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RED BOOK\ue000 : 2006
Author: Committee on Infectious Diseases
American Academy of Pediatrics
Larry K. Pickering, MD, FAAP, Editor

Carol J. Baker, MD, FAAP, Associate Editor
Sarah S. Long, MD, FAAP, Associate Editor
Julia A. McMillan, MD, FAAP, Associate Editor

American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60007-1098


The Committee on Infectious Diseases of the American Academy of
Pediatrics (AAP) is dedicated to providing practitioners with the most current
and accurate information available. Because the practice of pediatric
infectious diseases is changing rapidly and because of the emergence of new
infectious diseases and immunizations, the ability to obtain information quickly
is paramount. Although the Red Book is updated every 3 years, practitioners
who care for children should visit periodically the AAP Web site
(www.aap.org) and the Red Book Online Web site (www.aapredbook.org),
where interim updates will be provided.

The Committee on Infectious Diseases relies on information and advice from
many experts as evidenced by the lengthy list of contributors. We especially
are indebted to the many contributors from other AAP committees, the
Centers for Disease Control and Prevention, the Food and Drug
Administration, the National Institutes of Health, the Canadian Paediatric
Society, the World Health Organization, and many other organizations that
have made this edition possible. In addition, many suggestions made by
individual AAP members to improve the presentation of information on
specific issues have been taken into account under the able leadership of
Larry K. Pickering, MD, editor, and associate editors Carol J. Baker, MD,
Sarah S. Long, MD, and Julia A. McMillan, MD. We also are indebted to
Edgar O. Ledbetter, MD, who spent many hours gathering the slide materials
that are part of the electronic versions of the Red Book and provided other
invaluable assistance with this edition.

As noted in previous editions of the Red Book, some omissions and errors are
inevitable in a book of this type. We hope that AAP members will continue to
assist the committee actively by suggesting specific ways to improve the
quality of future editions.

Keith R. Powell, MD, FAAP
Chairperson, Committee on Infectious Diseases

The Committee on Infectious Diseases (COID) of the American Academy of
Pediatrics (AAP) is responsible for developing and revising guidelines of the
AAP for control of infectious diseases in children. At intervals of approximately
3 years, the committee issues the Red Book: Report of the Committee on

Infectious Diseases, which contains a composite summary of current AAP

recommendations concerning infectious diseases in and immunizations for
infants, children, and adolescents. These recommendations represent a
consensus of opinions developed by members of the committee in
conjunction with liaison representatives from the Centers for Disease Control
and Prevention (CDC), the Food and Drug Administration (FDA), the National
Institutes of Health, the National Vaccine Program Office, the Canadian
Paediatric Society, Red Book consultants, and numerous collaborators. This
edition is based on information available as of January 2006.

Unanswered scientific questions, the complexity of medical practice, the
explosion of new information, and inevitable differences of opinion among
experts result in inherent limitations of the Red Book. In the context of these
limitations, the committee endeavors to provide current, relevant, and
defensible recommendations for prevention and management of infectious
diseases in infants, children, and adolescents. In some cases, other
committees and experts may differ in their interpretation of data and resulting
recommendations. In some instances, no single recommendation can be
made because several options for management are equally acceptable.

In making recommendations in the Red Book, the committee acknowledges
these differences in viewpoints by use of the phrases "most experts
recommend..." and "some experts recommend..." Both phrases indicate valid
recommendations, but the first signifies more support among experts, and the
second, less support. Hence "some experts recommend..." indicates a
minority view that is based on data and/or experience and is sufficiently valid
to warrant consideration.

Inevitably in clinical practice, questions arise that cannot be answered on the
basis of currently available data. In such cases, the committee attempts to
provide guidelines and information that, in conjunction with clinical judgment,
will facilitate well-reasoned decisions. We appreciate the questions, different
perspectives, and alternative recommendations that we have received, and
encourage any suggestions or correspondence that will improve future
editions of the Red Book. Through this process, the committee seeks to
provide a practical and authoritative guide for physicians and other health
care professionals in their care of infants, children, and adolescents.

To aid physicians and other health care professionals in assimilating current
changes in the recommendations in the Red Book, a list of major changes has

been compiled (see Summary of Major Changes, p xxix). However, this listing
does not include many changes of lesser importance, and health care
professionals should consult individual chapters and sections of the book for
current guidelines. In addition, new information inevitably begins to outdate
some recommendations in the Red Book, and necessitates that health care
professionals remain informed of new developments and resulting changes in
recommendations. Between editions, the AAP publishes new
recommendations from the committee inPediatrics, in AAP News, and on the

Red Book Online Web site (www.aapredbook.org). In this edition, we have

provided Web site addresses throughout the text to enable early access to
new information. For the most up-to-date list of important Red Book errata,
please visit the Red Book Online Web site atwww.aapr edbook.org. The list of
errata is available in standard HTML format and as an easy-to-navigate and
easy-to-print PDF file and is freely accessible to all visitors to the site. OnRed

Book Online, you can sign up for e-mail alerts to be notified automatically
when new errata have been announced.

When using antimicrobial agents, physicians should review the package
inserts (product labels) prepared by manufacturers, particularly for information
concerning contraindications and adverse reactions. No attempt has been
made in the Red Book to provide this information, because it is readily
available in the Physicians' Desk Reference, online (www.pdr.net), and in
package inserts (product labels). As in previous editions, recommended
dosage schedules for antimicrobial agents are given (see Section 4,

Antimicrobial Agents and Related Therapy). Recommendations in theRed
Book for drug dosages may differ from those of the manufacturer in the

package insert. Physicians also should be familiar with information in the
package insert for vaccines and immune globulins as well as
recommendations of other committees (see Sources of Vaccine Information,
This book could not have been prepared without the dedicated professional
competence of Edgar O. Ledbetter, MD, who served as the Red Book
reviewer appointed by the AAP Board of Directors, who led the charge in
gathering and organizing the new slide materials for the electronic part of the

Red Book, and who provided valuable suggestions and support. The AAP

staff has been outstanding in its committed work and contributions,
particularly Martha Cook and Alison Siwek, managers, who served as the
administrative directors for the committee and coordinated the preparation of
the Red Book; Jennifer Pane, senior medical copy editor; Darlene Mattefs,
department assistant; Barbara Drelicharz, division assistant; and Mark
Ruthman and Mark Grimes, Department of Marketing, who make theRed

Book Online and other Red Book products possible. Special thanks are given

to Stephanie Renna, assistant to the editor, for her work, patience, and
support. Marc Fischer, MD, and Douglas Pratt, MD, of the CDC and FDA,
respectively, devoted a great deal of time and effort in providing input from
their organizations. I am especially indebted to the associate editors Carol J.
Baker, MD, Sarah S. Long, MD, and Julia A. McMillan, MD, for their expertise,
tireless work, good humor, and immense contributions in their editorial and
committee work. Georges Peter, MD, and Margaret Rennels, MD, continue to
provide constant support and advice. Members of the committee contributed
countless hours and deserve appropriate recognition for their patience,

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