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 Red Book®
Am P
er olic
of ica y o
Pe n A f th

Red
di ca e
at d

Red
ric em
s y
2021–2024 Report of the Committee on

Book®
Infectious Diseases, 32nd Edition
American Academy of Pediatrics Committee on Infectious Diseases

Book®
Editor: David W. Kimberlin, MD, FAAP
Associate Editors: Elizabeth D. Barnett, MD, FAAP; Ruth Lynfield, MD, FAAP;
and Mark H. Sawyer, MD, FAAP 32nd Edition
For more than 8 decades, the Red Book ®
US Food and Drug Administration, and
has set standards of quality, authority, hundreds of physician contributors.
and value that no other infectious disease In all, more than 1,000 hands have touched
resource can match. the Red Book prior to its publication! The
The 32nd edition provides the latest
evidence-based guidance on pediatric
Red Book is like having your own personal
infectious disease consultant available to you,
2021–2024
infections and vaccinations based on
the recommendations of the American
on your bookshelf, at all times. Report of the 2021–2024
Red Book ® Online
Academy of Pediatrics (AAP) Committee on Committee on
Infectious Diseases and AAP policy, as well
This powerful problem solver helps keeps
you current with the latest infectious disease Report of the Committee
as the combined expertise of the Centers
developments from the AAP. Infectious
for Disease Control and Prevention, the
Key features Diseases on Infectious Diseases
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 Red Book:
2021–2024 Report of the Committee
on Infectious Diseases
32nd Edition

Author: Committee on Infectious Diseases,

American Academy of Pediatrics
David W. Kimberlin, MD, FAAP, Editor
Elizabeth D. Barnett, MD, FAAP, Associate Editor
Ruth Lynfield, MD, FAAP, Associate Editor
Mark H. Sawyer, MD, FAAP, Associate Editor
American Academy of Pediatrics
345 Park Blvd
Itasca, IL 60143

Suggested citation: American Academy of Pediatrics. [Chapter title.] In: Kimberlin DW, Barnett
ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. Itasca, IL:
American Academy of Pediatrics: 2021[page numbers]

Red_Book_2020_FM.indd 1 30/03/21 11:58 AM

 32nd Edition
1st Edition – 1938
2nd Edition – 1939
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ISSN No. 1080-0131
ISBN No. 978-1-61002-521-8
eBook: 978-1-61002-522-5
MA1024
Quantity prices on request. Address all inquiries to:
American Academy of Pediatrics
345 Park Blvd
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or Phone:
1-888-227-1770 Publications

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard
of medical care. Variations, taking into account individual circumstances, may be appropriate.
Publications from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal
(AAP) and external reviewers. However, publications from the American Academy of Pediatrics may not reflect
the views of the liaisons of the organizations or government agencies that they represent.
The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the
development of the content of this publication.
© 2021 by the American Academy of Pediatrics. All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, without prior written permission from the publisher. Printed in the United States of
America.

3-358/0421 1 2 3 4 5 6 7 8 9 10

Red_Book_2020_FM.indd 2 30/03/21 11:58 AM

 iii

Committee on Infectious Diseases

2018-2021
Yvonne A. Maldonado, MD, FAAP, Flor M. Munoz, MD, MSc, FAAP
Chairperson Dawn Nolt, MD, MPH, FAAP
Sean T. O’Leary, MD, MPH, FAAP, Vice Ann-Christine Nyquist, MD, MSPH, FAAP
Chairperson Adam J. Ratner, MD, MPH
Ritu Banerjee, MD, PhD, FAAP Mark H. Sawyer, MD, FAAP, Red Book
Elizabeth D. Barnett, MD, FAAP, Red Book Associate Editor
Associate Editor Samir S. Shah, MD, MSCE, FAAP
James D. Campbell, MD, MS, FAAP William J. Steinbach, MD, FAAP
Mary T. Caserta, MD, FAAP Ken Zangwill, MD, FAAP
Jeffrey S. Gerber, MD, PhD, FAAP Theoklis E. Zaoutis, MD, MSCE, FAAP
Athena P. Kourtis, MD, PhD, MPH, FAAP
Ruth Lynfield, MD, FAAP, Red Book
Associate Editor
Ex Officio
David W. Kimberlin, MD, FAAP, Red Book Editor
Henry H. Bernstein, DO, MHCM, FAAP, Red Book Online Associate Editor
H. Cody Meissner, MD, FAAP, Visual Red Book Associate Editor
Liaisons
Amanda C. Cohn, MD, FAAP Centers for Disease Control and Prevention
Karen M. Farizo, MD US Food and Drug Administration
Marc Fischer, MD, FAAP Centers for Disease Control and Prevention
Natasha B. Halasa, MD, MPH, FAAP Pediatric Infectious Disease Society
David Kim, MD Office of Infectious Disease and HIV/AIDS
Policy (OIDP), Office of the Assistant
Secretary for Health, US Department of
Health and Human Services
Nicole Le Saux, MD, FRCP(C) Canadian Paediatric Society
Eduardo López Medina, MD, MSc Sociedad Latinoamericana de Infectología
Pediátrica (SLIPE)
Scot B. Moore, MD, FAAP AAP Committee on Practice and
Ambulatory Medicine
Neil S. Silverman, MD American College of Obstetricians and
Gynecologists
Jeffrey R. Starke, MD, FAAP American Thoracic Society
James J. Stevermer, MD, MSPH, FAAFP American Academy of Family Physicians
Kay M. Tomashek, MD, MPH, DTM National Institutes of Health
Staff
Jennifer M. Frantz, MPH

Red_Book_2020_FM.indd 3 30/03/21 11:58 AM

 iv

Collaborators
Francisca Abanyie, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Mark J. Abzug, MD, University of Colorado School of Medicine and Children’s Hospital
Colorado, Aurora, CO
Anna M. Acosta, MD, Centers for Disease Control and Prevention, Atlanta, GA
Edward P. Acosta, PharmD, University of Alabama at Birmingham, Birmingham, AL
Paula Ehrlich Agger, MD, MPH, Food and Drug Administration, Silver Spring, MD
Ibne Karim Ali, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Maria C. Allende, MD, Food and Drug Administration, Silver Spring, MD
Evan J. Anderson, MD, Emory University School of Medicine, Atlanta, GA
Jon Kim Andrus, MD, University of Colorado, Denver, CO, and George Washington
University, Washington, DC
Kristina M. Angelo, DO, MPH&TM, Centers for Disease Control and Prevention,
Atlanta, GA
Grace Dufie Appiah, MD, Centers for Disease Control and Prevention, Atlanta, GA
Paige A. Armstrong, MD, MHS, Centers for Disease Control and Prevention, Atlanta, GA
Stephen S. Arnon, MD, MPH, California Department of Public Health, Richmond, CA
Naomi E. Aronson, MD, Uniformed Services University of the Health Sciences, Bethesda,
MD
David M. Asher, MD, Food and Drug Administration, Silver Spring, MD
Negar Ashouri, MD, CHOC Children’s Hospital, Orange, CA
T. Prescott Atkinson, MD, PhD, University of Alabama at Birmingham, Birmingham, AL
Rachael D. Aubert, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Laura Bachmann, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Lorraine Backer, PhD, MPH, Centers for Disease Control and Prevention, Chamblee,
GA
John W. Baddley, MD, MSPH, University of Maryland, Baltimore, MD
Bethany Baer, MD, Food and Drug Administration, Silver Spring, MD
Gerri Baer, MD, Food and Drug Administration, Silver Spring, MD
Carol J. Baker, MD, University of Texas Health Science Center, McGovern Medical
School, Houston, TX
Robert S. Baltimore, MD, Yale School of Medicine, New Haven, CT
Ana Cecilia Bardossy, MD, Centers for Disease Control and Prevention, Atlanta, GA
Margaret Bash, MD, MPH, Food and Drug Administration, Silver Spring, MD
Melisse S. Baylor, MD, Food and Drug Administration, Silver Spring, MD
Judy A. Beeler, MD, Food and Drug Administration, Silver Spring, MD
Karlyn D. Beer, MS, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Ermias Belay, MD, Centers for Disease Control and Prevention, Atlanta, GA
Yodit Belew, MD, Food and Drug Administration, Silver Spring, MD
Melissa Bell, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Tanvir Bell, MD, FACP, FIDSA, Food and Drug Administration, Gaithersburg, MD
Roy Benaroch, MD, Emory University, Dunwoody, GA
Ivan Benavides, MD, Universidad del Valle, Cali, Valle, Columbia

Red_Book_2020_FM.indd 4 30/03/21 11:58 AM

 COLLABORATORS v

Kaitlin Benedict, MPH, Centers for Disease Control and Prevention, Atlanta, GA
William E. Benitz, MD, Stanford University School of Medicine, Palo Alto, CA
Stephanie R. Bialek, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Holly Biggs, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Jessica Biggs, PharmD, BCPPS, University of Maryland Medical Center, Baltimore, MD
Alison M. Binder, MS, Centers for Disease Control and Prevention, Atlanta, GA
Danae Bixler, MD, MPD, Centers for Disease Control and Prevention, Brookhaven, GA
David D. Blaney, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Karen C. Bloch, MD, MPH, Vanderbilt University Medical Center, Nashville, TN
Juri Boguniewicz, MD, University of Colorado School of Medicine, Aurora, CO
Michael A. Bolaris, MD, Harbor-UCLA Medical Center, Torrance, CA
Suresh B. Boppana, MD, University of Alabama at Birmingham, Birmingham, AL
Anna Bowen, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
William Alfred Bower, MD, Centers for Disease Control and Prevention, Atlanta, GA
Thomas G. Boyce, MD, MPH, Levine Children’s Hospital, Charlotte, NC
John S. Bradley, MD, University of California San Diego/Rady Children’s Hospital San
Diego, San Diego, CA
Joseph S. Bresee, MD, Centers for Disease Control and Prevention, Atlanta, GA
Karen R. Broder, MD, Centers for Disease Control and Prevention, Atlanta, GA
Samantha Anne Brokenshire, PharmD, Monroe Carell Jr. Children’s Hospital at
Vanderbilt, Nashville, TN
Patricia C. Brown, MD, Food and Drug Administration, Silver Spring, MD
Kevin E. Brown, MD, MRCP FRCPath, Public Health England, London, England
Sarah K. Browne, MD, Food and Drug Administration, Silver Spring, MD
Beau B. Bruce, MD, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Gale R. Burstein, MD, MPH, Erie County Department of Health, Buffalo, NY
Diego H. Caceres, BSc, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Susan B. Cali, MSN, RN, MHA, Centers for Disease Control and Prevention, Conyers,
GA
Angela J. P. Campbell, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Doug Campos-Outcalt, MD, MPA, University of Arizona, College of Public Health,
Phoeniz, AZ
Maria Cano, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Paul T. Cantey, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Joseph B. Cantey, MD, MPH, University of Texas Health San Antonio, San Antonio, TX
Michael Cappello, MD, Yale School of Medicine, New Haven, CT
Cristina V. Cardemil, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Jessica R. Cataldi, MD, MSCS, University of Colorado School of Medicine, Denver, CO
Robert M. Centor, MD, University of Alabama at Birmingham, Birmingham, AL
Ellen Gould Chadwick, MD, Northwestern University Feinberg School of Medicine, Ann
& Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
Rana Chakraborty, MD, MSc, FRCPCH, DPhil (Oxon), Mayo Clinic Alix School of
Medicine, Rochester, MN

