title: Immunizations, neonatal jaundice, and animal-induced injuries.
abstract: OBJECTIVE
  To concisely review data published over the past year on three topics pertinent to the practicing pediatrician: immunizations, neonatal jaundice, and animal-induced injuries.
  
  
  RESULTS
  Updates on immunizations, including varicella and pneumococcus in the post-vaccine era, use of a polyvalent conjugated meningococcal vaccine, and influenza vaccination during a vaccine shortage are discussed. Mortality and morbidity from varicella, and risk of invasive disease from pneumococcal infections have declined. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention released guidelines for the use of a tetravalent meningococcal conjugate vaccine in adolescents 11 years and older. Infants at younger gestational age are at higher risk for developing hyperbilirubinemia. The American Academy of Pediatrics has released new guidelines emphasizing breastfeeding, systematic pre-discharge assessment for risk factors, early follow-up and intervention. Use of home nursing services in the postnatal period is cost-effective. Although the incidence of rabies is low, many receive postexposure prophylaxis. Spider bites cause fewer systemic effects in children than adults. Pet reptile carriage of salmonella necessitates handwashing after handling of animals.
  
  
  CONCLUSIONS
  Recommendations for adolescent meningococcal vaccination, and the impact of varicella and pneumococcal immunization on our communities reflect an evolution in our management of infectious diseases. The latest practice guidelines on hyperbilirubinemia emphasize close follow-up of all newborns after postpartum discharge and even more careful evaluation of those infants near term. Education on rabies prophylaxis, spider bites, and salmonella from pet reptiles should focus on judicious use of resources and the proper handling of pets.
authors.affiliation: Harvard Combined Program in Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. molee@aya.yale.edu
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Lee
authors.forename: Henry H
authors.initials: HH
authors.lastname: Bernstein
mesh_terms: D000818:Animals; D019433:Chickenpox Vaccine; D000075202:Contraindications; D005865:Gestational Age; D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines; D006801:Humans; D006932:Hyperbilirubinemia / Q000628:therapy; D017589:Immunization Programs; D007231:Infant, Newborn; D007252:Influenza Vaccines; D007567:Jaundice, Neonatal; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines; D017410:Practice Guidelines as Topic; D011818:Rabies / Q000453:epidemiology; D012480:Salmonella Infections / Q000209:etiology; D012911:Snakes; D001098:Spider Bites / Q000628:therapy; D014481:United States / Q000453:epidemiology; D014611:Vaccination; D018074:Vaccines, Conjugate; D014777:Virus Diseases / Q000517:prevention & control*
chemical_list: D019433:Chickenpox Vaccine; D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines; D007252:Influenza Vaccines; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate