Tina Q Tan, MD, FAAP, FIDSA, FPIDS

This is a very exciting time for Contemporary Pediatrics®—we are welcoming 4 distinguished additions to our Editorial Advisory Board (EAB):

Vivian Hernandez-Trujillo, MD, FAAP, FAAAAI, FACAAI, 

director of the Division of Allergy & Immunology at Nicklaus Children’s Hospital in Miami, Florida, brings expertise in an important area that many clinicians address with patients daily. Her interests include allergic rhinitis, food allergy, anaphylaxis, and atopic dermatitis.

Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN,

 is a clinical professor of nursing at Baylor University Louise Herrington School of Nursing in Dallas, Texas, and immediate past president of the National Association of Pediatric Nurse Practitioners. A nationally recognized antihuman trafficking advocate, Peck served as founding chair of the Alliance for Children in Trafficking (ACT) and started the ACT Advocates grassroots program, training thousands of nursing professionals at the local, state, national, and international levels to respond to human trafficking, a problem that many clinicians may not be aware could exist in their communities.

 a developmental behavioral pediatrician and clinical professor of pediatrics at the University of North Carolina School of Medicine in Chapel Hill, where she serves as chief of the Section of Development, Behavior, and Learning. She was a contributing author for our March issue, which focused on the national emergency in children’s mental health. She brings a wealth of expertise on adolescent issues that practices are encountering more often.

 is a child and family psychiatrist, Medical Director, Medstar Infant and Early Childhood Clinic, and Associate Professor of Clinical Psychiatry, Medstar Georgetown University Hospital, Division of Child and Adolescent Psychiatry, in Washington, DC.

I also want to extend a special thank-you to Harlan Gephart, MD, who is retiring after 25 years as an active EAB member. We are so grateful for his robust contributions and dedication to Contemporary Pediatrics®—and we wish him all the best.

Be sure to check out the must-read articles in this month’s issue:

Practice Improvement offers an excellent guide on 

how to stay in practice and remain profitable

. Written by EAB member Andrew J. Schuman, MD, this practical piece packs valuable tips for pediatricians.

The Respiratory Disorders/Pediatric Pharmacology section report explains how 

 is furthering the development of vaccines for influenza, respiratory syncytial virus, and other conditions.

The Developmental Disorders section features a timely summary of what clinicians should know when treating eating disorders, which have surged throughout the pandemic.

As always, thank you for providing outstanding care to your patients during these rapidly changing times: and enjoy the warmer weather around the country! As Robin Williams said, “Spring is nature’s way of saying, ‘Let’s party.’ ”

Please stay safe and well. I welcome your suggestions, comments, and questions.

Articles

Dr. Tina Q. Tan welcomes 4 new members to our editorial advisory board, wishes a fond farewell to another board member, and shares her must-read articles from the May issue. 

New members, plus a fond farewell

Food allergies are always a source of concern in children. Because dairy is one of the most common allergies reported in pediatric health, this month our regular contributor, Rachael Zimlich, BSN, RN, covers 

assessing and mitigating this potential problem

On the COVID-19 front, we spoke with William J. Muller, MD, PhD, whose positions include scientific director of clinical and community trials at the Stanley Manne Children’s Research Institute at Ann & Robert H. Lurie Children’s Hospital of Chicago in Illinois. He 

shared with us news on vaccine research for potential new COVID-19 variants

, as well as updates on vaccines being looked at for other infectious diseases—in particular, respiratory syncytial virus (RSV). According to the Centers for Disease Control and Prevention, more than 2 million children contract RSV each year

; last year, pediatric health care providers reported off-season surges, so it is welcome news that a preventive measure may be on the horizon.

Continuing the topic of infectious/respiratory disease, Editorial Advisory Board member Rana F. Hamdy, MD, MPH, MSCE, shares what every pediatrician should know about 

antibiotic stewardship for common respiratory illnesses

Other don’t-miss articles in this month’s issue address 

atopic dermatitis and serious diaper rash in infants

; and describe the intriguing case of an infant girl whose 

right cheek had a warm, red, painful area that was firm to the touch

. To learn the diagnosis, check out our Puzzler section.