Red_Book_2020_FM.indd 5 30/03/21 11:58 AM

 vi COLLABORATORS

Kirk M. Chan-Tack, MD, Food and Drug Administration, Silver Spring, MD

Kevin Chatham-Stephens, MD, MPH, Centers for Disease Control and Prevention,
Chamblee, GA
Rana Chattopadhyay, PhD, Food and Drug Administration, Silver Spring, MD
Sofia Chaudhry, MD, Food and Drug Administration, Silver Spring, MD
Michelle Chen, BA, Cohen Children’s Medical Center of New York, New Hyde Park, NY
Cara Cherry, DVM, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Dena Cherry-Brown, MPH, Centers for Disease Control and Prevention, Decatur, GA
Preeti Chhabra, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Mary Choi, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Nancy A. Chow, PhD, Centers for Disease Control and Prevention, Atlanta, GA
John C. Christenson, MD, Indiana University School of Medicine, Indianapolis, IN
Paul R. Cieslak, MD, Oregon Health Authority, Portland, OR
Kevin L. Clark, MD, Food and Drug Administration, Silver Spring, MD
Susan E. Coffin, MD, MPH, Children’s Hospital of Philadelphia, Philadelphia, PA
Mark L. Cohen, MD, Case Western Reserve University, Cleveland, OH
Jennifer P. Collins, MD, MSc, Centers for Disease Control and Prevention, Decatur, GA
Joseph Wayne Conlan, BSc, PhD, National Research Council, Ottawa, Ontario, Canada
Roxanne Connelly, PhD, Centers for Disease Control and Prevention, Fort Collins, CO
Despina G. Contopoulos-Ioannidis, MD, Stanford University School of Medicine,
Stanford, CA
Laura A. Cooley, MD, MPHTM, Centers for Disease Control and Prevention, Atlanta,
GA
Jennifer Rittenhouse Cope, MD, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Margaret M. Cortese, MD, Centers for Disease Control and Prevention, Atlanta, GA
Lisa A. Cosgrove, MD, FAAP, Jacksonville, FL
Tamera Coyne-Beasley, MD, MPH, University of Alabama Birmingham, Children’s of
Alabama, Birmingham, AL
Sue E. Crawford, PhD, Baylor College of Medicine, Houston, TX
Matthew Brian Crist, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Richard N. Danila, PhD, MPH, Minnesota Department of Health, St. Paul, MN
Toni A. Darville, MD, University of North Carolina School of Medicine, Chapel Hill,
NC
Shom Dasgupta-Tsinikas, MD, Harbor-UCLA Medical Center & Los Angeles County
TB Control Program, Torrance, CA
Alma C. Davidson, MD, Food and Drug Administration, Silver Spring, MD
Roberta Lynn DeBiasi, MD, MS, Children’s National Health System/The George
Washington University School of Medicine and Health Sciences, Washington, DC
Mark R. Denison, MD, Vanderbilt University Medical Center, Nashville, TN
Sheila Dollard, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Kenneth Dominguez, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Dorothy E. Dow, MD, MSc, Duke University Medical Center, Durham, NC
Naomi A. Drexler, MPH, Centers for Disease Control and Prevention, Atlanta, GA

Red_Book_2020_FM.indd 6 30/03/21 11:58 AM

 COLLABORATORS vii

Christine L. Dubray, MD, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Jeffrey S. Duchin, MD, Public Health - Seattle & King County and the University of
Washington, Seattle, WA
Jonathan Duffy, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Diana Dunnigan, MD, Native Health, Phoenix, AZ
Judith K. Eckerle, MD, University of Minnesota, Minneapolis, MN
Morven S. Edwards, MD, Baylor College of Medicine, Houston, TX
Samer El-Kamary, MD, MPH, Food and Drug Administration, Baltimore, MD
Sean P. Elliott, MD, University of Arizona College of Medicine, Tucson, AZ
Mindy G. Elrod, Centers for Disease Control and Prevention, Atlanta, GA
Delia A. Enría, MD, MPH, Scientific Advisor, Pergamino, Argentina
Roselyn E. Epps, MD, Food and Drug Administration, Silver Spring, MD
Guliz Erdem, MD, Nationwide Children’s Hospital and the Ohio State University,
Columbus, OH
Darcie Lyn Everett, MD, MPH, Food and Drug Administration, Silver Spring, MD
Julia C. Feinstein, BA, Cohen Children’s Medical Center of New York, New Hyde Park,
NY
Meghan Ferris, MD, MPH, Food and Drug Administration, Silver Spring, MD
Amy Parker Fiebelkorn, MSN, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Doran L. Fink, MD, PhD, Food and Drug Administration, Silver Spring, MD
Theresa Finn, Food and Drug Administration, Silver Spring, MD
Anthony Fiore, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Katherine E. Fleming-Dutra, MD, Centers for Disease Control and Prevention, Atlanta,
GA
Gary W. Floyd, MD, FAAP, Keller, TX
Patricia Michelle Flynn, MD, MS, St. Jude Children’s Research Hospital, Memphis, TN
Kaitlin Forsberg, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Monique A. Foster, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Sheila Fallon Friedlander, MD, University of California San Diego School of Medicine,
San Diego, CA
Cindy R. Friedman, MD, Centers for Disease Control and Prevention, Atlanta, GA
Yasuko Fukuda, MD, FAAP, Pacific Pediatrics, San Francisco, CA
Sara Gagneten, PhD, Food and Drug Administration, Silver Spring, MD
Renee Galloway, Centers for Disease Control and Prevention, Atlanta, GA
Pooja D. Gandhi, MPH, CHES, Centers for Disease Control and Prevention, Atlanta, GA
Amanda G. Garcia-Williams, PhD, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Jay Edward Gee, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Susan Gerber, MD, Centers for Disease Control and Prevention, Atlanta, GA
Anne A. Gershon, MD, Columbia University College of Physicians and Surgeons, New
York, NY
Mayurika Ghosh, MD, FACP, FIDSA, Food and Drug Administration, Silver Spring, MD
Francis Gigliotti, MD, University of Rochester School of Medicine and Dentistry,
Rochester, NY
Janet R. Gilsdorf, MD, University of Michigan Medical Center, Ann Arbor, MI

Red_Book_2020_FM.indd 7 30/03/21 11:58 AM

 viii COLLABORATORS

Dominique G. Godfrey, BS, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Brittany E. Goldberg, MD, MS, Food and Drug Administration, Gleneg, MD
Ellie J.C. Goldstein, MD, R M Alden Research Laboratory, Santa Monica, CA
Gerardo A. Gomez, BS, BA, Centers for Disease Control and Prevention, Atlanta, GA
Carolyn Virginia Gould, MD, MSCR, Centers for Disease Control and Prevention, Fort
Collins, CO
Elizabeth B. Gray, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Christopher Gregory, MD, MPH, Centers for Disease Control and Prevention, Fort
Collins, CO
Patricia M. Griffin, MD, Centers for Disease Control and Prevention, Atlanta, GA
Daniel Griffin, MD, PhD CTropMed CTH, Columbia University, New York, NY
Lisa A. Grohskopf, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Alice Y. Guh, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Kriti Gupta, MD, Cohen Children’s Medical Center of New York, New Hyde Park, NY
Julie Gutman, MD, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Penina Haber, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Jesse Hackell, MD, Pomona Pediatrics, A Division of Boston Children’s Health
Physicians, Pomona, NY
Aron J. Hall, DVM, MSPH, Centers for Disease Control and Prevention, Atlanta, GA
Scott A. Halperin, MD, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia,
Canada
Davidson H. Hamer, MD, University of Vermont College of Medicine, Boston, MA
Susan Hariri, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Kathleen H. Harriman, PhD, MPH, RN, California Department of Public Health,
Richmond, CA
Theresa Harrington, MD, MPH&TM, Centers for Disease Control and Prevention,
Atlanta, GA
Aaron M. Harris, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Jason B. Harris, MD, MPH, Massachusetts General Hospital, Boston, MA
Elizabeth S. Hart, MD, Food and Drug Administration, Washington, DC
Joshua D. Hartzell, MD, MS-HPEd, Walter Reed National Military Medical Center,
Bethesda, MD
Fiona P. Havers, MD, MHS, Centers for Disease Control and Prevention, Atlanta, GA
Andrew Haynes, MD, Children’s Hospital Colorado, Aurora, CO
Jessica M. Healy, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Yosefa Hefter, MD, Food and Drug Administration, Silver Spring, MD
Kristen Nichols Heitman, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Tobin Hellyer, Food and Drug Administration, Silver Spring, MD
Katherine Ann Hendricks, MD, MPH&TM, Centers for Disease Control and Prevention,
Atlanta, GA
Adam L. Hersh, MD, PhD, University of Utah, Salt Lake City, UT
Barbara L. Herwaldt, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Maureen Hess, MPH, RD, Food and Drug Administration, Silver Spring, MD

