The Link - October 2024

As we prepare for another busy respiratory virus season, it is important to review preventive measures for patients and families against some of the most common and contagious respiratory viruses. Last month’s Link issue covered the updated 2024 recommendations for influenza and COVID-19 vaccines. When it comes to respiratory syncytial virus (RSV), this year marks the second in history that providers have had the opportunity to protect infants by offering either maternal RSV vaccination (Abrysvo) or long-acting RSV monoclonal antibody (nirsevimab). Abrysvo is recommended for pregnant individuals at 32 to 36 weeks’ gestation to prevent lower respiratory tract disease (LRTD) and severe LRTD from RSV in infants from birth to age 6 months. Nirsevimab is currently recommended to infants <8 months of age born during, or entering, their first RSV season – unless they were born 14 or more days after their mother received Abrysvo. Nirsevimab is also recommended for certain infants and toddlers aged 8-19 months at increased risk for severe RSV who are entering their second RSV season.

Sexually active adolescents are at risk for underdiagnosis and inadequate treatment of sexually transmitted infection (STI). In the United States, there are over 2.5 million new STI cases per year,¹ and people ages 15-24 account for half of STI cases.² This figure is an underestimate as it includes only the most common notifiable diseases: gonorrhea, chlamydia and syphilis. Most concerning perhaps is that from 2018 to 2022 syphilis cases rose 78.9%.¹ Despite widespread STI screening recommendations,³ only roughly half of all sexually active young adult females and less than a quarter of sexually active young adult males report receiving STI testing.⁴ Importantly, many of these STIs can be asymptomatic; 50%-70% of people with chlamydia and 40%-50% of people with gonorrhea do not have symptoms.² Therefore, it is crucial for providers to practice evidence-based testing and treatment of STIs to help prevent lasting effects of untreated disease.

The incidence of M. pneumoniae infections is cyclical with epidemic increases usually seen every three to five years. A review of NSSP data by the CDC showed a significant decrease (from 1.15% of all pneumonia-related [all ages] ED visits to 0.35% of visits) in M. pneumoniae from prior to the COVID-19 pandemic (January 2018-April 2020) to the pandemic period (May 2020-August 2023). Incidence appeared to be again increasing September 2023-December 2023 (0.89% of visits). More recently, M. pneumoniae was reported in 1.8% of visits by August 2024.

The practice of pediatric medicine and surgery is permeated by the reality that children of all ages represent a group characterized by vulnerability. This reality has ethical significance. Not only is it inherent in the ascertainment of exposing vulnerable populations such as children to risk in research, but it also characterizes the child – an individual with great potential but who requires time, guidance, nurturing, protection and the provision of basic needs such as food, clothing, shelter, education and health care.

For years, the standard of care for community-acquired pneumonia (CAP) in children often involved a 10-day course of antibiotics. However, recent studies challenging this approach are highlighting the efficacy of antibiotic regimens as short as three days. This shift toward short-course antibiotic therapy is significant not only for maintaining effective treatment courses while improving patient experience but also for mitigating the growing global problem of antimicrobial resistance. Understanding and implementing these updates is essential in delivering evidence-based care while promoting antibiotic stewardship.

…Maybe both!

Attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders frequently co-occur in children, presenting a complex diagnostic challenge for clinicians. Studies indicate that up to 50% of children with ADHD also meet criteria for an anxiety disorder, highlighting the need for careful assessment and differentiation. Although ADHD and anxiety often appear together in children, their symptoms can be quite similar, making it challenging for clinicians to distinguish between the two in practice.