Summary of Major Changes in the 2024 Red Book

All chapters in the last edition of the Red Book were assessed for relevance in the dynamic environment that is the practice of pediatric medicine today. The revisions to the Discussing Vaccines With Patients and Parents chapter included discussions of safety monitoring mechanisms, allowing for elimination of 6 chapters included in the last Red Book that reviewed each of these safety systems separately. Chapters on COVID-19 and Mpox have been broken out from the chapters in which they were discussed in the 2021 edition, creating 2 new chapters. This means we have a net decrease of 4 chapters in the 2024 Red Book compared with the prior edition.

Every chapter in the 2024 Red Book has been modified since the last edition. The listing below outlines the more major changes throughout the 2024 edition.

A major focus of the 2024 Red Book is to streamline the retrieval of information needed to care for the patient sitting in front of the clinician, either in the office or hospital room or remotely via telehealth. To accomplish this, we have greatly expanded the use of tables, figures, and algorithms that can rapidly be accessed to gather the information needed at that moment.

Appropriate chapters throughout the Red Book have been updated to be consistent with 2024 American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) vaccine recommendations, CDC recommendations for immunization of health care personnel, and drug recommendations from 2024 Nelson’s Pediatric Antimicrobial Therapy.² 

To ensure that the information presented in the Red Book is based on the most accurate and up-to-date scientific data, the primary reviewers of each Red Book chapter were selected for their specific academic expertise in each particular area. In this edition of the Red Book, 35% of the primary reviewers were new for their assigned chapters. This ensures that the Red Book content is viewed with fresh eyes with each publication cycle.

Throughout the Red Book, the number of websites where additional current and future information can be obtained has been updated. All websites are in bold type for ease of reference, and all have been verified for accuracy and accessibility.

Reference to evidence-based policy recommendations from the AAP, the Advisory Committee on Immunization Practices (ACIP) of the CDC, the National Institutes of Health (NIH), and other select professional organizations have been updated throughout the Red Book.

Standardized approaches to disease prevention through immunizations, antimicrobial prophylaxis, and infection-control practices have been updated throughout the Red Book.

Policy updates released after publication of this edition of the Red Book will be posted on Red Book Online.

The Systems-Based Treatment Table that was introduced in Section 4 of the 2021 edition of the Red Book has been moved to the front of the book for easier access. It also has been reordered so that the grouped recommendations by body system are more easily and quickly accessed. Empiric antibiotic options for several of the infections in this table have been expanded.

Internet resources for vaccine information have been updated in Sources of Information About Immunization.

The Discussing Vaccines With Patients and Parents chapter has been completely rewritten to align with the forthcoming AAP clinical report “Strategies for Improving Vaccine Communication and Uptake.” This chapter includes discussion of safety surveillance systems, allowing for elimination of separate chapters covering these in the prior edition of the Red Book.

In the Active Immunization chapter and across the Red Book, terminology has changed from “live and inactivated vaccines” to “live and non-live vaccines.” In addition, detailed information on mRNA vaccines has been added.

New-generation vaccines containing mRNA encoding for antigens or viral vectors that express antigens have been added to the Vaccine Ingredients chapter.

Guidance on storage of a frozen vaccine that has been thawed and on beyond-use date/time (BUD) has been added to the Vaccine Handling and Storage chapter.

In the Vaccine Administration chapter, a Vaccine Administration Errors section has been added, and the Patient Care Before, During, and After Vaccine Administration section has been expanded.

A listing of vaccines that are more likely to be painful has been added to the Managing Injection Pain chapter.

A strong statement discouraging creation of unique vaccination schedules outside of the reviewed and recommended schedules has been added to the Immunization Schedule and Timing of Vaccines chapter.

Recommendation has been added to Minimum Ages and Minimum Intervals Between Vaccine Doses for what to do if intervals between doses are longer than recommended.

Haemophilus influenzae type b, rotavirus, and quadrivalent meningococcal vaccines have been added to the list of approved vaccines in the Interchangeability of Vaccine Products chapter that may be used interchangeably during a vaccine series from different manufacturers.

