following treatment of Ascaris lumbricoides Infections are presented in greater detail.
Discussion of intrinsic and acquired antifungal resistance for Aspergillosis has been expanded, including empiric treatment options for areas with high levels of azole resistance.
Viral shedding prior to onset of symptoms from Astrovirus Infections has been added.
The Babesiosis chapter has been aligned with the IDSA babesiosis guidelines released in 2020. Diagnostic options and treatment recommendations have been updated.
The listing of foods implicated in Bacillus cereus outbreaks has been expanded.
The role of Gardnerella vaginalis in Bacterial Vaginosis has been updated. Diagnostic options have been expanded.
Treatment options for Bacteroides, Prevotella, and Other Anaerobic Gram-Negative Bacilli Infections have been expanded.
Treatment options for Balantidium coli Infections have been updated.
Clinical manifestations of Bartonella henselae are provided in greater detail. Challenges with some diagnostic tests are discussed.
Clinical manifestations of Baylisascaris Infections are provided in greater detail.
Etiologic information on Blastocystis hominis has been updated.
The diagnostic section of the Blastomycosis chapter has been updated.
Interpretation of diagnostic test results for Bocavirus has been expanded.
Transmission and serologic detection of Borrelia Infections Other Than Lyme Disease are provided in greater detail.
Serologic testing information for Brucellosis has been expanded.
Treatment options for Burkholderia Infections have been updated.
Molecular and antigenic testing for Campylobacter Infections has been updated.
Treatment recommendations for Candidiasis have been modified.
The diagnostic section of the Chancroid and Cutaneous Ulcers chapter has been updated, and the chapter has been harmonized with the CDC 2021 Sexually Transmitted Infections Treatment Guidelines.
Risk factors for long-term sequelae following Chikungunya have been added. Epidemiologic data have been updated.
Isolation precautions for Chlamydia pneumoniae infections have been updated.
Control measures for Chlamydia psittaci infections have been expanded.
Epidemiologic data forChlamydia trachomatis have been updated. Diagnostic options have been expanded based upon newer tests. Possible need for retreatment of neonatal infection has been added. Timing of test-of-cure in pregnant women has been modified. The chapter has been harmonized with the CDC 2021 Sexually Transmitted Infections Treatment Guidelines.
Diagnostic assessment for foodborne Botulism has been added.
Discussion of when testing is appropriate for Clostridioides difficile has been expanded. Fidaxomicin is now approved for use in the pediatric population (6 months of age and older). Bezlotoxumab is approved in adults to reduce recurrence.
A recommended sequential approach to diagnostic evaluation of Coccidioidomycosis has been added.
The Coronavirus chapter has been updated to include the worst global pandemic in 100 years, with specific information on SARS-CoV-2.
Information on antifungal resistance has been added to the Cryptococcus neoformans and Cryptococcus gattii Infections chapter. Timing of antiretroviral therapy after starting induction therapy for HIV-infected children with cryptococcal meningitis, in order to avoid immune reconstitution inflammatory syndrome, has been added.
Sources of Cryptosporidiosis infection have been updated to incorporate outbreaks in recent years.
Treatment options for Cutaneous Larva Migrans have been expanded.
Sources of Cyclosporiasis infection have been updated to incorporate outbreaks in recent years. Treatment options have been expanded.
Diagnostic tests for Cystoisosporiasis have been updated.
Role of race, ethnicity, and nonprimary infections in the incidence of congenital Cytomegalovirus infections has been added. The role of human milk in CMV transmission in preterm infants, and its prevention, has been expanded. Specific recommendations from Bright Futures for audiologic follow-up in congenital CMV have been added.
WHO classification of Dengue presentation has been added. Vertical transmission risks have been added. Dengue incidence rates in US states and territories have been updated. Chimeric yellow fever dengue-tetravalent dengue vaccine (Dengvaxia), approved on May 1, 2019, has been added to the chapter, along with detailed discussion of the complexity of determining whether and when to use it.
Changes in national reporting implemented in 2019 have been added to the Diphtheria chapter.
A taxonomy table has been added to the Ehrlichia, Anaplasma, and Related Infections chapter. Discussions of Anaplasma and Ehrlichia have been separated throughout chapter for ease of distinguishing between them.
Treatment of carbapenemase-producing gram negative organisms has been expanded in the Serious Bacterial Infections Caused ByEnterobacteriaceae chapter. Discussion of pseudomonal infections has been removed and placed in a new Pseudomonas Infections chapter.
Discussion of acute flaccid myelitis (AFM) has been expanded in the Enterovirus (Nonpoliovirus) Infections chapter. Therapeutic options have been updated.
Genetic mutations that impede control of Epstein-Bar Virus Infections have been expanded. Rituximab treatment for post-transplant lymphoproliferative disorder (PTLD) has been added.
Discussion of atypical EPEC strains has been added to the Escherichia coli Diarrhea chapter. Challenges interpreting culture-independent diagnostic methods that detect EAEC, EPEC, and ETEC on multiplex panels are discussed.
Otogenic and nonotogenic clinical manifestations of infection have been expanded in the Fusobacterium Infections chapter.
Descriptions of clinical manifestations of Giardia intestinalis have been extensively rewritten. Treatment of recurrent Giardia infections has been expanded.
The Gonococcal Infections chapter has been extensively revised, shortening by approximately one third. Specific dosages of antibiotics largely have been removed from the chapter, with cross-refencing of the STI Treatment Table 4.4 in Section 4. Use of gentamicin in neonates receiving intravenous calcium (in whom ceftriaxone is contraindicated) for prevention of neonatal ophthalmia has been added. The chapter has been harmonized with the CDC 2021 Sexually Transmitted Infections Treatment Guidelines.
The evolving epidemiology of Hia has been updated in the Haemophilus influenzae Infections chapter. The new PRP-OMP containing hexavalent combination vaccine (DTaP-IPV-Hib-HepB) has been added to the chapter.
Data on the geographic distribution of Hantavirus Pulmonary Syndrome has been added. A diagnostic criteria screening tool has been added.
Tables with treatment options for first-line treatment and rescue therapies for children with Helicobacter pylori Infections have been added to the chapter. The risks for peptic ulcer disease and gastric cancer have been added.
The number of viruses mentioned in the Hemorrhagic Fevers Caused by Arenaviruses chapter has been expanded.
The list of countries with recent outbreaks of Hemorrhagic Fevers Caused by Bunyaviruses has been expanded.
Discussion of in utero transmission has been expanded in the Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg chapter. The recent licensure of the first Ebola vaccine, for use in adults, has been added to the chapter.
HIV and homelessness have been added as risk groups for Hepatitis A infection. The recommendation of catchup immunization with HepA vaccine in people 2 to 18 years of age has been added. Use of HepA vaccine in 6- through 11-month-olds traveling internationally (in whom MMR also is being administered) has been added.
The Hepatitis B chapter extensively revised, shortening by approximately one quarter. A figure has been added for administration of the birth dose of hepatitis B vaccine by maternal HBsAg status. The new hexavalent vaccine, Vaxelis, has been added to Table 3.21: Recommended Dosages of Hepatitis B Vaccines.
Testing recommendations for Hepatitis C have been aligned with recommendations from the US Preventive Services Task Force. IDSA and AASLD recommendations for universal testing of pregnant women have been added. Antiviral therapies for HCV infection are now approved and recommended for people 3 years and older.
Specific examples of when Hepatitis D testing should be conducted have been added.
A recommendation has been added to discourage breastfeeding among confirmed Hepatitis E virus-infected mothers until further data are available.
Clarification has been added that suppressive therapy is not indicated following preemptive antiviral treatment to prevent Herpes Simplex Virus exposure at delivery from developing into neonatal HSV disease.
Using both urine and blood antigen testing to increase sensitivity of Histoplasmosis testing has been added to chapter.
Diagnostic methods to increase sensitivity for Hookworm Infections have been added.
Diagnostic approaches to distinguish chromosomally integrated HHV-6 DNA versus acute HHV-6 infection have been added to the Human Herpesvirus 6 (Including Roseola) and 7 chapter.
Clinical manifestations of Human Herpesvirus 8 in young children have been added.
The Human Immunodeficiency Virus Infection chapter has been extensively revised, shortening by approximately one third. The diagnostic approach following perinatal exposure has been summarized in 2 new figures.
The Influenza chapter has been shortened by approximately one third and harmonized with the most recent AAP and CDC recommendations as well as IDSA antiviral treatment guidelines.
Differences in aspirin dosing in the United States versus Japan and Western Europe have been added to the Kawasaki Disease chapter.
Discussion of antibiotics to use in Kingella kingae Infections has been expanded.
Sources of transmission of Legionella pneumophila have been expanded, as have prevention strategies.