As 19th-century Canadian physician William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease.” I believe that doctors who chose pediatrics do this every day: Treat the patient in totality.

Please stay safe and well. As always, I welcome your suggestions, comments, and questions.

1. Respiratory syncytial virus infection (RSV). Centers for Disease Control and Prevention. Updated December 18, 2020. Accessed March 1, 2022. 

https://www.cdc.gov/rsv/research/us-surveillance.htm

Dr. Tan shares what articles she thinks are "can't miss" in the April issue of Contemporary Pediatrics.

Treating the patient

Greetings. The number of children with mental health issues (eg, anxiety, depression, suicidal ideation, worsening attention-deficit/hyperactivity disorder) was skyrocketing for several years before the pandemic, and now, in our third year of grappling with COVID-19, these cases are expected to rise even further. This has culminated in a national mental health crisis in the pediatric population, the likes of which has never been seen before. In this month’s Contemporary Pediatrics®, we focus on this issue in a special section. Must-read articles feature the following:

Guiding principles in managing pediatric mental health issues

. This article, written by Peter S. Jensen, MD, the founder of the REACH Institute, shares guiding principles in caring for children and adolescents with mental health issues.

Screening adolescents for psychosocial concerns

. The authors here offer validated screening measures to assess patients who are presenting with anxiety and/or depression. This piece was cowritten by one of the Editorial Advisory Board members of Contemporary Pediatrics®, Michael S. Jellinek, MD.

Helping children grieve the loss of a caregiver due to COVID-19

. It is estimated that, to date, more than 175,000 children in the United States have lost a parent or caregiver to COVID-19. Offering important details on the support that these children need to cope with their loss, this was written by Candice Jones, MD, another member of the Contemporary Pediatrics® Editorial Advisory Board.

How pediatricians can help mitigate the mental health crisis

. Find out how to proactively support pediatric mental health services, an underfunded area with limited resources.

Thank you for providing outstanding care to your patients during these rapidly changing times. As the title of a book by Robert H. Schuller states, “Tough times never last, but tough people do.”

Please stay safe and well. And as always, I welcome your suggestions, comments, and questions.

Editor-in-chief Dr. Tina Q. Tan shares the articles that shes thinks our must-reads in our special report on the mental health crisis in children.

Battling a national crisis

It is hard to believe that 2022 (Chinese zodiac Year of the Tiger) has started. We begin the year, unfortunately, with COVID-19 still front and center of health care news. The Omicron variant has, as of this writing, spread to more than 110 countries, including here in the United States. This variant contains 30 mutations in the spike protein, which makes it highly transmissible and has been noted to be the most rapidly spreading of all the SARS-CoV-2 variants. The current COVID-19 vaccines provide some protection against this variant, although less than against the other variants. The risk for breakthrough infections and hospitalizations among those that are fully vaccinated is increased with the Omicron variant.

On a more promising note, ever since the US Food and Drug Administration granted emergency use authorization for the Pfizer/BioNTech vaccine for children aged 5 to 11 years, an estimated 20% of those in this age group (as of this writing) have received at least 1 dose of the vaccine. Let’s hope this trend continues.

This month’s January/February issue packs a number of must-read articles:

 features an excellent piece on harmful pharmaceutical excipients (eg, protein stabilizers, solvents, preservatives). We don’t think about this problem very often, but some of these agents can cause adverse reactions in certain patients.

 section offers a sobering look at the gun violence crisis, and particularly the dangers it presents for children in underserved areas. This includes commentary by Steven Selbst, MD, a member of the 

 explores the reasons behind the poor eating habits of adolescents. It also provides some practical recommendations for ways to improve their food choices.

Respiratory and Infections Diseases section

 discusses the crossover symptoms of COVID-19 and influenza, infections that everyone will be seeing in their practices. This piece was cowritten by Russell Libby, MD, also a member of the Contemporary Pediatrics® editorial board.

Thank you for providing outstanding care to your patients during these rapidly changing times. “Wishing you a Happy New Year! May it be filled with new adventures and good fortunes.” (Anonymous.)

Editor-in-chief Tina Q. Tan, MD, FAAP, FIDSA, FPIDS reflects on what 2022 may hold and shares her must-read articles from the January/February issue.