Red_Book_2020_FM.indd 8 30/03/21 11:58 AM

 COLLABORATORS ix

Beth Hibbs, MPH, RN, Centers for Disease Control and Prevention, Decatur, GA
Sheila M. Hickey, MD, University of New Mexico, Albuquerque, NM
Carole J. Hickman, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Susan L. Hills, MBBS, MTH, Centers for Disease Control and Prevention, Fort Collins,
CO
Alison F. Hinckley, PhD, Centers for Disease Control and Prevention, Fort Collins, CO
Hiwot Hiruy, MD, PhD, Food and Drug Administration, Silver Spring, MD
Michele C. Hlavsa, RN, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Aimee C. Hodowanec, MD, Food and Drug Administration, Silver Spring, MD
Megan Hofmeister, MD, MS, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Katherine K. Hsu, MD, MPH, Massachusetts Department of Public Health, Boston
University Medical Center, Jamaica Plain, MA
Christine M. Hughes, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Joseph P. Icenogle, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Ilan Irony, MD, Food and Drug Administration, Silver Spring, MD
Brendan R. Jackson, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Ruth A. Jajosky, DMD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Denise Jamieson, MD, MPH, Emory University, Atlanta, GA
Emily N. Jenkins, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Emily S. Jentes, PhD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
John Jereb, MD, Centers for Disease Control and Prevention, Atlanta, GA
Ravi Jhaveri, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago/Northwestern
University Feinberg School of Medicine, Chicago, IL
Caroline J. Jjingo, MD, MPH, Food and Drug Administration, Silver Spring, MD
Chandy C. John, MD, Indiana University School of Medicine, Riley Hospital for Children
at IU Health, Indianapolis, IN
Jefferson M. Jones, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Nicola L. Jones, MD, FRCPC, PhD, Division of Gastroenterology, SickKids, Toronto,
Canada
S. Patrick Kachur, MD, MPH, Columbia University Irving Medical Center, New York,
NY
Laura H. Kahn, MD, MPH, MPP, Woodrow Wilson School of Public and International
Affairs, Princeton University, Princeton, NJ
Alexander Kallen, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Mary L. Kamb, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Saleem S.M. Kamili, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Sheldon L. Kaplan, MD, Baylor College of Medicine, Houston, TX
Ben Z. Katz, MD, Northwestern University Feinberg School of Medicine, Ann & Robert
H. Lurie Children’s Hospital of Chicago, Chicago, IL
Carol A. Kauffman, MD, VA Ann Arbor Healthcare System, University of Michigan
Medical School, Ann Arbor, MI
Susana Williams Keeshin, MD, University of Utah, Salt Lake City, UT
Gilbert J. Kersh, PhD, Centers for Disease Control and Prevention, Atlanta, GA
David L. Kettl, MD, Food and Drug Administration, Silver Spring, MD
Grishma Kharod, Centers for Disease Control and Prevention, Atlanta, GA

Red_Book_2020_FM.indd 9 30/03/21 11:58 AM

 x COLLABORATORS

Peter W. Kim, MD, MS, Food and Drug Administration, Silver Spring, MD
Charles H. King, MD, MS, Case Western Reserve University, Cleveland, OH
Miwako Kobayashi, Centers for Disease Control and Prevention, Atlanta, GA
Philip R. Krause, MD, Food and Drug Administration, Silver Spring, MD
Kristen Kreisel, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Andrew T. Kroger, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
David Kuhar, MD, Centers for Disease Control and Prevention, Atlanta, GA
Adam J. Langer, DVM, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Gayle Langley, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Paul M. Lantos, MD, MS, Duke University, Greensboro, NC
Tatiana M. Lanzieri, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Brent Lasker, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Ana Lauer, BS, PhD, Centers for Disease Control and Prevention, Lilburn, GA
Mark E. Laughlin, DVM, MPH-VPH, DACVPM, Centers for Disease Control and
Prevention, Atlanta, GA
Ralph Eli LeBlanc, MD, MPH, DTMH, PhD, Food and Drug Administration, Baltimore,
MD
Joohee Lee, MD, Food and Drug Administration, Silver Spring, MD
Lucia H. Lee, MD, Food and Drug Administration, Silver Spring, MD
Myron M. Levine, MD, DTPH, Center for Vaccine Development and Global Health,
University of Maryland School of Medicine, Baltimore, MD
Stephen Lindstrom, PhD, Centers for Disease Control and Prevention, Atlanta, GA
John J. LiPuma, MD, University of Michigan, Ann Arbor, MI
Lindy Liu, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Eloisa Llata, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Shawn R. Lockhart, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Benjamin D. Lorenz, MD, Food and Drug Administration, Silver Spring, MD
Xiaoyan Lu, Centers for Disease Control and Prevention, Atlanta, GA
Carolina Lúquez, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Anna Mandra, DVM, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Mona Marin, MD, Centers for Disease Control and Prevention, Atlanta, GA
Lauri E. Markowitz, MD, Centers for Disease Control and Prevention, Atlanta, GA
Mariel Marlow, Centers for Disease Control and Prevention, Atlanta, GA
Zachary A. Marsh, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Gary S. Marshall, MD, University of Louisville School of Medicine, Louisville, KY
Barbara J. Marston, MD, Centers for Disease Control and Prevention, Atlanta, GA
Emily Toth Martin, PhD, MPH, University of Michigan School of Public Health, Ann
Arbor, MI
Grace E. Marx, MD, MPH, Centers for Disease Control and Prevention, Fort Collins,
CO
Sarah R. Maxwell, MD, MPH, University of Colorado, Children’s Hospital of Colorado,
Aurora, CO
Sarah Mbaeyi, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Orion McCotter, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Anita K. McElroy, MD, PhD, University of Pittsburgh, Pittsburgh, PA

Red_Book_2020_FM.indd 10 30/03/21 11:58 AM

 COLLABORATORS xi

Olivia Lauren McGovern, PhD, MS, Centers for Disease Control and Prevention, Atlanta,
GA
Susan L.F. McLellan, MD, MPH, University of Texas Medical Branch, Galveston, TX
Lucy A. McNamara, PhD, MS, Centers for Disease Control and Prevention, Atlanta, GA
Michael M. McNeil, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
John McQuiston, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Elissa Meites, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Asuncion Mejias, MD, PhD, MsCS, Nationwide Children’s Hospital and The Ohio State
University, Columbus, OH
Ian C. Michelow, MD, DTM&H, Warren Alpert Medical School of Brown University,
Providence, RI
Claire M. Midgley, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Elaine R. Miller, BSN, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Eric Mintz, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
John F. Modlin, MD, Bill and Melinda Gates Foundation, Seattle, WA
Tina Khoie Mongeau, MD, MPH, Food and Drug Administration, Silver Spring, MD
Martha P. Montgomery, MD, MHS, Centers for Disease Control and Prevention, Atlanta,
GA
José G. Montoya, MD, Stanford University and Palo Alto Medical Foundation Toxoplasma
Serology Laboratory, Stanford, CA
Anne C. Moorman, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Pedro L. Moro, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
William Moss, MD, MPH, Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD
Charu Mullick, MD, Food and Drug Administration, Silver Spring, MD
Barbara E. Murray, MD, University of Texas Health Science Center at Houston,
Houston, TX
Oidda Ikumboka Museru, MSN, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Christina A. Muzny, MD, MSPH, Centers for Disease Control and Prevention,
Birmingham, AL
Sumathi Nambiar, MD, MPH, Food and Drug Administration, Germantown, MD
Srinivas Acharya Nanduri, MBBS, MD, MPH, Centers for Disease Control and
Prevention, Atlanta, GA
Theodore E. Nash, MD, National Institue of Health (Retired), Asheville, NC
James Nataro, MD, PhD, MBA, University of Virginia, Charlottesville, VA
Mark S. Needles, MD, Food and Drug Administration, Silver Spring, MD
Christina Nelson, MD, MPH, Centers for Disease Control and Prevention, Fort Collins,
CO
Noele P. Nelson, MD, PhD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Steven R. Nesheim, MD, Centers for Disease Control and Prevention, Atlanta, GA
Jason G. Newland, MD, MEd, Washington University School of Medicine, St. Louis, MO
Megin Nichols, DVM, MPH, Centers for Disease Control and Prevention, Atlanta, GA
William L. Nicholson, BSc, MSc, PhD, Centers for Disease Control and Prevention,
Atlanta, GA

Red_Book_2020_FM.indd 11 30/03/21 11:58 AM

 xii COLLABORATORS

William Allan Nix, Centers for Disease Control and Prevention, Atlanta, GA
Thomas B. Nutman, MD, National Institutes of Health, Bethesda, MD
Steve Oberste, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Tina S. Objio, MSN, MHA, Centers for Disease Control and Prevention, Atlanta, GA
Andrew O’Carroll, DVM, Food and Drug Administration, Silver Spring, MD
Theresa Jean Ochoa, MD, Universidad Peruana Cayetano Heredia, Lima, Peru
Titilope Oduyebo, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Sara E. Oliver, MD, MSPH, Centers for Disease Control and Prevention, Atlanta, GA
Christina M. Osborne, MD, University of Colorado School of Medicine, Aurora, CO
Elizabeth O’Shaughnessy, MB, BCh, Food and Drug Administration, Silver Spring, MD
Gary D. Overturf, MD, University of New Mexico, Albuquerque, NM
Sherry Michele Owen, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Christopher D. Paddock, MD, MPHTM, Centers for Disease Control and Prevention,
Atlanta, GA
Mark A. Pallansch, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Lakshmi Panagiotakopoulos, MD, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
Pia S. Pannaraj, MD, MPH, Children’s Hospital Los Angeles/University of Southern
California, Los Angeles, CA
Ina U. Park, MD, MS, Centers for Disease Control and Prevention, Berkeley, CA
Manisha Patel, MD, MS, Centers for Disease Control and Prevention, Atlanta, GA
Sheral Patel, MD, FAAP, FASTMH, FIDSA, Food and Drug Administration, Silver
Spring, MD
Nehali Patel, MD, St. Jude Children’s Research Hospital, Memphis, TN
Thomas F. Patterson, MD, FACP, FIDSA, UT Health San Antonio and South Texas
Veterans Health Care System, San Antonio, TX
Stephen I. Pelton, MD, Boston University Schools of Medicine and Public Health, Boston
Medical Center, Boston, MA
Teresa C.T. Peret, PhD, Centers for Disease Control and Prevention, Atlanta, GA
John R. Perfect, MD, Duke University Medical Center, Durham, NC
Kiran M. Perkins, MD, MPH, Centers for Disease Control and Prevention, Brookhaven,
GA
Joseph F. Perz, DrPH, MA, Centers for Disease Control and Prevention, Decatur, GA
Brett W. Petersen, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Amy E. Peterson, DVM, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Andreas Pikis, MD, Food and Drug Administration, Silver Spring, MD
Tamara Pilishvili, PhD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Ana Yecê das Neves Pinto, MD, Evandro Chagas Institute, Ananindeua City, Pará, Brazil
Paul Joseph Planet, MD, PhD, University of Pennsylvania, Children’s Hospital of
Philadelphia, Philadelphia, PA
Ian D. Plumb, MBBS, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Nicole M. Poole, MD, MPH, University of Colorado, Aurora, CO
Drew L. Posey, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Ann M. Powers, PhD, Centers for Disease Control and Prevention, Fort Collins, CO
R. Douglas Pratt, MD, MPH, Food and Drug Administration, Silver Spring, MD
Christopher Prestel, MD, Centers for Disease Control and Prevention, Atlanta, GA

