RED BOOK® 2024-2027 Report of the Committee on Infectious Diseases

Summary of Major Changes in the 2024 Red Book
Systems-Based Treatment Table
Section 1: Active and Passive Immunization
Prologue
Sources of Information About Vaccines and Immunization
Discussing Vaccines With Patients and Parents
Vaccine Uptake: Definitions and Understanding Common Influences of Vaccine Behavior
Understanding Vaccine Evaluation and Safety as an Approach to Addressing Parental Concerns
Evidence-Based Communication Strategies to Increase Uptake of Childhood Vaccines
Use a Strong Vaccine Recommendation and the Presumptive Format for Initiating the Vaccine Discussion
For Parents Who Express Hesitancy, Use Additional Evidence-Based Communication Strategies
Leverage Systems, Organizational Approaches, and Community Initiatives to Improve Parental Access to
Policies for Families Who Refuse or Delay Vaccination
Vaccine Injury Compensation
Active Immunization
Vaccine Ingredients
Vaccine Handling and Storage
Vaccine Administration
Managing Injection Pain
Immunization Schedule and Timing of Vaccines
Minimum Ages and Minimum Intervals Between Vaccine Doses
Interchangeability of Vaccine Products
Simultaneous Administration of Multiple Vaccines
Combination Vaccines
Lapsed Immunizations
Unknown or Uncertain Immunization Status
Vaccine Dose
Active Immunization After Receipt of Antibody-ContainingProducts
Hypersensitivity Reactions After Immunization
Immediate-Type Allergic Reactions
Delayed-Type Allergic Reactions
Other Vaccine Reactions
Passive Immunization
Immune Globulin Intramuscular (IGIM)
Immune Globulin Intravenous (IGIV)
Immune Globulin Subcutaneous (IGSC)
Treatment of Anaphylactic Reactions
Immunization in Special Clinical Circumstances
Immunization in Preterm and Low Birth Weight Infants
Immunization in Pregnancy
Immunization and Other Considerations in Immunocompromised Children
Immunization in Children With a Personal or Family History of Seizures
Immunization in Children With Chronic Diseases
Immunization in American Indian/Alaska Native Children and Adolescents
Immunization in Adolescent and College Populations
Immunization in Health Care Personnel
Children Who Received Immunizations Outside the United States or Whose Immunization Status is Unknow
International Travel
Section 2: Recommendations for Care of Children in Special Circumstances
Breastfeeding and Human Milk
AAP Recommendations on Breastfeeding
Contraindications to Breastfeeding
Transmission of Infectious Agents via Human Milk
Immunization of Breastfeeding Parents and Infants
Human Milk Banks
Inadvertent Human Milk Exposure
Antimicrobial Agents and Other Drugs in Human Milk
Anti-TNF Biologic Response Modifiers in Human Milk
Children in Group Child Care and Schools
Modes of Spread of Infectious Diseases
Respiratory Tract Diseases
Enteric Diseases
Bloodborne Infections
Other Infections
Management and Prevention of Infectious Diseases
Immunization
Infection Prevention and Control
Exclusion and Return to Care or School
Infection Prevention and Control for Hospitalized Children
Infection Prevention and Control Precautions
Strategies to Prevent Health Care-Associated Infections
Occupational Health
Sibling Visitation
Adult Visitation
Pet Visitation
Infection Prevention and Control in Ambulatory Settings
Sexually Transmitted Infections in Adolescents and Children
STIs During Preventive Health Care of Adolescents
Sexual Assault and Abuse in Children and Adolescents/Young Adults
Medical Evaluation for Infectious Diseases for Internationally Adopted, Refugee, and Other Immigrant
Internationally Adopted Children
Refugees
Immigrants
Consideration for Testing for Infectious Agents
Hepatitis A
Hepatitis B
Hepatitis C
Intestinal Pathogens
Tissue Parasites/Eosinophilia
Sexually Transmitted Infections
Tuberculosis
HIV Infections
Chagas Disease (American Trypanosomiasis)
Other Infectious Diseases
Injuries From Needles Discarded in the Community
