• Is a new cholera vaccine is needed? The devastating effect of the ongoing cholera outbreak in Haiti has raised discussion regarding the need for a more efficacious and readily available cholera vaccine. As of late December, 58,190 hospitalizations and 2,535 deaths have been reported in Haiti. Check out an eloquently written commentary by Dr. Peter J. Hotez, president of the American Society of Tropical Medicine and Hygiene, coauthored with Dr. Matthew K. Waldor and Dr. John D. Clemens, detailing the potential role of the United States in stockpiling and distributing cholera vaccine in cholera-distressed regions of the world (N. Engl. J. Med. 2010; 363:2279-82).
• Will we have pertussis outbreaks because of reduced vaccine efficacy related to improper storage? Baylor College of Medicine researchers have confirmed that inadvertent freezing of DTaP vaccine (which inactivates the acellular pertussis component) occurred frequently when 54 refrigerators that were used in the Texas county health system were evaluated. Typically, this occurred on weekends and at night when the appliances became excessively cold because they were not being opened for retrieval of doses. Investigators were able to correlate the risk of frozen vaccine with increased pertussis rates in specific regions of the community (Am. J. Public Health 2011;101:46-7).
These findings actually confirm information that has been known for many years, but the study is the first to outline the potential scope of the problem in the United States. Currently, we require only twice-daily measurements of refrigerator temperatures. Could tackling the problem of continued pertussis outbreaks be as simple as better temperature regulation?
• Could standard-dose amoxicillin return for treating otitis media? The epidemiology of pneumococcal disease will continue to evolve following implementation of PCV13. In a few more years, we could potentially see eradication of multidrug resistant serotype 19A with replacement by other serotypes that are penicillin susceptible. Dr. Doug Swanson from my section has been serotyping our strains for several years, and now is seeing previously uncommon types that are nearly all penicillin susceptible.
• IDSA guidelines for treatment of pediatric community-acquired pneumonia are coming your way soon. They are evidence based and have been formulated specifically for the pediatric patient. Look for highlights to include guidance regarding situations in which to obtain blood culture and chest radiography, the first-line agent of choice, and how to identify and handle the patient with complicated disease.
• More complicated Clostridium difficile–associated diarrhea (CDAD) makes its way to the pediatric patient. About 2 years ago, we looked at several years of data to document the epidemiology of CDAD in our pediatric population, and found that most were in patients with underlying comorbid conditions and an association with antecedent beta-lactam antibiotics – the more conventional epidemiologic features. At that point, we had not encountered many cases of severe CDAD that was associated with increased mortality and a reduced effectiveness of metronidazole, as have been seen by adult practitioners in previously healthy outpatients who had not received antecedent antibiotics.
But recently, we cared for an otherwise-healthy child with fulminant colitis who was referred for concern that her disease would necessitate emergency colectomy. Fortunately, she recovered without surgery. I fully suspect that this diagnosis will increase in incidence, and that community-acquired CDAD without prior antibiotic use will become more familiar to the pediatric practitioner.
My best wishes to you all for a year filled with goodness and peace!
This column, "ID Consult," regularly appears in Pediatric News, an Elsevier publication. Dr. Jackson is chief of pediatric infectious diseases at Children’s Mercy Hospital, Kansas City, Mo., and professor of pediatrics at the University of Missouri–Kansas City. Dr. Jackson said she had no relevant financial disclosures to make.