Red_Book_2020_FM.indd 12 30/03/21 11:58 AM

 COLLABORATORS xiii

Nathan Price, MD, University of Arizona, Tucson, AZ

Gary W. Procop, MD, MS, Cleveland Clinic, Cleveland, OH
Karen M. Puopolo, MD, PhD, Children’s Hospital of Philadelphia, Philadelphia, PA
Laura A. S. Quilter, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Shawn L. Ralston, MD, MA, MS, Johns Hopkins Children’s Center, Baltimore, MD
Octavio Ramilo, MD, Nationwide Children’s Hospital and The Ohio State University,
Columbus, OH
Agam Kumari Rao, MD, Centers for Disease Control and Prevention, Atlanta, GA
Anuja Rastogi, MD, MHS, Food and Drug Administration, Silver Spring, MD
Mobeen Hasan Rathore, MD, University of Florida Center for AIDS/HIV, Research,
Education and Service, Jacksonville, FL
Logan C. Ray, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Sujan C. Reddy, Centers for Disease Control and Prevention, Atlanta, GA
Susan Reef, MD, Centers for Disease Control and Prevention, Atlanta, GA
Rebecca Reindel, MD, Food and Drug Administration, Silver Spring, MD
Hilary E. Reno, MD, PhD, Centers for Disease Control and Prevention, Saint Louis, MO
Melissa Reyes, MD, MPH, DTMH, Food and Drug Administration, Silver Spring, MD
Brian Rha, MD, MSPH, Centers for Disease Control and Prevention, Atlanta, GA
Frank Richards, Jr., MD, The Carter Center, Atlanta, GA
Nicholas Rister, MD, Food and Drug Administration, Fort Worth, TX
Virginia A. Roberts, MSPH, Centers for Disease Control and Prevention, Atlanta, GA
Jeff Roberts, MD, Food and Drug Administration, Silver Spring, MD
Candice L. Robinson, MD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Joan L. Robinson, MD, FRCPC, University of Alberta, Edmonton, Alberta, Canada
Martin Rodriguez, MD, University of Alabama at Birmingham, Birmingham, AL
Dawn M. Roellig, MS, PhD, Centers for Disease Control and Prevention, Atlanta, GA
José R. Romero, MD, University of Arkansas for Medical Sciences and Arkansas
Children’s Hospital, Little Rock, AR
Shannon Ross, MD, MSPH, The University of Alabama at Birmingham, Birmingham,
AL
John Alden Rossow, DVM, MPH, Centers for Disease Control and Prevention, Decatur,
GA
Janell A. Routh, MD, MHS, Centers for Disease Control and Prevention, Atlanta, GA
Anne H. Rowley, MD, Northwestern University Feinberg School of Medicine, Ann &
Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
Sharon L. Roy, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Lorry G. Rubin, MD, Steven and Alexandra Cohen Children’s Medical Center of New
York, New Hyde Park, NY
A. Blythe Ryerson, PhD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Hari Cheryl Sachs, MD, Food and Drug Administration, Silver Spring, MD
Johanna S. Salzer, DVM, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Hugh A. Sampson, BA, MD, Icahn School of Medicine at Mount Sinai, New York, NY
Sara R. Saporta-Keating, MD, MS, Children’s Hospital Colorado, Aurora, CO
Kim Sapsford-Medintz, PhD, Food and Drug Administration, Silver Spring, MD

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 xiv COLLABORATORS

Jason B. Sauberan, PharmD, Neonatal Research Institute, Sharp Mary Birch Hospital for
Women and Newborns, San Diego, CA
Christian J. Sauder, PhD, Food and Drug Administration, Silver Spring, MD
Ilana J. Schafer, DVM, MSPH, Centers for Disease Control and Prevention, Atlanta,
GA
Sarah Schillie, MD, MPH, MBA, Centers for Disease Control and Prevention, Atlanta,
GA
Julia Ann Schillinger, MD, MSc, Centers for Disease Control and Prevention, New York,
NY
D. Scott Schmid, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Eileen Schneider, MD, MPH, Centers for Disease Control and Prevention, Stone
Mountain, GA
Stacey Schultz-Cherry, PhD, St. Jude Children’s Research Hospital, Memphis, TN
Gordon E. Schutze, MD, Baylor College of Medicine, Houston, TX
Ann T. Schwartz, MD, Food and Drug Administration, Gaithersburg, MD
Justin B. Searns, MD, University of Colorado School of Medicine, Aurora, CO
W. Evan Secor, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Isaac See, MD, Centers for Disease Control and Prevention, Atlanta, GA
Andi L. Shane, MD, MPH, MSc, Emory University School of Medicine and Children’s
Healthcare of Atlanta, Atlanta, GA
Virginia M.W. Sheikh, MD, MHS, Food and Drug Administration, Silver Spring, MD
Margaret Sherin, BA, Cohen Children’s Medical Center of New York, New Hyde Park,
NY
Tom T. Shimabukuro, MD, MPH, MBA, Centers for Disease Control and Prevention,
Atlanta, GA
Azadeh Shoaibi, PhD, MHS, Food and Drug Administration, Silver Spring, MD
Trevor R. Shoemaker, PhD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Timothy R. Shope, MD, MPH, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh,
PA
Stanford T. Shulman, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago,
Chicago, IL
Scott H. Sicherer, MD, Icahn School of Medicine at Mount Sinai, New York, NY
Benjamin Silk, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Rosalyn J. Singleton, MD, MPH, Alaska Native Tribal Health Consortium, Anchorage,
AK
Anders Sjöstedt, MD, PhD, Umeå University, Umeå, Sweden
Tami H. Skoff, MS, Centers for Disease Control and Prevention, Atlanta, GA
Thomas Smith, MD, Food and Drug Administration, Silver Spring, MD
Heidi L. Smith, MD, PhD, Food and Drug Administration, Silver Spring, MD
Thomas D. Smith, MD, Food and Drug Administration, Silver Spring, MD
P. Brian Smith, MD, MPH, MHS, Duke University Medical Center, Durham, NC
Kirk Smith, DVM, MS, PhD, Minnesota Department of Health, St Paul, MN
Sunil Kumar Sood, MD, Cohen Children’s & Southside Hospitals, Northwell Health, Bay
Shore, NY
Paul W. Spearman, MD, Cincinnati Children’s Hospital, Cincinnati, OH

Red_Book_2020_FM.indd 14 30/03/21 11:58 AM

 COLLABORATORS xv

Stanley M. Spinola, MD, Indiana University School of Medicine, Indianapolis, IN

Philip R. Spradling, MD, Centers for Disease Control and Prevention, Atlanta, GA
Sancta B. St. Cyr, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Mary Allen Staat, MD, MPH, Cincinnati Children’s Hospital Medical Center, Cincinnati,
OH
J. Erin Staples, MD, PhD, Centers for Disease Control and Prevention, Fort Collins, CO
William M. Stauffer, MD, MSPH, University of Minnesota, Lake Elmo, MN
Irving Steinberg, PharmD, University of Southern California, Schools of Pharmacy and
Medicine, Los Angeles, CA
David S. Stephens, MD, Emory University School of Medicine, Atlanta, GA
Shannon Stokley, DrPH, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Anne M. Straily, DVM, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Tara W. Strine, MPH, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Nancy A. Strockbine, PhD, Centers for Disease Control and Prevention, Atlanta, GA
John R. Su, MD, PhD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Maria E. Negron Sureda, DVM, PhD, MS, Centers for Disease Control and Prevention,
Atlanta, GA
Adam M. Szewc, BS, SM(ASCP), MB, QLS, Centers for Disease Control and Prevention,
Atlanta, GA
Peter G. Szilagyi, MD, UCLA School of Medicine, Los Angeles, CA
Danielle M. Tack, DVM, MPVM, Centers for Disease Control and Prevention, Atlanta,
GA
Pranita D. Tamma, MD, MHS, Johns Hopkins University School of Medicine, Ellicott
City, MD
Kathrine R. Tan, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Gillian Taormina, DO, MS, Food and Drug Administration, Silver Spring, MD
Cheryl Tarr, Centers for Disease Control and Prevention, Atlanta, GA
Edna Termilus, MD, MPH, Food and Drug Administration, Washington, DC
Eyasu Habtu Teshale, MD, Centers for Disease Control and Prevention, Atlanta, GA
Brenda L. Tesini, MD, University of Rochester, Rochester, NY
Alan T.N. Tita, MD, PhD, University of Alabama at Birmingham, Birmingham, AL
Tejpratap S.P. Tiwari, MD, Centers for Disease Control and Prevention, Atlanta, GA
Melissa Tobin-D’Angelo, MD, MPH, Georgia Department of Public Health, Atlanta, GA
Mitsuru Toda, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Rita M. Traxler, MHS, Centers for Disease Control and Prevention, Atlanta, GA
Sean R. Trimble, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Stephanie Troy, MD, Food and Drug Administration, Silver Spring, MD
Richard W. Truman, PhD, LSU School of Veterinary Medicine, Baton Rouge, LA
Ronald B. Turner, MD, University of Virginia School of Medicine, Charlottesville, VA
Elizabeth R. Unger, PhD, MD, Centers for Disease Control and Prevention, Atlanta, GA
Chris A. Van Beneden, MD, MPH, Centers for Disease Control and Prevention, Altanta,
GA
John A. Vanchiere, MD, PhD, Louisiana State University, Health Sciences Center,
Shreveport, LA
Antonio Vieira, DVM, MPH, PhD, Centers for Disease Control and Prevention, Atlanta,
GA