Recommendations have been added to the chapter on Simultaneous Administration of Multiple Vaccines for spacing between mpox vaccine and COVID-19 vaccines.

In the Combination Vaccines chapter, use of DTaP-IPV (Quadracel) as a 4th or 5th dose in the IPV series has been expanded to include patients who previously had received Vaxelis.

In the Unknown or Uncertain Immunization Status chapter, specific acceptable approaches are provided for when the immunogenicity of vaccines or the completeness of the vaccine series are unknown, especially for vaccines administered outside of the United States.

Guidance is provided in the Vaccine Dose chapter on appropriate dosing for a child receiving a COVID-19 vaccine when the child’s age changes between doses.

The chapter on Active Immunization After Receipt of Antibody-Containing Products has been modified to better reflect the chapter contents. An interval between receipt of an antibody product and administration of dengue vaccine has been added. “Different anatomic site” language for hepatitis B vaccine (HepB) and hepatitis B immune globulin (HBIG) has been clarified.

Recommendations have been updated to the Hypersensitivity Reactions After Immunization chapter for skin testing for reactions to excipients in vaccines.

Bioavailability adjustments for immune globulin subcutaneous (IGSC) compared with immune globulin intravenous (IGIV) are provided in the Passive Immunization chapter.

A link to a listing of all immune globulin intramuscular (IGIM) products available in the United States has been added to the Immune Globulin Intramuscular chapter.

Use of IGIV in multisystem inflammatory syndrome in children (MIS-C) has been added to the Immune Globulin Intravenous chapter.

Dose-adjustment instructions on transitioning from IGIV to IGSC are provided in the Immune Globulin Subcutaneous chapter.

Language has been added to Immunization in Special Clinical Circumstances chapter stressing the need for caregivers of preterm and very low birth weight infants to receive COVID-19 vaccine.

In the Immunization in Pregnancy chapter, COVID-19 vaccine has been added to the list of vaccines specifically recommended for routine administration during pregnancy. Tdap vaccines have been approved by the US Food and Drug Administration (FDA) for use in pregnancy since the last edition, and these have been added. Guidance on use of mpox vaccine during pregnancy has been added.

The definition of severe immunosuppression from human immunodeficiency virus (HIV) has been standardized across the Red Book, including the chapter on Immunization and Other Considerations in Immunocompromised Children. Recommendations have been added for vaccine administration to persons who have received CD19-targeted chimeric antigen receptor (CAR) T-cell therapy.

Guidance is provided in the Immunization in Children With a Personal or Family History of Seizures chapter on what information should be provided to parents of children with a personal history of febrile seizures.

Asplenia and persistent compliment component deficiency have been added to the Immunization in Children With Chronic Diseases chapter.

Discussion of pertussis and COVID-19 vaccination has been added to the chapter on Immunization in American Indian/Alaska Native Children and Adolescents.

Recent detections of circulating vaccine-derived poliovirus in the United States have been added to the Immunization in Health Care Personnel chapter. COVID-19 vaccination of health care personnel is addressed.

A new table has been added to the chapter on Children Who Received Immunizations Outside the United States or Whose Immunization Status is Unknown or Uncertain showing when antibody testing for vaccine-preventable diseases should be performed in unimmunized or underimmunized children.

Tick-borne encephalitis (TBE) and COVID-19 vaccines have been added to the International Travel chapter. Rabies preexposure prophylaxis recommendations have been updated. Availability of the yellow fever vaccine in the United States has been updated.

The Breastfeeding and Human Milk chapter was updated to align with information in the 2022 AAP policy statement on breastfeeding. This chapter includes recommendations on COVID-19, group B Streptococcus, cytomegalovirus (CMV), hepatitis C virus (HCV), HIV, mpox, and tick-borne encephalitis infections in breastfeeding individuals or transmission in human milk.

COVID-19 has been added to the Children in Group Child Care and Schools chapter.

On the basis of experience from the COVID-19 pandemic, recommendations on prevention of airborne and droplet transmission are presented in the Infection Prevention and Control for Hospitalized Children chapter more in terms of points along a continuum rather than discrete modes of transmission. Discussion of source control of sick visitors is expanded.