What might 2022 hold?

It is hard to believe that we are about to enter 2022. The Delta variant of SARS-CoV-2 continues to surge throughout the United States and other parts of the world, especially in unvaccinated populations. We have also seen the emergence of the Delta Plus variant, which has been found in at least 44 countries and 41 US states. This new substrain of the Delta variant contains an extra spike protein mutation that may make it easier for the virus to infect individuals because it binds more easily to lung epithelial cells. The World Health Organization and the Centers for Disease Control and Prevention are closely monitoring Delta Plus, along with the Mu and Lambda variants.

In November 2021, the US Food and Drug Administration granted a lower-dose Pfizer/BioNTech COVID-19 vaccine emergency use authorization for children aged 5 to 11 years. This marks an exciting and important development because it allows us to provide protection against COVID-19 to a large population of children (28 million) who returned to in-person learning this past fall.

This month’s journal has a number of must-read articles, including the following:

 and other emerging infectious diseases of which the clinician should be aware. This article was cowritten by Rana F. Hamdy, MD, MPH, MSCE, a Contemporary Pediatrics® Editorial Advisory Board member.

 that are indicated for use in children. This list, found in our pediatric pharmacology section, includes treatments for attention-deficit/ hyperactivity disorder; pain medications including morphine oral solution, bupivacaine liposomal (Exparel) and diclofenac potassium (Zipsor) formulations; and treatment for Zaire ebolavirus (atoltivimab/maftivimab/odesivimab-ebgn [Inmazeb], a fixed-dose combination of 3 monoclonal antibodies).

. This respiratory section report explores the possible causes of the recent surge in out-of-season cases.

A reminder of the importance of suspecting child abuse when physical exam findings and history do not make sense in the context of what is seen. In the 

case described in our dermatology section

, an 18-month-old toddler presented with annular scars.

As always, thank you for providing outstanding care to your patients during these rapidly changing times. As C.S. Lewis stated, “You are never too old to set another goal or to dream a new dream.” I wish everyone peace and happiness as the adventure continues in 2022.

Dr. Tina Q. Tan shares the stories from the December 2021 issues of Contemporary Pediatrics that she considers must reads.

Season’s greetings!

More than 2600 vaccines are in development world- wide for several infectious diseases.

 When they are licensed and become available, some of the vaccines would have a significant effect on various diseases in the United States (Table).

 serotypes continue to cause a significant amount of morbidity and mortality in infants and children. Two increased valency pneumococcal conjugate vaccines (PCV) are in the process of completing phase 3 clinical trials in the pediatric population. PCV15 (Merck) is expected to be licensed by the end of 2021; PCV20 (Pfizer), by the second quarter of 2022. Both vaccines protect against some of the additional serotypes that have emerged as significant causes of pneumococcal infections in infants and children.

The currently recommended meningococcal vaccine schedule is a source of confusion for patients and health care providers. A universal recommendation states that all pre- teens and adolescents should receive the first dose of meningococcal quadrivalent conjugate vaccine (ACW135Y) at age 11 to 12 years, followed by a booster dose at 16 years. However, meningococcal serogroup B vaccines have a shared clinical decision recommendation so that only some adolescents may receive the vaccine. Two pentavalent meningococcal conjugate vaccines that contain meningococcal serotypes AB- CW135Y are completing phase 2 (Pfizer) and phase 3 (GlaxoSmithKline) clinical trials. These vaccines combine the quadrivalent ACW135Y meningococcal and the meningococcal serogroup B vaccines into a single vaccine. This vaccine will simplify administering the recommended meningococcal vaccines to preteens and adolescents, improve vaccination rates, and provide protection against the most common meningococcal serotypes that cause disease.

Respiratory syncytial virus (RSV) usually causes mild, coldlike symptoms. However, this common respiratory virus can lead to severe bronchiolitis or pneumonia, especially in young infants, older adults, and people with serious cardiopulmonary or underlying immunocompromising conditions. Each year, more than 57,000 children and 177,000 older adults are hospitalized with RSV infections.