Red_Book_2020_FM.indd 15 30/03/21 11:58 AM

 xvi COLLABORATORS

Joseph M. Vinetz, MD, Yale University School of Medicine, New Haven, CT

Jan Vinje, PhD, Centers for Disease Control and Prevention, Atlanta, GA
Prabha Viswanathan, MD, Food and Drug Administration, Silver Spring, MD
Duc J. Vugia, MD, MPH, California Department of Public Health, Richmond, CA
Timothy J. Wade, MD, United States Environmental Protection Agency, Research
Triangle Park, NC
Emmanuel B. Walter, MD, MPH, Duke University School of Medicine, Durham, NC
Robin Warner, MD, Union Pediatrics, PSC, Union, KY
Richard L. Wasserman, MD, PhD, Medical City Children’s Hospital, Dallas, TX
Stephen H. Waterman, MD, MPH, Centers for Disease Control and Prevention, San
Juan, PR
Louise K. Francois Watkins, MD, MPH, Centers for Disease Control and Prevention,
Atlanta, GA
John T. Watson, MD, MSc, Centers for Disease Control and Prevention, Atlanta, GA
Michelle Weinberg, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Eric Weintraub, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Mark K. Weng, MD, MSc, FAAP, Centers for Disease Control and Prevention, Atlanta,
GA
J. Gary Wheeler, MD, Arkansas Department of Health, Little Rock, AR
A. Clinton White, Jr., MD, University of Texas Medical Branch, Galveston, TX
Hilary K. Whitham, PhD, MPH, Centers for Disease Control and Prevention, Atlanta,
GA
Richard James Whitley, MD, University of Alabama at Birmingham, Birmingham, AL
Rodney E. Willoughby, Jr., MD, Medical College of Wisconsin, Milwaukee, WI
Kelly Wilt, MD, Children’s Hospital Colorado, Denver, CO
Alison Winstead, MD, Centers for Disease Control and Prevention, Atlanta, GA
Carla Winston, PhD, MA, Centers for Disease Control and Prevention, Atlanta, GA
A. Patricia Wodi, MD, Centers for Disease Control and Prevention, Atlanta, GA
Joellen Wolicki, BSN, Centers for Disease Control and Prevention, Atlanta, GA
Susan K. Wollersheim, MD, Food and Drug Administration, Silver Spring, MD
Karen K. Wong, MD, MPH, Centers for Disease Control and Prevention, Atlanta, GA
Emily Jane Woo, MD, MPH, Food and Drug Administration, Silver Spring, MD
Meklit Workneh, MD, MPH, Food and Drug Administration, Silver Spring, MD
Kimberly Workowski, MD, FACP, FIDSA, Centers for Disease Control and Prevention,
Atlanta, GA
Alexandra S. Worobec, MD, Food and Drug Administration, Silver Spring, MD
Mary A. Worthington, PharmD, BCPS, BCPPS, Samford University McWhorter School
of Pharmacy, Birmingham, AL
Pablo Yagupsky, MD, Soroka University Medical Center, Ben-Gurion University of the
Negev, Herzliya, Israel
Albert C. Yan, MD, Children’s Hospital of Philadelphia - Perelman School of Medicine
at the University of Pennsylvania, Philadelphia, PA
Carolyn L. Yancey, MD, Food and Drug Administration, Silver Spring, MD
April H. Yarbrough, PharmD, BCPS, Children’s of Alabama, Birmingham, AL
Alexandra B. Yonts, MD, Food and Drug Administration, Silver Spring, MD
Jonathan Zenilman, MD, Johns Hopkins University, Baltimore, MD
Rachel Zhang, MD, Food and Drug Administration, Silver Spring, MD

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 COLLABORATORS xvii

AAP Committee on Bioethics

AAP Committee on Coding and Nomenclature
AAP Committee on Continuing Medical Education
AAP Committee on Drugs
AAP Committee on Fetus and Newborn
AAP Committee on Hospital Care
AAP Committee on Medical Liability and Risk Management
AAP Committee on Native American Child Health
AAP Committee on Pediatric AIDS
AAP Committee on Pediatric Emergency Medicine
AAP Committee on Practice and Ambulatory Medicine
AAP Committee on Substance Use and Prevention
AAP Council on Child Abuse and Neglect
AAP Council on Children and Disasters
AAP Council on Children With Disabilities
AAP Council on Clinical Information Technology
AAP Council on Early Childhood
AAP Council on Environmental Health
AAP Council on Foster Care, Adoption, and Kinship Care
AAP Council on School Health
AAP FamilY Partnerships Network
AAP Payer Advocacy Advisory Committee
AAP Section on Administration and Practice Management
AAP Section on Allergy and Immunology
AAP Section on Breastfeeding
AAP Section on Cardiology and Cardiac Surgery
AAP Section on Critical Care
AAP Section on Dermatology
AAP Section on Emergency Medicine
AAP Section on Epidemiology, Public Health, and Evidence
AAP Section on Gastroenterology, Hepatology, and Nutrition
AAP Section on Hematology/Oncology
AAP Section on Home Care
AAP Section on Hospital Medicine
AAP Section on Infectious Diseases
AAP Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness
AAP Section on Minority Health, Equity, and Inclusion
AAP Section on Nephrology
AAP Section on Neurology
AAP Section on Ophthalmology
AAP Section on Oral Health
AAP Section on Otolaryngology - Head and Neck Surgery
AAP Section on Pediatric Pulmonology and Sleep Medicine
AAP Section on Rheumatology
AAP Section on Surgery
AAP Section on Uniformed Services
AAP Section on Urology

Red_Book_2020_FM.indd 17 30/03/21 11:58 AM

Red_Book_2020_FM.indd 18

xviii
Committee on Infectious Diseases,
2018-2021
TOP ROW, LEFT TO RIGHT: Ritu Banerjee, Elizabeth D. Barnett, Henry H. Bernstein, James D. Campbell,
Mary T. Caserta, Amanda C. Cohn, Karen M. Farizo, Jennifer M. Frantz
SECOND ROW, LEFT TO RIGHT: Jeffrey S. Gerber, Natasha B. Halasa, David Kim, David W. Kimberlin,
Athena P. Kourtis, Nicole Le Saux, Eduardo López Medina, Ruth Lynfield
THIRD ROW, LEFT TO RIGHT: Yvonne A. Maldonado, H. Cody Meissner, Scot B. Moore, Flor M. Munoz,
Dawn Nolt, Ann-Christine Nyquist, Sean T. O’Leary, Adam Ratner
FOURTH ROW, LEFT TO RIGHT: Mark H. Sawyer, Samir S. Shah, Neil S. Silverman, Jeffrey R. Starke,
30/03/21 11:58 AM

William J. Steinbach, James J. Stevermer, Kenneth M. Zangwill, Kay M. Tomashek

NOT PICTURED: Theoklis E. Zaoutis, Marc Fischer
 xix

2021 Red Book Dedication for

Louis Z. Cooper, MD, FAAP

Unprecedented. As we continue to move through the coronavirus pandemic that started

at the end of 2019 and accelerated throughout 2020, use of this word has skyrocketed not
only as it applies to medicine but also in business, politics, the media, and countless other
aspects of our everyday lives. Truth increasingly is called into question, and basic facts are
disputed to the point where it is challenging to find common language to try to chart our
path forward. We truly are living in unsettled and unsettling times, and it can sometimes
feel overwhelming and, yes, unprecedented.
But rarely is a given circumstance completely novel. Almost always, we can reach
back to an earlier time, with earlier leaders, to learn how challenges were met and ulti-
mately overcome. There is precedent even in the unprecedented. The 2021 Red Book is
dedicated to such a visionary leader from an earlier era. A man who stared down an ear-
lier pandemic—rubella—and helped lead the world through it in the 1960s. A man who
went on to lead the American Academy of Pediatrics (AAP) at the turn of the new millen-
nium, as the world was being forever changed following the September 11, 2001, terrorist
attacks. Across all of these decades, Louis Z. Cooper, MD, FAAP, exhibited both the com-
passion and the determination that we can learn from as we face our current global crisis
today. It is for all of these reasons that the 2021 Red Book is dedicated to him.
During his residency in Boston, Lou studied penicillin-resistant Staphylococcus aureus.
After serving in the United States Air Force, he completed a public health service fellow-
ship, during which he worked with Saul Krugman, MD, on development of a rubella
vaccine. During this time, the world was immersed in the rubella pandemic of 1964–65.
In the United States alone, an estimated 12.5 million people were infected with rubella,
11 000 pregnant women lost their babies, 2100 newborn infants died, and 20 000 infants
were born with congenital rubella syndrome (CRS). Literally moving from the bench to
the bedside, Lou isolated rubella virus and measured antibody responses in the labora-
tory while also evaluating hundreds of mothers and infants with CRS. Through these
efforts, Lou established the clinical definition, features, and health impacts of CRS.

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 xx DEDICATION

Realizing that defining the disease and diagnosing the infection were only a part of what
was needed, in 1965 Lou founded the Rubella Project with initial funding from a March
of Dimes grant and public health department support. The clinic delivered medical and
psychosocial care to 300 patients with CRS in the first year alone. The project eventually
evolved into a multidisciplinary medical, educational, and social service organization, and
laws passed in New York with the strong backing of the Rubella Project later served as
examples for a federal special education law.
In addition to service to patients and their families, Lou served the Academy across
many years. He was District II Chair, New York Chapter 3 Chair, and a member of the
AAP Committee on Child Health Financing and Task Force on Pediatric AIDS. In 2001–
02, he was the AAP President, helping to guide our field during another most challenging
period following the September 11 terrorist attacks in New York, Washington, DC, and
Pennsylvania. In later years, he resumed his work on rubella as a senior adviser of the
Measles & Rubella Initiative, a global eradication project supported by the Academy.
Lou died on October 3, 2019, of pancreatic cancer at the age of 87. He did not see
this current pandemic, but I believe that we can glean from his lifetime of accomplish-
ments what his advice to us would be. He would tell us to roll up our sleeves, find a way
to help, and run the race that is ours to complete. He would tell us to always put our
patients at the center of all that we do. He would tell us that, together, all of us can make
a difference and change the outcome of this current crisis. After all, when Lou entered
Saul Krugman’s laboratory, the rubella pandemic had not yet flared, but he was in the
right place at the right time, and this, coupled with his passions and energies, changed the
course of that pandemic. I believe that Lou would say that nothing is unprecedented—we
just need to know where to look to find the guidance from the past to lead us through the
challenges of the present.

