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On the Floor at ID Week
It was a Red Book morning on the second day of ID Week 2012, with Larry Pickering, MD, FAAP, FIDSA and Michael T. Brady, MD, beginning the day presenting key updates in the 2012 Edition of the AAP Red Book and Red Book online.
Dr. Pickering presented the changing epidemiology of arboviral infections in the US. While La Crosse virus remains the No. 1 cause of arboviral encephalopathy in children, the dramatic increase in West Nile virus cases during the past year was quite impressive, largely affecting the Southwest and Midwest, presenting updated arboviral epidemiologic maps that can be found in the updated Red Book online. Dr. Pickering then discussed the concerning trend of rising antimicrobial resistance in Neisseria gonorrhoeae.
N. gonorrhoeae isolates have demonstrated continued mounting resistance to much of our antimicrobial armamentarium, with cephalosporins, the previous de facto therapeutic class, demonstrating the unfortunate rise in MICs to cephalosporins.
Cefixime (Suprax, Lupin) is no longer a recommended agent for this disease, with the preferred first-line therapy a combination of doxycycline and azithromycin, which also provides coverage for chlamydia, a common coinfection in gonococcal sexually transmitted infections. Dr. Pickering stressed that providers should seek to obtain culture and susceptibilities of N. gonorrhoeae, rather than relying purely on rapid nucleic acid diagnostics for management.
Dr. Brady provided an overview of the vaccine updates coming in the 2012 Red Book. Highlights of upcoming changes are the new recommendations for HPV vaccination in males, with new recommendations of routine immunization for males beginning at 9 years of age and catch-up immunization in males aged 13 to 21 years. A three-dose regimen of HPV4 has been shown to have 89% efficacy, with an estimated 67% efficacy following one dose of HPV4. This broadening of HPV vaccination strategy begins to address the lack of target coverage in young women to provide effective herd immunity and begins to address the lack of impact in the MSM community with regard to HPV.
Dr. Brady closed with a comment on the ongoing prevalence of pertussis disease in the US and the recent ACIP recommendation that a dose of Tdap be provided during pregnancy (after 28 weeks gestation) and is now recommended over the previously recommended post-natal Tdap delivery.
Stephen Thacker, MD, is a fellow in the Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston.
Disclosure: Thacker reports no relevant financial disclosures.