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Highlights in Epidemiology and Public Health

April 10, 2023

Commentary From the AAP Section on Epidemiology, Public Health, and Evidence (SOEPHE)

The Section on Epidemiology, Public Health, and Evidence (SOEPHE) was formed in 1988 and serves as the home within the AAP for pediatricians with interests in epidemiology and public health. We also support evidence-based medicine initiatives and provide methodologists for AAP Clinical Practice Guidelines. As such, our section crosses multiple disciplines, subspecialties, and skill sets within pediatrics. Given our broad clinical interests, it was especially challenging for SOEPHE to choose just a few landmark papers from Pediatrics over the past 75 years. However, the SOEPHE Executive Committee surveyed the entire section to nominate papers and subsequently vote for one landmark paper from each 25-year period.

Highlights in Epidemiology and Public Health

Michael J. Smith, MD, MSCE,1 on behalf of the Section on Epidemiology, Public Health, and Evidence

Affiliation: 1Duke University School of Medicine, Durham, NC

Highlighted Articles From Pediatrics

First Quarter Century (1948 to 1973)

Seat Belts in the Prevention of Automobile Injuries: Report of the Committee on Accident Prevention

The 1962 report by the AAP Committee on Accident Prevention predates the inauguration of our section, but our members agreed it was a critical publication in pediatric public health. SOEPHE members noted that:

“Defining the knowledge, science, and common sense about and promoting the use of seat belts tops the list for me. What was once so very controversial is almost a reflex behavior now.”

“This article introduced the possible effectiveness of seatbelts for children extrapolating the proven effect in adults and promoting the dissemination to pediatricians to help promote their use and further research to prove their effectiveness in protecting children. Throughout the years with further legislation and research, today we have clear guidelines for the use of infant and child car seats and campaigns to educate parents.”

Second Quarter Century (1973 to 1998)

Positioning and SIDS

The Section on Epidemiology was only about a year old when asked to nominate someone from the section to serve on the new AAP Task Force on Infant Positioning and SIDS. The AAP appointed Dr. John Kattwinkel as the chair of the task force and led the development of the AAP 1992 statement on infant positioning and SIDS. This is undoubtedly the most influential statement that our section helped develop during the period, and was responsible for major changes in infant positioning practices throughout the United States (following the “Back to Sleep” Campaign). These changes were associated with reductions in SIDS deaths throughout the country. This article was the first official statement by the AAP that recommended to discontinue the prone sleeping position and instead to adopt the supine position to decrease risk of SIDS. Multiple studies that despite some limitations nonetheless presented a compelling rationale for a foundational change to the then current sleep position practice informed this recommendation. As a result, further confirmatory studies ensued, and Back to Sleep campaigns resulted in fewer SIDS deaths and a meaningful decrease in infant mortality.

Third Quarter Century (1998 to 2023)

Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era

This study reported on an existing longitudinal cohort of children with acute otitis media (AOM) who had undergone tympanocentesis. The authors performed several analyses to identify risk factors for AOM and recurrent AOM. Of particular interest is the change in the distribution of specific pathogens that grew from middle ear fluid that occurred from the pre-vaccine (1995-2001) through the post-vaccine PCV7 (2001-2010) and PCV13 (2010-2016) eras. The authors found decreases in the total number of infections in the vaccine era, a decrease in the proportion of AOM cases due to S pneumoniae, and an increase in the proportion of cases due to M catarrhalis. As the nominating member wrote, this is a “clear demonstration of the significance of vaccines as a preventive and protective measure.”

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