The 33rd edition of the American Academy of Pediatrics' 2024-2027 Report of the Committee on Infectious Diseases, aka Red Book, arrived online (and on my doorstep) recently. This latest edition adds about 100 pages to the 32nd edition, even as many sections were combined or shortened. More than annual spring cleaning, this is a renewal effort for me that has become an enjoyable triennial task for me. Although the early pages provide a brief summary of changes (total 222) from the previous edition, I operationalize this by having the new Red Book at my side always, looking up every clinical situation I encounter in reading or in patient care. Not surprisingly, even after doing this for maybe the next year, I still won't remember everything, but I'll know when and where to look. Remember also that the Red Book advice is in many instances a set of consensus opinions that are subject to author bias, even with extensive review and editing. Nothing is etched in stone, and individual patient circumstances may require deviation from general recommendations.
In the meantime, let's look at what's been going on in pediatric infectious diseases recently; this isn't in the Red Book.
A New Look CDC Website
Our friends at CDC announced a new look to their website with a focus on reducing clutter and making access easier. After my first series of run-throughs, I think they are well on their way to that goal. It's worth your while to view their 2-minute YouTube video describing the changes.
Bird Flu News
Still no reason to increase fears of the next human pandemic, but plenty going on. The US Department of Agriculture (they should talk to their CDC colleagues about reducing website clutter and improving navigation!) updated beef safety with some new studies. First, USDA tested ground beef samples from stores in states known to have influenza A H5N1 present in cattle; all were negative by PCR, although they don't mention how many samples were tested. Second, they performed studies on cooking ground beef spiked with Highly Pathogenic Avian Influenza "surrogate" virus (they don't specify details or numbers). Cooking the burgers to medium (145 F) or well done (160 F) eliminated all live virus. Rare (120 F) cooking "substantially inactivated" the virus, whatever that means. I'm looking forward to results of another ongoing study of PCR testing of muscle samples from cows who were culled due to "systemic pathologies" which should go a long way in helping understand if there is any reasonable risk of transmission of H5N1 in raw beef.
Meanwhile, in the latest update there have been no new state detections in domestic livestock since April 24. Bird infections remain a major problem as judged from USDA's main avian influenza website.
FDA provided a little more detailed information than did USDA. They found no viable virus in 297 pasteurized dairy products tested and confirmed by egg inoculation studies which should be highly sensitive.
Things are improving, but more proactive testing, especially of asymptomatic wild and domestic animals and high-risk humans such as poultry and dairy workers, is needed to stay ahead of any epidemic trends.
MMWR Trifecta
I'm not a big horse-racing fan, though I did watch the Preakness this weekend. This week's (May 16) MMWR hit a trifecta for me in that 3 topics are worth mentioning, so here's a quick look.
Measles: We have a detailed report of the outbreak associated with the migrant shelter in Chicago, spread over February through April 2024. Here's the quick overview:
The key take-home points: 1) Most of the 57 cases occurred in unvaccinated individuals; 2) active case-finding and a mass vaccination campaign (882 residents were vaccinated) likely averted a larger disaster.
I wish we had similar reporting from the Florida public school outbreak, apparently managed very differently but we know nothing about what was done. I can still find only a March 8 update that sounds mostly like a political statement.
Clade I Mpox: This clade I outbreak continues in the Democratic Republic of Congo and, compared to the clade II strain that caused the global outbreak in 2022, this clade I seems more virulent, with higher morbidity and mortality than seen with clade II (this was known prior to this outbreak). Again, here's the big picture:
While the numbers appear to be trending downward in the latter dates on this graph, this could be due to delays in reporting.
Age distributions are alarming for pediatric healthcare providers though clearly are influenced by social factors present in the DRC and might not apply to any US cases if we do see global spread.
The Jynneos mpox vaccine is effective against both clades, and high-risk individuals in the US should be vaccinated. The newly revamped CDC mpox site is a good example of how they've improved the look and ease of navigation. Providers should access this again to be sure they have offered vaccine to those at risk.
Polio: This was an update on progress towards polio eradication and is a good news/bad news report. The good news is that wild-type polio infections appear to be decreasing over the period January 2022 to December 2023. Wild type polioviruses types 2 and 3 (WPV2 and WPV3) have been eradicated, and only WPV1 continues to circulate but just in Afghanistan and Pakistan. In 2023 there were only 12 cases of WPV1 identified, compared to 22 in 2022, a decrease even with more extensive sewage screening in 2023. The bad news is that circulating vaccine-derived polio (cVDPV) cases, from live polio vaccine, continues to be a problem. The number of cases decreased (881 in 2022 to 524 in 2023) but the number of countries affected increased from 24 to 32. The vast majority of these are cVDPV1 and cVDPV2. WHO has newer and more effective vaccination strategies to eliminate both wild and vaccine-derived strain infections, but implementation is difficult.
Books - Red and Other Colors
Regular readers of this blog know that I'm an avid reader. I'm not an avid book collector, however. I try to keep a relatively static number of books in the house, requiring donating old books to my neighborhood public library's used bookstore as I acquire new ones (my last trip to a used bookstore resulted in 11 additions to my sagging bookshelves). However, I'm now reminded that I have 3 collections that I don't recycle from my shelves.
First is the Red Book. I own all editions dating back to 1961, the 13th edition, plus the 6th edition of 1944. I've been unable to find the remaining 11 editions, probably because I'm not as adept at used bookstore searches as I am at PubMed searches. I'll keep trying. Three pediatric infectious diseases giants, Drs. Larry Pickering, Georges Peter, and Stan Shulman, wrote a nice review of Red Book history in 2013.
My other 2 non-recyclable book collections are very different. One is the Audrey/Maturin series of nautical novels by Patrick O'Brian. I also own several of his lesser works. I'm not sure why I hang on to all of those; perhaps it's because my initial attempt at reading one was quickly abandoned due to boredom. Years later I picked it up again and was hooked. My other collector fascination is the Parker noir series by Richard Stark, a pseudonym of Donald Westlake. I lack many in the series which I could easily buy as newly issued printings, but I prefer to prowl used bookstores for older copies. I haven't happened upon an old one in years, but hope springs eternal.
