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, children, 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 (NIH), 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 2024.

To aid physicians and other health care professionals in assimilating current changes in recommendations in the Red Book, a listing of major changes between the 2021 and 2024 editions has been compiled (see Summary of Major Changes, p xxxvii). 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 available following the publication date. In addition, specific chapters within the Red Book may be updated prior to the publication of the next edition to incorporate new information from AAP policy statements and clinical reports, publications in the CDC Morbidity and Mortality Weekly Report (MMWR), society guidelines (eg, from the Infectious Diseases Society of America or the American Thoracic Society), management recommendations from the World Health Organization, and similar authoritative guidance documents from organizations of similar stature. When updates to existing Red Book chapters are made, the new material is posted on Red Book Online with clear delineation of how the chapter has been updated with the new information. This and other Red Book Online content can be accessed at publications.aap.org/redbook.

The Red Book is your personal access to literally hundreds of pediatric 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 situations that guidance from experts in the field is most critical, and the COID has literally thousands of years of cumulative expertise to bring to bear on such recommendations. This is all the more important as we move into the post-pandemic era, in which the rapid retrieval of accurate and reliable information is critical to the care of patients and the workflow of physician practices. A major emphasis of the 2024 Red Book is to provide more guidance in the format of tables, figures, and algorithms to allow for busy clinicians in offices, hospitals, and via telehealth to quickly find management recommendations from the hundreds of contributors to Red Book content.

One significant change since the publication of the 2021 Red Book is our appreciation that “Words Matter,” to use the phrase embraced by the AAP.¹  Throughout the 2024 edition of the Red Book, we have sought to use inclusive, anti-biased language contextualized to the unique moment in history in which we practice medicine. For some chapters, however, the terms “male” and “female” are used for clarity of recommendations; when so utilized, a footnote has been added at the beginning of the chapter to indicate that these terms refer to the sex assigned at birth. Likewise, the word chestfeeding may be used by nonbinary, transgender, and other parents to identify how they feed their infants. It may refer to human milk or human milk substitute feeding, from a person who lactates or not. Because of this broad and variable definition, chestfeeding and breastfeeding are not always synonymous, and the words are not interchangeable. Published literature findings on breastfeeding may not hold the same outcomes for chestfeeding, so throughout the 2024 edition, the words breastfeeding and human milk are used.

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 2024 Red Book, one third of primary reviewers were new to this process, ensuring that the most up-to-date information has been included in this new edition. 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, NIH, and FDA and to members of all AAP Sections, Committees, and Councils who 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 inclusion of any needed additional modifications. Chapters requiring consideration by the full committee then are debated at the COID “Marathon Meeting,” where the chapters are finalized. Copyediting by the Editor and Senior Medical Copy Editor, Jennifer Shaw, follows, and the book then is reviewed by the Red Book reviewers appointed by the AAP Board of Directors. In all, over 1000 hands have touched the 2024 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.

Through the deliberative and inclusive process that defines the production of the Red Book, 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 occasionally 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 recommendations, but the first phrase signifies more agreement and support among the experts. 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, clinically 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.

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 available readily 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 information in the package inserts of vaccines licensed by the FDA (which also may differ from COID and CDC recommendations for use) and of immune globulins, as well as recommendations of other committees (see Sources of Information About Vaccines and Immunization, p 21), many of which are included in the Red Book.

This book could not have been prepared without the dedicated professional competence of numerous people. The AAP staff has been outstanding in its committed work and contributions, particularly Jennifer Shaw, Senior Medical Copy Editor; Linda Rutt, Division Coordinator; Jennifer Frantz and Gillian Gibbs, Senior Managers, who served as the administrative directors for the COID and coordinated preparation of the Red Book; Theresa Wiener, Manager of Publishing and Production Services; and all of the directors and staff of the AAP publishing and marketing groups who make the full Red Book product line possible.

Lakshmi Panagiotakopoulos, MD, of the CDC, and Karen M. Farizo, MD, of the FDA, devoted time and effort in providing significant input from their organizations. Patricia Flanagan, MD, Yasuko Fukuda, MD, and Warren Seigel, MD, served as Red Book reviewers appointed by the AAP Board of Directors, spending scores of hours reviewing the final chapters for consistency and accuracy. I am especially indebted to the Associate Editors, Ritu Banerjee, MD, PhD, Elizabeth D. Barnett, MD, Ruth Lynfield, MD, and Mark H. Sawyer, 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 Sean O’Leary, MD, COID Chairperson, whose knowledge, dedication, insight, and leadership are reflected in the quality and productivity of the committee’s work. There are many additional contributors whose professional work and commitment have been essential in the committee’s preparation of the Red Book. Please forgive any omissions I have made in expressing my gratitude.

And last but certainly not least, I thank my wife, Kim, for always being there and for her patience, understanding, and never-ending support as this edition of the Red Book came to fruition.