PREVIOUS RED BOOK DEDICATION RECIPIENTS:

2018 Larry K. Pickering, MD, FAAP, and Carol J. Baker, MD, FAAP
2015 Stanley Plotkin, MD, FAAP
2012 Samuel L. Katz, MD, FAAP
2009 Ralph Feigin, MD, FAAP
2006 Caroline Breese Hall, MD, FAAP
2003 Georges Peter, MD, FAAP
2000 Edgar O. Ledbetter, MD, FAAP
1997 Georges Peter, MD, FAAP
1988 Jean D. Lockhart, MD, FAAP

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 xxi

Preface
The Red Book, now in its 32nd edition, has been a unique and valuable source of informa-
tion on infectious diseases and immunizations for pediatric practitioners since 1938. In
the 21st century, with the practice of pediatric infectious diseases changing rapidly and
the limited time available to the practitioner, the Red Book remains an essential resource
to quickly obtain current, accurate, and easily accessible information about vaccines
and vaccine recommendations, emerging infectious diseases, diagnostic modalities, and
treatment recommendations. The Committee on Infectious Diseases of the American
Academy of Pediatrics (AAP), the editors of the Red Book, and the 500 Red Book contribu-
tors are dedicated to providing the most current and accurate information available in the
concise, practical format for which the Red Book is known.
As with the 2018 edition, the print version of the Red Book will be provided to every
AAP member as part of their member benefit. This commitment reflects the Academy’s
strong interest in its members’ needs. In addition, AAP members also will continue to
have access to Red Book content on Red Book Online (www.aapredbook.org). AAP
policy statements, clinical reports, and technical reports and recommendations endorsed
by the AAP are posted on Red Book Online as they become available during the 3 years
between Red Book editions, and online chapters are modified as needed to reflect these
changes. The Outbreaks section of Red Book Online is a new resource that concisely sum-
marizes current infectious disease outbreaks that affect the pediatric population and that
have been identified in multiple US states; other outbreak types may be covered occasion-
ally as situations warrant. Red Book users also are encouraged to sign up for e-mail alerts
on www.aapredbook.org to receive new information and policy updates between
editions.
Another important resource is the visual library of Red Book Online, which is continu-
ally updated and expanded to include more images of infectious diseases, examples of
classic radiologic and other findings, and recent information on epidemiology of infec-
tious diseases. The Committee on Infectious Diseases relies on information and advice
from many experts, as evidenced by the lengthy list of contributors to the Red Book.
We especially are indebted to the many contributors from other AAP committees, sec-
tions, and councils; the American Academy of Family Physicians; the American College
of Obstetricians and Gynecologists; the American Thoracic Society; the Canadian
Paediatric Society; the Centers for Disease Control and Prevention; the US Food and
Drug Administration; the National Institutes of Health; the National Vaccine Program
Office; the Pediatric Infectious Diseases Society; la Sociedad Latinoamericana de
Infectología Pediátrica; the World Health Organization; and many other organizations
and individuals who have made this edition possible. In addition, suggestions made by
individual AAP members to improve the presentation of information on specific issues
and on topic selection have been incorporated whenever possible.
Most important to the success of this edition is the dedication and work of the edi-
tors, whose commitment to excellence is unparalleled. This new edition was made pos-
sible under the able leadership of David W. Kimberlin, MD, Editor, along with Associate

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 xxii PREFACE

Editors Elizabeth D. Barnett, MD, Ruth Lynfield, MD, and Mark H. Sawyer, MD. We
also are indebted to H. Cody Meissner, MD, for his untiring efforts to gather and organize
the slide materials that make up the visual library of Red Book Online and are part of the
electronic versions of the Red Book, and to Henry H. Bernstein, DO, MHCM, for his con-
tinuous efforts to maintain up-to-date content as Editor of Red Book Online.
As noted in previous editions of the Red Book, some omissions and errors are inevi-
table in a book of this type. We ask that AAP members continue to assist the committee
actively by suggesting specific ways to improve the quality of future editions. The commit-
tee membership and editorial staff hope that the 2021 Red Book will enhance your practice
and benefit the children you serve.

Yvonne A. Maldonado, MD, FAAP

Chairperson, Committee on Infectious Diseases

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 xxiii

Introduction
The Committee on Infectious Diseases (COID) of the American Academy of Pediatrics
(AAP) is responsible for developing and revising guidance from the AAP for management
and control of infectious diseases in infants, children, and adolescents. Every 3 years,
the COID issues the Red Book: Report of the Committee on Infectious Diseases, which contains
a composite summary of current recommendations representing the policy of the AAP
on various aspects of infectious diseases, including updated vaccine recommendations for
the most recent US Food and Drug Administration (FDA)-licensed vaccines for infants,
children, and adolescents. These recommendations represent a consensus of opinions
based on consideration of the best available evidence by members of the COID, in con-
junction with liaison representatives from the Centers for Disease Control and Prevention
(CDC), the FDA, the National Institutes of Health, the National Vaccine Program Office,
the Canadian Paediatric Society, the American Thoracic Society, the Pediatric Infectious
Diseases Society, the American Academy of Family Physicians, the American College of
Obstetricians and Gynecologists, Red Book consultants, and scores of collaborators. This
edition of the Red Book is based on information available as of February 2021. The Red
Book is your own personal infectious disease consultant, on your bookshelf and ready for
you 24 hours a day, 7 days a week. Arguably, it is most valuable in those circumstances in
which definitive data from randomized controlled trials are lacking. It is in those situations
that guidance from experts in the field is most critical, and the COID has literally hun-
dreds of years of cumulative expertise to bring to bear on such recommendations.
Preparation of the Red Book is a team effort in the truest sense of the term. Within
weeks following the publication of each Red Book edition, all Red Book chapters are sent for
updates to primary reviewers who are leading national and international experts in their
specific areas. For the 2021 Red Book, one third of primary reviewers were new to this
process, ensuring that the most up-to-date information has been included in this new edi-
tion. Following review by the primary reviewer, each chapter is returned to the assigned
Associate Editor for incorporation of the reviewer’s edits. The chapter then is dissemi-
nated to content experts at the CDC and FDA and to members of all AAP Sections,
Committees, and Councils that agree to review specific chapters for their additional edits
as needed, after which it again is returned to the assigned Associate Editor for harmoni-
zation and incorporation of edits as appropriate. Two designated COID reviewers then
complete a final review of the chapter, and it is returned to the assigned Associate Editor
for inclusion of any needed additional modifications. Chapters requiring consideration
by the full committee then are debated at the “Marathon Meeting,” where the chapters
are finalized. Copyediting by the Editor and Senior Medical Copy Editor, Jennifer Shaw,
follows, and the book then is reviewed by the Red Book reviewers appointed by the AAP
Board of Directors. In all, 1000 hands have touched the 2021 Red Book prior to its publi-
cation! That so many contributors dedicate so much time and expertise to this product is
a testament to the role the Red Book plays in the care of children.
As with literally everything in the world in 2020, the SARS-CoV-2 pandemic necessi-
tated on-the-fly modifications to the production process. The Marathon Meeting typically

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 xxiv INTRODUCTION

is held in person in March of the year prior to publication. With the rolling restrictions
on travel during the spring of 2020, the Marathon Meeting initially was pushed to April
and then finally changed to a virtual meeting in June 2020. This put us 3 months behind
in the production cycle, at a time when pediatricians more than ever needed timely
guidance with the management of infectious diseases and when the pediatric infectious
diseases experts who are the members of COID were being stretched more thinly than
ever before. The responses of the committee members were simply amazing, and quite
honestly I have never been more proud to be in the field of pediatric infectious diseases.
As a direct consequence of their commitment and that of the AAP Board of Directors
reviewers, and the tireless effort of Senior Medical Copy Editor Jennifer Shaw, we were
able to make up 3 months of delay to bring this edition to you on time in the midst of a
once-in-a-century pandemic.
Through the deliberative and inclusive process that defines the production of the Red
Book, the COID endeavors to provide current, relevant, evidence-based recommendations
for the prevention and management of infectious diseases in infants, children, and ado-
lescents. Seemingly unanswerable scientific questions, the complexity of medical practice,
ongoing innovative technology, continuous new information, and inevitable differences
of opinion among experts all are addressed during production of the Red Book. In some
cases, other committees and experts may differ in their interpretation of data and result-
ing recommendations, and occasionally no single recommendation can be made because
several options for management are equally acceptable. In such circumstances, the lan-
guage incorporated in the chapter acknowledges these differing acceptable management
options by use of the phrases “most experts recommend...” and “some experts recom-
mend...” Both phrases indicate valid recommendations, but the first phrase signifies more
agreement and support among the experts. Inevitably in clinical practice, questions arise
that cannot be answered easily on the basis of currently available data. When this hap-
pens, the COID still provides guidance and information that, coupled with clinical judg-
ment, will facilitate well-reasoned, clinically relevant decisions. Through this process of
lifelong learning, the committee seeks to provide a practical guide for physicians and other
health care professionals in their care of infants, children, and adolescents.
To aid physicians and other health care professionals in assimilating current changes
in recommendations in the Red Book, a list of major changes between the 2018 and 2021
editions has been compiled (see Summary of Major Changes, p xxxv). However, this list
only begins to cover the many in-depth changes that have occurred in each chapter and
section. Throughout the Red Book, internet addresses enable rapid access to new informa-
tion. In addition, new information between editions from the COID, in the form of Policy
Statements, Clinical Reports, and Technical Reports, are posted on Red Book Online
(www.aapredbook.org), and online chapters are modified as needed with clear indica-
tions of where changes have been made. These completed work products are a result of
the continuous reassessment by the COID of its current positions across the spectrum of
pediatric infectious diseases and demonstrate the dynamic process by which the commit-
tee’s deliberations always are inclusive of new data and perspectives.
Information on use of antimicrobial agents is included in the package inserts (product
labels) prepared by manufacturers, including contraindications and adverse events. The
Red Book does not attempt to provide this information comprehensively, because it is avail-
able readily in the Physicians’ Desk Reference (www.pdr.net) and in package inserts.

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 INTRODUCTION xxv

As in previous editions of the Red Book, recommended dosage schedules for antimi-
crobial agents are provided (see Section 4, Antimicrobial Agents and Related Therapy)
and may differ from those of the manufacturer as provided in the package insert.
Antimicrobial agents recommended for specific infections in the Red Book may or may
not have an FDA indication for treatment of that infection. Physicians also can reference
additional information in the package inserts of vaccines licensed by the FDA (which
also may differ from COID and ACIP/CDC recommendations for use) and of immune
globulins, as well as recommendations of other committees (see Sources of Vaccine
Information, p 0), many of which are included in the Red Book.
Likewise, we strive to utilize the accurate terminology for licensure, approval, or
clearance of drugs and devices by the FDA. The correct term used depends on the clas-
sification of the product (eg, drug, biological product, or device) and, for devices, whether
a “premarket notification” or a “premarket application” has been submitted. Drugs are
approved by the FDA, biologic products (eg, vaccines, immunoglobulin preparations) are
licensed by the FDA, and vaccines are approved for use in certain populations and age
groups. The FDA “clears” devices after reviewing premarket notifications, but “approves”
devices after reviewing a premarket application. Whether a premarket notification or
premarket application needs to be filed depends on the classification of the medical
device. “Cleared” devices (also called “510 (k)” or “premarket notification” devices) can
be searched at www.fda.gov/medical-devices/device-approvals-denials-and-
clearances/510k-clearances. Devices@FDA (www.fda.gov/medical-devices) is
more comprehensive and includes both “cleared” and “approved” tests and other devices.
Where we fail in the Red Book to select the appropriate term for a given product, we apolo-
gize for any (additional) confusion this adds to this regulatory structure.
This book could not have been prepared without the dedicated professional com-
petence of many people. The AAP staff has been outstanding in its committed work
and contributions, particularly Jennifer Shaw, Senior Medical Copy Editor; Linda Rutt,
Project Specialist; Jennifer Frantz, Senior Manager, who serves as the administrative
director for the COID and coordinated preparation of the Red Book; Theresa Wiener,
Manager of Publishing and Production Services; and all of the directors and staff of the
AAP publishing and marketing groups who make the full Red Book product line possible.
Marc Fischer, MD, of the CDC, and Karen M. Farizo, MD, of the FDA, devoted
time and effort in providing significant input from their organizations. Lisa Cosgrove,
MD, Gary Floyd, MD, and Yasuko Fukuda, MD, served as Red Book reviewers appointed
by the AAP Board of Directors, spending scores of hours reviewing the final chapters for
consistency and accuracy. I am especially indebted to the Associate Editors Elizabeth D.
Barnett, MD, Ruth Lynfield, MD, and Mark H. Sawyer, MD, for their expertise, tireless
work, good humor, and immense contributions in their editorial and committee work.
Members of the COID contributed countless hours and deserve appropriate recognition
for their patience, dedication, revisions, and reviews. The COID appreciates the guidance
and dedication of Yvonne A. Maldonado, MD, COID Chairperson, whose knowledge,
dedication, insight, and leadership are reflected in the quality and productivity of the
committee’s work. I thank my wife, Kim, for always being there and for her patience,
understanding, and never-ending support as this edition of the Red Book came to fruition.
I also would like to personally thank Mark Del Monte, JD, Chief Executive Officer/
Executive Vice President of the Academy, for his calm demeanor and exceptional support

