Volume 33 • Number 12 • December 2012
Recommendations for MMR vaccine updated
by Jane F. Seward, M.B.B.S., M.P.H., FAAP
• Laboratory confirmation of measles or mumps
is acceptable presumptive evidence of immunity.
AAP policy: Pesticides
pose serious health risks
The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and
Prevention voted unanimously in October to
approve changes to its recommendations for the
measles-mumps-rubella (MMR) vaccine. The
changes focus on evidence of immunity to measles
and mumps, vaccination of HIV-infected people,
and use of immune globulin (IG) for measles post-exposure prophylaxis.
The provisional ACIP recommendations will be
available at www.cdc.gov/vaccines/recs/provisional/
by Patrick M. O’Connell • Digital Content Editor
Evidence of immunity
The criteria for evidence of immunity to measles
and mumps for children and adults include the fol-
• Documentation of physician-diagnosed measles
or mumps no longer is acceptable presumptive
evidence of immunity.
Vaccination of HIV-infected people
The recommendations for vaccination of HIV-infected people were revised to simplify language
(remove symptomatic and asymptomatic), to recommend that the second dose of MMR vaccine be given
routinely at 4 to 6 years of age, and to recommend revaccination of children who got MMR vaccine before
effective antiretroviral therapy (ART) was established.
• Two doses of MMR vaccine should be given to
HIV-infected people ages 12 months and older
who do not have evidence of current severe
immunosuppression. Absence of severe
immunosuppression is defined as CD4 percentages ≥15% for six months or longer for children
ages 5 years and younger, and CD4 percentages
≥15% and CD4 count ≥200 cells/mm3 for six
months or longer for those older than 5 years
See MMR, page 8
Pulitzer prize-winning cartoonist Walt Handelsman (inset) gave the keynote address at the 2012 AAP National Conference & Exhibition Oct. 20-23 in New Orleans. Below is a sample of Handelsman’s work that he used to illustrate his presentation, “A Cartoonist’s Look at the World: From Politics to Kids and Everywhere in Between.” For more conference highlights, turn to pages 14 and 15.
From city apartment buildings
to vast expanses of farmland, pesticides are used widely across the
country. But the chemicals affect
more than cockroaches and weeds, rats and mold.
Studies show prevalent pesticide usage has
broad-reaching and serious health consequences,
affecting children and adults. Exposure to pesticides, whether at home, school or through the
food and water systems, causes both acute and
chronic effects in children.
A new AAP policy statement, Pesticide Exposure
in Children, (Pediatrics. 2012;130:e1757-e1763,
542/peds.2012-2757), recommends that physicians educate themselves about the dangers of pesticides — encompassing any chemical used on
unwanted plants, insects, rodents or mold in buildings, backyards, farm fields and school yards. An
accompanying technical report (Pediatrics.
2758), examines the ramifications of pesticides
and outlines their clear health hazards, especially
for young children. Prenatal, household and occupational exposures appear to pose the biggest risks.
“The goal with this is to raise awareness among
pediatricians of acute pesticide poisoning and how
(conditions) might present,” said James R. Roberts,
M.D., M.P.H., FAAP, a former member of the
AAP Council on Environmental Health Executive
Committee and a co-author of the policy statement
and technical report.
An ounce of prevention
Studies link the chemicals to leukemia, brain
tumors, neurodevelopmental disorders and impaired cognitive development. Children are par-
See Pesticides, page 4
In this issue
Puberty early in boys, too
A Pediatric Research in Office Settings study reveals that boys
start puberty earlier now. Page 9
Antivirals for high-risk patients
Timely use of antivirals is paramount to protecting patients at
greatest risk of complications from influenza disease. Infectious
disease experts review the reasons behind the AAP recommen-
dations. Page 12