 Two RSV vaccines are currently in phase 1 (Moderna) and phase 3 (Pfizer) clinical trials. The Pfizer vaccine is being tested in adults 60 years or older, healthy adults aged 18 to 50 years, and pregnant women aged 18 to 49 years and their infants. Moderna’s vaccine, which was created using mRNA technology, is being examined for tolerability and its ability to create antibodies to protect against RSV in individuals ranging from children to older adults. The licensing of an effective RSV vaccine could have a major effect on reducing the number of hospitalizations caused by this virus.

An estimated 1 out of every 200 babies is born with a congenital cytomegalovirus (CMV) infection; of those infected babies, 1 out of 5 babies will have long-term health problems. A pregnant woman can pass CMV to her fetus following primary infection, reinfection with a different CMV strain, or reactivation of a previous infection during pregnancy. The risk of transmission for primary infection is 30% to 40% in the first and second trimesters and 40% to 70% in the third trimester. The risk of transmission following nonprimary infection is much lower (3%). Approximately 40% to 60% of symptomatic infants with congenital CMV infection have permanent sequelae. In addition, 10% to 15% of infants with asymptomatic CMV infection will have some type of permanent impairment. Congenital CMV infection is the leading nongenetic cause of sensorineural hearing loss in children in the United States, resulting in an estimated 21% of all hearing loss at birth and 25% of childhood hearing loss by 4 years of age.

 Moderna is getting set to start a phase 3 study to evaluate the efficacy of its mRNA vaccine against primary CMV infection in a population that includes women of childbearing age, with the goal of a vaccine that can be administered to pregnant women.

Human metapneumovirus and parainfluenza 3 vaccines

Human metapneumovirus (HMPV) and human parainfluenza virus (HPIV)-3 are common respiratory viruses that can cause upper and lower respiratory tract disease in people of all ages, especially young children, older adults, and immunocompromised people, in whom disease may be severe. Although HPIV-1 and HPIV-2 both cause croup, HPIV-3 is more often associated with bronchiolitis, bronchitis, and pneumonia. Moderna has developed a combination HMPV and HPIV-3 vaccine that is nearing the end of its phase 1 clinical trials in adults. Data from the trials show that the different doses of the vaccine were immunogenic and well tolerated. A phase 1b trial is planned to look at the vaccine’s immunogenicity in seropositive toddlers who have previously been exposed to these viruses.

 (GBS) is a common bacterium that is often carried in the intestines or lower genital tract. It may cause serious invasive disease (eg, bacteremia, pneumonia, meningitis, osteoarticular infections) in newborns and young infants, anyone with an immunocompromising condition, and the elderly. Pfizer has completed a phase 1 and 2 dose-escalation trial to evaluate the safety and immunogenicity of a hexavalent conjugate GBS vac- cine in nonpregnant adults aged 18 to 49 years. The findings showed that the vaccine was well tolerated in healthy adults and elicited robust immune responses for all dose levels and formulations tested, which persisted for 6 months after vaccination. The next step will be to perform a trial in pregnant women.

More than a dozen vaccines are in development and show promise for infections commonly seen in the pediatric population. Soon, we hope to use these new tools in our offices and at our hospitals.

1. WHO vaccine pipeline tracker. World Health Organization. Accessed Sept 5, 2021. 

https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines

2. Health products in the pipeline from discovery to market launch for all diseases. World Health Organization. Updated September 2021. Accessed September 5, 2021. 

https://www.who.int/observatories/global-observatory-on-health-research-and-development/monitoring/health-products-in-the-pipeline-from-discovery-to-market-launch-for-all-diseases

3. Respiratory syncytial virus infection (RSV). Centers for Disease Control and Prevention. Accessed October 1, 2021. 

https://www.cdc.gov/rsv/research/us-surveillance.html

4. Fowler KB. Congenital cytomegalovirus infection: audiologic outcome. 

 2013;57(suppl 4):S182-S184. doi:10.1093/cid/cit609

5. Absalon J, Segall N, Block SL, et al. Safety and immunogenicity of a novel hexavalent group B streptococcus conjugate vaccine in healthy, non-pregnant adults: a phase 1/2, randomised, placebo-controlled, observer-blinded, dose-escalation trial. 

 2021;21(2):263-274. doi:10.1016/S1473-3099(20)30478-3

What we can look forward to in preventing infectious diseases.