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 xxvi INTRODUCTION

throughout what likely is the most stressful year that any of us have ever experienced. His
steady hand on the rudder of the AAP directly results in the productivity that we have
been able to achieve during these extraordinary times. All pediatricians across the coun-
try, and the patients they serve, owe him a debt of gratitude.
There are many other contributors whose professional work and commitment have
been essential in the committee’s preparation of the Red Book. Please forgive any omissions
I have made in expressing my gratitude. As stated in the African proverb, if you want to
go fast, go alone; if you want to go far, go together. This edition of the Red Book, produced
in the most unusual and difficult of times, shows just how far we can go, together.

David W. Kimberlin, MD, FAAP, Editor

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 xxvii

Table of Contents
Summary of Major Changes in the 2021 Red Book

SECTION 1
ACTIVE AND PASSIVE IMMUNIZATION
Prologue............................................................................................................................. 1
Sources of Information About Immunization................................................................... 3
Discussing Vaccines With Patients and Parents................................................................. 7
Addressing Parents’ Questions About Vaccine Safety and Effectiveness..................... 7
Common Misconceptions About Immunizations........................................................ 7
Resources for Optimizing Communications With Parents About Vaccines................. 10
Parental Refusal of Immunizations.............................................................................. 11
Immunization Documentation..................................................................................... 12
Active Immunization.......................................................................................................... 13
Vaccine Ingredients...................................................................................................... 17
Vaccine Handling and Storage..................................................................................... 19
Vaccine Administration................................................................................................ 26
Managing Injection Pain.............................................................................................. 30
Immunization Schedule and Timing of Vaccines........................................................ 31
Minimum Ages and Minimum Intervals Between Vaccine Doses............................... 34
Interchangeability of Vaccine Products....................................................................... 34
Simultaneous Administration of Multiple Vaccines..................................................... 36
Combination Vaccines.................................................................................................. 37
Lapsed Immunizations................................................................................................. 38
Unknown or Uncertain Immunization Status.............................................................. 39
Vaccine Dose................................................................................................................ 39
Active Immunization After Receipt of Immune Globulin or Other
Blood Products.............................................................................................. 40
Vaccine Safety.............................................................................................................. 42
Risks and Adverse Events...................................................................................... 42
National Academy of Medicine Reviews of Adverse Events
After Immunization................................................................................ 43
Immunization Safety Review................................................................................. 44
Childhood Immunization Schedule and Safety..................................................... 45
Vaccine Adverse Event Reporting System............................................................. 46
Vaccine Safety Datalink Project............................................................................. 47
FDA CBER Sentinel Program............................................................................... 48
Clinical Immunization Safety Assessment (CISA) Project..................................... 48
Vaccine Injury Compensation............................................................................... 50
Hypersensitivity Reactions After Immunization.................................................... 51
Immediate-Type Allergic Reactions....................................................................... 52
Delayed-Type Allergic Reactions........................................................................... 53

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 xxviii TABLE OF CONTENTS

Other Vaccine Reactions....................................................................................... 54

Passive Immunization......................................................................................................... 54
Immune Globulin Intramuscular (IGIM)..................................................................... 55
Immune Globulin Intravenous (IGIV)......................................................................... 57
Immune Globulin Subcutaneous (IGSC)..................................................................... 62
Treatment of Anaphylactic Reactions.......................................................................... 64
Immunization in Special Clinical Circumstances.............................................................. 67
Immunization in Preterm and Low Birth Weight Infants............................................ 67
Immunization in Pregnancy......................................................................................... 69
Immunization and Other Considerations in Immunocompromised Children............ 72
Immunization in Children With a Personal or Family History of Seizures................. 87
Immunization in Children With Chronic Diseases...................................................... 87
Immunization in American Indian/Alaska Native Children
and Adolescents............................................................................................ 88
Immunization in Adolescent and College Populations................................................ 91
Immunization in Health Care Personnel .................................................................... 92
Children Who Received Immunizations Outside the United States or
Whose Immunization Status is Unknown or Uncertain............................... 96
International Travel...................................................................................................... 99

SECTION 2
RECOMMENDATIONS FOR CARE OF CHILDREN IN SPECIAL
CIRCUMSTANCES
Breastfeeding and Human Milk....................................................................................... 107
AAP Recommendations on Breastfeeding................................................................. 107
Contraindications to Breastfeeding............................................................................ 108
Immunization of Mothers and Infants....................................................................... 108
Transmission of Infectious Agents via Human Milk.................................................. 109
Antimicrobial Agents and Other Drugs in Human Milk........................................... 115
Anti-TNF Biologic Response Modifiers in Human Milk........................................... 116
Children in Group Child Care and Schools.................................................................... 116
Modes of Spread of Infectious Diseases.................................................................... 117
Respiratory Tract Diseases................................................................................... 117
Enteric Diseases................................................................................................... 117
Bloodborne Infections.......................................................................................... 119
Other Infections................................................................................................... 121
Management and Prevention of Infectious Diseases................................................. 122
Immunization....................................................................................................... 122
Infection Control and Prevention........................................................................ 124
Exclusion and Return to Care............................................................................. 126
Infection Prevention and Control for Hospitalized Children.......................................... 133
Infection Prevention and Control Precautions........................................................... 134
Strategies to Prevent Health Care-Associated Infections........................................... 141
Occupational Health.................................................................................................. 142
Sibling Visitation........................................................................................................ 143
Adult Visitation........................................................................................................... 143

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 TABLE OF CONTENTS xxix

Pet Visitation............................................................................................................... 144

Infection Prevention and Control in Ambulatory Settings.............................................. 145
Sexually Transmitted Infections in Adolescents and Children........................................ 148
STIs During Preventive Health Care of Adolescents................................................ 148
Sexual Assault and Abuse in Children and Adolescents/Young Adults..................... 150
Medical Evaluation for Infectious Diseases for Internationally Adopted,
Refugee, and Immigrant Children.................................................................... 158
Consideration for Testing for Infectious Agents......................................................... 159
Hepatitis A........................................................................................................... 159
Hepatitis B........................................................................................................... 161
Hepatitis C........................................................................................................... 162
Intestinal Pathogens............................................................................................. 162
Tissue Parasites/Eosinophilia.............................................................................. 163
Sexually Transmitted Infections........................................................................... 163
Tuberculosis......................................................................................................... 164
HIV Infection....................................................................................................... 165
Chagas Disease (American Trypanosomiasis)...................................................... 165
Other Infectious Diseases..................................................................................... 165
Injuries From Needles Discarded in the Community...................................................... 166
Wound Care and Tetanus Prophylaxis....................................................................... 167
Bloodborne Pathogens................................................................................................ 167
Preventing Needlestick Injuries.................................................................................. 169
Bite Wounds..................................................................................................................... 169
Prevention of Mosquitoborne and Tickborne Infections................................................ 175
General Protective Measures...................................................................................... 176
Repellents for Use on Skin......................................................................................... 177
Tick Inspection and Removal..................................................................................... 179
Other Preventive Measures........................................................................................ 180
Prevention of Illnesses Associated with Recreational Water Use.................................... 180

SECTION 3
SUMMARIES OF INFECTIOUS DISEASES
Actinomycosis................................................................................................................... 187
Adenovirus Infections....................................................................................................... 188
Amebiasis......................................................................................................................... 190
Amebic Meningoencephalitis and Keratitis (Naegleria fowleri, Acanthamoeba
species, and Balamuthia mandrillaris).................................................................... 193
Anthrax ........................................................................................................................... 196
Arboviruses (Including Colorado tick fever, Eastern equine encephalitis,
Heartland, Jamestown Canyon, Japanese encephalitis, La Crosse,
Powassan, St. Louis encephalitis, tickborne encephalitis, and yellow
fever viruses)....................................................................................................... 202
Arcanobacterium haemolyticum Infections............................................................................... 209
Ascaris lumbricoides Infections............................................................................................. 210
Aspergillosis...................................................................................................................... 211
Astrovirus Infections......................................................................................................... 216

