Volume 33 • Number 9 • September 2012
AAP issues updated guidance
on flu prevention, treatment
by Henry H. Bernstein, D.O., FAAP
Health benefits linked to
While it may seem more like beach weather than
flu season, it is time to start preparing for the 2012-
’ 13 influenza season. The Academy’s updated recommendations for the prevention and treatment
of influenza in children have been released online
aspx) and also will be published in the October
issue of Pediatrics.
Although last season was mild compared with
recent years — with a lower percentage of outpatient
visits for influenza-like illness, lower rates of hospitalizations, and fewer deaths attributed to pneumonia
and influenza — providers still must remain vigilant.
The influenza virus is unpredictable.
Protective immune responses persist throughout
the influenza season, which can have more than one
disease peak and often extends into late spring. There-
fore, vaccine should continue to be offered until its
expiration date. This approach provides ample oppor-
tunity to administer a second dose of vaccine because
children younger than 9 years may require two doses
to confer optimal protection. In addition, with inter-
national travel so common, there is potential exposure
to influenza virtually at all times of the year.
by Lori O’Keefe • Correspondent
The influenza vaccine composition this season
has changed from last season.
The trivalent vaccine for the 2012-’ 13 influenza
season contains the following three virus strains:
•A/California/7/2009 (H1N1)-like antigen
(derived from influenza A [H1N1] pdm09
• A/Victoria/361/2011 (H3N2)-like antigen
• B/Wisconsin/1/2010-like antigen
While the H1N1 antigen is the same, the influenza
A (H3N2) and B antigens differ from those contained
in the 2010-’ 11 and 2011-’ 12 seasonal vaccines.
See Influenza, page 10
AAP policy revises levels of newborn care in the United States
A revised AAP policy statement does not recommend routine circumcision for newborn males,
but it does say current evidence indicates the health
benefits of the procedure outweigh the risks.
The previous circumcision policy statement in
1999 — reaffirmed in 2005 — said there was not
enough evidence for a recommendation either way.
Since then, however, numerous
studies suggest newborn circumcision can reduce the risk of urinary tract infections (UTIs), penile
cancer and some sexually transmitted infections (STIs), including heterosexually
acquired HIV, syphilis, herpes and human papillomavirus (HPV).
“This is a field that has changed quite a bit in the
last 10 years,” said Douglas S. Diekema, M.D.,
FAAP, a member of the AAP Task Force on Circumcision and a bioethics expert. “In 1999, there
was some data suggesting that there were some
small medical benefits to circumcision but, at the
time, there was not a compelling medical reason
to recommend circumcision. So the previous policy
didn’t argue for or against circumcision. However,
now there is much stronger evidence about protective medical benefits associated with circumcision,
so the tone of this policy statement has changed.”
Like last time, the policy statement indicates
that it is important for physicians to regularly
inform parents in an unbiased manner about the
health benefits and risks of circumcision, leaving
the decision about whether to circumcise up to
the parents. Cultural, religious and ethical beliefs
and practices may play a part in parents’ decision
about what is in the best interest of their child,
according to the Circumcision Policy Statement
(Pediatrics. 2012;130:585-586; http://pediatrics.
1989), which also has been endorsed by the American College of Obstetricians and Gynecologists.
See Circumcision, page 4
In this issue
Based on data since 2004 and as part of continuing efforts to improve the outcomes of high-risk infants born
preterm or with serious medical or surgical conditions, a revised statement from the Committee on Fetus and
Newborn now separates neonatal care into Levels I through IV, with no subdivisions. Page 8
AAP president-elect candidates
explain why epigenetics is important to pediatric practice. Cast your
vote online by Oct. 1. Page 7
Honor Roll of Giving Pages 20-30