Red Book

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2018–2021 Report of the Committee on

Infectious Diseases, 31st Edition Red
American Academy of Pediatrics Committee on Infectious Diseases Book®

Book
Editor: David W. Kimberlin, MD, FAAP
Associate Editors: Michael T. Brady, MD, FAAP; Mary Anne Jackson, MD, FAAP;
Sarah S. Long, MD, FAAP
31ST EDITION ®
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diseases in infants, children, and adolescents. more than 1,000 hands have touched the
2018–2021
The 31st edition provides evidence- Red Book® prior to its publication! The
Report of the
based guidance on pediatric infections and Red Book® is like having your own personal 2018–2021
vaccinations based on the recommendations infectious disease consultant available to Committee on
of the American Academy of Pediatrics (AAP) you, on your bookshelf, at all times.
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RB18_COVER_SPREAD_PRINTER.indd 1 4/3/18 2:17 PM

 Red Book:
2018–2021 Report of the Committee
on Infectious Diseases
31st Edition

Author: Committee on Infectious Diseases,

American Academy of Pediatrics
David W. Kimberlin, MD, FAAP, Editor
Michael T. Brady, MD, FAAP, Associate Editor
Mary Anne Jackson, MD, FAAP, Associate Editor
Sarah S. Long, MD, FAAP, Associate Editor
American Academy of Pediatrics
345 Park Blvd
Itasca, IL 60143

Suggested citation: American Academy of Pediatrics. [Chapter title.] In: Kimberlin DW, Brady
MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed.
Itasca, IL: American Academy of Pediatrics; 2018:[chapter page numbers]

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 31st Edition
1st Edition – 1938
2nd Edition – 1939
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4th Edition – 1942
5th Edition – 1943
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13th Edition – 1961
14th Edition – 1964
15th Edition – 1966
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16th Edition Revised – 1971
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19th Edition – 1982
20th Edition – 1986
21st Edition – 1988
22nd Edition – 1991
23rd Edition – 1994
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26th Edition – 2003
27th Edition – 2006
28th Edition – 2009
29th Edition – 2012
30th Edition – 2015
ISSN No. 1080-0131
ISBN No. 978-1-61002-146-3
MA0858

Quantity prices on request. Address all inquiries to:

American Academy of Pediatrics
345 Park Blvd
Itasca, IL 60143

or Phone:
1-888-227-1770 Publications

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
Publications from the American Academy of Pediatrics benefit from expertise and resources of liaisons and
internal (AAP) and external reviewers. However, publications from the American Academy of Pediatrics may
not reflect the views of the liaisons of the organizations or government agencies that they represent.
The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the
development of the content of this publication.
© 2018 by the American Academy of Pediatrics. All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
Printed in the United States of America.
3-341/0418 1 2 3 4 5 6 7 8 9 10

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 III

Committee on Infectious Diseases,

2015---2018
Carrie L. Byington, MD, FAAP, Ruth Lynfield, MD, FAAP
Chairperson Flor M. Munoz, MD, MSc, FAAP
Yvonne A. Maldonado, MD, FAAP, Vice Dawn Nolt, MD, MPH, FAAP
Chairperson Ann-Christine Nyquist, MD, MSPH, FAAP
Ritu Banerjee, MD, PhD, FAAP Sean T. O’Leary, MD, MPH, FAAP
Elizabeth D. Barnett, MD, FAAP Mobeen H. Rathore, MD, FAAP
James D. Campbell, MD, MS, FAAP Mark H. Sawyer, MD, FAAP
H. Dele Davies, MD, MS, MHCM, FAAP William J. Steinbach, MD, FAAP
Kathryn M. Edwards, MD, FAAP Tina Q. Tan, MD, FAAP
Jeffrey S. Gerber, MD, PhD, FAAP Theoklis E. Zaoutis, MD, MSCE, FAAP
Ex Officio
David W. Kimberlin, MD, FAAP, Red Book Editor
Michael T. Brady, MD, FAAP, Red Book Associate Editor
Mary Anne Jackson, MD, FAAP, Red Book Associate Editor
Sarah S. Long, MD, FAAP, Red Book Associate Editor
Henry H. Bernstein, DO, MHCM, FAAP, Red Book Online Associate Editor
H. Cody Meissner, MD, FAAP, Visual Red Book Associate Editor
Liaisons
Douglas Campos-Outcalt, MD, MPA American Academy of Family Physicians
Amanda C. Cohn, MD, FAAP Centers for Disease Control and Prevention
Jamie Deseda-Tous, MD Sociedad Latinoamericana de Infectología
Pediátrica
Karen M. Farizo, MD US Food and Drug Administration
Marc Fischer, MD, FAAP Centers for Disease Control and Prevention
Bruce G. Gellin, MD, MPH National Vaccine Program Office
Richard L. Gorman, MD, FAAP National Institutes of Health
Natasha Halasa, MD, MPH, FAAP Pediatric Infectious Diseases Society
R. Phillips Heine, MD American College of Obstetricians and
Gynecologists
Nicole Le Saux, MD Canadian Paediatric Society
Scot Moore, MD, FAAP Committee on Practice and Ambulatory
Medicine
Joan L. Robinson, MD Canadian Paediatric Society
Geoffrey R. Simon, MD, FAAP Committee on Practice Ambulatory
Medicine
Neil S. Silverman, MD American College of Obstetricians and
Gynecologists
Jeffrey R. Starke, MD, FAAP American Thoracic Society
James J. Stevermer, MD, MSPH, FAAFP American Academy of Family Physicians
Kay M. Tomashek, MD, MPH, DTM National Institutes of Health
Staff
Jennifer M. Frantz, MPH

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 IV

Collaborators
Francisca Abanyie, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Mark J. Abzug, MD, University of Colorado School of Medicine and Children’s Hospital
Colorado, Aurora, CO
Anna M. Acosta, MD, Centers for Disease Control and Prevention, Atlanta, GA
Edward P. Acosta, PharmD, University of Alabama at Birmingham, Birmingham, AL
Paula Ehrlich Agger, MD, MPH, Food and Drug Administration, Silver Spring, MD
Andrés Esteban Alarcón, MD, MPH, Food and Drug Administration, Silver Spring, MD
Grace Aldrovandi, MD, David Geffen School of Medicine at UCLA, Mattel Children’s
Hospital UCLA, Los Angeles, CA
John J. Alexander, MD, MPH, Food and Drug Administration, Silver Spring, MD
Maria C. Allende, MD, Food and Drug Administration, Silver Spring, MD
Mandy A. Allison, MD, MSPH, University of Colorado, Anschutz Medical Campus,
Children’s Hospital Colorado, Aurora, CO
Jon Kim Andrus, MD, Sabin Vaccine Institute, Washington, DC
Jorge Arana, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Paul M. Arguin, MD, Centers for Disease Control and Prevention, Atlanta, GA
Paige Armstrong, MD MHS, Centers for Disease Control and Prevention, Atlanta, GA
Stephen S. Arnon, MD, MPH, California Department of Public Health, Richmond, CA
David M. Asher, MD, Food and Drug Administration, Silver Spring, MD
Negar Ashouri, MD, Children’s Hospital of Orange County, Orange, CA
John William Baddley, MD, MSPH, University of Alabama at Birmingham,
Birmingham, AL
Bethany Baer, MD, Food and Drug Administration, Silver Spring, MD
Carol J. Baker, MD, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
M. Douglas Baker, MD, Johns Hopkins University School of Medicine, Baltimore, MD
Robert S. Baltimore, MD, Yale University School of Medicine, New Haven, CT
Margaret C. Bash, MD, MPH, Food and Drug Administration, Silver Spring, MD
Judy A. Beeler, MD, Food and Drug Administration, Silver Spring, MD
Karlyn D. Beer, MS, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Ermias Belay, MD, Centers for Disease Control and Prevention, Atlanta, GA
Ozlem Belen, MD, MPH, Food and Drug Administration, Silver Spring, MD
Yodit Belew, MD, Food and Drug Administration, Silver Spring, MD
Melissa Bell, MS, Centers for Disease Control and Prevention, Atlanta, GA
Roy Benaroch, MD, Emory University, Dunwoody, GA
Kaitlin Benedict, MPH, Centers for Disease Control and Prevention, Atlanta, GA
William E. Benitz, MD, Stanford University, Palo Alto, CA
Daniel K. Benjamin, Jr, MD, PhD, Duke University, Durham, NC
Casidhe-Nicole Bethancourt, BA, Cohen Children’s Medical Center of New York, New
Hyde Park, NY
Stephanie R. Bialek, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Holly Biggs, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Jessica M. Biggs, PharmD, BCPPS, University of Maryland Medical Center, Severna
Park, MD

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 COLLABORATORS V

David Blaney, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Karen C. Bloch, MD, MPH, Vanderbilt University Medical Center, Nashville, TN
Joseph A. Bocchini, Jr, MD, Louisiana State University Health Sciences Center-
Shreveport, Shreveport, LA
Suresh B. Boppana, MD, University of Alabama at Birmingham, Birmingham, AL
Anna Bowen, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Michael D. Bowen, PhD, Centers for Disease Control and Prevention, Atlanta, GA
William Bower, MD, Centers for Disease Control and Prevention, Atlanta, GA
Mary Adetinuke Boyd, MD, Food and Drug Administration, Gaithersburg, MD
John S. Bradley, MD, University of California San Diego, Rady Children’s Hospital San
Diego, San Diego, CA
Joseph Bresee, MD, Centers for Disease Control and Prevention, Atlanta, GA
Elizabeth Briere, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
William J. Britt, MD, University of Alabama at Birmingham Medical Center,
Birmingham, AL
Karen R. Broder, MD, Centers for Disease Control and Prevention, Atlanta, GA
Patricia C. Brown, MD, Food and Drug Administration, Silver Spring, MD
Kevin Edward Brown, MD, MRCP, FRCPath, Public Health England, London, United
Kingdom
Sarah K. Browne, MD, Food and Drug Administration, Silver Spring, MD
Beau B. Bruce, MD, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Gary Brunette, MD, MS, Centers for Disease Control and Prevention, Alpharetta, GA
Heather Burke, MA, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Gale R. Burstein, MD, MPH, Erie County Department of Health, Buffalo, NY
Diego H. Caceres, BSc, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Carlos C. Campbell, MD, MPH, Program for Appropriate Technology in Health
(PATH), Tucson, AZ
Maria V. Cano, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Paul Cantey, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Michael Cappello, MD, Yale School of Medicine, New Haven, CT
Cristina V. Cardemil, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Mary T. Caserta, MD, University of Rochester School of Medicine and Dentistry,
Rochester, NY
Corey Casper, MD, MPH, University of Washington, Seattle, WA
Jessica R. Cataldi, MD, MSCS, University of Colorado School of Medicine, Aurora, CO
Robert Maccabee Centor, MD, University of Alabama at Birmingham, Birmingham, AL
Larisa Cervenakova, MD, PhD, American National Red Cross, Rockville, MD
Ellen G. Chadwick, MD, Northwestern University Feinberg School of Medicine,
Chicago, IL
Rana Chakraborty, MD, MSc, FRCPCH, DPhil, Emory University, Atlanta, GA
Kirk M. Chan-Tack, MD, Food and Drug Administration, Silver Spring, MD
Kevin Chatham-Stephens, MD, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Archana Chatterjee, MD, PhD, University of South Dakota, Sanford School of Medicine,
Sioux Falls, SD
Rana Chattopadhyay, PhD, Food and Drug Administration, Silver Spring, MD
Preeti Chhabra, PhD, Centers for Disease Control and Prevention, Atlanta, GA

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 VI COLLABORATORS

Brian Chow, MD, Tufts Medical Center, Boston, MA

John C. Christenson, MD, Indiana University School of Medicine, Indianapolis, IN
Paul R. Cieslak, MD, Oregon Health Authority, Portland, OR
Kevin L. Clark, MD, Food and Drug Administration, Silver Spring, MD
Shannon S. Cleary, BA, Cohen Children’s Medical Center of New York, New Hyde
Park, NY
Susan E. Coffin, MD, MPH, Children’s Hospital of Philadelphia, Philadelphia, PA
Melissa Gerhart Collier, MD, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Wayne Conlan, PhD, National Research Council Canada, Ottawa, Ontario, Canada
Laura Cooley, MD, MPHTM, Centers for Disease Control and Prevention, Atlanta, GA
Jennifer R. Cope, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Margaret M. Cortese, MD, Centers for Disease Control and Prevention, Atlanta, GA
Christina M. Coyle, MD, MS, Albert Einstein College of Medicine, Bronx, NY
Tamera Coyne-Beasley, MD, MPH, University of North Carolina, Chapel Hill, NC
Sam J. Crowe, PhD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
James E. Crowe, Jr, MD, Vanderbilt University Medical Center, Nashville, TN
F. Scott Dahlgren, MSPH, Centers for Disease Control and Prevention, Atlanta, GA
Lara Danziger-Isakov, MD, MPH, Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH
Lee (Toni) A. Darville, MD, University of North Carolina School of Medicine, Chapel
Hill, NC
Alma C. Davidson, MD, Food and Drug Administration, Silver Spring, MD
Roberta L. DeBiasi, MD, MS, Children’s National Health System, The George
Washington University School of Medicine, Washington, DC
Melissa Del Castillo, MD, Food and Drug Administration, Mackinaw, IL
Penelope Hill Dennehy, MD, Alpert Medical School of Brown University and Hasbro
Children’s Hospital, Providence, RI
Carmen C. Deseda, MD, Sociedad Latinoamericana de Infectología Pediátrica (SLIPE),
San Juan, Puerto Rico
Simon Dobson, MBBS, MD, FRCPC, BC Children’s Hospital, University of British
Columbia, Canada, Vancouver, British Columbia, Canada
Sheila Dollard, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Kenneth Dominguez, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Naomi A. Drexler, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Christine Dubray, MD, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Gueorgui (George) Dubrocq, MD, Food and Drug Administration, Silver Spring, MD
Jonathan Duffy, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Daniel E. Dulek, MD, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville,
TN
Judith K. Eckerle, MD, University of Minnesota, Minneapolis, MN
Morven S. Edwards, MD, Baylor College of Medicine, Houston, TX
Sean P. Elliott, MD, University of Arizona College of Medicine, Tucson, AZ
Delia Alcira Enría, MD, MPH, Instituto Nacional de Enfermedades Virales Humanas,
Pergamino, Argentina
Roselyn E. Epps, MD, Food and Drug Administration, Silver Spring, MD

