What We'll Be Discussing in 2011

▸ Will we have pertussis outbreaks because of reduced vaccine efficacy related to improper storage? Researchers have confirmed that inadvertent freezing of DTaP vaccine (which inactivates the acellular pertussis component) occurred frequently in 54 refrigerators used in the Texas county health system. 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 (Am. J. Public Health 2011;101:46-7). 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, when we looked at several years of data to document the epidemiology of CDAD in our pediatric population, we had not encountered many cases of severe CDAD that was associated with increased mortality and a reduced effectiveness of metronidazole.

Recently, however, 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 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!