Discussion of post-kala-azar dermal Leishmaniasis has been expanded. Worldwide geographic distribution has been updated.
Discussion of the varied presentations of the skin lesions of Leprosy is provided. Treatment recommendations now reference contact of the National Hansen’s Disease Program.
Recommendations for convalescent serologic testing for Leptospirosis have been broadened.
Risks during pregnancy for acquiring Listeria monocytogenes Infections have been updated.
The Lyme Disease chapter has been harmonized with 2020 IDSA Lyme Guidelines. Management of partial therapeutic response of Lyme arthritis has been expanded. Options for second tier diagnostic testing have been expanded.
Hematologic manifestations of Malaria have been expanded. Impact of premature discontinuation of malaria prophylaxis on timing of disease presentation has been added. Quinidine has been removed as a treatment option because it has been removed from the US market. Tafenoquine has been added as a prophylaxis option.
Measles inclusion body encephalitis has been added. Newer estimates of incidence of SSPE have been added. Immunologic amnesia following measles infection has been added. A new table summarizing postexposure prophylaxis recommendations has been created.
Booster dosing for MenB vaccines has been added to the Meningococcal Infections chapter. The newly approved MenQuadfi has been added to the chapter.
Cross-reference to the AAP clinical practice guideline on bronchiolitis has been added to the management section of the Human Metapneumovirus chapter.
Treatment options for Microsporidia Infections have been expanded.
A preferential ranking of treatment options for Molluscum Contagiosum has been added.
Epidemiologic data on Mumps outbreaks among college-aged young adults and people previously receiving 2 doses of MMR vaccine have been updated.
Mycoplasma genitalium has been added to the Mycoplasma pneumoniae and Other Mycoplasma Species Infections chapter, including diagnosis and treatment.
Diagnostic methods for Nocardiosis have been updated.
Discussion of coinfection with other gastrointestinal tract pathogens has been added to the Norovirus and Sapovirus Infections chapter.
Moxidectin has been added to the treatment section for Onchocerciasis (River Blindness).
Discussion of screening programs for Human Papillomavirus-associated cancers has been expanded. Age ranges for use of HPV vaccines have been standardized.
Treatment options for Paracoccidioidomycosis have been updated.
Extrapulmonary manifestations of Paragonimiasis in children have been added. Access to triclabendazole has been updated in the chapter.
Diagnostic approaches for Parainfluenza Viral Infections have been updated.
The table of Parasitic Diseases has been updated with diagnostic testing and clinical manifestations.
The propensity for neurologic sequelae following Parechovirus Infections has been emphasized.
Management of Parvovirus B19 in the immunocompromised host has been expanded.
The need to assess for rabies prophylaxis when diagnosing Pasteurella Infections has been added to chapter.
The table “Pediculicides for the Treatment of Head Lice” has been updated in the Pediculosis Capitis chapter, including the newly approved abametapir by prescription and the availability of ivermectin lotion over the counter.
Follow-up assessments and possible retreatment have been added to the Pediculosis Pubis chapter.
The Pelvic Inflammatory Disease chapter has been harmonized with the CDC 2021 Sexually Transmitted Infections Treatment Guidelines. The polymicrobial nature of PID has been emphasized. Treatment tables have been moved from this chapter and merged into Table 4.4.
In the Pertussis (Whooping Cough) chapter, allowance has been added for using either Tdap or Td in situations where previously only Td would have been permitted.
Treatment of refractory or recurrent Pinworm Infections has been addressed.
Diagnostic approaches for Pityriasis Versicolor have been expanded.
Recommendations for management of Plague have been harmonized with 2020 CDC guidance. These include recommendations for combination therapy. Treatment of neonates whose mothers have plague also has been added.
The epidemiology of Pneumococcal Infections in the PCV13 era has been updated.
Discussion of prophylaxis for Pneumocystis jirovecii Infections in solid organ transplant recipients has been expanded.
Global eradication efforts for Poliovirus Infections have been updated, including the vaccines being used.
Members of the family Polyomaviridae have been expanded in the Polyomaviruses chapter.
The mechanism by which abnormal protein folding occurs in Prion Diseases is explained in greater detail.
Pseudomonas aeruginosa Infections is an entirely new chapter.
Association of anticardiolipin antibodies with severe complications of Q Fever has been added. Situations that increase aerosolization risks have been added.
KEDRAB Rabies Immune Globulin has been added to the Rabies chapter.