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 COLLABORATORS VII

Rachel Epstein, MD, MA, Boston Medical Center, Boston, MA

Dean Erdman, DrPH, Centers for Disease Control and Prevention, Atlanta, GA
Susan Even, MD, University of Missouri Student Health Center, Columbia, MO
Darcie Everett, MD, MPH, Food and Drug Administration, Silver Spring, MD
Anat R. Feingold, MD, MPH, Cooper Medical School of Rowan University, Camden, NJ
Meghan Ferris, MD, MPH, Food and Drug Administration, Silver Spring, MD
Patricia I. Fields, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Doran L. Fink, MD, PhD, Food and Drug Administration, Silver Spring, MD
Theresa M. Finn, PhD, Food and Drug Administration, Silver Spring, MD
Margaret C. Fisher, MD, Unterberg Children’s Hospital at Monmouth Medical Center,
Long Branch, NJ
Collette Fitzgerald, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Elaine W. Flagg, PhD, MS, Centers for Disease Control and Prevention, Atlanta, GA
Katherine E. Fleming-Dutra, MD, Centers for Disease Control and Prevention, Atlanta,
GA
Patricia M. Flynn, MD, MS, St. Jude Children’s Research Hospital, Memphis, TN
Monique A. Foster, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
LeAnne Fox, MD, MPH, DTM&H, Centers for Disease Control and Prevention,
Atlanta, GA
Louise K. Francois Watkins, MD, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Sheila F. Friedlander, MD, University of California San Diego School of Medicine, San
Diego, CA
Sara Gagneten, PhD, Food and Drug Administration, Silver Spring, MD
Renee L. Galloway, MLS(ASCP)CM, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Hayley A. Gans, MD, Stanford University Medical Center, Stanford, CA
Paul A. Gastañaduy, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Julianne Gee, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Bob Geng, MD, University of California San Diego, San Diego, CA
Noel J. Gerald, PhD, Food and Drug Administration, Silver Spring, MD
Susan Gerber, MD, Centers for Disease Control and Prevention, Atlanta, GA
Anne A. Gershon, MD, Columbia University College of Physicians and Surgeons, New
York, NY
Francis Gigliotti, MD, University of Rochester School of Medicine and Dentistry,
Rochester, NY
Jessica Gillon, PharmD, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville,
TN
Janet R. Gilsdorf, MD, University of Michigan Medical Center, Ann Arbor, MI
Brittany Goldberg, MD, MS, Food and Drug Administration, Silver Spring, MD
Gerardo A. Gomez, BS, BA, Centers for Disease Control and Prevention, Atlanta, GA
Ramya Gopinath, MBBS, FRCP(C), Food and Drug Administration, Silver Spring, MD
Rachel J. Gorwitz, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Elizabeth B. Gray, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Greg Greene, MSPH, Centers for Disease Control and Prevention, Marietta, GA
Patricia M. Griffin, MD, Centers for Disease Control and Prevention, Atlanta, GA

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 VIII COLLABORATORS

Charles F. Grose, MD, University of Iowa, Iowa City, IA

Alice Y. Guh, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Julie R. Gutman, MD, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Penina Haber, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Aron Hall, DVM, MSPH, Centers for Disease Control and Prevention, Atlanta, GA
Scott A. Halperin, MD, Dalhousie University, Canadian Center for Vaccinology,
Halifax, Nova Scotia, Canada
Theresa Harrington, MD, MPH&TM, Centers for Disease Control and Prevention,
Atlanta, GA
Jason B. Harris, MD, Massachusetts General Hospital, Boston, MA
Joshua D. Hartzell, MD, Walter Reed National Military Medical Center, Bethesda, MD
C. Mary Healy, MD, Baylor College of Medicine, Houston, TX
Katherine Hendricks, MD, MPH&TM, Centers for Disease Control and Prevention,
Atlanta, GA
Thomas Hennessy, MD, MPH, Centers for Disease Control and Prevention, Anchorage,
AK
Adam L. Hersh, MD, PhD, University of Utah, Salt Lake City, UT
Barbara L. Herwaldt, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Beth Hibbs, RN, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Sheila M. Hickey, MD, University of New Mexico, Albuquerque, NM
Hiwot Hiruy, MD, PhD, Food and Drug Administration, Silver Spring, MD
Michele Hlavsa, RN, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Scott Holmberg, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Katherine Hsu, MD, MPH, Massachusetts Department of Public Health, Boston
University Medical Center, Jamaica Plain, MA
Christine M. Hughes, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Dmitri Iarikov, MD, PhD, Food and Drug Administration, Silver Spring, MD
Joseph P. Icenogle, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Martha Iwamoto, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Brendan R. Jackson, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Preeti Jaggi, MD, Nationwide Children’s Hospital, Columbus, OH
Ruth A. Jajosky, DMD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Renée R. Jenkins, MD, Howard University College of Medicine, Washington, DC
Ling Jing, BA, Cohen Children’s Medical Center of New York, New Hyde Park, NY
Caroline J. Jjingo, MD, MPH, Food and Drug Administration, Silver Spring, MD
Chandy C. John, MD, Indiana University School of Medicine, Riley Hospital for
Children at IU Health, Indianapolis, IN
Jeffrey L. Jones, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Sheldon L. Kaplan, MD, Baylor College of Medicine, Houston, TX
Rama Kapoor, MD, Food and Drug Administration, Silver Spring, MD
Ben Z. Katz, MD, Northwestern University Feinberg School of Medicine, Ann & Robert
H. Lurie Children’s Hospital of Chicago, Chicago, IL
Carol A. Kauffman, MD, VA Ann Arbor Healthcare System, University of Michigan
Medical School, Ann Arbor, MI
Gilbert Kersh, PhD, Centers for Disease Control and Prevention, Atlanta, GA
David L. Kettl, MD, Food and Drug Administration, Silver Spring, MD

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 COLLABORATORS IX

Grishma Kharod, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Bharat Khurana, DVM, PhD, Food and Drug Administration, Silver Spring, MD
Sarah Kidd, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Lindsay Kim, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Peter W. Kim, MD, MS, Food and Drug Administration, Silver Spring, MD
Charles H. King, MD, Case Western Reserve University, Cleveland, OH
Miwako Kobayashi, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Larry K. Kociolek, MD, MSCI, Ann & Robert H. Lurie Children’s Hospital of Chicago
and Northwestern University Feinberg School of Medicine, Chicago, IL
Andreas G. Konstantopoulos, MD, PhD, Athens University, Greece, Athens, Greece
Athena P. Kourtis, MD, PhD, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Phyllis E. Kozarsky, MD, Centers for Disease Control and Prevention, Atlanta, GA
Philip R. Krause, MD, Food and Drug Administration, Silver Spring, MD
Kristen Kreisel, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Andrew Thaddeus Kroger, MD, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Madan Kumar, DO, Food and Drug Administration, Silver Spring, MD
Preeta Krishnan Kutty, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Adam J. Langer, DVM, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Gayle Langley, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Paul M. Lantos, MD, MS, GIS, Duke University School of Medicine, Greensboro, NC
Tatiana Lanzieri, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Rotem Lapidot, MD, Boston Medical Center, Boston, MA
Ralph E. LeBlanc, MD, MPH, DTMH, PhD, Food and Drug Administration, Silver
Spring, MD
Joohee Lee, MD, Food and Drug Administration, Silver Spring, MD
Lucia Lee, MD, Food and Drug Administration, Silver Spring, MD
Myron M. Levine, MD, DTPH, Center for Vaccine Development, University of
Maryland School of Medicine, Baltimore, MD
Felicia M. T. Lewis, MD, Centers for Disease Control and Prevention, Philadelphia, PA
Linda L. Lewis, MD, Food and Drug Administration, Bethesda, MD
Jennifer L. Liang, DVM, MPVM, Centers for Disease Control and Prevention, Atlanta,
GA
Jill A. Lindstrom, MD, Food and Drug Administration, Silver Spring, MD
John J. LiPuma, MD, University of Michigan, Ann Arbor, MI
Anastasia P. Litvintseva, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Lindy Liu, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Eloisa Llata, MD MPH, Centers for Disease Control and Prevention, Atlanta, GA
Mark Lobato, MD, Centers for Disease Control and Prevention, Atlanta, GA
Cortland Lohff, MD, MPH, Chicago Department of Public Health, Chicago, IL
Bennett Lorber, MD, MACP, Temple University School of Medicine, Philadelphia, PA
Benjamin D. Lorenz, MD, Food and Drug Administration, Silver Spring, MD
Carolina Lúquez, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Jessica R. MacNeil, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Ryan A. Maddox, PhD, Centers for Disease Control and Prevention, Atlanta, GA

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 X COLLABORATORS

Mario J. Marcon, PhD, Ohio State University College of Medicine, Westerville, OH

Mona Marin, MD, Centers for Disease Control and Prevention, Atlanta, GA
Lauri Markowitz, MD Centers for Disease Control and Prevention, Atlanta, GA
Gary S. Marshall, MD, University of Louisville School of Medicine, Louisville, KY
Diana Martin, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Jessica R. Marus, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Susan Maslanka, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Janet C. McAllister, PhD, Centers for Disease Control and Prevention, Ft. Collins, CO
Orion McCotter, BS MPH, Centers for Disease Control and Prevention, Atlanta, GA
Anita K. McElroy, MD, PhD, Emory University, Atlanta, GA
Michael M. McNeil, MD MPH, Centers for Disease Control and Prevention, Atlanta, GA
John McQuiston, PhD, Centers for Disease Control and Prevention, Atlanta, GA
H. Cody Meissner, MD, Tufts University School of Medicine, Weston, MA
Elissa Meites, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Sarah Meyer, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Joette M. Meyer, PharmD, Food and Drug Administration, Silver Spring, MD
Ian C. Michelow MD, DTM&H, Warren Alpert Medical School of Brown University,
Providence, RI
Amy Middleman, MD, MSEd, MPH, University of Oklahoma Health Sciences Center,
Oklahoma City, OK
Peter Miele, MD, Food and Drug Administration, Silver Spring, MD
Elaine R. Miller, RN, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Alexander J. Millman, MD, Centers for Disease Control and Prevention, Atlanta, GA
Eric D. Mintz, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
John F. Modlin, MD, Bill and Melinda Gates Foundation, Seattle, WA
Tina Khoie Mongeau, MD, MPH, Food and Drug Administration, Silver Spring, MD
Susan P. Montgomery, DVM, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
José G. Montoya, MD, Stanford University School of Medicine, Stanford, CA
Pedro Moro, MD, MPH, Centers for Disease Control & Prevention, Atlanta, GA
Charu Mullick, MD, Food and Drug Administration, Silver Spring, MD
Julia M. Murphy, DVM, MS, DACVPM, Virginia Department of Health, Richmond,
VA
Henry W. Murray, MD, Weill Cornell Medical College, New York, NY
Oidda Ikumboka Museru, MSN, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Angela L. Myers, MD, MPH, Children’s Mercy, Kansas City, Kansas City, MO
Sumathi Nambiar, MD, MPH, Food and Drug Administration, Silver Spring, MD
Srinivas Acharya Nanduri, MBBS, MD, MPH, Centers for Disease Control and
Prevention, Atlanta, GA
James P. Nataro, MD, PhD, MBA, University of Virginia Children’s Hospital,
Charlottesville, VA
Mark S. Needles, MD, Food and Drug Administration, Silver Spring, MD
Maria E. Negron Sureda, DVM, PhD, MS, Centers for Disease Control and Prevention,
Atlanta, GA
Noele Nelson, MD, PhD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Danielle Nesbit, BS, Duke University, Durham, NC

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 COLLABORATORS XI

Steven R. Nesheim, MD, Centers for Disease Control and Prevention, Atlanta, GA
Jason G. Newland, MD, MEd, Washington University School of Medicine, St Louis, MO
Megin Nichols, DVM, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Kristen Nichols Heitman, MPH, Centers for Disease Control and Prevention,
Brookhaven, GA
William Nicholson, MS, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Obianuju N. Nsofor, PhD, Food and Drug Administration, College Park, MD
Thomas B. Nutman, MD, National Institutes of Health, Bethesda, MD
Steve Oberste, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Theresa J. Ochoa, MD, Instituto de Medicina Tropical “Alexander von Humboldt,”
Lima, Peru
Miguel Luis O’Ryan Gallardo, MD, Universidad de Chile, Santiago, Chile
Elizabeth O’Shaughnessy, MB, BCh, Food and Drug Administration, Silver Spring, MD
Gary D. Overturf, MD, University of New Mexico School of Medicine, Los Ranchos,
NM
Sherry Michele Owen, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Chris D. Paddock, MD, MPHTM, Centers for Disease Control and Prevention, Atlanta,
GA
Mark A. Pallansch, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Zoi Dorothea Pana, MD, MSc, PhD, Johns Hopkins Hospital, Baltimore, MD
Manisha Patel, MD, Centers for Disease Control and Prevention, Atlanta, GA
Sheral S. Patel, MD, Food and Drug Administration, Silver Spring, MD
Thomas F. Patterson, MD, University of Texas Health Science Center at San Antonio,
South Texas Veterans Health Care System, San Antonio, TX
Andrew T. Pavia, MD, University of Utah, Salt Lake City, UT
Jessica R. Payne, MPH, California Department of Public Health, Richmond, CA
Stephen Ira Pelton, MD, Boston University Schools of Medicine and Public Health and
Boston Medical Center, Boston, MA
Teresa C. T. Peret, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Joe F. Perz, DrPH, MA, Centers for Disease Control and Prevention, Atlanta, GA
Thomas A. Peterman, MD, MSc, Centers for Disease Control and Prevention, Atlanta,
GA
Larry K. Pickering, MD, Emory University School of Medicine, Atlanta, GA
Andreas Pikis, MD, Food and Drug Administration, Silver Spring, MD
Tamara Pilishvili, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Ana Yecê das Neves Pinto, MD, Evandro Chagas Institute, Ananindeua City, Para,
Brazil
Alice Pong, MD, University of California San Diego, Rady Children’s Hospital San
Diego, San Diego, CA
Claudette Lapage Poole, MBChB, University of Alabama at Birmingham, Birmingham,
AL
Drew L. Posey, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Susan M. Poutanen, MD, MPH, FRCPC, Mount Sinai Hospital, Toronto, Ontario,
Canada
R. Douglas Pratt, MD, MPH, Food and Drug Administration, Silver Spring, MD
Nathan Price, MD, University of Iowa Children’s Hospital, Iowa City, IA
Gary W. Procop, MD, MS, Cleveland Clinic, Twinsburg, OH