Wound Care and Tetanus Prophylaxis
Bloodborne Pathogens
Preventing Needlestick Injuries
Bite Wounds
Prevention of Mosquito-borne and Tick-borne Infections
General Protective Measures
Repellents for Use on Skin
Tick Inspection and Removal
Other Preventive Measures
Prevention of Illnesses Associated With Recreational Water Use
Control Measures
“Swimmer’s Ear”/Acute Otitis Externa
Section 3: Summaries of Infectious Diseases
Actinomycosis
Adenovirus Infections
Amebiasis
Amebic Meningoencephalitis and Keratitis (Naegleria fowleri, Acanthamoeba species, and Balamuthia ma
Anthrax
Arboviruses (Including Cache Valley, Colorado Tick Fever, Eastern Equine Encephalitis, Heartland, Ja
Arcanobacterium haemolyticum Infections
Ascaris lumbricoides Infections
Aspergillosis
Astrovirus Infections
Babesiosis
Bacillus cereus Infections and Intoxications
Bacterial Vaginosis
Bacteroides, Prevotella, and Other Anaerobic Gram-Negative Bacilli Infections
Balantidium coli Infections
Bartonella henselae (Cat-Scratch Disease)
Baylisascaris Infections
Infections With Blastocystis Species
Blastomycosis
Bocavirus
Borrelia Infections Other Than Lyme Disease
Brucellosis
Burkholderia Infections
Campylobacter Infections
Candidiasis
Chancroid and Cutaneous Ulcers
Chikungunya
Chlamydial Infections
Clostridial Infections
Coccidioidomycosis
Coronavirus Disease 2019 (COVID-19)
Coronaviruses, Including MERS-CoV and SARS-CoV-1
Cryptococcus neoformans and Cryptococcus gattii Infections
Cryptosporidiosis
Cutaneous Larva Migrans
Cyclosporiasis
Cystoisosporiasis (Formerly Isosporiasis)
Cytomegalovirus Infection
Dengue
Diphtheria
Ehrlichia, Anaplasma, and Related Infections (Human Ehrlichiosis, Anaplasmosis, and Related Infectio
Serious Neonatal Bacterial Infections Caused by Enterobacterales (Including Septicemia and Meningit
Enterovirus (Nonpoliovirus) (Group A and B Coxsackieviruses, Echoviruses, Numbered Enteroviruses)
Epstein-Barr Virus Infections (Infectious Mononucleosis)
Escherichia coli Diarrhea (Including Hemolytic-Uremic Syndrome)
Other Fungal Diseases
Fusobacterium Infections (Including Lemierre Syndrome)
Giardia duodenalis (Formerly Giardia lamblia and Giardiaintestinalis) Infections (Giardiasis)
Gonococcal Infections
Granuloma Inguinale (Donovanosis)
Haemophilus influenzae Infections
Hantavirus Pulmonary Syndrome
Helicobacter pylori Infections
Hemorrhagic Fevers Caused by Arenaviruses
Hemorrhagic Fevers Caused by Bunyaviruses
Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Herpes Simplex
Histoplasmosis
Hookworm Infections (Necator americanus and Ancylostoma species)
Human Herpesvirus 6 (Including Roseola) and 7
Human Herpesvirus 8
Human Immunodeficiency Virus Infection
Human Papillomaviruses
Influenza
Kawasaki Disease
Kingella kingae Infections
Legionella Infections
Leishmaniasis
Leprosy
Leptospirosis
Listeria monocytogenes Infections (Listeriosis)
Lyme Disease (Lyme Borreliosis, Borrelia burgdorferi sensu lato Infection)
Lymphatic Filariasis (Bancroftian, Malayan, and Timorian)
Lymphocytic Choriomeningitis Virus
Malaria
Measles
Meningococcal Infections
Human Metapneumovirus
Microsporidia Infections (Microsporidiosis)
Molluscum Contagiosum
Moraxella catarrhalis Infections
Mpox
Mumps
Mycoplasma pneumoniae and Other Mycoplasma Species Infections
Nocardiosis
Norovirus and Sapovirus Infections
Onchocerciasis (River Blindness, Filariasis)
Paracoccidioidomycosis (Formerly Known as South American Blastomycosis)
Paragonimiasis
Parainfluenza Viral Infections
Parasitic Diseases
Parechovirus Infections
Parvovirus B19 (Erythema Infectiosum, Fifth Disease)
Pasteurella Infections
Pediculosis Capitis (Head Lice)
Pediculosis Corporis (Body Lice)
Pediculosis Pubis (Pubic Lice, Crab Lice)
Pelvic Inflammatory Disease
Pertussis (Whooping Cough)
Pinworm Infection (Enterobius vermicularis)
Pityriasis Versicolor (Formerly Tinea Versicolor)
Plague
Pneumocystis jirovecii Infections
Poliovirus Infections
