December 11, 2018
2 min read

2 Red Book changes physicians should know

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David Kimberlin
David W. Kimberlin

NEW YORK — Numerous changes have been made to the AAP’s 2018 Red Book, but two specific sections have significant implications for return-to-school policies for Streptococcus infection and the timing of HPV vaccination.

David W. Kimberlin, MD, professor and co-director of pediatric infectious diseases, the Sergio B. Stagno, MD, Endowed Chair in Pediatric Infectious Diseases and vice chair for clinical and translational research at Children’s of Alabama, said in his presentation at the Annual Infectious Diseases in Children Symposium that 2018 marks the most recent update on the AAP’s guidance on the diagnosis, treatment and management of pediatric infectious diseases.

The guidance is updated every 3 years and is determined by 14 voting committee members, including representatives from the AAP Section on Infectious Diseases and liaisons from several agencies, including the CDC, FDA, NIH, the National Vaccine Program and more.

Return-to-school policies

According to Kimberlin, an editor of the Red Book, previous recommendations suggested that children should be excluded from school until they appear well at least 24 hours after beginning antimicrobial therapy. The 2018 updates shortened the time needed between treatment and school inclusion from 24 hours to 12 hours after a study published in the Pediatric Infectious Disease Journal found that 91% of children administered their first dose of amoxicillin in their pediatrician’s office did not have detectable group A Streptococcus between 11 and 23 hours after the visit.

“The problem about waiting 24 hours before returning to school is that you may be going to see your pediatrician at 2 p.m.,” he said. “By the time the patient gets their antibiotics, it might be about 4 p.m. This means another day of missed school, but it also means missed work for parents who need to be home with their child.”

HPV vaccine series initiation

Kimberlin also stressed the AAP’s recommendation to begin HPV vaccination between age 9 and 12 years. This recommendation is in concordance with the CDC’s Advisory Committee on Immunization Practice’s recommendations.

Kimberlin said that the series could be initiated at any time between age 9 and 12 years at the provider’s discretion for “optimal for acceptance and completion of the vaccination series.” He noted a study conducted by researchers at the Rochester Epidemiology Project in Minnesota, which compared the initiation and completion rates of children aged 9 and 10 years with those aged 11 and 12 years. Children who started the series between ages 9 and 10 years were more likely to complete all three doses by 13.5 years (97.5% vs. 78.%) and 15 years (99.6% vs. 94%).

Additionally, children who initiated HPV vaccination earlier were more likely to receive two doses of the vaccine by 13.5 years (99.5% vs. 91.7%) and by 15 years (99.9% vs. 97.8%).

“The changes made to the Red Book regarding HPV vaccination are more a difference of emphasis,” Kimberlin said. “This is not brand-new information, it is just being emphasized in a different way.” – by Katherine Bortz


Kimberlin DW. New recommendations from the 2018 Red Book. Presented at: Annual Infectious Diseases in Children Symposium. Nov. 17-18, 2018; New York.

Schwartz RH, et al. Pediatr Infect Dis J. 2015;doi:10.1097/INF.0000000000000883.

St. Sauver JL, et al. Prev Med. 2016;doi:10.1016/j.ypmed.2016.02.039.

Disclosure: Kimberlin reports receiving a research grant from Novavax for an RSV vaccine study. All funds are collected by University of Alabama at Birmingham.