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 XII COLLABORATORS

Amol Purandare, MD, Food and Drug Administration, Silver Spring, MD

Ronald E. Pust, MD, University of Arizona College of Medicine, Tucson, AZ
Roshan Ramanathan, MD, MPH, Food and Drug Administration, Silver Spring, MD
Octavio Ramilo, MD, Nationwide Children’s Hospital and The Ohio State University,
Columbus, OH
Anuja Rastogi, MD, MHS, Food and Drug Administration, Silver Spring, MD
Jennifer S. Read, MD, MS, MPH, DTM&H, Centers for Disease Control and
Prevention, San Juan, Puerto Rico
Susan Reef, MD, Centers for Disease Control and Prevention, Atlanta, GA
Mary G. Reynolds, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Brian Rha, MD, MSPH, Centers for Disease Control and Prevention, Atlanta, GA
Frank O. Richards, Jr, MD, The Carter Center, Atlanta, GA
Nicholas S. Rister, MD, Food and Drug Administration, Silver Spring, MD
Jeffrey N. Roberts, MD, Food and Drug Administration, Silver Spring, MD
Candice L. Robinson, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Dawn M. Roellig, MS, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Pierre E. Rollin, MD, Centers for Disease Control and Prevention, Atlanta, GA
José Rafael Romero, MD, University of Arkansas for Medical Sciences and Arkansas
Children’s Hospital, Little Rock, AR
Paul A. Rota, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Anne H. Rowley, MD, Northwestern University Feinberg School of Medicine, Chicago,
IL
Steven A. Rubin, PhD, Food and Drug Administration, Silver Spring, MD
Lorry G. Rubin, MD, Cohen Children’s Medical Center of New York of Northwell
Health, New Hyde Park, NY, and Hofstra Northwell School of Medicine, New Hyde
Park, NY
Hari Cheryl Sachs, MD, Food and Drug Administration, Silver Spring, MD
Marco Aurelio P. Safadi, MD, PhD, Santa Casa de São Paulo School of Medical
Sciences, São Paulo, Brazil
Hugh A. Sampson, MD, Icahn School of Medicine at Mount Sinai, New York, NY
Kim Sapsford-Medintz, PhD, Food and Drug Administration, Silver Spring, MD
Jason B. Sauberan, PharmD, Rady Children’s Hospital San Diego, San Diego, CA
Ilana J. Schafer, DVM, MSPH, Centers for Disease Control and Prevention, Atlanta, GA
Sarah Schillie, MD, MPH, MBA, Centers for Disease Control and Prevention, Atlanta,
GA
Julia A. Schillinger, MD, MSc, Centers for Disease Control and Prevention, New York,
NY
Scott Schmid, BA, MS, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Eileen Schneider, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Gordon E. Schutze, MD, Baylor College of Medicine, Houston, TX
Ann Talbot Schwartz, MD, Food and Drug Administration, Silver Spring, MD
Robert A. Schwartz, MD, MPH, DSc (Hon), Rutgers New Jersey Medical School,
Newark, NJ
Kathleen B. Schwarz, MD, Johns Hopkins University School of Medicine, Baltimore, MD
Dorothy E. Scott, MD, Food and Drug Administration, Silver Spring, MD
Justin B. Searns, MD, Children’s Hospital Colorado, University of Colorado, Aurora, CO

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 COLLABORATORS XIII

William Evan Secor, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Isaac See, MD, Centers for Disease Control and Prevention, Atlanta, GA
Rangaraj Selvarangan, BVSc, PhD, D(ABMM), Children’s Mercy Hospital, Kansas City,
MO
Samir S. Shah, MD, MSCE, Cincinnati Children’s Hospital Medical Center, Cincinnati,
OH
Hala Shamsuddin, MD, Food and Drug Administration, Silver Spring, MD
Andi L. Shane, MD, MPH, MSc, Emory University School of Medicine and Children’s
Healthcare of Atlanta, Atlanta, GA
Alan M. Shapiro, MD PhD, Food and Drug Administration, Silver Spring, MD
Devindra Sharma, MSN, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Tyler M. Sharp, PhD, Centers for Disease Control and Prevention, San Juan, PR
Tom T. Shimabukuro, MD, MPH, MBA, Centers for Disease Control and Prevention,
Atlanta, GA
Timothy R. Shope, MD, MPH, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh,
PA
Stanford T. Shulman, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago,
Northwestern University Feinberg School of Medicine, Evanston, IL
Upinder Singh, MD, Stanford University, Stanford, CA
Anders Sjöstedt, MD, PhD, Umeå University, Sweden
Tami Skoff, MS, Centers for Disease Control and Prevention, Atlanta, GA
Thomas D. Smith, MD, Food and Drug Administration, Silver Spring, MD
P. Brian Smith, MD, MPH, MHS, Duke University Medical Center, Durham, NC
Kirk Smith, DVM, MS, PhD, Minnesota Department of Health, St Paul, MN
Donna L. Snyder, MD, Food and Drug Administration, Silver Spring, MD
Sunil Kumar Sood, MD, Cohen Children’s Medical Center, Northwell Health, Hofstra
North Shore-LIJ School of Medicine, Bay Shore, NY
Paul W. Spearman, MD, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Stanley M. Spinola, MD, Indiana University School of Medicine, Indianapolis, IN
Arjun Srinivasan, MD, Centers for Disease Control and Prevention, Atlanta, GA
Joseph W. St. Geme III, MD, The Children’s Hospital of Philadelphia, Philadelphia, PA
William M. Stauffer, MD, MSPH, FASTMH, University of Minnesota, Minneapolis, MN
Irving Steinberg, PharmD, University of Southern California, Keck School of Medicine
and School of Pharmacy, Los Angeles, CA
Shannon Stokley, DrPH, Centers for Disease Control and Prevention, Atlanta, GA
Anne M. Straily, DVM, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Raymond Strikas, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Tara W. Strine, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Nancy A. Strockbine, PhD, Centers for Disease Control and Prevention, Atlanta, GA
John R. Su, MD, PhD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Lakshmi Sukumaran, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Wellington Sun, MD, Food and Drug Administration, Silver Spring, MD
Jacqueline E. Tate, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Eyasu Habtu Teshale, MD, Centers for Disease Control and Prevention, Atlanta, GA
Beth Kristine Thielen, MD, PhD, University of Minnesota, Minneapolis, MN
Tejpratap S. P. Tiwari, MD, Centers for Disease Control and Prevention, Atlanta, GA

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 XIV COLLABORATORS

Melissa Tobin-D’Angelo, MD, MPH, Georgia Department of Public Health, Atlanta, GA

Sean Trimble, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Richard W. Truman, PhD, Louisiana State University School of Veterinary Medicine,
Baton Rouge, LA
Ronald B. Turner, MD, University of Virginia School of Medicine, Charlottesville, VA
Elizabeth R. Unger, PhD, MD, Centers for Disease Control and Prevention, Atlanta, GA
Snigdha Vallabhaneni, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Chris A. Van Beneden, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
John A. Vanchiere, MD, PhD, Louisiana State University, Health Sciences Center,
Shreveport, LA
Marietta Vázquez, MD, Yale University School of Medicine, New Haven, CT
Claudia Vellozzi, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Joseph M. Vinetz, MD, University of California San Diego School of Medicine, LaJolla,
CA
Jan Vinje, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Prabha Viswanathan, MD, Food and Drug Administration, Silver Spring, MD
Duc J. Vugia, MD, MPH, California Department of Public Health, Richmond, CA
Ken B. Waites, MD, University of Alabama at Birmingham, Birmingham, AL
Tiffany Walker, MD, Centers for Disease Control and Prevention, Atlanta, GA
Tiffany Wang, BA, Cohen Children’s Medical Center of New York New, Hyde Park, NY
Richard L. Wasserman, MD, PhD, Medical City Children’s Hospital, Dallas, TX
John T. Watson, MD, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Donna L. Weaver, RN, MN, Centers for Disease Control and Prevention, Atlanta, GA
Michelle Weinberg, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Edward A. Weinstein, MD, PhD, Food and Drug Administration, Silver Spring, MD
Eric Weintraub, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Emily J. Weston, MPH Centers for Disease Control and Prevention, Atlanta, GA
A. Clinton White, Jr, MD, University of Texas Medical Branch, Galveston, TX
Mary Beth White-Comstock, DNP, RN, CIC, Centers for Disease Control and
Prevention, Atlanta, GA
Richard J. Whitley, MD, University of Alabama at Birmingham, Birmingham, AL
Rodney E. Willoughby, Jr, MD, Medical College of Wisconsin, Milwaukee, WI
Jessie S. Wing, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Amber Haynes Winn, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Carla A. Winston, PhD, MA, Centers for Disease Control and Prevention, Atlanta, GA
A. Patricia Wodi, MD, Centers for Disease Control and Prevention, Atlanta, GA
JoEllen Wolicki, BSN, RN, Centers for Disease Control and Prevention, Atlanta, GA
Karen K. Wong, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Emily Jane Woo, MD, MPH, Food and Drug Administration, Silver Spring, MD
Kimberly Ann Workowski, MD, Centers for Disease Control and Prevention, Atlanta,
GA
Gary P. Wormser, MD, New York Medical College, Valhalla, NY
Alexandra S. Worobec, MD, Food and Drug Administration, Silver Spring, MD
Mary A. Worthington, PharmD, BCPS, McWhorter School of Pharmacy, Samford
University, Birmingham, AL

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 COLLABORATORS XV

Albert C. Yan, MD, The Children’s Hospital of Philadelphia - University of Pennsylvania

School of Medicine, Philadelphia, PA
Yuliya, Yasinskaya, MD, Food and Drug Administration, Silver Spring, MD

AAP Committee on Adolescence

AAP Committee on Child Abuse and Neglect
AAP Committee on Coding and Nomenclature
AAP Committee on Fetus and Newborn
AAP Committee on Medical Liability and Risk Management
AAP Committee on Native American Child Health
AAP Committee on Nutrition
AAP Committee on Pediatric AIDS
AAP Committee on Pediatric Emergency Medicine
AAP Committee on Practice and Ambulatory Medicine
AAP Council on Children With Disabilities
AAP Council on Early Childhood
AAP Council on Environmental Health
AAP Council on Foster Care, Adoption, and Kinship Care
AAP Council on School Health
AAP Disaster Preparedness Advisory Council
AAP Section on Administration and Practice Management
AAP Section on Adolescent Health
AAP Section on Breastfeeding
AAP Section on Cardiology and Cardiac Surgery
AAP Section on Child Abuse and Neglect
AAP Section on Critical Care
AAP Section on Early Career Physicians
AAP Section on Emergency Medicine
AAP Section on Epidemiology, Public Health, and Evidence
AAP Section on Hematology/Oncology
AAP Section on Home Care
AAP Section on Hospital Medicine
AAP Section on Infectious Diseases
AAP Section on Neonatal-Perinatal Medicine
AAP Section on Nephrology
AAP Section on Neurology
AAP Section on Oral Health
AAP Section on Orthopaedics
AAP Section on Otolaryngology – Head and Neck Surgery
AAP Section on Pediatric Pulmonology and Sleep Medicine
AAP Section on Rheumatology

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2015–2018

SEATED, LEFT TO RIGHT: Sean T. O’Leary, Ann-Christine Nyquist, Mary Anne Jackson, Michael T. Brady, Yvonne A.
Maldonado, Carrie L. Byington, David W. Kimberlin, Sarah S. Long, Natasha B. Halasa, H. Dele Davies, William J. Steinbach
STANDING, LEFT TO RIGHT: Marc Fischer, Dawn Nolt, Geoffrey R. Simon, Karen M. Farizo, Tina Q. Tan, Amanda C. Cohn,

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Mobeen H. Rathore, Theoklis E. Zaoutis, Joan L. Robinson, Henry H. Bernstein, R. Phillips Heine, Elizabeth D. Barnett, Mark H.
Sawyer, Ruth Lynfield, James D. Campbell, Flor M. Munoz, Jennifer M. Frantz
NOT PICTURED: Ritu Banerjee, Douglas Campos-Outcalt, Jamie Deseda-Tous, Kathryn M. Edwards, Bruce G. Gellin, Jeffrey S.
Committee on Infectious Diseases,

Gerber, Richard L. Gorman, Nicole Le Saux, H. Cody Meissner, Scot Moore, Neil S. Silverman, Jeffrey R. Starke, James J. Stevermer,
Kay M. Tomashek
 XVII

2018 Red Book Dedication for

Larry K. Pickering, MD, FAAP, and
Carol J. Baker, MD, FAAP

Partnerships have been foundational to the American Academy of Pediatrics (AAP) since
its establishment in 1930. At the individual level, pediatricians have partnered with one
another to improve the lives of the children for whom they care. At the organizational
level, the AAP has partnered with groups that impact children’s health, such as the
Centers for Disease Control and Prevention (CDC), the American College of Obstetri-
cians and Gynecologists (ACOG), the American Academy of Family Physicians (AAFP),
and the US Food and Drug Administration (FDA). And at the governance level, the
Academy has partnered with local and national leaders across party lines to advance
policies that benefit children. At their core, partnerships have been the fundamental
reason for the Academy’s success in advancing the health and well-being of children for
almost 90 years.
The 2018 Red Book: Report of the Committee on Infectious Diseases is dedicated to two of
the Academy’s most influential partners, Larry K. Pickering, MD, and Carol J. Baker,
MD. Drs. Pickering and Baker personify the highest ideals of effective collaboration
and partnership. Both are passionate advocates for children who have harnessed their
energies and friendship to achieve more together than would have been accomplished
separately. As Editor and Associate Editor, respectively, for 5 editions of the Red Book
spanning 15 years, Drs. Pickering and Baker worked side by side to create a product that
is used the world over by pediatricians caring for children. To be sure, the editions of the
Red Book that they led in 2000, 2003, 2006, 2009, and 2012 were very much a group
effort, with several skilled associate editors and scores of Committee on Infectious
Diseases (COID) members and liaisons also guiding the development of great Red Books.
But it was Larry and Carol who inspired and led this group to achieve truly remarkable
things.