Identification of patients known to be infected or colonized with highly resistant organisms is emphasized in the Infection Prevention and Control in Ambulatory Settings chapter. Guidance on drawing up of medications is provided.

The preexposure HIV prophylaxis description has been expanded in the Sexually Transmitted Infections in Adolescents and Children chapter. Trichomonas treatment and expedited partner therapy information have been updated.

The Medical Evaluation for Infectious Diseases for Internationally Adopted, Refugee, and Other Immigrant Children chapter has had a number of modifications. When to test for hepatitis A has been clarified. Testing recommendations for syphilis have been updated. Acceptable assays for tuberculosis (TB) testing have been expanded. Circumstances in which repeat testing for HIV following resettlement have been added. Presumptive treatment recommendations for malaria are provided.

Testing recommendations following possible exposure to HCV are updated and expanded in the Injuries From Needles Discarded in the Community chapter.

Risk of B virus infection following macaque bites, of Salmonella and Aeromonas infection following reptile bites, and of Vibrio species infection following shark bites has been added to the Bite Wounds chapter.

A table has been added to the Prevention of Mosquito-borne and Tick-borne Infections chapter summarizing mosquito- and tick-borne infections in the United States.

Actinomyces as a cause of adverse pregnancy outcomes and neonatal bacteremia has been added to the Actinomycosis chapter.

Adenovirus has been added as a cause of severe hepatitis and liver failure. Discussion of the antiviral treatment of adenovirus infections has been expanded. Management of adenovirus in immunocompromised patients has been added.

Secnidazole has been added as a treatment option for mild to moderate intestinal Amebiasis.

Acanthamoeba as a cause of rhinosinusitis has been added to the Amebic Meningoencephalitis and Keratitis chapter. Treatment options for Acanthamoeba infections have been expanded.

Treatment and postexposure prophylaxis of Anthrax has been aligned with new CDC recommendations. New vaccine information is also provided.

Dengue and yellow fever vaccine information has been updated in the Arboviruses chapter. Tick-borne encephalitis vaccine has been added. Cache Valley virus has been added.

Description of invasive disease, which occurs rarely, has been added to the Arcanobacterium haemolyticum Infections chapter.

Mention of the cost of albendazole and mebendazole for Ascaris lumbricoides Infections has been added.

Use of polymerase chain reaction (PCR) assay in patients with Aspergillosis who have underlying hematologic malignancies and hematopoietic cell transplantation recipients has been added.

Typing by amplification and sequencing of small regions of the Astrovirus capsid gene for assessment of outbreaks has been added.

The expanding geographic area with Babesiosis is detailed. New information is provided in the Diagnosis section.

The pathogenesis of disease caused by diarrheal toxins of Bacillus cereus has been clarified.

Discussion of nucleic acid amplification tests (NAATs) is expanded in the Bacterial Vaginosis chapter.

Antibacterial treatment options for Bacteroides, Prevotella, and Other Anaerobic Gram-Negative Bacilli Infections have been updated.

Descriptions of diagnostic modalities for Balantidium coli Infections have been expanded. Foodborne sources of infection have been updated.

Information on PCR diagnosis of Bartonella henselae (Cat-Scratch Disease) has been added. Antibiotics and prolonged treatment durations have been expanded.

The Clinical Manifestations and Epidemiology sections of the Baylisascaris Infections chapter have been greatly expanded.

Diagnostic approaches to detection and interpretation of Blastocystis species in stool have been updated.

Newer formulations of itraconazole with enhanced bioavailablity are discussed in the Blastomycosis chapter.

Greater detail is provided on duration of shedding of Bocavirus and its impact on interpreting positive diagnostic tests.

The Clinical Manifestations, Epidemiology, and Treatment sections of Borrelia Infections Other Than Lyme Disease have been greatly expanded.

Clinical Manifestations of Brucellosis have been expanded. Secondary treatment options have been added.

Burkholderia pseudomallei epidemiology and chronicity are addressed more fully in the Burkholderia Infections chapter. Postexposure prophylaxis following laboratory exposure to Burkholderia species has been added.