Polyomaviruses (BK, JC, and Other Polyomaviruses)
Prion Diseases: Transmissible Spongiform Encephalopathies
Pseudomonas aeruginosa Infections
Q Fever (Coxiella burnetii Infection)
Rabies
Rat-Bite Fever
Respiratory Syncytial Virus
Rhinovirus Infections
Rickettsial Diseases
Rickettsialpox
Rocky Mountain Spotted Fever
Rotavirus Infections
Rubella
Salmonella Infections
Scabies
Schistosomiasis
Shigella Infections
Smallpox (Variola)
Sporotrichosis
Staphylococcal Food Poisoning
Staphylococcus aureus
Coagulase-Negative Staphylococcal Infections
Group A Streptococcal Infections
Group B Streptococcal Infections
Non-Group A or B Streptococcal and Enterococcal Infections
Streptococcus pneumoniae (Pneumococcal) Infections
Strongyloidiasis (Strongyloides stercoralis)
Syphilis
Tapeworm Diseases (Taeniasis and Cysticercosis)
Other Tapeworm Infections (Including Hydatid Disease)
Tetanus (Lockjaw)
Tinea Capitis (Ringworm of the Scalp)
Tinea Corporis (Ringworm of the Body)
Tinea Cruris (Jock Itch)
Tinea Pedis and Tinea Unguium (Onychomycosis) (Athlete’s Foot, Ringworm of the Feet)
Toxocariasis
Toxoplasma gondii Infections (Toxoplasmosis)
Trichinellosis (Trichinella spiralis and Other Species)
Trichomonas vaginalis Infections (Trichomoniasis)
Trichuriasis (Whipworm Infection)
African Trypanosomiasis (Sleeping Sickness)
American Trypanosomiasis (Chagas Disease)
Tuberculosis
Nontuberculous Mycobacteria (Environmental Mycobacteria, Mycobacteria Other Than Mycobacterium tuber
Tularemia
Louse-borne Typhus (Epidemic or Sylvatic Typhus)
Murine Typhus (Endemic or Flea-borne Typhus)
Ureaplasma urealyticum and Ureaplasma parvum Infections
Varicella-Zoster Virus Infections
Vibrio Infections
West Nile Virus
Yersinia enterocolitica and Yersinia pseudotuberculosis Infections (Enteritis and Other Illnesses)
Zika
Section 4: Antimicrobial Agents and Related Therapy
Introduction
Fluoroquinolones
Tetracyclines
Antimicrobial Agents Approved for Use in Adults but Not Children
Beta-lactam and Monobactam Allergies
Antimicrobial Resistance and Antimicrobial Stewardship: Appropriate and Judicious Use of Antimicrobi
Antimicrobial Resistance
Factors Contributing to Resistance
Actions to Prevent or Slow Antimicrobial Resistance
Antimicrobial Stewardship
Role of the Clinician
Principles of Appropriate Use of Antimicrobial Therapy for Upper Respiratory Tract Infections
Tables of Antibacterial Drug Dosages
Sexually Transmitted Infections
Antifungal Drugs for Systemic Fungal Infections
Polyenes
Pyrimidines
Azoles
Echinocandins
Triterpenoids
Recommended Doses of Parenteral and Oral Antifungal Drugs
Topical Drugs for Superficial Fungal Infections
Non-HIV Antiviral Drugs
Drugs for Parasitic Infections
MedWatch—The FDA Safety Information and Adverse Event Reporting Program
Section 5: Antimicrobial Prophylaxis
Antimicrobial Prophylaxis
Infection-Prone Body Sites
Prophylaxis Following Exposure to Specific Pathogens
Vulnerable Hosts
Antimicrobial Prophylaxis in Pediatric Surgical Patients
Guidelines for Appropriate Use
Indications for Prophylaxis
Surgical Site Infection Criteria
Timing of Administration of Prophylactic Antimicrobial Agents
Dosing and Duration of Administration of Antimicrobial Agents
Preoperative Screening and Decolonization
Recommended Antimicrobial Agents
Prevention of Bacterial Endocarditis
Neonatal Ophthalmia Prevention
Primary Prevention
Secondary Prevention
Legal Mandates for Topical Prophylaxis for Neonatal Ophthalmia
Pseudomonal Ophthalmia Neonatorum
Other Nongonococcal, Nonchlamydial Ophthalmia
Appendices
I. Directory of Resources
II. Codes for Commonly Administered Pediatric Vaccines, Toxoids, and Immune Globulins
III. Nationally Notifiable Infectious Diseases in the United States
IV. Guide to Contraindications and Precautions to Immunizations
V. Prevention of Infectious Disease From Contaminated Food Products
VI. Clinical Syndromes Associated With Foodborne Diseases
VII. Diseases Transmitted by Animals (Zoonoses)
Index