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 XVIII DEDICATION

Carol Baker entered medicine in an era when women physicians were rare. She was
the only woman in her medical school class at Baylor College of Medicine from 1964 to
1968. Following graduation, she completed an internship in pediatrics at the University of
Southern California before returning to Baylor for residency and pediatric infectious
disease fellowship training. She then spent two years at Harvard Medical School as a
research fellow and instructor before accepting a faculty position at Baylor College of
Medicine in 1975, where she has remained for her entire career. Carol is responsible for
generating an extraordinary amount of information regarding Streptococcus agalactiae. She
performed the seminal epidemiologic and natural history investigations of the role this
pathogen plays in neonatal sepsis and meningitis, correlated maternal colonization of
group B streptococcus at delivery with risk to the neonate, and devised the screening plan,
in collaboration with the AAP, CDC, and ACOG, that is used worldwide for the
prevention of early-onset group B streptococcal disease, whereby women are universally
screened for colonization with the bacteria near the end of pregnancy and treated
perinatally if positive.
Larry Pickering completed medical school at West Virginia University School of
Medicine in 1970 and then completed his residency and pediatric infectious diseases
fellowship training at Washington University in St. Louis. He was recruited to the
University of Texas School of Medicine at Houston in 1974, where he began a long
career focusing on viral, bacterial, and protozoal enteric diseases. His research explored
the protective factors against enteric pathogens that are present in human milk, contrib-
uting to the resurgence of breastfeeding across the country in the 1980s and 1990s.
Larry’s work on the pathophysiology of enteric diseases was truly bench to bedside to
bench and laid the groundwork for outbreak investigations, diagnostic advances, thera-
peutic interventions, and prevention of enteric diseases through hygienic improvements
and vaccine development.
Although at separate institutions, the environment in Houston was inclusive and col-
laborative as well as a bit competitive. Drs. Baker and Pickering would see each other at
least weekly at the citywide infectious disease conference, where representatives of the
participating institutions would prepare and present cases for the meeting. At many, if not
most, of these weekly meetings, Larry would present a patient for the stated purpose of
stumping Carol, or vice versa. They forged a deep friendship based on profound respect
for the clinical acumen, scientific rigor, and ethical underpinnings of the other. Their first
publication together was in 1981, the case of a child with group A streptococcal meningi-
tis. It was the first of many collaborative efforts.
After leaving UT Houston in 1992, Larry moved to Eastern Virginia Medical School,
where he was vice chair for pediatric research. In 2001, he moved to the CDC to serve as
the Senior Advisor to the Director and the Executive Secretary of the Advisory Commit-
tee on Immunization Practices (ACIP). Larry served on the AAP COID from 1990–1996
and was an Associate Editor of the 1994 and 1997 editions of the Red Book. Following
publication of the 1997 Red Book, Larry was named Editor of the 2000 edition, and he
immediately recruited Carol to serve as an Associate Editor. Carol served as a COID
member from 1999–2005, and together she and Larry produced five editions of the Red
Book. Their partnership extended to the CDC as well when Dr. Baker joined the ACIP
in 2006 as a member and ascended to Chair of the ACIP from 2009–2012. Whether
sitting side by side at ACIP meetings or around the conference room table at COID
meetings, Drs. Pickering and Baker modeled respect for one another as they worked

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 DEDICATION XIX

tirelessly toward the better health of all children. Their thoughtful and informed leader-
ship at the AAP and CDC helped establish the current era of historically low rates of
most vaccine-preventable diseases.
There is an old African proverb that if you want to go fast, go alone; but if you want
to go far, go together. Larry and Carol have always gone together, and children across
the world have benefited from how far they traveled. This edition of the Red Book is
dedicated to Larry and Carol as a small token of thanks and appreciation on behalf of all
of the children and pediatricians whose lives are better because of their partnership.

PREVIOUS RED BOOK DEDICATION RECIPIENTS:

2015 Stanley Plotkin, MD, FAAP
2012 Samuel L. Katz, MD, FAAP
2009 Ralph Feigin, MD, FAAP
2006 Caroline Breese Hall, MD, FAAP
2003 Georges Peter, MD, FAAP
2000 Edgar O. Ledbetter, MD, FAAP
1997 Georges Peter, MD, FAAP

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 XXI

Preface
The Red Book, now in its 31st edition, has been a unique and valuable source of infor-
mation on infectious diseases and immunizations for pediatric practitioners since 1938.
In the 21st century, with the practice of pediatric infectious diseases changing rapidly and
the limited time available to the practitioner, the Red Book remains an essential resource to
quickly obtain current, accurate, and easily accessible information about vaccines and
vaccine recommendations, emerging infectious diseases, diagnostic modalities, and
treatment recommendations. The Committee on Infectious Diseases of the American
Academy of Pediatrics (AAP), the editors of the Red Book, and the 500 Red Book contribu-
tors are dedicated to providing the most current and accurate information available in
the concise, practical format for which the Red Book is known.
For the first time since the 2006 edition, the print version of the Red Book will be
provided to every AAP member as part of their member benefit. This change reflects
the Academy’s strong interest in its members’ needs. In a series of AAP Periodic Surveys
conducted of its members, pediatricians expressed that the ease of retrieval of information
from the book format is highly valued in the midst of busy practices.
As with each of the last 4 editions, AAP members also will continue to have access to
Red Book content on Red Book Online (www.aapredbook.org). AAP policy statements,
clinical reports, and technical reports and recommendations endorsed by the AAP are
posted on Red Book Online as they become available during the 3 years between Red Book
editions, and online chapters are modified as needed to reflect these changes. Red Book
users also are encouraged to sign up for e-mail alerts on www.aapredbook.org to
receive new information and policy updates between editions.
Another important resource is the visual library of Red Book Online, which is continu-
ally updated and expanded to include more images of infectious diseases, examples of
classic radiologic and other findings, and recent information on epidemiology of infec-
tious diseases.
The Committee on Infectious Diseases relies on information and advice from many
experts, as evidenced by the lengthy list of contributors to Red Book. We especially are
indebted to the many contributors from other AAP committees, sections, and councils;
the American Academy of Family Physicians; the American College of Obstetricians and
Gynecologists; the American Thoracic Society; the Canadian Paediatric Society; the
Centers for Disease Control and Prevention; the US Food and Drug Administration; the
National Institutes of Health; the National Vaccine Program Office; the Pediatric
Infectious Diseases Society; la Sociedad Latinoamericana de Infectología Pediátrica; the
World Health Organization; and many other organizations and individuals who have
made this edition possible. In addition, suggestions made by individual AAP members to
improve the presentation of information on specific issues and on topic selection have
been incorporated whenever possible.
Most important to the success of this edition is the dedication and work of the editors,
whose commitment to excellence is unparalleled. This new edition was made possible
under the able leadership of David W. Kimberlin, MD, editor, along with associate
editors Michael T. Brady, MD, Mary Anne Jackson, MD, and Sarah S. Long, MD. We

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 XXII PREFACE

also are indebted to H. Cody Meissner, MD, for his untiring efforts to gather and organ-
ize the slide materials that make up the visual library of Red Book Online and are part of
the electronic versions of the Red Book, and to Henry H. Bernstein, DO, MHCM, for his
continuous efforts to maintain up-to-date content as editor of Red Book Online.
As noted in previous editions of the Red Book, some omissions and errors are inevitable
in a book of this type. We ask that AAP members continue to assist the committee ac-
tively by suggesting specific ways to improve the quality of future editions. The committee
membership and editorial staff hope that the 2018 Red Book will enhance your practice
and benefit the children you serve.

Carrie L. Byington, MD, FAAP

Chair, Committee on Infectious Diseases

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 XXIII

Introduction
The Committee on Infectious Diseases (COID) of the American Academy of Pediatrics
(AAP) is responsible for developing and revising guidance from the AAP for management
and control of infectious diseases in infants, children, and adolescents. Every 3 years, the
COID issues the Red Book: Report of the Committee on Infectious Diseases, which contains a
composite summary of current recommendations representing the policy of the AAP on
various aspects of infectious diseases, including updated vaccine recommendations for the
most recent US Food and Drug Administration (FDA)-licensed vaccines for infants, chil-
dren, and adolescents. These recommendations represent a consensus of opinions based
on consideration of the best available evidence by members of the COID, in conjunction
with liaison representatives from the Centers for Disease Control and Prevention (CDC),
the FDA, the National Institutes of Health, the National Vaccine Program Office, the
Canadian Paediatric Society, the American Thoracic Society, the Pediatric Infectious
Diseases Society, the American Academy of Family Physicians, the American College of
Obstetricians and Gynecologists, Red Book consultants, and scores of collaborators. This
edition of the Red Book is based on information available as of February 2018. The Red
Book is your own personal infectious disease consultant, on your bookshelf and ready for
you 24 hours a day, 7 days a week. Arguably, it is most valuable in those circumstances in
which definitive data from randomized controlled trials are lacking. It is in those situa-
tions that guidance from experts in the field is most critical, and the COID has literally
hundreds of years of cumulative expertise to bring to bear on such recommendations.
The Red Book is formatted as hard copy, mobile app, and online Web version, with the
electronic versions containing links to supplemental information, including visual images,
graphs, maps, and tables.
Preparation of the Red Book is a team effort in the truest sense of the term. Within
weeks following the publication of each Red Book edition, all Red Book chapters are sent for
updates to primary reviewers who are leading national and international experts in their
specific areas. For the 2018 Red Book, one quarter of primary reviewers were new to this
process, ensuring that the most up-to-date information has been included in this new edi-
tion. Following review by the primary reviewer, each chapter is returned to the assigned
Associate Editor for incorporation of the reviewer’s edits. The chapter then is disseminated
to content experts at the CDC and FDA and to members of all AAP Sections, Commit-
tees, and Councils that agree to review specific chapters for their additional edits as
needed, after which it again is returned to the assigned Associate Editor for harmonization
and incorporation of edits as appropriate. Two designated COID reviewers then complete
a final review of the chapter, and it is returned to the assigned Associate Editor for inclu-
sion of any needed additional modifications. Finally, each chapter is discussed and debated
by the full COID at its “Marathon Meeting,” held at the AAP during the spring of the
year prior to publication, where it is finalized. Copyediting by the Editor and senior medi-
cal copy editor follows, and the book then is reviewed by the Red Book reviewers appointed
by the AAP Board of Directors. In all, 1000 hands have touched the 2018 Red Book prior to
its publication! That so many contributors dedicate so much time and expertise to this
product is a testament to the role the Red Book plays in the care of children.

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 XXIV INTRODUCTION

Through this deliberative and inclusive process, the COID endeavors to provide
current, relevant, evidence-based recommendations for the prevention and management
of infectious diseases in infants, children, and adolescents. Seemingly unanswerable
scientific questions, the complexity of medical practice, ongoing innovative technology,
continuous new information, and inevitable differences of opinion among experts all are
addressed during production of the Red Book. In some cases, other committees and experts
may differ in their interpretation of data and resulting recommendations, and occasion-
ally no single recommendation can be made because several options for management are
equally acceptable. In such circumstances, the language incorporated in the chapter
acknowledges these differing acceptable management options by use of the phrases “most
experts recommend...” and “some experts recommend...” Both phrases indicate valid rec-
ommendations, but the first phrase signifies more agreement and support among the ex-
perts. Inevitably in clinical practice, questions arise that cannot be answered easily on the
basis of currently available data. When this happens, the COID still provides guidance
and information that, coupled with clinical judgment, will facilitate well-reasoned, clini-
cally relevant decisions. Through this process of lifelong learning, the committee seeks to
provide a practical guide for physicians and other health care professionals in their care of
infants, children, and adolescents.
To aid physicians and other health care professionals in assimilating current changes
in recommendations in the Red Book, a list of major changes between the 2015 and 2018
editions has been compiled (see Summary of Major Changes, p XXXV). However, this
list only begins to cover the many in-depth changes that have occurred in each chapter
and section. Throughout the Red Book, Internet addresses enable rapid access to new
information. In addition, new information between editions from the COID, in the form
of Policy Statements, Clinical Reports, and Technical Reports, are posted on Red Book
Online (www.aapredbook.org), and online chapters are modified as needed with
clear indications of where changes have been made. These completed work products are
a result of the continuous reassessment by the COID of its current positions across the
spectrum of pediatric infectious diseases, and demonstrate the dynamic process by which
the Committee’s deliberations always are inclusive of new data and perspectives.
Information on use of antimicrobial agents is included in the package inserts (product
labels) prepared by manufacturers, including contraindications and adverse events. The
Red Book does not attempt to provide this information comprehensively, because it is avail-
able readily in the Physicians’ Desk Reference (www.pdr.net) and in package inserts.
As in previous editions of the Red Book, recommended dosage schedules for antimicrobial
agents are provided (see Section 4, Antimicrobial Agents and Related Therapy) and may
differ from those of the manufacturer as provided in the package insert. Antimicrobial
agents recommended for specific infections in the Red Book may or may not have an FDA
indication for treatment of that infection. Physicians also can reference additional infor-
mation in the package inserts of vaccines licensed by the FDA (which also may differ from
COID and ACIP/CDC recommendations for use) and of immune globulins, as well as
recommendations of other committees (see Sources of Vaccine Information, p 0), many of
which are included in the Red Book.
Likewise, we strive to utilize the accurate terminology for licensure, approval, or
clearance of drugs and devices by the FDA. The correct term used depends on the
classification of the product (eg, drug, biological product, or device) and, for devices,
whether a “premarket notification” or a “premarket application” has been submitted.

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 INTRODUCTION XXV

Drugs are approved by the FDA. Biologic products (eg, vaccines, immunoglobulin
preparations) are licensed by the FDA, and vaccines are approved for use in certain
populations and age groups. The FDA “clears” devices after reviewing premarket
notifications, but “approves” devices after reviewing a premarket application. Whether a
premarket notification or premarket application needs to be filed depends on the
classification of the medical device. “Cleared” devices (also called “510 (k)” or “premarket
notification” devices) can be searched at www.fda.gov/MedicalDevices/
ProductsandMedicalProcedures/DeviceApprovalsandClearances/
510kClearances/ucm089319.htm. Devices@FDA (www.accessdata.fda.gov/
scripts/cdrh/devicesatfda/index.cfm) is more comprehensive and includes both
“cleared” and “approved” tests and other devices. Where we fail in the Red Book to select
the appropriate term for a given product, we apologize for any (additional) confusion this
adds to this regulatory structure.
This book could not have been prepared without the dedicated professional compe-
tence of many people. The AAP staff has been outstanding in its committed work and
contributions, particularly Jennifer Frantz, senior manager, who served as the administra-
tive director for the COID and coordinated preparation of the Red Book; Jennifer Shaw,
senior medical copy editor; Linda Rutt, division coordinator; Theresa Wiener, manager
of publishing and production services; and all of the directors and staff of the AAP pub-
lishing and marketing groups who make the full Red Book product line possible.
Marc Fischer, MD, of the CDC, and Karen M. Farizo, MD, of the FDA, devoted
time and effort in providing significant input from their organizations. Meg Fisher, MD,
and Renée Jenkins, MD, served as Red Book reviewers appointed by the AAP Board of Di-
rectors, spending scores of hours reviewing the final chapters for consistency and accu-
racy. I am especially indebted to the Associate Editors Michael T. Brady, MD, Mary
Anne Jackson, MD, and Sarah S. Long, MD, for their expertise, tireless work, good
humor, and immense contributions in their editorial and committee work. Members
of the COID contributed countless hours and deserve appropriate recognition for their
patience, dedication, revisions, and reviews. The COID appreciates the guidance and
dedication of Carrie L. Byington, MD, COID Chairperson, whose knowledge, dedica-
tion, insight, and leadership are reflected in the quality and productivity of the commit-
tee’s work. I thank my wife, Kim, for always being there and for her patience, under-
standing, and never-ending support as this edition of the Red Book came to fruition.
I also would like to personally thank Karen Remley, MD, for her leadership of the
AAP and for her support of the COID and the Red Book. In her travels across the country,
Dr. Remley has heard first-hand the value that the Red Book brings to the treatment of
children. These experiences mirror her own as a pediatric emergency medicine physician
earlier in her luminous career. Dr. Remley has provided keen insights into the design of
the new Red Book cover to be inclusive of the years that it will be current, between now
and 2021. She also has tirelessly supported efforts across the AAP to be responsive to
members’ stated desire to have access to the printed version of the Red Book, culminating
in the AAP Board of Directors’ approval of providing a hard copy of the book to all AAP
members as part of their member benefit. Her tireless fight for the welfare of all children
is inspiring to all who look to the AAP for leadership.
There are many other contributors whose professional work and commitment have
been essential in the committee’s preparation of the Red Book. Of special note are the indi-
viduals to whom this edition of the Red Book is dedicated, Larry K. Pickering, MD, and

