Link Newsletter - January 2024

“The spit-up never ends!” As pediatricians, we commonly hear exclamation like this during our day-to-day workflow, as we are asked to differentiate normal physiology from pathology. Infantile gastroesophageal reflux (GER) is a common phenomenon experienced by 70%-85% of infants within the first two months of life. For most patients, dietary changes and medication are not needed, as over 95% of patients will “grow out” of their GER without complication by 1 year of age. However, those who present with more concerning or persistent findings require prompt management to prevent complications such as inadequate weight gain or mucosal injury.^1,2 Differentiating GER from true gastroesophageal reflux disease (GERD), then, is important.

What precautions should be taken when immunizing a patient with a bleeding disorder? Should vaccines be held in a child with respiratory symptoms? When is a vaccine truly contraindicated? The start of a new year provides a valuable opportunity to revisit the Advisory Committee on Immunization Practices (ACIP) best practice guidelines for vaccination practices, including valid instances when deferring vaccination is necessary—and commonly misperceived instances when it is not. The comprehensive list of ACIP’s contraindications and precautions for commonly used vaccines, along with conditions often incorrectly perceived as contraindications or precautions, can be found here.¹

Anthrax is now extremely rare in humans in the United States, with only a single case confirmed from 2012-2018. However, anthrax continues to occur, sometimes in significant outbreaks, in other parts of the world, especially where vaccination of livestock against anthrax is less available or less practiced. In eastern Africa, there has been a recent outbreak in five countries (Kenya, Malawi, Uganda, Zambia and Zimbabwe) involving a reported nearly 1,200 human cases and 20 deaths. These victims are assumed to have been infected mostly by contaminated meat.