The diagnostic section of Rat-Bite Fever has been updated to include 16S ribosomal RNA gene sequencing and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry.
Discussion of isolation precautions in Respiratory Syncytial Virus infections have been expanded. The chapter has been harmonized with the forthcoming technical report. Although the overall recommendations for palivizumab have not changed, the basis for maintaining those recommendations now includes recent publications.
The role of Rhinovirus Infections as a major viral cause of exacerbations of asthma, cystic fibrosis, and chronic obstructive pulmonary disease has been expanded.
Rickettsia akari has been added to the Rickettsial Infections chapter, and a CDC website is provided for information on spotted fevers occurring outside of the United States.
Duration of doxycycline therapy for Rickettsialpox has been made more precise.
The proportion of Rocky Mountain Spotted Fever cases not reporting tick bites (approximately half) has been added. Serologic testing has been updated to indicate IgM being relatively less specific.
Administration of rotavirus vaccine to patients while still in the NICU has been added to the Rotavirus Infections chapter. Rotavirus vaccine use in HIV-infected people has been added. Vaccination of infants who have had rotavirus gastroenteritis has been addressed.
Isolation guidance for Rubella in the hospital and school settings has been updated to include PCR testing.
Global resistance rates for Salmonella Infections have been updated, with a subsequent impact on empiric antibiotic recommendations. A new conjugate typhoid vaccine available outside of the United States has been added.
Information about environmental disinfection for crusted Scabies has been added.
Use of repeat dosing of praziquantel in chronic Schistosomiasis has been clarified.
Increasing fluoroquinolone and azithromycin resistance patterns for Shigella Infections have been added, along with CDC’s request for treatment failure information.
Tecovirimat (TPOXX or ST-246) has been licensed by the FDA for the treatment of Smallpox. A third-generation vaccine (JYNNEOS) that is an attenuated, live, replication-deficient vaccinia virus has been approved.
Situations in which serologic testing for Sporotrichosis may be beneficial have been added.
Mention of commercially available tests for enterotoxin in Staphylococcal Food Poisoning has been added.
Management of secondary MRSA pneumonias following influenza infections has been expanded in theStaphylococcus aureus chapter. Discussion of second- and third-tier MRSA therapeutics has been expanded. Preoperative antibacterial prophylaxis in MRSA colonized people has been modified.
Discussion of second-tier therapeutics for Coagulase-Negative Staphylococcal Infections has been expanded.
Complications of Group A Streptococcal Infections, and management thereof, have been updated and expanded.
The Group B Streptococcal Infections chapter has been harmonized with the 2019 AAP clinical report and the 2019 statement from the American College of Obstetricians and Gynecologists on GBS.
The treatment section of the Non-Group A or B Streptococcal and Enterococcal Infections chapter has been updated, and antibiotic options are more thoroughly explained.
People at risk for Strongyloides hyperinfection syndrome are more thoroughly described. The diagnostic section has been updated in the Strongyloidiasis chapter.
The Syphilis chapter has been harmonized with the CDC 2021 Sexually Transmitted Infections Treatment Guidelines. The chapter has been decreased in length by greater than 10%. Epidemiologic data have been updated, including the increase in incidence of congenital syphilis. Therapeutic options for patients with severe penicillin allergy have been provided.
The diagnostic section of the Tapeworm Diseases chapter has been updated.
Therapeutic options and when test of cure is indicated have been updated across the pathogens described in the Other Tapeworm Infections chapter.
Recommendations for how to respond to inadvertent Tdap doses have been added to the Tetanus chapter. Risk factors in the United States for tetanus have been added.
Treatment options for Tinea Capitis have been updated.
The table on “Products for Topical Treatment of Tinea Corporis, Cruris, and Pedis” has been updated in the Tinea Corporis chapter.
Oral options for Tinea Cruris infections recalcitrant to topical management have been added.
A differential diagnosis listing has been added to the Tinea Pedis and Tinea Unguium chapter.
Clinical manifestations of Toxocariasis are presented in greater detail.
The chapter on Toxoplasma gondii Infections has been decreased in length by one third. Treatment recommendations are presented in table form for ease of access.
The Trichomonas vaginalis Infections chapter has been harmonized with the CDC 2021 Sexually Transmitted Infections Treatment Guidelines. The diagnostic section has been updated.
The diagnostic section of the Trichuriasis chapter has been updated.