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 XXVI INTRODUCTION

Carol J. Baker, MD. I have learned so much from each of them, and the legacies that
they leave in pediatrics and the Red Book will endure for generations to come.
David W. Kimberlin, MD, FAAP
Editor

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 XXVII

Table of Contents
Summary of Major Changes in the 2018 Red Book .................................................. XXXV

SECTION 1
ACTIVE AND PASSIVE IMMUNIZATION
Prologue ............................................................................................................................ 1
Sources of Information About Immunization .................................................................... 3
Discussing Vaccines With Patients and Parents ................................................................. 7
Addressing Parents’ Questions About Vaccine Safety and Effectiveness ..................... 7
Common Misconceptions About Immunizations and the Institute of
Medicine Findings ........................................................................................ 7
Resources for Optimizing Communications With Parent About Vaccines ................. 8
Parental Refusal of Immunizations ............................................................................ 11
Active Immunization ....................................................................................................... 13
Vaccine Ingredients .................................................................................................... 17
Vaccine Handling and Storage .................................................................................. 20
Vaccine Administration.............................................................................................. 26
Managing Injection Pain ............................................................................................ 30
Timing of Vaccines and the Immunization Schedule ................................................ 31
Minimum Ages and Minimum Intervals Between Vaccine Doses ............................. 34
Interchangeability of Vaccine Products ..................................................................... 34
Simultaneous Administration of Multiple Vaccines ................................................... 35
Combination Vaccines ............................................................................................... 36
Lapsed Immunizations ............................................................................................... 38
Unknown or Uncertain Immunization Status ............................................................ 38
Vaccine Dose.............................................................................................................. 38
Active Immunization of People Who Recently Received Immune Globulin
and Other Blood Products .......................................................................... 39
Vaccine Safety ............................................................................................................ 41
Risks and Adverse Events ..................................................................................... 41
Institute of Medicine Reviews of Adverse Events After Immunization ................ 43
Vaccine Adverse Event Reporting System ........................................................... 45
Vaccine Safety Datalink Project ........................................................................... 46
Post-Licensure Rapid Immunization Safety Monitoring (PRISM) ...................... 49
Clinical Immunization Safety Assessment (CISA) Project .................................... 50
Vaccine Injury Compensation .............................................................................. 51
Hypersensitivity Reactions After Immunization ................................................... 52
Immediate-Type Allergic Reactions ..................................................................... 53
Delayed-Type Allergic Reactions ......................................................................... 54
Other Vaccine Reactions...................................................................................... 54
Passive Immunization ...................................................................................................... 55
Immune Globulin Intramuscular (IGIM) ................................................................... 56

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Immune Globulin Intravenous (IGIV) ....................................................................... 58

Immune Globulin Subcutaneous (IGSC) ................................................................... 62
Treatment of Anaphylactic Reactions........................................................................ 64
Immunization in Special Clinical Circumstances ............................................................ 67
Immunization in Preterm and Low Birth Weight Infants .......................................... 67
Immunization in Pregnancy ....................................................................................... 69
Immunization and Other Considerations in Immunocompromised Children .......... 72
Immunization in Children With a Personal or Family History of Seizures................ 91
Immunization in Children With Chronic Diseases .................................................... 92
Immunization in American Indian/Alaska Native Children and Adolescents .......... 93
Immunization in Adolescent and College Populations .............................................. 95
Immunization in Health Care Personnel .................................................................. 97
Children Who Received Immunizations Outside the United States or Whose
Immunization Status is Unknown or Uncertain ...................................... 100
International Travel ................................................................................................. 103

SECTION 2
RECOMMENDATIONS FOR CARE OF CHILDREN IN
SPECIAL CIRCUMSTANCES
Human Milk .................................................................................................................. 113
Immunization of Mothers and Infants ..................................................................... 114
Transmission of Infectious Agents via Human Milk ................................................ 115
Antimicrobial Agents and Other Drugs in Human Milk ......................................... 121
Biologic Response Modifiers in Human Milk .......................................................... 121
Children in Out-of-Home Child Care ........................................................................... 122
Modes of Spread of Infectious Diseases.................................................................... 122
Management and Prevention of Infectious Diseases ................................................ 125
School Health ................................................................................................................ 136
Diseases Preventable by Routine Childhood Immunization .................................... 138
Infections Spread by the Respiratory Route ............................................................ 140
Infections Spread by Direct Contact ........................................................................ 141
Infections Spread by the Fecal-Oral Route .............................................................. 143
Infections Spread by Blood and Body Fluids ........................................................... 144
Infection Control and Prevention for Hospitalized Children ........................................ 147
Isolation Precautions ................................................................................................ 148
Strategies to Prevent Health Care-Associated Infections ......................................... 158
Occupational Health ................................................................................................ 159
Sibling Visitation ...................................................................................................... 160
Adult Visitation ........................................................................................................ 161
Pet Visitation ............................................................................................................ 161
Infection Control and Prevention in Ambulatory Settings ............................................ 163
Sexually Transmitted Infections in Adolescents and Children ...................................... 165
STIs in Adolescents .................................................................................................. 165
STIs in Children....................................................................................................... 168
Medical Evaluation for Infectious Diseases for Internationally Adopted, Refugee,
and Immigrant Children ................................................................................ 176

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 TABLE OF CONTENTS XXIX

Consideration for Testing for Infectious Agents ....................................................... 178

Hepatitis A .......................................................................................................... 178
Hepatitis B .......................................................................................................... 179
Hepatitis C .......................................................................................................... 179
Intestinal Pathogens ............................................................................................ 180
Tissue Parasites/Eosinophilia ............................................................................. 181
Syphilis ............................................................................................................... 181
Tuberculosis........................................................................................................ 182
HIV Infection ..................................................................................................... 183
Chagas Disease (American Trypanosomiasis)..................................................... 183
Other Infectious Diseases ................................................................................... 184
Injuries From Discarded Needles in the Community .................................................... 185
Wound Care and Tetanus Prophylaxis .................................................................... 186
Bloodborne Pathogens ............................................................................................. 186
Preventing Needlestick Injuries ................................................................................ 189
Bite Wounds................................................................................................................... 189
Prevention of Mosquitoborne and Tickborne Infections ............................................... 195
General Protective Measures.................................................................................... 196
Repellents for Use on Skin ....................................................................................... 197
Tick Inspection and Removal .................................................................................. 200
Other Preventive Measures ...................................................................................... 200
Prevention of Illnesses Associated with Recreational Water Use ................................... 201

SECTION 3
SUMMARIES OF INFECTIOUS DISEASES
Actinomycosis ................................................................................................................ 205
Adenovirus Infections .................................................................................................... 206
Amebiasis ....................................................................................................................... 208
Amebic Meningoencephalitis and Keratitis ................................................................... 211
Anthrax ....................................................................................................................... 214
Arboviruses .................................................................................................................... 220
Arcanobacterium haemolyticum Infections ............................................................................. 227
Ascaris lumbricoides Infections ........................................................................................... 228
Aspergillosis.................................................................................................................... 230
Astrovirus Infections ...................................................................................................... 234
Babesiosis ....................................................................................................................... 235
Bacillus cereus Infections and Intoxications ...................................................................... 237
Bacterial Vaginosis ......................................................................................................... 239
Bacteroides, Prevotella, and Other Anaerobic Gram-Negative Bacilli Infections ............... 242
Balantidium coli Infections (Balantidiasis) ......................................................................... 243
Bartonella henselae (Cat-Scratch Disease) .......................................................................... 244
Baylisascaris Infections ..................................................................................................... 247
Infections With Blastocystis hominis and Other Subtypes ................................................. 248
Blastomycosis ................................................................................................................. 249
Bocavirus ....................................................................................................................... 251
Borrelia Infections Other Than Lyme Disease (Relapsing Fever) ................................... 252

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Brucellosis ...................................................................................................................... 255

Burkholderia Infections ..................................................................................................... 258
Campylobacter Infections................................................................................................... 260
Candidiasis ..................................................................................................................... 263
Chancroid and Cutaneous Ulcers .................................................................................. 269
Chikungunya ................................................................................................................. 271
Chlamydial Infections .................................................................................................... 273
Chlamydia pneumoniae .................................................................................................. 273
Chlamydia psittaci (Psittacosis, Ornithosis, Parrot Fever) ........................................... 274
Chlamydia trachomatis .................................................................................................. 276
Clostridial Infections ...................................................................................................... 283
Botulism and Infant Botulism (Clostridium botulinum) ................................................. 283
Clostridial Myonecrosis (Gas Gangrene) ................................................................. 286
Clostridium difficile ....................................................................................................... 288
Clostridium perfringens Food Poisoning......................................................................... 292
Coccidioidomycosis........................................................................................................ 294
Coronaviruses, Including SARS and MERS ................................................................. 297
Cryptococcus neoformans and Cryptococcus gattii Infections (Cryptococcosis) ........................ 301
Cryptosporidiosis ........................................................................................................... 304
Cutaneous Larva Migrans ............................................................................................. 307
Cyclosporiasis................................................................................................................. 308
Cystoisosporiasis (Formerly Isosporiasis) ........................................................................ 309
Cytomegalovirus Infection ............................................................................................. 310
Dengue ........................................................................................................................... 317
Diphtheria ...................................................................................................................... 319
Ehrlichia, Anaplasma, and Related Infections (Human Ehrlichiosis,
Anaplasmosis, and Related Infections Attributable to Bacteria
in the Family Anaplasmataceae) ........................................................................ 323
Serious Bacterial Infections Caused by Enterobacteriaceae (With Emphasis on
Septicemia and Meningitis in Neonates) ........................................................ 328
Enterovirus (Nonpoliovirus) (Group A and B Coxsackieviruses, Echoviruses,
Numbered Enteroviruses) .............................................................................. 331
Epstein-Barr Virus Infections (Infectious Mononucleosis) ............................................ 334
Escherichia coli Diarrhea (Including Hemolytic-Uremic Syndrome) ............................... 338
Other Fungal Diseases ................................................................................................... 344
Fusobacterium Infections (Including Lemierre Disease) ................................................... 350
Giardia intestinalis (formerly Giardia lamblia and Giardia duodenalis)
Infections (Giardiasis)…. ................................................................................ 352
Gonococcal Infections.................................................................................................... 355
Granuloma Inguinale (Donovanosis) ............................................................................. 365
Haemophilus influenzae Infections ...................................................................................... 367
Hantavirus Pulmonary Syndrome ................................................................................. 375
Helicobacter pylori Infections ............................................................................................. 378
Hemorrhagic Fevers Caused by Arenaviruses ............................................................... 381
Hemorrhagic Fevers Caused by Bunyaviruses ............................................................... 384
Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg ................................. 387
Hepatitis A ..................................................................................................................... 392

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 TABLE OF CONTENTS XXXI

Hepatitis B ..................................................................................................................... 401

Hepatitis C ..................................................................................................................... 428
Hepatitis D ..................................................................................................................... 434
Hepatitis E ..................................................................................................................... 436
Herpes Simplex .............................................................................................................. 437
Histoplasmosis ............................................................................................................... 449
Hookworm Infections (Ancylostoma duodenale and Necator americanus) ................................ 453
Human Herpesvirus 6 (Including Roseola) and 7 .......................................................... 454
Human Herpesvirus 8 .................................................................................................... 457
Human Immunodeficiency Virus Infection ................................................................... 459
Influenza ........................................................................................................................ 476
Kawasaki Disease ........................................................................................................... 490
Kingella kingae Infections .................................................................................................. 497
Legionella pneumophila Infections ....................................................................................... 498
Leishmaniasis ................................................................................................................. 501
Leprosy .......................................................................................................................... 504
Leptospirosis .................................................................................................................. 508
Listeria monocytogenes Infections (Listeriosis) ...................................................................... 511
Lyme Disease (Lyme Borreliosis, Borrelia burgdorferi sensu lato Infection) ....................... 515
Lymphatic Filariasis (Bancroftian, Malayan, and Timorian) ......................................... 523
Lymphocytic Choriomeningitis ..................................................................................... 525
Malaria .......................................................................................................................... 527
Measles........................................................................................................................... 537
Meningococcal Infections .............................................................................................. 550
Human Metapneumovirus............................................................................................. 561
Microsporidia Infections (Microsporidiosis) ................................................................... 563
Molluscum Contagiosum ............................................................................................... 565
Moraxella catarrhalis Infections ......................................................................................... 566
Mumps ........................................................................................................................... 567
Mycoplasma pneumoniae and Other Mycoplasma Species Infections .................................... 573
Nocardiosis .................................................................................................................... 575
Norovirus and Sapovirus Infections ............................................................................... 577
Onchocerciasis (River Blindness, Filariasis) ................................................................... 580
Human Papillomaviruses ............................................................................................... 582
Paracoccidioidomycosis (Formerly Known as South American Blastomycosis) ............ 590
Paragonimiasis ............................................................................................................... 591
Parainfluenza Viral Infections ....................................................................................... 593
Parasitic Diseases ........................................................................................................... 595
Human Parechovirus Infections .................................................................................... 601
Parvovirus B19 (Erythema Infectiosum, Fifth Disease) .................................................. 602
Pasteurella Infections ........................................................................................................ 606
Pediculosis Capitis (Head Lice) ...................................................................................... 607
Pediculosis Corporis (Body Lice) .................................................................................... 612
Pediculosis Pubis (Pubic Lice, Crab Lice) ...................................................................... 613
Pelvic Inflammatory Disease .......................................................................................... 614
Pertussis (Whooping Cough) .......................................................................................... 620
Pinworm Infection (Enterobius vermicularis) ...................................................................... 634

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Pityriasis Versicolor (Formerly Tinea Versicolor) .......................................................... 635