Red Book®, 33rd Edition provides the latest clinical guidance on the manifestations, etiology, epidemiology, diagnosis, andtreatment of more than 200 childhood infectious diseases. Find the latest information about vaccines, emerging novel diseases, diagnostic modalities, and treatment recommendations from the combined expertise of the CDC, the FDA, the NIH, and hundreds of physician contributors. New in the 2024 Red Book

• All chapters were assessed for relevance in the dynamic environment that is the practice of pediatric medicine today, and every chapter has been modified since the last edition.
• Significantly revised Discussing Vaccines With Patients and Parents chapter.
• Two new chapters on COVID-19 and Mpox have been added.
• Greatly expanded tables, figures and algorithms enable quick access to essential information.
• The Systems-Based Treatment Table has been reordered so that the grouped recommendations by body system are more easily and quickly accessed.
• Standardized approaches to disease prevention through immunizations, antimicrobial prophylaxis, and infection-control practices have been updated throughout the Red Book.
• References to evidence-based policy recommendations have been updated throughout the Red Book.
• Appropriate chapters throughout the Red Book have been updated to be consistent with 2024 AAP and CDC vaccine recommendations, CDC recommendations for immunization of healthcare personnel, and drug recommendations from 2024 Nelson’s Pediatric Antimicrobial Therapy.
• The Breastfeeding and Human Milk chapter was updated to align with information in the 2022 AAP policy statement on breastfeeding.

David W. Kimberlin, MD, FAAP is the Editor of the 2021 AAP Report of the Committee on Infectious Diseases (Red Book). He also was Editor of the 2015 and 2018 editions and was an Associate Editor of the 2012 and 2009 editions and served on the AAP Committee on Infectious Diseases from 2005- 2011. Dr. Kimberlin is the Sergio Stagno, MD. Endowed Chair in Infectious Diseases, Professor and Co-Division Director, Vice Chair for Clinical and Translational Research. His clinical and research interests include pediatric infectious diseases, antiviral therapeutics in rare diseases with a large unmet medical need, including neonatal herpes simplex virus (HSV) infections, congenital cytomegalovirus (CMV) disease, congenital Zika infection, neonatal and infantile influenza infection, and neonatal enteroviral sepsis syndrome.

Elizabeth D. Barnett, MD, FAAP is an Associate Editor of the 2021 Red Book and was a member of the Committee on Infectious Diseases from 2014 - 2020. Dr. Elizabeth Barnett is Professor of Pediatrics at Boston University School of Medicine and Chief, Section of Pediatric Infectious Diseases in the Department of Pediatrics at Boston Medical Center. She leads the Refugee Health Assessment Program and the Pediatric Travel Clinic. Her clinical and research interests include vaccines and vaccine safety, refugee and immigrant medicine, travel medicine, and general pediatric infectious diseases.

Ruth Lynfield, MD, FAAP is an Associate Editor of the 2021 Red Book and has been a member of the Committee on Infectious Diseases since 2015. Dr. Lynfield is the State Epidemiologist and Medical Director at the Minnesota Department of Health. She leads Minnesota’s component of CDC’s Emerging Infections Program Active Bacterial Core Surveillance System, influenza projects, and healthcare-associated infections projects. She is also Adjunct Professor of Medicine, and Epidemiology and Community Health at the University of Minnesota. Her clinical and research interests include pediatric infectious diseases, antimicrobial resistance and antimicrobial stewardship, emerging infections, prevention and control of infectious diseases, and outbreak response.

Mark Sawyer, MD, FAAP is an Associate Editor of the 2021 Red Book and served on the Committee on Infectious Diseases from 2013- 2019. Dr. Sawyer is an infectious disease specialist at Rady Children's Hospital and a professor of clinical pediatrics at UC San Diego. Additionally, Dr. Sawyer is vice chair for education in the UC San Diego Department of Pediatrics and the program director for the UC San Diego/Rady Children's Pediatric Residency Program and the medical director of the UC San Diego Immunization Partnership. His clinical and research interests include pediatric infectious diseases, medical education, training, and working with public health on the delivery of vaccines and national vaccine policy.