Treatment recommendations for Campylobacter Infections are provided with greater specificity. Epidemiologic data have been updated.

Treatment recommendations for invasive Candidiasis, including congenital and neonatal Candida disease, have been updated. Diagnosis and Treatment of Candida auris have been expanded. Fluconazole prophylaxis recommendations for extremely low birthweight neonates have been updated.

Avoidance of corticosteroids during the acute phase of Chikungunya disease, and use of disease-modifying anti-rheumatic drugs (DMARDs) during the chronic phase, have been added. Clinical Manifestations in children have been enhanced.

Epidemiology and diagnosis of Chlamydia pneumoniae have been updated.

Mention and definition of Horder spots have been added to the Chlamydia psittaci chapter. Rare human-to-human spread has now been documented.

Routine screening recommendations for Chlamydia trachomatis have been updated.

Ancillary testing in patients with suspected Botulism has been outlined. A PCR assay to detect botulinum neurotoxin genes (BoNT) in clostridial species in cultures is discussed.

New data on the clinical effectiveness of fidaxomicin on lowering recurrence rates of Clostridioides difficile disease has been added. Success rates following fecal transplant have been updated.

Seasonal occurrence of Clostridium perfringens outbreaks has been added.

Serologic, molecular, and antigen detection testing availability and performance for Coccidioidomycosis have been updated.

Information on COVID-19 has been moved to its own chapter. Discussion of the severity of disease caused by the other human Coronaviruses, especially in immunocompromised people, has been expanded.

Prevalence of Cryptococcus disease in children compared with adults has been added. Treatment of HIV-positive adults with a single dose of liposomal amphotericin following by flucytosine and fluconazole is mentioned.

Molecular diagnostic testing for Cryptosporidiosis has been updated. Antimicrobial options for immunocompromised hosts have been expanded.

Description of the skin rash of Cutaneous Larva Migrans has been expanded.

Additional treatment options in persons with HIV who are infected with Cyclosporiasis have been added.

Discussion of targeted screening for congenital Cytomegalovirus infection is expanded. Maribavir has been added to the list of approved CMV antiviral drugs. Treatment recommendations for congenital CMV have been liberalized with regard to timing of initiation of therapy and use in patients with isolated sensorineural hearing loss.

Recent CDC recommendations for use of Dengvaxia have been incorporated in the Dengue chapter. Diagnostic testing has been updated.

Antimicrobial treatment of Diphtheria is provided in greater detail. Treatment options for eradication of carriage have been expanded. Updates to national notification requirements have been added.

In the Ehrlichia, Anaplasma, and Related Infections chapter, the increasing number of cases of Anaplasma infections in the United States and the rarity of rash in these patients is emphasized. Hemophagocytic lymphohistiocytosis occurring with ehrlichiosis is described.

In the Serious Neonatal Bacterial Infections Caused By Enterobacterales chapter, the order name has been changed from Enterobacteriaceae to Enterobacterales. Treatment recommendations for extended-spectrum beta-lactamases and carbapenem-resistant Enterobacterales using new antibiotics and beta-lactamase inhibitor combinations are provided.

Clinical manifestations associated with specific Enterovirus types are added. Recommendations for return to school or child care are provided.

Etiology and treatment of Epstein-Barr Virus-associated post-transplant lymphoproliferative disease (PTLD) has been expanded.

In the Escherichia coli Diarrhea chapter, description of disease caused by enteropathogenic E coli (EPEC) is expanded. Long-term sequelae following hemolytic-uremic syndrome are added.

Treatment recommendations for Other Fungal Diseases have been modified for 8 of the 10 pathogens listed in the table that comprise this chapter.

Discussion of rapid diagnostic tests for Fusobacterium species has been added.

Sources of recent Giardia duodenalis outbreaks are updated.

Discussion of antibiotic resistance in Gonococcal Infections has been expanded. Routine screening recommendations have been updated.

Discussion of otitis media treatment has been streamlined in the Haemophilus influenzae Infections chapter.

The listing of characteristic laboratory findings in Hantavirus Pulmonary Syndrome is expanded.