Clinical manifestations of African Trypanosomiasis (African Sleeping Sickness) are presented in greater detail. Interim WHO treatment guidelines are referenced.
CDC algorithms for evaluation of pregnant women and infants with American Trypanosomiasis (Chagas Disease) have been added. American Heart Association guidance on management of Chagas cardiomyopathy is referenced.
The terminology in the Tuberculosis chapter has changed to tuberculosis infection (TBI, formerly LTBI) and tuberculosis disease (TBD). The chapter has been harmonized with new AAP clinical report titled “Tuberculosis Infection in Children: Testing and Treatment,” including new treatment options for multidrug-resistant tuberculosis and a new table for treatment dosing for TBI.
Treatment recommendations for Nontuberculous Mycobacteria have been harmonized with the upcoming IDSA/ATS guidelines for NTM treatment.
Geographic areas in the United States where Tularemia is found have been updated.
Clinical manifestations of Murine Typhus are presented in greater detail.
Clinical manifestations of Louseborne Typhus are presented in greater detail.
Sepsis with hyperammonemia in lung transplant recipients has been added Ureaplasma urealyticum and Ureaplasma parvum Infections chapter. The treatment section has been updated.
Isolation precautions in Varicella-Zoster Virus Infections have been separated by patient (eg, mother, neonate) in the Control Measures section of the chapter.
Discussion of vaccines for prevention of Cholera has been updated.
The diagnostic section of the Other Vibrio Infections chapter has been updated.
Epidemiologic data for West Nile Virus have been updated.
Incidence data forYersinia enterocolitica and Yersinia pseudotuberculosis Infections have been updated.
The time interval for avoiding sex or using condoms following return from an area with Zika has been changed from 6 months to 3 months.
Antimicrobial Agents and Related Therapy
Warnings concerning fluoroquinolones have been strengthened in Antimicrobial Agents and Related Therapy. A table has been added presenting cephalosporin cross-reactivity with other beta lactam antibiotics.
The antimicrobial stewardship portion of the Antimicrobial Resistance and Antimicrobial Stewardship: Appropriate and Judicious Use of Antimicrobial Agents chapter has been aligned with the new AAP policy statement on antimicrobial stewardship.
The Tables of Antimicrobial Drug Dosages have been updated with new antibiotics and with new dosages based on recent publications.
The Sexually Transmitted Infections tables have been harmonized with the CDC 2021 Sexually Transmitted Infections Treatment Guidelines.
Activity and age indications for the newer azoles have been updated in the Antifungal Drugs for Systemic Fungal Infections chapter.
Newer pediatric dosages have been added to the Recommended Doses of Parenteral and Oral Antifungal Drugs table.
Newer Topical Drugs for Superficial Fungal Infections have been added, and ones that are no longer available have been deleted.
New antivirals, including many HCV antivirals, have been added to the Non-HIV Antiviral Drugs table.
Updated dosing recommendations based on new guidance have been incorporated throughout the Drugs for Parasitic Infections table.
The Systems-based Treatment Table is a completely new table, and the first time the Red Book has grouped recommendations by body system.
Recommendations based on new studies for prophylaxis for UTIs have been added to the Antimicrobial Prophylaxis chapter.
Delabeling of antibiotic allergies has been added to the Antimicrobial Prophylaxis in Pediatric Surgical Patients chapter.
Approaches to erythromycin shortages have been added to the Prevention of Neonatal Ophthalmia chapter. Recommendations have been added for gonococcal prophylaxis following exposure at birth in a newborn infant who cannot receive ceftriaxone (eg, receiving continuous intravenous calcium, as in parenteral nutrition).
Telephone and website addresses for organizations listed in the Directory of Resources have been updated.
Codes for Commonly Administered Pediatric Vaccines/Toxoids and Immune Globulins have been updated.
The diseases listed in the Nationally Notifiable Infectious Diseases in the United States table are those required for 2020 and include coronavirus disease 2019 (COVID-19).
The table in Guide to Contraindications and Precautions to Immunizations has been deleted, and the link to the CDC General Recommendations table is provided.
The Prevention of Disease From Contaminated Food Products appendix has been updated to take into account recent outbreaks. Raw dough has been added.
The Clinical Syndromes Associated With Foodborne Diseases table has been updated with recent information from foodborne outbreaks.
The Diseases Transmitted by Animals (Zoonoses) table has been updated with the 2019 DHHS Zoonotic Diseases Report.