What Will Rate in '08 as Top Concerns?

▸ 6. Infections from exotic pets will continue to rise. Many families with young children continue to own reptiles and other unusual animals, despite AAP recommendations against it. Every well-child evaluation should include a question about pet ownership. There is cause for concern if the family has an animal other than a dog, cat, small rodent, or fish. Here is a question-based mnemonic borrowed from the Black Pine Animal Park, an exotic animal rescue organization in Indiana:

G: How much will this animal Grow?

O: How Old can this animal live to be?

O: Will this animal create Odors I won't like?

D: What kind of Diet does this animal require?

L: Can this animal be Lethal to me and others?

I: Is it Illegal for me to own this animal?

F: Just how much Fun will it really be to own this animal?

E: What are the Environmental requirements for this animal?

▸ 7. Rotavirus cases will decrease. There is high hope that the rotavirus vaccine will have an impact on hospitalization and emergency visit rates for rotavirus disease. Currently 1 in 17 children infected with rotavirus becomes ill enough to visit the emergency department, and 1 in 65 is hospitalized. If, as anticipated, the vaccine eliminates 98% of such severe cases, it will be easy to appreciate its impact.

▸ 8. Vaccination coverage will be high, but still not high enough. Although the 2004 numbers showed the highest rates ever recorded, about 20% of children younger than 2 years are still inadequately immunized. New strategies will be needed for 2008, but they must be designed carefully.

A court in Maryland recently ordered that parents be sent to jail if their children are not immunized. This did not go over well with the public and many physicians questioned the approach.

▸ 9. Methicillin-resistant Staphylococcus aureus cases will continue to rise. Unfortunately, clindamycin-resistance rates will increase in 2008, making empiric treatment of invasive diseases such as osteomyelitis increasingly difficult.

▸ 10. Active surveillance for MRSA will become a reality for the hospitalized patient, at least for children in high-risk settings such as the intensive care unit. Where and how often children will be cultured (nasal/axilla/rectal?weekly/while hospitalized?) will vary from institution to institution. However, all institutions will attempt to identify those patients already colonized with MRSA at the time of hospitalization and will utilize barrier precautions to prevent hospital spread.