Indications for testing for Helicobacter pylori have been added to the chapter.

In the Hemorrhagic Fevers Caused by Arenaviruses chapter, wording supporting the use of intravenous ribavirin for treatment of Lassa fever has been softened.

In the Hemorrhagic Fevers Caused by Bunyaviruses chapter, duration of observation following exposure to Crimean-Congo hemorrhagic fever (CCHF) has been modified. An inactivated vaccine for CCHF is available in Eastern Europe.

In the Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg chapter, vaccine information against differing Ebola species has been updated.

Increasing cases of Hepatitis A infection among people using injection drugs and people lacking housing are described.

New Hepatitis B vaccines (for adults) have been added to the chapter. A statement has been added that routine nursery procedures, such as skin-to-skin care, delayed bathing, and breastfeeding within the first hour, may continue as recommended by the facility.

Antiviral treatments for Hepatitis C have been updated, including options for children as young as 3 years and for pregnant people. Testing recommendations for infants whose birthing parent is HCV positive have been updated.

Antiviral therapies for Hepatitis D have been added to the chapter.

In the Herpes Simplex chapter, exclusion of athletes with active herpes gladiatorum or rugbiorum infections is provided. Antiviral suppression in these athletes is endorsed. Management of neonates whose birthing parent has a first episode genital herpes in the final trimester of pregnancy but no lesions at delivery has been modified.

Details of central nervous system manifestations of Histoplasmosis have been added.

Diagnostic modalities for Hookworm Infections have been updated and expanded.

Description of diagnostic studies suggesting inherited chromosomally integrated HHV-6 (iciHHV6) has been expanded in the Human Herpesvirus 6 (Including Roseola) and 7 chapter.

Diagnostic approaches for management in infants whose birthing parent has Human Immunodeficiency Virus Infection and in adolescents have been updated. Postexposure management of people with HIV following measles and varicella exposure has been clarified. Postexposure management following hepatitis A exposure has been added.

Epidemiologic information and cervical cancer screening recommendations in Human Papillomaviruses have been updated.

The Influenza chapter has been brought into alignment with the annual influenza policy statements published by the AAP since 2021.

Contrasts between Kawasaki Disease and MIS-C are provided. Descriptions of adjunctive therapies for primary treatment and management of IGIV resistance have both been expanded.

Management options for Kingella kingae Infections in outbreak settings have been added.

Diagnostic modalities for Legionella pneumophila Infections have been updated. Control measures for prevention of Legionella infections have been expanded.

Mention of cases of Leishmaniasis in Indigenous populations in the southwestern United States has been added.

The Leprosy chapter includes mention of the open-access International Textbook of Leprosy as a resource.

Use of matrix-assisted laser desorption/ionization–time-of-flight (MALDI-TOF) mass spectrometry for rapid identification of Listeria monocytogenes Infections is discussed.

The diagnostic testing required for Lyme Disease has been modified for greater clarity.

A listing of extracerebral involvement has been added to the Lymphocytic Choriomeningitis Virus chapter.

Clinical and laboratory parameters defining severe Malaria have been added. The need to confirm the diagnosis of malaria prior to initiating therapy has been emphasized.

Distinguishing between someone with fever and rash from measles, mumps, and rubella (MMR) vaccine versus someone with Measles infection has been added. The postexposure prophylaxis tables have been modified.

Text and a new table have been added to the Meningococcal Infections chapter providing guidance for when ciprofloxacin-resistant isolates are detected.

A diagnostic pearl to improve visualization of the umbilicated lesions of Molluscum Contagiosum is provided.

Wording has been added to distinguish between Moraxella catarrhalis respiratory colonization versus disease.

Mpox is an entirely new chapter to the 2024 Red Book.

In the Mycoplasma pneumoniae and Other Mycoplasma Species Infections chapter, disease caused by Mycoplasma genitalium has been expanded, as have treatment recommendations for this pathogen. The increasing antibiotic resistance of all Mycoplasma species is discussed.

Discussion of risk factors for Nocardiosis is expanded. Treatment options have been updated.