Plague ............................................................................................................................ 637
Pneumococcal Infections ............................................................................................... 639
Pneumocystis jirovecii Infections.......................................................................................... 651
Poliovirus Infections ....................................................................................................... 657
Polyomaviruses (BK, JC, and Other Polyomaviruses) ................................................... 664
Prion Diseases: Transmissible Spongiform Encephalopathies ....................................... 666
Q Fever (Coxiella burnetii Infection) ................................................................................. 671
Rabies ............................................................................................................................ 673
Rat-Bite Fever ................................................................................................................ 680
Respiratory Syncytial Virus .......................................................................................... 682
Rhinovirus Infections ..................................................................................................... 692
Rickettsial Diseases ........................................................................................................ 693
Rickettsialpox................................................................................................................. 696
Rocky Mountain Spotted Fever ..................................................................................... 697
Rotavirus Infections ....................................................................................................... 700
Rubella ........................................................................................................................... 705
Salmonella Infections ........................................................................................................ 711
Scabies ........................................................................................................................... 718
Schistosomiasis ............................................................................................................... 721
Shigella Infections ............................................................................................................ 723
Smallpox (Variola) ......................................................................................................... 727
Sporotrichosis ................................................................................................................ 730
Staphylococcal Food Poisoning ..................................................................................... 732
Staphylococcus aureus .......................................................................................................... 733
Coagulase-Negative Staphylococcal Infections .............................................................. 746
Group A Streptococcal Infections .................................................................................. 748
Group B Streptococcal Infections .................................................................................. 762
Non-Group A or B Streptococcal and Enterococcal Infections ..................................... 768
Strongyloidiasis (Strongyloides stercoralis) ........................................................................... 772
Syphilis ........................................................................................................................... 773
Tapeworm Diseases (Taeniasis and Cysticercosis) ......................................................... 788
Other Tapeworm Infections (Including Hydatid Disease) ............................................. 791
Tetanus (Lockjaw) .......................................................................................................... 793
Tinea Capitis (Ringworm of the Scalp) .......................................................................... 798
Tinea Corporis (Ringworm of the Body) ....................................................................... 801
Tinea Cruris (Jock Itch) ................................................................................................. 804
Tinea Pedis and Tinea Unguium (Onychomycosis) (Athlete’s Foot,
Ringworm of the Feet) ................................................................................... 806
Toxocariasis (Visceral Toxocariasis [a Form of Visceral Larva Migrans], Ocular
Toxocariasis [a Form of Ocular Larva Migrans]) .......................................... 808
Toxoplasma gondii Infections (Toxoplasmosis) .................................................................. 809
Trichinellosis (Trichinella spiralis and Other Species) ....................................................... 819
Trichomonas vaginalis Infections (Trichomoniasis) ............................................................ 820
Trichuriasis (Whipworm Infection) ................................................................................ 823
African Trypanosomiasis (African Sleeping Sickness) .................................................... 824
American Trypanosomiasis (Chagas Disease) ................................................................ 826

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 TABLE OF CONTENTS XXXIII

Tuberculosis ................................................................................................................... 829

Nontuberculous Mycobacteria (Environmental Mycobacteria, Mycobacteria
Other Than Mycobacterium tuberculosis) ............................................................. 853
Tularemia ...................................................................................................................... 861
Endemic Typhus (Murine Typhus) ................................................................................ 864
Epidemic Typhus (Louseborne or Sylvatic Typhus) ...................................................... 865
Ureaplasma urealyticum and Ureaplasma parvum Infections .................................................. 867
Varicella-Zoster Virus Infections ................................................................................... 869
Vibrio Infections .............................................................................................................. 883
Cholera (Vibrio cholerae) ............................................................................................. 883
Other Vibrio Infections .............................................................................................. 887
West Nile Virus .............................................................................................................. 888
Yersinia enterocolitica and Yersinia pseudotuberculosis Infections (Enteritis and
Other Illnesses) ............................................................................................... 891
Zika Virus ...................................................................................................................... 894

SECTION 4
ANTIMICROBIAL AGENTS AND RELATED THERAPY
Introduction ................................................................................................................... 903
Fluoroquinolones ...................................................................................................... 904
Tetracyclines ............................................................................................................ 905
Other Agents ............................................................................................................ 906
Antimicrobial Resistance and Antimicrobial Stewardship: Appropriate and
Judicious Use of Antimicrobial Agents........................................................... 906
Antimicrobial Resistance .......................................................................................... 906
Factors Contributing to Resistance .......................................................................... 907
Antimicrobial Resistance Threats ............................................................................ 907
Actions to Prevent or Slow Antimicrobial Resistance .............................................. 908
Antimicrobial Stewardship ....................................................................................... 909
Role of the Medical Provider ................................................................................... 910
Principles of Appropriate Use of Antimicrobial Therapy for Upper
Respiratory Tract Infections .................................................................... 910
Drug Interactions ........................................................................................................... 913
Tables of Antibacterial Drug Dosages ........................................................................... 914
Sexually Transmitted Infections .................................................................................... 933
Antifungal Drugs for Systemic Fungal Infections .......................................................... 938
Polyenes .................................................................................................................. 938
Pyrimidines ............................................................................................................... 940
Azoles ....................................................................................................................... 940
Echinocandins .......................................................................................................... 941
Recommended Doses of Parenteral and Oral Antifungal Drugs ................................... 945
Topical Drugs for Superficial Fungal Infections ............................................................ 956
Non-HIV Antiviral Drugs .............................................................................................. 966
Drugs for Parasitic Infections ......................................................................................... 985
MedWatch—The FDA Safety Information and Adverse
Event-Reporting Program ........................................................................... 1026

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 XXXIV TABLE OF CONTENTS

SECTION 5
ANTIMICROBIAL PROPHYLAXIS
Antimicrobial Prophylaxis ........................................................................................... 1029
Infection-Prone Body Sites ..................................................................................... 1029
Exposure to Specific Pathogens .............................................................................. 1031
Vulnerable Hosts .................................................................................................... 1031
Antimicrobial Prophylaxis in Pediatric Surgical Patients ............................................ 1031
Guidelines for Appropriate Use ............................................................................. 1032
Indications for Prophylaxis ..................................................................................... 1032
Surgical Site Infection Criteria ............................................................................... 1034
Timing of Administration of Prophylactic Antimicrobial Agents........................... 1035
Dosing and Duration of Administration of Antimicrobial Agents ......................... 1035
Preoperative Screening and Decolonization .......................................................... 1035
Recommended Antimicrobial Agents .................................................................... 1035
Prevention of Bacterial Endocarditis ........................................................................... 1044
Prevention of Neonatal Ophthalmia............................................................................ 1046
Gonococcal Ophthalmia ........................................................................................ 1046
Chlamydial Ophthalmia ........................................................................................ 1047
Pseudomonal Ophthalmia...................................................................................... 1047
Other Nongonococcal, Nonchlamydial Ophthalmia ............................................. 1048
Administration of Neonatal Ophthalmic Prophylaxis ............................................ 1049

APPENDICES
I Directory of Resources ................................................................................. 1051
II Codes for Commonly Administered Pediatric Vaccines/Toxoids and
Immune Globulins ....................................................................................... 1057
III Vaccine Injury Table ................................................................................... 1058
IV Nationally Notifiable Infectious Diseases in the United States .................... 1069
V Guide to Contraindications and Precautions to Immunizations .................. 1071
VI Prevention of Disease From Contaminated Food Products ......................... 1082
VII Clinical Syndromes Associated With Foodborne Diseases .......................... 1086
VIII Diseases Transmitted by Animals (Zoonoses) .............................................. 1093

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 XXXV

Summary of Major Changes

in the 2018 Red Book
MAJOR CHANGES: GENERAL
1. All chapters in the last edition of the Red Book were assessed for relevance in the dy-
namic environment that is the practice of pediatric medicine today. This assessment
led to the elimination of 27 chapters from the 2018 Red Book. At the same time, 3
chapters were added (Chikungunya, Coagulase-Negative Staphylococcal Infections,
and Zika). This results in a 9% overall decrease in the number of chapters in the
2018 Red Book compared with the last edition.
2. Every chapter in the 2018 Red Book has been modified since the last edition. The
listing below outlines the more major changes throughout the 2018 edition.
3. To ensure that the information presented in the Red Book is based on the most accu-
rate 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, 24% 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.
4. All Diagnostic Tests portions of the pathogen-specific chapters in Section 3 were
reviewed by 2 microbiology laboratory experts to ensure that they include state-of-
the-art diagnostic modalities.
5. Throughout the Red Book, the number of Web sites where additional current and
future information can be obtained has been updated. All Web sites are in bold type
for ease of reference, and all have been verified for accuracy and accessibility.
6. 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 profes-
sional organizations have been updated throughout the Red Book.
7. Standardized approaches to disease prevention through immunizations,
antimicrobial prophylaxis, and infection-control practices have been updated
throughout the Red Book.
8. Recommendations for the use of doxycycline have been liberalized. Recent
comparative data in younger children suggest that doxycycline is not likely to cause
visible teeth staining or enamel hypoplasia in children younger than 8 years. These
reassuring data support the revised recommendation of the AAP that doxycycline
can be administered for short durations (ie, 21 days or less) without regard to the
patient’s age. When used, patients should be careful to avoid excess sun exposure
because of the photosensitivity associated with doxycycline (see Tetracyclines,
p 905).
9. Mebendazole is available again in the United States beginning in 2016, after being
unavailable for a number of years. It has been added back into the relevant chapters
as a therapeutic option.

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 XXXVI SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK

10. Policy updates released after publication of this edition of the Red Book will be posted
on Red Book Online.
11. Appropriate chapters throughout the Red Book have been updated to be consistent
with 2018 AAP and CDC vaccine recommendations, CDC recommendations for
immunization of health care personnel, and drug recommendations from 2018
Nelson’s Pediatric Antimicrobial Therapy. 1
12. Several tables and figures have been added for ease of information retrieval.

SECTION 1. ACTIVE AND PASSIVE IMMUNIZATION

1. Information sources about immunization have been updated and added. A
resource for the names of international vaccines also has been added, as has a quick
reference table for Web site addresses for reliable information on immunization.
2. Information from the 2016 AAP clinical report “Countering Vaccine Hesitancy”
has been incorporated in the Discussing Vaccines With Patients and
Parents chapter.
3. New vaccines approved since 2015 have been added to the Active Immunization
chapter, and those removed from the market have been deleted.
4. New information on pharmacologic options, including over-the-counter topical
medications, for Managing Injection Site Pain has been added.
5. Guidance on timing of administration of Menactra (MCV4-D, Sanofi Pasteur) and
Daptacel (DTaP, Sanofi Pasteur) in children 4 through 6 years of age has been
added to the Timing of Vaccines and the Immunization Schedule chapter,
based on recent data indicating that administration of Menactra 1 month after
Daptacel reduces meningococcal antibody response to Menactra.
6. The epidemiology of increased risk of seizure among recipients of concurrent
influenza vaccine and conjugate pneumococcal vaccine has been updated in the
chapter on Simultaneous Administration of Multiple Vaccines.
7. HibMenCY has been removed from the Combination Vaccines chapter
following its removal from the US market.
8. The Unknown or Uncertain Immunization Status chapter now includes
recent guidance on reconciling documentation of adequate poliovirus vaccination in
refugee or immigrant children immunized internationally.
9. Oral typhoid vaccine has been added to the chapter on Active Immunization of
People Who Recently Received Immune Globulin and Other Blood
Products. The table detailing the suggested intervals between IG administration
and active immunization with MMR, MMRV, or monovalent varicella vaccines
has been updated to account for a new BabyBIG formulation, recent changes to
the measles IG prophylaxis recommendations, and inclusion of the time interval
following CMV hyperimmune globulin.
10. The Vaccine Adverse Event Reporting System chapter has updated
information on monitoring of VAERS reports and reporting of adverse events.
11. Information on 21st Century Cures and on pregnant women has been added to the
Vaccine Injury Compensation chapter.

1
Bradley JS, Nelson JD, Barnett ED, et al, eds. 2018 Nelson’s Pediatric Antimicrobial Therapy. 24th ed. Elk Grove
Village, IL: American Academy of Pediatrics; 2018

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 SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK XXXVII

12. Clarification on when referral to immunology is warranted following an allergic

reaction to a vaccine has been added in the Hypersensitivity Reactions After
Immunization chapter, as has information on gelatin.
13. Preference of MMR vaccine over IGIM in vaccine-eligible measles nonimmune
people, if it can be administered within 72 hours of initial exposure to measles, has
been added to the Immune Globulin Intramuscular chapter.
14. The upper amount of IGIV dosing as replacement therapy in antibody-deficiency
disorders has been increased in the Immune Globulin Intravenous chapter.
Management options for patients who have had reactions to IGIV have been
expanded.
15. The 4 IGSC products licensed for use in the United States have been added to the
Immune Globulin Subcutaneous chapter. A table has been added to aid in
determination of which route of IG administration is most appropriate for a given
patient.
16. The Immunization in Pregnancy chapter has been harmonized with American
College of Obstetricians and Gynecologists (ACOG) recommendations. Recom-
mendations for timing ot Tdap administration have been added, and recommenda-
tions on breastfeeding following yellow fever vaccine have been incorporated.
17. The chapter on Immunization and Other Considerations in
Immunocompromised Children has been extensively rewritten. Information
on inactivated vaccines, primary and secondary immunodeficiencies, household
members of immunocompromised patients, and biologic response modifiers (includ-
ing rotavirus vaccination in infants exposed to biologic response modifiers in utero)
has been updated. The table detailing immunization of children and adolescents
with primary and secondary immune deficiencies has been expanded. The chapter
and table are fully harmonized with the recommendations of the Infectious Diseases
Society of America and the CDC.
18. Information on febrile seizures associated with inactivated influenza vaccine has
been added to the Immunization in Children With a Personal or Family
History of Seizures chapter.
19. Immunization of HIV-infected children with quadrivalent meningococcal conjugate
vaccine (MCV4) beginning at 2 months of age has been added to the Immuniza-
tion in Children With Chronic Diseases chapter. This harmonizes AAP
recommendations with those of the ACIP.
20. In the Immunization in American Indian/Alaska Native Children and
Adolescents chapter, permissive language for chemoprophylaxis of close contacts
of an index case with Haemophilus influenzae type a (Hia) has been added. The
epidemiology of rotavirus and HPV in this population also was added.
21. Emphasis on the acceptability of starting the HPV vaccine series as early as 9 years
of age has been added to the chapter on Immunization in Adolescent and
College Populations.
22. The option to give a single dose of HepB vaccine to health care personnel who fail
to serologically respond to a first vaccination series and then test again for anti-HBs
(rather than immediately commit to an additional full 3 doses of vaccine) has been
added to the Immunization in Health Care Personnel chapter. Information
on meningococcal vaccine also has been added.
23. In the chapter Children Who Received Immunizations Outside the United

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 XXXVIII SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK

States or Whose Immunization Status is Unknown or Uncertain, inter-

pretation of polio vaccines received outside the United States has been updated.
Criteria for acceptance of records of immunizations received outside of the United
States have been modified.
24. Information on booster dose recommendations for yellow fever vaccine and for
Japanese encephalitis vaccine has been added to the International Travel
chapter. Information on the new oral cholera vaccine (Vaxchora) also has been
incorporated.

