Volume 32 • Number 10 • October 2011
Data on febrile seizures prompt
update of varicella vaccine guidance
25 years of PROS research
changes the way
pediatrics is practiced
by David W. Kimberlin, M.D., FAAP
The Academy has updated its recommendations for use of quadrivalent and monovalent varicella vaccines in children
based on new data regarding the risk of febrile seizures
in young children.
The policy statement, Prevention of Varicella: Update
of Recommendations for Use of Quadrivalent and Monovalent Varicella Vaccines in Children, is available at
30.full and was published in the September issue of
In the statement, the Academy reiterates its support
for two doses of varicella vaccine. It also states that
the first dose of varicella-containing vaccine given at
12 through 15 months of age can be either measles-mumps-rubella (MMR) and varicella vaccines administered concurrently but at separate sites or
(MMRV) vaccine. Use of separate MMR and varicella
vaccines avoids a slight increase in the risk of febrile
seizures following MMRV vaccine administration.
However, separate vaccines increase the pain associated
with an extra injection and increase the risk of an
infant falling behind schedule if all vaccines indicated
at that visit are not given.
The risk of febrile seizures is not higher in older
children receiving the second dose of MMRV. Therefore, MMRV vaccine generally is preferred for the
second dose at any age, in keeping with the Academy’s
longstanding policy to use combination vaccines
when feasible to reduce the number of painful injections and to improve immunization rates (
Children with a personal or family history of
seizures generally should be vaccinated with MMR
and varicella vaccines because the risks of using
MMRV vaccine in this group of children generally
outweigh the benefit of the quadrivalent vaccine.
Utilization of the varicella vaccine has resulted in
near elimination of varicella-related deaths in the
United States, according to the Centers for Disease
See Varicella vaccines, page 11
by Kristy Kennedy• Correspondent
Within the next six months, findings from a
study on the onset of puberty in thousands of
boys will be released to the public.
The laboratories that conducted the study?
Pediatric offices across the country.
The results will be the latest in the AAP Pediatric Research in Office Settings (PROS) program, which is celebrating its 25th anniversary.
Since 1986, more than 30 national studies on
pediatric primary care issues have been conducted
through information gathered from practicing
“We’re trying to address things that are really
everyday issues that affect our parents and
patients,” said Stephen Yano, M.D., FAAP, a
pediatrician who participates in PROS research.
Back in the 1980s, most research on child
health was done in academic medical centers,
drawing mostly from urban, disadvantaged pop-
ulations not typical of most of the United States.
“The research being done on primary pediatric
care was not really being informed by the wisdom
of people delivering the care,” said Richard C.
(Mort) Wasserman, M.D., M.P.H., FAAP, PROS
director since 1990. “PROS shone a light on an
area of health care not being studied.”
Be aware of medicolegal risks in caring for depressed newborns
See PROS, page 19
AAP Immediate Past Presi-
In this issue
dent Judith S. Palfrey, M.D.,
FAAP, steps into new role as
executive director of first lady
Michelle Obama’s Let’s Move!
See page 50.
Revised neonatal resuscitation guidelines create several new legal exposures for pediatricians in the
delivery room and underscore the need to complete the Neonatal Resuscitation Program course every
two years. Among the major changes in the sixth edition of the guidelines is increased focus on ventilation,
such as that pictured here. Revised guideline highlights and advice on risk prevention are on page 10.
AAP awardees in the spotlight
More than 60 high achievers are recognized for their accomplishments. Pages 33-40
HPV vaccine coverage lags behind
meningococcal, Tdap vaccines
Read a review of the data and expert insight into why the
rate may be lower for the human papillomavirus vaccine.