Mention of nitazoxanide as a possible treatment in immunocompromised transplant recipients has been added to the Norovirus and Sapovirus Infections chapter, albeit in “some experts recommend” language.

Treatment of Onchocerciasis (River Blindness, Filariasis) has been updated.

Sensitivity and specificity of diagnostic tests for Paracoccidioidomycosis have been added.

Cerebral Paragonimiasis is discussed in greater detail.

Use of corticosteroids and nebulized epinephrine in the management of Parainfluenza Viral Infections has been added.

Modes of human infection and clinical manifestations in humans have been updated for many of the Parasitic Diseases in the table of this chapter.

Molecular diagnostic testing for Parechovirus Infections has been updated.

Persistence of low concentrations of noninfectious Parvovirus B19 DNA for months or years is emphasized.

Manifestations of Pasteurella Infections in neonates has been added. Treatment duration for endocarditis has been added.

The treatment section of the Pediculosis Capitis chapter has been updated with the recommendations from the 2022 clinical report published by the AAP. A new treatment algorithm figure has been added.

The cause of pruritis from body lice has been added to the Pediculosis Corporis chapter.

A time period has been added to the Pediculosis Pubis chapter for persistence of pubic lice on bedding, towels, and clothing.

Treatment recommendations for Pelvic Inflammatory Disease during pregnancy are provided.

Tdap vaccines have been approved by the FDA for use in pregnancy since the last edition of the Red Book, and the Pertussis (Whooping Cough) chapter has been updated accordingly.

Modes of transmission for Pinworm Infections have been updated.

Treatment of Pityriasis Versicolor with topical retinoids has been added.

The diagnosis and treatment sections of the Plague chapter have been aligned with the 2021 CDC recommendations.

Extrapulmonary manifestations of Pneumocystis jirovecii Infections have been added. Intravenous steroid dosing for people unable to take oral steroids has been added.

The Poliovirus Infections chapter has been updated to include risk of circulating vaccine-derived polioviruses to undervaccinated communities in the United States. Proof of vaccination that is accepted by the United States is listed.

Options for treatment of Polyomaviruses has been expanded.

The utility of brain magnetic resonance imaging (MRI) in Creutzfeldt-Jakob disease has been added to the Prion Diseases chapter.

Duration of therapy recommendations for Pseudomonas aeruginosa Infections have been updated.

Outcomes of Q Fever among pregnant people have been added. A treatment option for chronic Q fever in children is provided.

The pre- and postexposure prophylaxis sections of the Rabies chapter have been harmonized with recent CDC guidance. A new table on preexposure prophylaxis has been developed.

Information has been added to the Rat-Bite Fever chapter on anticoagulants in blood culture media that can inhibit growth of Streptobacillus moniliformis.

The unusual Respiratory Syncytial Virus circulation patterns in 2021 and 2022 are discussed. Precaution measures are updated. New active and passive immunization products that likely are nearing FDA approval are mentioned.

The average number of Rhinovirus Infections a child experiences each year is provided.

Guidance on duration of antibiotic therapy for Rickettsialpox has been updated.

Identification of groups at higher risk of death from Rocky Mountain Spotted Fever, including children younger than 10 years and patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, has been added.

Reduction in risk of seizures with use of Rotavirus vaccine has been added to the chapter.

Manifestations of persistence of Rubella virus in patients with primary immunodeficiencies have been added.

Treatment options for Salmonella Typhi have been updated in the Salmonella Infections chapter. Details on the extensively drug-resistant (XDR) S Typhi outbreak in Pakistan, and its impact on international travelers, are updated as well.

The treatment section of the Scabies chapter has been updated to include additional alternative therapeutic options.

Information on hybridization and local transmission of Schistosoma haematobium and Schistosoma bovis has been added to the Schistosomiasis chapter.

The increasing number of antibiotic-resistant Shigella isolates detected in the United States is detailed, and treatment options updated accordingly.

Antiviral therapy options and new information on vaccines that protect against Smallpox have been added.

Hyperthermia has been added as a treatment option for pregnant people with Sporotrichosis, in whom antimicrobial therapy should be avoided.

Discussion of the enterotoxins that produce Staphylococcal Food Poisoning has been expanded.