SECTION 2. RECOMMENDATIONS FOR CARE OF CHILDREN

IN SPECIAL CLINICAL CIRCUMSTANCES
1. Information on yellow fever vaccine and on Zika virus in human milk has been
added to the Human Milk chapter. Discussion of inadvertent human milk expo-
sure has been enhanced and harmonized with CDC recommendations. Presenta-
tion of donor human milk has been expanded to include recommendations in the
2017 AAP policy statement on this topic. Discussion of breastfeeding when the
mother is receiving biologic response modifiers has been added, and resources
regarding drugs and lactation have been provided.
2. The Children in Out-of-Home Child Care chapter has been extensively
rewritten and reorganized. Recommendations on return to school after diarrheal
diseases have been harmonized with the AAP’s Purple Book,1 and across the rele-
vant pathogen-specific chapters in Section 3 of the 2018 Red Book. The recommen-
dation for return to school with group A streptococcal pharyngitis has been short-
ened from 24 hours to 12 hours after initiation of antimicrobial therapy. Specific an-
imals that should be excluded from child care facilities have been identified in the
chapter.
3. The time to return to school following initiation of antimicrobial therapy for group
A streptococcal pharyngitis has been shortened from 24 hours to 12 hours in the
School Health chapter. Topics related to organized sports have been updated to
reflect the content of the new AAP policy statement on that topic.
4. The Infection Control and Prevention in Ambulatory Settings chapter has
been expanded and updated with data and recommendations from the revised AAP
policy statement of the same name published in 2017.
5. The Sexually Transmitted Infections in Adolescents and Children chap-
ter has been streamlined substantially, with approximately a 20% decrease in
length, to aid in rapid retrieval of needed information.
6. The Medical Evaluation for Infectious Diseases for Internationally
Adopted, Refugee, and Immigrant Children chapter has been reorganized
to better delineate recommendations among these 3 population groups.
7. Recommendations in the Bite Wounds chapter have been modified to take into
account the recent guidelines relating to this area published by the Infectious
Diseases Society of America and endorsed by the Pediatric Infectious Diseases
Society.

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1

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 SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK XXXIX

8. The Prevention of Mosquitoborne and Tickborne Infections chapter is a

combination of 2 separate chapters, one on mosquitoborne and one on tickborne
infections, in prior editions of the Red Book. Recommendations on use of DEET
(maximal concentration, minimal age, etc) have been updated, and new products
(eg, undecanone) have been added. Recommendations also have been harmonized
with those in the AAP publication Pediatric Environmental Health, 4th Edition (the
Green Book).

SECTION 3. SUMMARIES OF INFECTIOUS DISEASES

1. Mention of brincidofovir as a therapeutic option has been removed from the
Adenovirus chapter after disappointing results of the AdVise study were presented
at the IDWeek 2016 meeting.
2. Treatment recommendations for Amebiasis have been harmonized with the
Drugs for Parasitic Infections table in Section 4, and more specificity with respect to
dosages has been added.
3. Sappinia species have been added to the Amebic Meningoencephalitis and
Keratitis chapter. Contact information for guidance from the CDC on the
diagnosis and management of primary amebic meningoencephalitis caused by
Naegleria fowleri has been added.
4. Obiltoxaximab, approved in March 2016 for the treatment of inhalational
anthrax and the prevention of inhalational anthrax, has been added to the Anthrax
chapter.
5. Both chikungunya and Zika have been separated from the Arbovirus chapter into
their own chapters of the 2018 Red Book. Yellow fever vaccine has been updated
both in terms of booster dose (which generally is not needed) and current vaccine
shortage (resources provided). The durability of protection following Japanese
encephalitis vaccine has been updated as well.
6. The epidemiology and treatment of Arcanobacterium haemolyticum
Infections has been updated and expanded.
7. The Aspergillosis chapter has been harmonized with the 2016 guidelines from the
Infectious Diseases Society of America. The diagnosis portion of the chapter has
been updated.
8. The clinical manifestations of Astrovirus Infections have been broadened to
include central nervous system disease, primarily in immunocompromised hosts.
Molecular diagnostics have also been updated.
9. Discussion of molecular diagnostics for Babesiosis has been expanded, and discus-
sion of coinfection with Borrelia burgdorferi or Anaplasma phagocytophilum has been
added. Treatment of babesiosis in severely immunocompromised individuals has
been added.
10. Information on Bacillus cereus enterotoxins causing emetic and diarrheal disease
have been added to that chapter.
11. The chapter on Bacteroides and Prevotella has been expanded to include other
anaerobic bacteria as the Bacteroides, Prevotella, and Other Anaerobic
Gram-Negative Bacilli Infections chapter. Information on antibiotic resistance
has been added, and therapeutic options have been updated.
12. Greater specificity about the serologic diagnosis and the treatment of cat scratch

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 XL SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK

disease has been added to the Bartonella henselae chapter.

13. Tinidazole has been added as an alternative treatment for Infections With
Blastocystis hominis and Other Subtypes.
14. The epidemiology of Blastomycosis has been expanded. Use of an enzyme
immunoassay that detects Blastomyces antigen in urine for diagnosis and monitoring
response to therapy has been updated. Treatment durations have been arranged to
improve ease of access.
15. The clinical manifestations of Bocavirus have been updated to reflect new data
that more strongly suggest primary infection causes respiratory disease. Information
on duration of shedding has been added.
16. Discussion of Borrelia miyamotoi has been added to the Borrelia Infections Other
Than Lyme Disease (Relapsing Fever) chapter. The epidemiology of soft-
and hard-bodied ticks has been expanded.
17. Guidance for mothers with active brucellosis not to breastfeed their infants has been
added to the Brucellosis chapter.
18. Sources of health care-associated Burkholderia Infections have been updated.
Clinical manifestations of melioidosis in children have been added based on recent
data. Information on Burkholderia gladioli disease in cystic fibrosis and lung transplant
patients has been added.
19. Molecular assays available for the diagnosis of Campylobacter Infections have
been updated. Current resistance rates of Campylobacter species to macrolides and
quinolones have been added. Recommendations on return to school have been
harmonized with the AAP’s Purple Book. 1
20. The Candidiasis chapter has been harmonized with the 2016 candidiasis
guideline published by the Infectious Diseases Society of America and endorsed
by the AAP. Candida auris also has been added to the chapter. Molecular diagnostic
advancements have been incorporated as well.
21. Recent data implicating Haemophilus ducreyi as a major cause of cutaneous ulcers
in children in equatorial regions have been added to the Chancroid and
Cutaneous Ulcers chapter.
22. Chikungunya has been separated out into its own chapter. It previously was
included in the Arbovirus chapter.
23. The duration of therapy for Chlamydia pneumoniae infections has been
harmonized with the community-acquired pneumonia guidelines published by the
Pediatric Infectious Diseases Society.
24. Diagnosis of Chlamydia psittaci infections has been harmonized with the 2017
compendium published by the National Association of State Public Health
Veterinarians.
25. The epidemiology of Chlamydia trachomatis, especially among adolescents, has
been updated. The diagnostic section of the chapter also has been updated.
26. The number of cases of Botulism and Infant Botulism (Clostridium
botulinum) has been updated. Additional guidance on avoidance of honey in
prepared cereals during the first year of life has been added.

Managing Infectious Diseases in Child Care and Schools, 4th Ed. A Quick Reference Guide. Aronson SS, Shope TR, eds.
1

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 SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK XLI

27. In the Clostridium difficile chapter, clinical manifestations and therapeutic op-
tions have been updated. Treatment recommendations have been assembled into a
table for easier reference and have been harmonized with the 2017 guidelines from
the Infectious Diseases Society of America. Updated information on community-
associated C difficile disease has been added.
28. The Coccidioidomycosis chapter has been harmonized with the 2016 guidelines
from the Infectious Diseases Society of America.
29. The epidemiology and clinical manifestations of Coronaviruses, Including
SARS and MERS have been updated.
30. The epidemiology, diagnosis, and treatment of Cryptosporidiosis has been
modified, with harmonization with the Infectious Diseases Society of America
guidelines for the diagnosis and management of infectious diarrhea in the final
stages of development.
31. Isospora belli is now named Cystoisospora belli, and the Cystoisosporiasis chapter is
now among the chapters beginning with C in Section 3.
32. Saliva polymerase chain reaction assay as the preferred diagnostic tool for screening
for Cytomegalovirus has been emphasized. Treatment recommendations for
symptomatic congenital cytomegalovirus disease have been harmonized with inter-
national guidelines published in 2017.
33. New information on development of a vaccine to prevent Dengue Fever and on
diagnostic testing has been added.
34. Laboratory abnormalities seen with Ehrlichia, Anaplasma, and Related
Infections and duration of antimicrobial therapy have been updated.
35. The newly renamed Serious Bacterial Infections Caused By
Enterobacteriaceae (With Emphasis on Septicemia and Meningitis
in Neonates) chapter includes new information on the epidemiology and
treatment of extended-spectrum beta-lactamases (ESBLs).
36. New data on the epidemiology and clinical manifestations of EV-D68 have been
incorporated in the Enterovirus (Nonpoliovirus) Infections chapter.
37. The clinical manifestations, epidemiology, and diagnostic modalities for
Escherichia coli Diarrhea have been updated.
38. Table 3.7 for Other Fungal Diseases has been modified and enhanced.
39. Abdominal manifestations of Fusobacterium Infections have been added to the
chapter.
40. Discussion of molecular diagnostic tests for Giardia intestinalis (formerly Giardia lamblia
and Giardia duodenalis) Infections (Giardiasis) have been added to the chapter.
41. The epidemiology of and molecular diagnostic testing for Gonococcal Infections
have been updated. Treatment of adolescents and young adults with gonorrhea has
been consolidated into a new table, separate from treatment of infants and children.
42. The incidence of typeable and nontypeable Haemophilus influenzae Infections
has been updated. Nucleic acid amplification tests have been incorporated into the
diagnostic approach to Haemophilus infections. The chapter has been modified to
account for 2 Hib vaccines that have been removed from the market. Permissive
language has been added for chemoprophylaxis of contacts of invasive Haemophilus
influenzae type a infections.
43. Laboratory and clinical findings that suggest Hantavirus Pulmonary Syndrome
have been more clearly stated.

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 XLII SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK

44. Clinical manifestations and antibiotic resistance in Helicobacter pylori

Infections have been added to the chapter. Diagnostic groups and treatment
recommendations have been harmonized with the 2016 update of the joint
ESPGHAN/NASPGHAN guidelines for children and adolescents.
45. Vectors and hosts for Hemorrhagic Fevers Caused by Arenaviruses have been
added.
46. The epidemiology and diagnostic approach to Hemorrhagic Fevers Caused by
Bunyaviruses have been updated and expanded. Ribavirin has been identified as
increasing the likelihood of central nervous system disease in Rift Valley fever and,
therefore, should be avoided.
47. The Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg
chapter was first included in the 2015 edition of the Red Book. The chapter in the
2018 edition provides updated epidemiologic data from the 2014-2015 Ebola
pandemic as well as new information on virus transmission (eg, human milk).
Guidance from the AAP clinical report “Parental Presence During Treatment of
Ebola or Other Highly Consequential Infection” has been included, and contact
information for therapeutic options at the CDC has been added.
48. Diagnostic and epidemiologic updates have been provided to the Hepatitis A
chapter.
49. The interval for postvaccination testing of infants born to HBsAg-positive mothers
has been modified in the Hepatitis B chapter. A figure and table have been added,
providing guidance for evaluating health care personnel for hepatitis B virus protec-
tion and for administering postexposure management. The recent emphasis of the
AAP and CDC on giving the first HepB vaccination within 24 hours of birth has
been added. Molecular diagnostic testing options have been updated.
50. The diagnostic testing and treatment options for Hepatitis C have been modified
to match this rapidly changing field.
51. Clinical trial data suggesting a possible therapeutic advance in the management of
Hepatitis D has been incorporated in the chapter.
52. The clinical manifestations, etiology, and diagnosis of Hepatitis E have been
updated.
53. Herpes simplex virus. Treatment of genital herpes has been harmonized with
sexually transmitted infections guidelines from the CDC. The chapter has been
shortened.
54. Target itraconazole trough concentrations and interpretation of laboratory results
thereof have been updated in the Histoplasmosis chapter.
55. Methods for distinguishing chromosomally integrated HHV-6 have been added to
the Human Herpesvirus 6 (Including Roseola) and 7 chapter.
56. The Human Immunodeficiency Virus Infection chapter has been reduced in
length by approximately 25%. Testing information has been updated. Management
and prevention of opportunistic infection have been harmonized with the AIDSInfo
recommendations, including for meningococcal vaccination. Breastfeeding infor-
mation has been added.
57. The Kawasaki Disease chapter has been updated and harmonized with the 2017
guidelines from the American Heart Association.
58. The diagnosis section has been updated with information on mass spectrometry of
bacterial cellular components that may be used for rapid identification, and the

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 SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK XLIII

treatment section has been updated with information on TEM-1 β-lactamase

production, for the Kingella kingae Infections chapter.
59. The clinical manifestations Legionella pneumophila Infections have been
updated. The availability of a polymerase chain reaction diagnostic assay that has
been cleared by the US Food and Drug Administration (FDA) has been added.
Levofloxacin (or another fluoroquinolone) has been added to intravenous
azithromycin as the drug of choice for treatment of disease in immunocompetent
patients.
60. The Leishmaniasis chapter has been harmonized with the 2016 practice
guidelines published by the Infectious Diseases Society of America and the
American Society of Tropical Medicine and Hygiene.
61. The serovar and serogroup criteria for Leptospirosis has been modified, and
this newer nomenclature supersedes the former division of these organisms into 2
species. The global impact of disease has been updated.
62. Sources of acquisition of Listeria monocytogenes Infections have been added
to the chapter. Diagnostic assays for central nervous system infections have been
expanded.
63. The epidemiology and treatment of Lyme Disease has been updated, including
the recently discovered Borrelia mayonii. Management recommendations have been
harmonized with advanced drafts of the updated guidelines under development by
the Infectious Diseases Society of America.
64. The clinical manifestations of Lymphatic Filariasis have been expanded.
65. A table listing drugs available for prophylaxis, including dosing, timing, and adverse
effects, has been added to the Malaria chapter.
66. Recent outbreaks of Measles have been added to the epidemiology portion of the
chapter. The diagnostic evaluation of suspected measles cases has been updated and
streamlined.
67. Changes have been added for vaccine recommendations in Meningococcal
Infections. These include a 2-dose schedule for Trumenba in some patient popu-
lations, and removal of MenHibRix and the polysaccharide MenACWY vaccines,
which have been removed from the US market. Increased risk of meningococcal
disease in patients receiving eculizumab has been added, and antibiotic prophylaxis
in addition to vaccination in these patients is suggested. Recommendations for
vaccinating HIV-infected children down to 2 months of age have been harmonized
with those of the ACIP.
68. The Microsporidia Infections chapter has been harmonized with the updated
the “Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-
Exposed and HIV-Infected Children” on the AIDSInfo Web site and the 2016 in-
fectious diarrhea guidelines from the Infectious Diseases Society of America. A table
of clinical manifestations by microsporidia species has been added.
69. Correlation between DOCK8 deficiency and more extensive Molluscum
Contagiosum has been added. Risk factors for transmission have been expanded.
70. Information on the new and ongoing outbreaks in Marshallese populations and on
college campuses has been added to the Mumps chapter.
71. Diagnostic assays and specific treatment recommendations have been added to the
Mycoplasma pneumoniae and Other Mycoplasma Species Infections
chapter.

