Looking Back, Looking Forward

In celebration of the 20th anniversary of Red Book Online, we reflect on the first edition of the Red Book published in 1938—a mere 8 pages covering a mix of 18 topics including the common cold, pertussis, and variola.

XI. Measles

The initial Report of the Committee on Immunization Procedures of the American Academy of Pediatrics (AAP) published in January 1938, now known as the Red Book, included 8 short sentences on measles on page 5 of the 8-page booklet.

In contrast, the current 32nd edition of the Red Book dedicates 17 pages to measles¹, describing its clinical manifestations and epidemiology, advances in diagnostic testing, and protection through active immunization—the latter perhaps being the most important measles development and addition to the Red Book since the first edition. Measles became a notifiable disease in the United States (US) in 1912; with an R₀ of 12-18 and an attack rate of ≥ 90%, measles was estimated to cause 3-4 million annual cases, resulting in approximately 6,000 deaths/year in the US before an effective vaccine was available.^2,3,4    

After the measles-mumps-rubella (MMR) vaccine was licensed in 1963 and widespread vaccination with a two-dose MMR vaccine series was recommended in 1989, measles was declared eliminated in the US in 2000.^5,6  Two doses of MMR vaccine are safe and 97% effective in protecting against measles, however ≥ 95% of the population must be optimally vaccinated to sustain this protection.

Unfortunately, one of the greatest public health achievements is re-emerging as a challenge. Vaccine misinformation and vaccine hesitancy leading to suboptimal MMR vaccination rates, further exacerbated by the COVID-19 pandemic⁷, have resulted in the contemporary resurgence of measles. Globally, measles remains a leading cause of death in children, with 128,000 deaths reported in unvaccinated or incompletely vaccinated children ≤ 5 years of age in 2021.⁸  In the US, measles outbreaks are occurring at the highest rate since measles was declared eliminated (22 outbreaks in 2019 alone!) and disproportionately affects unvaccinated or incompletely vaccinated children and under-immunized communities.^9,10,11

MMR vaccination remains one of the most important and effective tools in protecting our children, families, and communities against measles and measles-associated complications and ongoing outbreaks. Resources and strategies for providers are available to help reduce vaccine misinformation and improve vaccination rates among their patient population. Providers should remain vigilant and suspect measles based on clinical signs and symptoms. The AAP Red Book provides evidence-based guidance for measles management, including: prompt institution of isolation precautions, appropriate diagnostic testing, recommendations for measles immunization within 72 hours of exposure in susceptible individuals or passive prophylaxis strategies for at-risk children not eligible for MMR vaccine, and prompt reporting of suspected measles cases to local health departments and other strategies for outbreak control. 

References

1. American Academy of Pediatrics. Measles.  In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds.  Red Book 2021 Report of the Committee on Infectious Diseases. Itasca, IL: AAP, 2021 [pp. 503-519].
2. Centers for Disease Control and Prevention. Measles History. (Accessed 12/20/2023, at https://www.cdc.gov/measles/about/history.html#Measles%20Elimination.)
3. Rota PA, Moss WJ, Takeda M, de Swart RL, Thompson KM, Goodson JL. Measles. Nat Rev Dis Primers 2016;2:16049.
4. Guerra FM, Bolotin S, Lim G, et al. The basic reproduction number (R(0)) of measles: a systematic review. Lancet Infect Dis 2017;17:e420-e8.
5. Centers for Disease Control and Prevention. Measles Elimination. (Accessed 12/20/2023, at https://www.cdc.gov/measles/elimination.html.)
6. Hinman AR, Orenstein WA, Papania MJ. Evolution of measles elimination strategies in the United States. J Infect Dis 2004;189 Suppl 1:S17-22.
7. Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration - United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:591-3.
8. World Health Organization. Measles. August 9, 2023. (Accessed 12/20/2023, at https://www.who.int/news-room/fact-sheets/detail/measles.)
9. Tiller EC, Masters NB, Raines KL, et al. Notes from the Field: Measles Outbreak - Central Ohio, 2022-2023. MMWR Morb Mortal Wkly Rep 2023;72:847-9.
10. Patel M, Lee AD, Clemmons NS, et al. National Update on Measles Cases and Outbreaks - United States, January 1-October 1, 2019. MMWR Morb Mortal Wkly Rep 2019;68:893-6.
11. Centers for Disease Control and Prevention. Measles (Rubeola). Measles Cases and Outbreaks. (Accessed 12/20/2023, at https://www.cdc.gov/measles/cases-outbreaks.html.)