Treatment durations for Staphylococcus aureus osteomyelitis have been decreased, in alignment with the Pediatric Infectious Diseases Society/Infectious Diseases Society of America guidance document that was recently published. Decolonization approaches are discussed in greater detail. New drugs with antistaphylococcal activity are summarized.

New antibiotics with utility in Coagulase-Negative Staphylococcal Infections are listed. Situations in which combination therapy can be considered are provided. Durations of treatment are updated.

Diagnosis of poststreptococcal acute glomerulonephritis is specifically stated in the Group A Streptococcal Infections chapter. Eradication of nephritogenic strains has been added. The increasing degree of clindamycin resistance is addressed, and use of linezolid for blocking protein (toxin) production in cases of clindamycin resistance has been added.

New long-term outcome data for survivors of Group B Streptococcal Infections during infancy have been added. Treatment of sequential parenteral-oral therapy of bacteremia without a focus and isolated urinary tract infections has been liberalized somewhat. Testing of human milk for an infant with late-onset GBS is discouraged.

The treatment section of the Non-Group A or B Streptococcal and Enterococcal Infections chapter has been modified to include updated duration recommendations.

PCV15 and PCV20 have been added to the Streptococcus pneumoniae (Pneumococcal) Infections chapter. A table with susceptibility breakpoints by drug and site of infection has been added.

Treatment for suspected or confirmed hyperinfection/dissemination syndrome has been added to the Strongyloidiasis chapter. Management of eligible refugees who arrive in the United States through the US Refugee Resettlement Program versus other immigrants, including internationally adopted children, has been added.

The increasing incidence of Syphilis and congenital syphilis is documented. Performance characteristics of treponemal tests are discussed. Neonates known to be exposed to syphilis at delivery should not have delayed bathing.

Transmission and obligate versus intermediate host descriptions have been expanded in the Tapeworm Diseases chapter.

Treatment of Echinococcus has been updated in the Other Tapeworm Infections chapter.

Management of patients who experience anaphylactic reaction to Tetanus vaccine has been added. Progress toward global elimination of maternal and neonatal tetanus has been updated.

Treatment recommendations, including drugs available in the United States, have been updated in the Tinea Capitis and Tinea Corporis chapters.

Description of the clinical manifestations of Tinea Cruris have been expanded.

Use of efinaconazole and tavaborole in children as young as 6 years for Tinea Pedis and Tinea Unguium has been added.

The specific classes of immunoglobulin that constitute hypergammaglobulinemia for the diagnosis of Toxocariasis have been clarified.

Benefits of each type of imaging modality (ultrasonography, magnetic resonance imaging [MRI], computed tomography [CT]) for congenital Toxoplasma gondii Infections are provided.

Discussion of the role of steroids in severe systemic Trichinellosis has been added. Mention of the cost of albendazole and mebendazole has been included.

Use of NAAT for diagnosis of Trichomonas vaginalis Infections has been updated. Treatment options have been expanded, and discussion of management of recurrent infection is provided.

Combination therapy for Trichuriasis is added as a management option.

Fexinidazole has been added as a treatment option for some patients with African Trypanosomiasis.

Newer diagnostic modalities for American Trypanosomiasis (Chagas Disease), including next-generation techniques using cell-free pathogen DNA and newer immunoassays, have been added.

New Tuberculosis treatment durations aligning with WHO recommendations have been added. IGRA testing at any pediatric age has been expanded (previously was 2 years and older). Terminology of TB infection versus TB disease is emphasized.

Identification of macrolide resistance in the treatment of Nontuberculous Mycobacteria through detection of the erm gene with sequencing or line-probe assay has been added. Initiation recommendations for Mycobacterium avium complex (MAC) prophylaxis in patients starting antiretroviral therapy (ART) are provided.

Tularemia treatment options have been reorganized for clarity.

Serologic responses in patients with Brill-Zinsser disease have been added to the Louse-borne Typhus chapter.

Sensitivity of PCR assay in whole blood, serum, and skin biopsies has been added to the Murine Typhus chapter.