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 XLIV SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK

72. Discussion of antimicrobial resistance in the management of Nocardiosis has been

added.
73. The epidemiology and diagnostic sections of the Norovirus and Sapovirus
Infections chapter have been updated.
74. A 2-dose schedule for HPV vaccination for children younger than 15 years has been
added to the Human Papillomaviruses chapter. The 9-valent HPV vaccine is
now the only vaccine on the US market. The AAP is emphasizing that children as
young as 9 years of age can start their HPV vaccination series, so it is acceptable not
to wait until the adolescent platform at 11 through 12 years of age to administer the
vaccine.
75. A new species causing Paracoccidioidomycosis has been added to the chapter.
Target itraconazole trough concentrations and interpretation of laboratory results
thereof have been updated.
76. The clinical and laboratory manifestations of Paragonimiasis are presented in
greater detail.
77. Fascioliasis has been added to the table in the Parasitic Diseases chapter.
78. Clinical manifestations and diagnostic assays for Human Parechovirus
Infections have been updated.
79. Detailed information on the molecular detection of Parvovirus B19 has been
added.
80. The clinical presentations and epidemiology of Pasteurella Infections has been
updated.
81. The Pediculosis Capitis chapter has been updated with information from the
AAP’s 2015 Clinical Report. The table of pediculicides available for use has been
expanded for quick reference by health care providers. Control measures have been
updated.
82. Discussion of diagnosis of Pelvic Inflammatory Disease has been expanded in
greater detail.
83. Azithromycin has been reinforced as the drug of choice for treatment or prophylaxis
of Pertussis (Whooping Cough). Some information on treatment of Bordetella
parapertussis also has been added. Vaccination with Tdap during pregnancy is now
recommended to occur earlier in the window of 27 to 36 weeks’ gestational age.
Recommendations are now provided on how to respond to inadvertent administra-
tion of Tdap instead of DTaP, or vice versa.
84. Treatment options for Pinworm Infections have been updated, including the
reintroduction of mebendazole to the US market and use of ivermectin.
85. The epidemiology of Pneumococcal Infections in the 7 years following introduc-
tion of the 13-valent conjugate pneumococcal vaccine in 2010 has been updated.
Diagnostic assays for the detection of Streptococcus pneumoniae also have been ex-
panded. Specific therapeutic recommendations for pneumonia have been added.
86. Recommendations for the treatment of Pneumocystis jirovecii Infections have
been harmonized with recommendations on AIDSInfo, including treatment dura-
tions (now 21 days instead of 14-21 days). A new table has been added to guide
utilization of steroids in the management of Pneumocystis pneumonia.
87. Worldwide eradication efforts for Poliovirus Infections have been updated. Polio
vaccination requirements for immigrants and refugees to the United States has been
clarified, given the eradication efforts’ movement toward bivalent oral polio vaccine.

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 SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK XLV

88. The epidemiology, diagnosis, and treatment of Polyomaviruses has been

updated. This includes more detailed discussion of polyomaviruses other than BK
virus and JC virus.
89. Newer diagnostics for Prion Diseases: Transmissible Spongiform Encephalopathies
have been added.
90. The numbers of cases of Rabies has been updated. Information on expertise at the
level of the states has been added. The discussion of rabies diagnostic testing has
been expanded.
91. The description of diagnostic tests for Rat-Bite Fever has been expanded. The
limited availability of streptomycin has been added.
92. Considerations for when to test patients for Respiratory Syncytial Virus in the
outpatient and inpatient settings have been added. Recommendations for popula-
tions in which palivizumab should be used have not changed from the 2015 Red
Book. An increased risk for RSV disease in pediatric liver transplant recipients has
been reported in a review of the national transplantation database.
93. The clinical manifestations and epidemiology of, and diagnostic tests for,
Rhinovirus Infections have been updated.
94. The list of causes of other rickettsial spotted fever infections has been expanded in
the Rickettsial Infections chapter. The importance of prompt initiation of treat-
ment with doxycycline for all patients in all age groups with suspected Rocky Moun-
tain spotted fever or ehrlichiosis, without waiting for confirmative diagnostic testing,
is emphasized.
95. The diagnosis and treatment of Rocky Mountain Spotted Fever has been
harmonized with those of the CDC on tickborne rickettsial diseases.
96. The epidemiology of Rotavirus Infections in the postvaccine era has been
updated. Clinical manifestations have been expanded. Avoidance of rotavirus
vaccine for infants born to mothers who received biologic response modifiers during
pregnancy has been added to the chapter.
97. Salmonella Infections have been substantially reorganized and separated into
nontyphoid and typhoid/paratyphoid portions throughout the chapter. Treatment
recommendations for both typhoid fever and nontyphoid bacteremia have been
modified. Recommendations on return to school have been harmonized with those
in the AAP Purple Book. 1
98. Emerging data on antibiotic resistance in Shigella Infections have been added to
the chapter. Molecular diagnostic tests have been updated. Recommendations on
return to school have been harmonized with those in the AAP Purple Book.1
99. The Staphylococcus aureus chapter has been separated from the coagulase-
negative Staphylococcus chapter, and has been shortened. Disease incidence and
diagnostic approaches have been updated. Data on drainage plus antimicrobial
therapy for skin and soft tissue abscesses have been added. Treatment recommenda-
tions have been streamlined.
100. The Coagulase-Negative Staphylococcal Infections chapter is a new chapter
in the 2018 Red Book.
101. Several changes have been made to the Group A Streptococcal Infections

Managing Infectious Diseases in Child Care and Schools, 4th Ed. A Quick Reference Guide. Aronson SS, Shope TR, eds.
1

Elk Grove Village, IL: American Academy of Pediatrics; 2017

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 XLVI SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK

chapter. The diagnosis of rheumatic fever, including the modified Jones criteria,
has been harmonized with the 2015 scientific statement from the American Heart
Association. Time to return to school following initiation of treatment for strepto-
coccal pharyngitis has been modified, from 24 hours to 12 hours. In addition, lan-
guage has been strengthened discouraging antimicrobial treatment or prophylaxis,
IGIV, or plasmapheresis for children with symptoms suggestive of pediatric autoim-
mune neuropsychiatric disorders associated with streptococcal infections (PANDAS)
or pediatric acute-onset neuropsychiatric syndrome (PANS).
102. The Non-Group A or B Streptococcal and Enterococcal Infections
chapter has been harmonized with the updated endocarditis guidelines published by
the American Heart Association and endorsed by the Infectious Diseases Society of
America. Clinical manifestations of infection have been expanded.
103. The Syphilis chapter has been shortened substantially. “Reverse-sequence screen-
ing” has been added to the algorithm for the diagnostic approach of infants born to
mothers with reactive serologic tests. A table detailing the approach to the evalua-
tion and treatment of infants with possible, probable, or confirmed congenital syphi-
lis has been added. The epidemiology of syphilis, including recent increases in dis-
ease incidence, has been updated.
104. The option for use of combination therapy for neurocysticercosis has been added to
the Tapeworm Disease chapter. The recommendation has been added to screen
household members of patients with cysticercosis for taeniasis.
105. The etiology and number of cases of Tetanus worldwide have been updated.
Global efforts to eliminate maternal and neonatal tetanus have been added. The
Control Measures portion of the chapter has been reorganized for easier retrieval of
recommendations following exposure to Clostridium tetani.
106. The epidemiology of Tinea Capitis is presented in greater detail, including racial
differences by pathogen and genetic predisposition to infection.
107. A new table listing products for topical treatment of tinea infections has been added
to the Tinea Corporis chapter. This table applies to tinea cruris and pedis as well.
A differential diagnosis for tinea corporis has been added.
108. The differential diagnosis for Tinea Cruris has been incorporated in the Clinical
Manifestations portion of the chapter.
109. The epidemiology of Tinea Pedis and Tinea Unguium is presented in greater
detail, including racial differences by pathogen, genetic predisposition to infection,
and incidence rates. Options for topical management of tinea unguium have been
expanded.
110. The chapter on Toxoplasma gondii Infections has been harmonized with the
2017 AAP technical report addressing the diagnosis, treatment, and prevention of
congenital toxoplasmosis. It has been shortened to increase ease of use in retrieving
diagnostic and treatment recommendations.
111. The epidemiology, including increasing rates of antimicrobial resistance, and
diagnostic testing modalities for Trichomonas vaginalis Infections have been
updated.
112. Data on the endemic occurrence of American Trypanosomiasis (Chagas
Disease) in the United States has been added to the chapter. The approval of
benznidazole by the US FDA in August 2017 for the treatment of Chagas disease in
children 2 through 12 years of age has been incorporated as well.

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 SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK XLVII

113. The recommended age for use of interferon gamma release assays (IGRAs) for the
diagnosis of Tuberculosis has been decreased from 5 years to 2 years. For treat-
ment of latent Mycobacterium tuberculosis infection (LTBI), 3 treatment options are
offered and considered adequate, depending on the circumstances for individual
patients: (1) 12 weeks of isoniazid plus rifapentine, once a week; (2) 4 months of
rifampin, once a day; or (3) 9 months of isoniazid, once a day. In addition, the
chapter has been shortened to more easily locate and utilize information for the
management of a patient in the office, clinic, or hospital.
114. Discussion of Mycobacterium chimaera contamination of heater-cooler units used in
open heart surgery has been added to the Nontuberculous Mycobacteria
(NTM) chapter. Medical and surgical management options for NTM lymphadenitis
have been expanded, and the overall length of the chapter has been shortened.
115. The epidemiology of Tularemia infections has been updated to include recent
increases in cases in Colorado, Nebraska, South Dakota, and Wyoming. Wording
discouraging the use of doxycycline has been added because of the increased likeli-
hood of relapse when this antibiotic is used.
116. Lack of transmission of wild-type and vaccine-strain Varicella Zoster Virus in
human milk has been added, and discussion of both administration of expressed hu-
man milk and isolation of infants born to mothers with varicella in the perinatal pe-
riod has been provided in greater detail. Use of the vaccine in immunocompromised
patients has been harmonized with the guidelines of the Infectious Diseases Society
of America. The option of using oral acyclovir as postexposure prophylaxis when
VariZIG is not available has been liberalized. The chapter has been shortened to
increase ease of use in retrieving diagnostic and treatment recommendations.
117. The new single-dose, live-attenuated monovalent oral Cholera (Vibrio cholerae)
vaccine, Vaxchora, has been added to the chapter. This vaccine is approved by the
US FDA and is available in the United States for use for travelers 18 through 64
years of age who are traveling to areas where cholera is a risk.
118. Disease manifestations and risk factors for Other Vibrio Infections have been
added to the chapter. Monotherapy for severe diarrhea using doxycycline or
ciprofloxacin has been added as well.
119. Description of West Nile Virus transmission via human milk has been expanded.
The number of cases has been updated, along with infection incidence rates in more
heavily affected states. A Web link to a review summarizing potential treatments
(including Immune Globulin Intravenous with or without a high titer of WNV
antibody, WNV recombinant humanized monoclonal antibody, interferon,
corticosteroid, ribavirin) has been added.
120. The number of species constituting the genus Yersinia has been updated (increased)
in the Yersinia enterocolitica and Yersinia pseudotuberculosis Infections
chapter. The etiology of infection has been expanded to discuss differences in
virulence gene distribution among Yersinia species, and correlating with clinical
manifestations.
121. Zika is a new chapter in the 2018 Red Book. Its development has been carefully
coordinated to include input from Zika experts and to harmonize with diagnostic
recommendations from the CDC, including partnership between the AAP and
CDC on the evaluation and management of infants with possible congenital Zika

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 XLVIII SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK

virus infection as the case incidence decreased in 2017. This chapter was early re-
leased online by the AAP in 2017 to aid in management.

SECTION 4. ANTIMICROBIAL AGENTS AND

RELATED THERAPY
1. The Introduction to Antimicrobial Agents and Related Therapy has incor-
porated the information from the 2016 AAP clinical report “Use of Systemic and
Topical Fluoroquinolones.” It also explains the rationale for the liberalization of
recommendations on use of doxycycline in children younger than 8 years.
2. The chapter on Antimicrobial Resistance and Antimicrobial Stewardship:
Appropriate and Judicious Use of Antimicrobial Agents has been updated
to reflect the current recommendations from the CDC addressing antimicrobial
stewardship core elements as well as guidelines from the Infectious Diseases Society
of America and the Society for Healthcare Epidemiology of America published in
2016.
3. The Tables of Antimicrobial Drug Dosages have been updated throughout.
Dosing in neonates has been modified to take into account variables such as gesta-
tional age, postnatal age, and postmenstrual age, that best guide neonatal dosing for
a given group of agents. Maximum dosages for infants and children have been
added to emphasize that higher dosages generally are used in more severe infec-
tions.
4. The Sexually Transmitted Infections tables have been separated to include
older children, adolescents, and young adults in one table and younger (smaller)
children in a separate table for ease of use.
5. Candida auris has been added to the Antifungal Drugs for Systemic Fungal
Infections chapter. Route of administration, cerebrospinal fluid penetration,
therapeutic drug monitoring requirements, and adverse reactions have been added
to the table in this chapter as well.
6. Micafungin dosing in neonates and posaconazole dosing in children have been
added to the Recommended Doses of Parenteral and Oral Antifungal
Drugs table. The new antifungal drug isavuconazole has been added.
7. The Drugs for Parasitic Infections table has been revised to reflect drugs that
currently are accessible in the United States, with specific drugs added or removed
since the 2015 edition. Recommendations in the table also have been harmonized
with published guidelines from professional societies (eg, the Leishmania guideline
from the Infectious Diseases Society of America) or technical reports from the AAP
(eg, toxoplasmosis).

SECTION 5. ANTIMICROBIAL PROPHYLAXIS

1. The Antimicrobial Prophylaxis in Pediatric Surgical Patients chapter
has been harmonized with the surgical site infections portion of the National
Healthcare Safety Network, which is the CDC’s health care-associated infection
tracking system.
2. In the chapter on Prevention of Neonatal Ophthalmia, the AAP begins
the process of advocating for repeal of state mandates for topical prophylaxis for
neonatal ophthalmia. Specific alternative approaches to successfully prevent

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 SUMMARY OF MAJOR CHANGES IN THE 2018 RED BOOK XLIX

gonococcal ophthalmia are provided. Nongonococcal and nonchlamydial causes of

neonatal ophthalmia have been expanded.

APPENDICES
1. Telephone and Web site addresses for organizations listed in the Directory of
Resources have been updated.
2. ICD9 codes have been removed from the Codes for Commonly Administered
Pediatric Vaccines/Toxoids and Immune Globulins appendix. The table
of codes for commonly administered vaccines has been replaced with a Web link to
an AAP Web site with the same that is regularly updated.
3. The Vaccine Injury Table has been modified to include combine VAERS
reporting and the vaccine injury listings.
4. The diseases listed in the Nationally Notifiable Infectious Diseases in the
United States table are those required for 2017, and include the addition of Zika
virus since the last Red Book.
5. Terminology used throughout the table of Guide to Contraindications and
Precautions to Immunizations, 2018 has been standardized.

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