XIII. Staphylococcus Infections

Chapter 13 in the first edition of the Red Book was “Staphylococcus Infections.” There was no diagnostic test available, and treatment was limited to staphylococcus antitoxin, for which there was “no evidence that it (was) of any value.”

In the 2021 Red Book, staphylococci are addressed in three separate chapters: “Staphylococcal Food Poisoning,” “Staphylococcus aureus,” and “Coagulase-Negative Staphylococcal Infections.” S aureus is recognized to cause a spectrum of clinical manifestations, from localized skin and soft and tissue infections to toxin-mediated syndromes. Through advances in microbiology, we now know there are more than 40 species of coagulase-negative Staphylococcus species, and we have an array of diagnostic tests, such as molecular assays and MALDI-TOF, to assist with rapid identification.

Despite an armamentarium of parenteral and oral antibiotics to treat staphylococcal infections, these infections remain challenging to manage, with high rates of recurrent infection and the ever-present concern for emerging antimicrobial resistance. Further research is needed to guide optimal antibiotic duration and to develop novel preventative vaccines and therapeutics. As new evidence emerges, the Red Book will also continue to evolve to capture scientific progress.

VI. Epidemic Parotitis

Chapter 6 was “Epidemic Parotitis”, a disease for which there was no diagnostic test available, and the only treatment was convalescent serum, without convincing evidence of its therapeutic effect. 

How things change over time. The current Red Book recognizes “Epidemic Parotitis” as Mumps, caused by an RNA virus of the paramyxoviridae family. This virus remains the only known epidemic cause of parotitis. With the widespread recommendation of a two-dose MMR vaccine in 1989, mumps infection rates in the US fell to extremely low levels. Today, there remain sporadic outbreaks with more than 3,000 cases per year. 

Many young health care providers have never seen a case of mumps. As a result, vigilance and a high index of suspicion are necessary to prevent the next outbreak. Regardless of vaccination status, anyone with parotitis, orchitis, or oophoritis without another identifiable cause , should be evaluated for mumps by PCR testing. If the test is negative, but there is more than one case of mumps in the community, further testing may be advisable. 

The Red Book’s description of “Epidemic Parotitis” has grown from 7 lines of text to 6 pages delineating etiology, epidemiology, diagnostics, and prevention by vaccination. Red Book Online brings the collective knowledge of many ID experts and remains your trusted source for all contemporary information about  pediatric infectious diseases.

I. The Common Cold

The Common Cold was the first section:

A. Test: None

B. Active Immunity: No active immune principle of any proven value has been described.

C. Passive Immunity: None

Today, 85 years later, we now know what causes the common cold and can even test for many of these pathogens at point-of-care. 

The 2021 Red Book emphasizes that rhinoviruses are the most frequent cause of the common cold, accounting for 2/3 of cases. Other viruses associated with the common cold include human bocavirus, adenoviruses, and human coronaviruses 229E, OC43, NL63, and HKU1. SARS-CoV-2 can present with common cold symptoms, particularly in young children. And remember the common cold is not a bacterial infection, although Bordetella pertussis infection is an important exception that often manifests with cold symptoms during its catarrhal phase.

Unfortunately, we may know what causes the common cold, but we still can't do much about it. There aren't vaccines for children to protect against the many viral causes except SARS-CoV-2, and effective treatments are mostly limited to supportive care.  

"Twenty years of Red Book Online is a remarkable accomplishment! RBO has grown and matured across these past two decades to be a versatile, accessible, parallel way to get Red Book content when and where a practitioner needs it."— David W. Kimberlin, MD, FAAP | Editor, Red Book

Read more about RBO's 20th Anniversary at https://publications.aap.org/aapnews/news/23701