The anti-inflammatory characteristics of azithromycin have been added to the Ureaplasma urealyticum and Ureaplasma parvum Infections chapter.

Birth in the United States before 1980 is added to those things that provide evidence of immunity to Varicella-Zoster Virus Infections. The types of highly immunocompromised patients who should not receive varicella vaccine are specifically listed.

Vaxchora now is available in children down to 2 years of age for the prevention of Cholera.

The anticipated impact of climate change on incidence of Vibrio infections has been added to the Other Vibrio Infections chapter.

Discussion of community-level mosquito control measures for prevention of West Nile Virus is expanded.

Description of disease caused by Yersinia pseudotuberculosis has been expanded in the Yersinia enterocolitica and Yersinia pseudotuberculosis Infections chapter.

Testing recommendations for Zika virus have been updated. A new table to aid with interpreting test results has been added. Restrictions on blood donations have been loosened.

Adverse events from use of fluoroquinolones have been updated in Antimicrobial Agents and Related Therapy.

Recommendations are provided in the Antimicrobial Resistance and Antimicrobial Stewardship: Appropriate and Judicious Use of Antimicrobial Agents chapter to enhance clear and effective communication across clinical settings in order to improve antimicrobial stewardship efforts.

Several new antibiotics have been added to the Tables of Antimicrobial Drug Dosages. For the neonatal dosing table, gestational ages are provided with more precise breakpoints.

Treatment options for Sexually Transmitted Infections are now listed as those that are preferred and those that are alternatives to the preferred option.

Differences in formulations of posaconazole and itraconazole are provided in the Antifungal Drugs for Systemic Fungal Infections chapter. Ibrexafungerp has been added. The durations of time on drug before checking trough concentrations for the azoles and flucytosine are clarified.

New dosing recommendations are provided for many of the antifungal medications in the table that contains the Recommended Doses of Parenteral and Oral Antifungal Drugs.

The listing of drugs in the Topical Drugs for Superficial Fungal Infections table have been aligned with what is currently available in the United States.

Antivirals for COVID-19 and mpox have been added to the Non-HIV Antiviral Drugs table. Age indications for many antiviral drugs, including HCV and influenza drugs, have been lowered to reflect current indications for use by the FDA.

Updated dosing recommendations based on new guidance have been incorporated throughout the Drugs for Parasitic Infections table.

Results of the NIH RIVUR study have been added to the discussion of UTI prophylaxis in the Antimicrobial Prophylaxis chapter.

The decline of MRSA infections in children and, therefore, a decreased need to cover for these resistant bacteria prophylactically is detailed in the Antimicrobial Prophylaxis in Pediatric Surgical Patients chapter.

The Prevention of Bacterial Endocarditis chapter has been harmonized with the 2021 updated statement on infectious endocarditis from the American Heart Association.

Options for periods of shortage of erythromycin ointment have been updated in the Neonatal Ophthalmia Prevention chapter.

Web links have been updated in the Directory of Resources. A link to the CDC’s website on vaccine shortages and delays has been added. The European Society for Pediatric Infectious Diseases has been added.

The listing of Codes for Commonly Administered Pediatric Vaccines, Toxoids, and Immune Globulins has been expanded to include specific codes for wound prophylaxis for tetanus, respiratory syncytial virus (RSV) prophylaxis with palivizumab, and hepatitis B immune globulin (HBIG) use in perinatal hepatitis B exposure.

The diseases listed in the Nationally Notifiable Infectious Diseases in the United States table have been updated to those required in 2023.

In the Guide to Contraindications and Precautions to Immunizations appendix, moderate or severe acute illness, with or without fever, has been identified as the only precaution applicable to all vaccines.

Sources of foodborne infections have been updated in the Prevention of Disease From Contaminated Food Products appendix.

The incubation periods for hemolytic-uremic syndrome and botulism have been tightened in the Clinical Syndromes Associated With Foodborne Diseases table.

Sources and modes of transmission have been updated throughout the Diseases Transmitted by Animals (Zoonoses) table. Leishmaniasis, Streptococcus suis, Cache Valley virus, Heartland virus, and Lujo hemorrhagic fever have been added.