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 xxx TABLE OF CONTENTS

Babesiosis......................................................................................................................... 217
Bacillus cereus Infections and Intoxications........................................................................ 219
Bacterial Vaginosis........................................................................................................... 221
Bacteroides, Prevotella, and Other Anaerobic Gram-Negative Bacilli Infections................. 224
Balantidium coli Infections (Balantidiasis)........................................................................... 226
Bartonella henselae (Cat-Scratch Disease)............................................................................ 226
Baylisascaris Infections....................................................................................................... 229
Infections With Blastocystis Species................................................................................... 230
Blastomycosis................................................................................................................... 232
Bocavirus.......................................................................................................................... 233
Borrelia Infections Other Than Lyme Disease (Relapsing Fever)..................................... 235
Brucellosis........................................................................................................................ 238
Burkholderia Infections....................................................................................................... 240
Campylobacter Infections..................................................................................................... 243
Candidiasis....................................................................................................................... 246
Chancroid and Cutaneous Ulcers.................................................................................... 252
Chikungunya.................................................................................................................... 254
Chlamydial Infections.......................................................................................................... 256
Chlamydia pneumoniae ................................................................................................... 256
Chlamydia psittaci (Psittacosis, Ornithosis, Parrot Fever) .............................................. 258
Chlamydia trachomatis.................................................................................................... 260
Clostridial Infections........................................................................................................ 266
Botulism and Infant Botulism (Clostridium botulinum)................................................... 266
Clostridial Myonecrosis (Gas Gangrene) ................................................................... 269
Clostridioides difficile (formerly Clostridium difficile).......................................................... 271
Clostridium perfringens Foodborne Illness....................................................................... 276
Coccidioidomycosis.......................................................................................................... 277
Coronaviruses, Including SARS-CoV-2 and MERS-CoV.............................................. 280
Cryptococcus neoformans and Cryptococcus gattii Infections (Cryptococcosis) ......................... 285
Cryptosporidiosis............................................................................................................. 288
Cutaneous Larva Migrans............................................................................................... 291
Cyclosporiasis................................................................................................................... 292
Cystoisosporiasis (formerly Isosporiasis) .......................................................................... 293
Cytomegalovirus Infection............................................................................................... 294
Dengue ........................................................................................................................... 301
Diphtheria........................................................................................................................ 304
Ehrlichia, Anaplasma, and Related Infections (Human Ehrlichiosis, Anaplasmosis,
and Related Infections Attributable to Bacteria in the Family
Anaplasmataceae) .................................................................................................. 308
Serious Neonatal Bacterial Infections Caused by Enterobacteriaceae (Including
Septicemia and Meningitis)............................................................................... 311
Enterovirus (Nonpoliovirus) (Group A and B Coxsackieviruses, Echoviruses,
Numbered Enteroviruses).................................................................................. 315
Epstein-Barr Virus Infections (Infectious Mononucleosis) .............................................. 318
Escherichia coli Diarrhea (Including Hemolytic-Uremic Syndrome) ................................. 322
Other Fungal Diseases..................................................................................................... 328

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Fusobacterium Infections (Including Lemierre Syndrome) ................................................ 333

Giardia duodenalis (formerly Giardia lamblia and Giardia intestinalis) Infections
(Giardiasis)…..................................................................................................... 335
Gonococcal Infections...................................................................................................... 338
Granuloma Inguinale (Donovanosis)............................................................................... 344
Haemophilus influenzae Infections........................................................................................ 345
Hantavirus Pulmonary Syndrome................................................................................... 354
Helicobacter pylori Infections............................................................................................... 357
Hemorrhagic Fevers Caused by Arenaviruses................................................................. 362
Hemorrhagic Fevers Caused by Bunyaviruses................................................................. 365
Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg................................... 368
Hepatitis A....................................................................................................................... 373
Hepatitis B....................................................................................................................... 381
Hepatitis C....................................................................................................................... 399
Hepatitis D....................................................................................................................... 404
Hepatitis E....................................................................................................................... 405
Herpes Simplex................................................................................................................ 407
Histoplasmosis.................................................................................................................. 417
Hookworm Infections (Ancylostoma duodenale and Necator americanus)................................. 421
Human Herpesvirus 6 (Including Roseola) and 7............................................................ 422
Human Herpesvirus 8...................................................................................................... 425
Human Immunodeficiency Virus Infection..................................................................... 427
Human Papillomaviruses................................................................................................. 440
Influenza.......................................................................................................................... 447
Kawasaki Disease............................................................................................................. 457
Kingella kingae Infections.................................................................................................... 464
Legionella pneumophila Infections......................................................................................... 465
Leishmaniasis................................................................................................................... 468
Leprosy..............................................................................................................................472
Leptospirosis..................................................................................................................... 475
Listeria monocytogenes Infections (Listeriosis)........................................................................ 478
Lyme Disease (Lyme Borreliosis, Borrelia burgdorferi sensu lato Infection)......................... 482
Lymphatic Filariasis (Bancroftian, Malayan, and Timorian)........................................... 490
Lymphocytic Choriomeningitis Virus.............................................................................. 492
Malaria............................................................................................................................. 493
Measles............................................................................................................................. 503
Meningococcal Infections................................................................................................ 519
Human Metapneumovirus............................................................................................... 532
Microsporidia Infections (Microsporidiosis)..................................................................... 533
Molluscum Contagiosum................................................................................................. 535
Moraxella catarrhalis Infections........................................................................................... 537
Mumps............................................................................................................................. 538
Mycoplasma pneumoniae and Other Mycoplasma Species Infections...................................... 543
Nocardiosis....................................................................................................................... 546
Norovirus and Sapovirus Infections................................................................................. 548
Onchocerciasis (River Blindness, Filariasis)..................................................................... 550

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Paracoccidioidomycosis (Formerly Known as South American Blastomycosis).............. 552

Paragonimiasis................................................................................................................. 554
Parainfluenza Viral Infections.......................................................................................... 555
Parasitic Diseases.............................................................................................................. 557
Parechovirus Infections.................................................................................................... 561
Parvovirus B19 (Erythema Infectiosum, Fifth Disease).................................................... 562
Pasteurella Infections.......................................................................................................... 566
Pediculosis Capitis (Head Lice)........................................................................................ 567
Pediculosis Corporis (Body Lice)...................................................................................... 571
Pediculosis Pubis (Pubic Lice, Crab Lice)........................................................................ 572
Pelvic Inflammatory Disease............................................................................................ 574
Pertussis (Whooping Cough)............................................................................................ 578
Pinworm Infection (Enterobius vermicularis)........................................................................ 589
Pityriasis Versicolor (Formerly Tinea Versicolor)............................................................. 591
Plague............................................................................................................................... 592
Pneumocystis jirovecii Infections............................................................................................ 595
Poliovirus Infections......................................................................................................... 601
Polyomaviruses (BK, JC, and Other Polyomaviruses)...................................................... 607
Prion Diseases: Transmissible Spongiform Encephalopathies......................................... 610
Pseudomonas aeruginosa Infections....................................................................................... 614
Q Fever (Coxiella burnetii Infection).................................................................................... 617
Rabies............................................................................................................................... 619
Rat-Bite Fever.................................................................................................................. 627
Respiratory Syncytial Virus ............................................................................................ 628
Rhinovirus Infections....................................................................................................... 636
Rickettsial Diseases.......................................................................................................... 638
Rickettsialpox................................................................................................................... 640
Rocky Mountain Spotted Fever....................................................................................... 641
Rotavirus Infections......................................................................................................... 644
Rubella............................................................................................................................. 648
Salmonella Infections.......................................................................................................... 655
Scabies.............................................................................................................................. 663
Schistosomiasis................................................................................................................. 666
Shigella Infections.............................................................................................................. 668
Smallpox (Variola)............................................................................................................ 672
Sporotrichosis................................................................................................................... 676
Staphylococcal Food Poisoning........................................................................................ 677
Staphylococcus aureus................................................................................................................ 678
Coagulase-Negative Staphylococcal Infections................................................................ 692
Group A Streptococcal Infections.................................................................................... 694
Group B Streptococcal Infections.................................................................................... 707
Non-Group A or B Streptococcal and Enterococcal Infections...................................... 713
Streptococcus pneumoniae (Pneumococcal) Infections............................................................ 717
Strongyloidiasis (Strongyloides stercoralis) ............................................................................ 727
Syphilis............................................................................................................................. 729
Tapeworm Diseases (Taeniasis and Cysticercosis)........................................................... 744

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 TABLE OF CONTENTS xxxiii

Other Tapeworm Infections (Including Hydatid Disease)............................................... 747

Tetanus (Lockjaw)............................................................................................................ 750
Tinea Capitis (Ringworm of the Scalp)........................................................................... 755
Tinea Corporis (Ringworm of the Body)........................................................................ 759
Tinea Cruris (Jock Itch).................................................................................................... 762
Tinea Pedis and Tinea Unguium (Onychomycosis) (Athlete’s Foot,
Ringworm of the Feet)...................................................................................... 764
Toxocariasis...................................................................................................................... 766
Toxoplasma gondii Infections (Toxoplasmosis)..................................................................... 767
Trichinellosis (Trichinella spiralis and Other Species)......................................................... 775
Trichomonas vaginalis Infections (Trichomoniasis)............................................................... 777
Trichuriasis (Whipworm Infection).................................................................................. 780
African Trypanosomiasis (African Sleeping Sickness)...................................................... 781
American Trypanosomiasis (Chagas Disease).................................................................. 783
Tuberculosis..................................................................................................................... 786
Nontuberculous Mycobacteria (Environmental Mycobacteria, Mycobacteria
Other Than Mycobacterium tuberculosis)................................................................ 814
Tularemia......................................................................................................................... 822
Louseborne Typhus (Epidemic or Sylvatic Typhus)........................................................ 825
Murine Typhus (Endemic or Fleaborne Typhus)............................................................ 827
Ureaplasma urealyticum and Ureaplasma parvum Infections................................................... 829
Varicella-Zoster Virus Infections...................................................................................... 831
Vibrio Infections................................................................................................................ 843
Cholera (Vibrio cholerae)............................................................................................... 843
Other Vibrio Infections................................................................................................ 847
West Nile Virus................................................................................................................ 848
Yersinia enterocolitica and Yersinia pseudotuberculosis Infections
(Enteritis and Other Illnesses)............................................................................ 851
Zika.................................................................................................................................. 854

SECTION 4
ANTIMICROBIAL AGENTS AND RELATED THERAPY
Introduction..................................................................................................................... 863
Fluoroquinolones........................................................................................................ 864
Tetracyclines............................................................................................................... 866
Antimicrobial Agents Approved for Use in Adults but Not Children........................ 866
Cephalosporin Cross-Reactivity With Other Beta Lactam Antibiotics..................... 866
Antimicrobial Resistance and Antimicrobial Stewardship:
Appropriate and Judicious Use of Antimicrobial Agents.................................. 868
Antimicrobial Resistance............................................................................................ 868
Factors Contributing to Resistance............................................................................. 868
Actions to Prevent or Slow Antimicrobial Resistance................................................ 869
Antimicrobial Stewardship......................................................................................... 870
Role of the Medical Provider..................................................................................... 872
Principles of Appropriate Use of Antimicrobial Therapy for Upper
Respiratory Tract Infections....................................................................... 873

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 xxxiv TABLE OF CONTENTS

Drug Interactions............................................................................................................. 876

Tables of Antibacterial Drug Dosages............................................................................. 876
Sexually Transmitted Infections....................................................................................... 898
Antifungal Drugs for Systemic Fungal Infections............................................................ 905
Polyenes...................................................................................................................... 905
Pyrimidines................................................................................................................. 906
Azoles......................................................................................................................... 907
Echinocandins............................................................................................................ 908
Recommended Doses of Parenteral and Oral Antifungal Drugs.................................... 913
Topical Drugs for Superficial Fungal Infections.............................................................. 922
Non-HIV Antiviral Drugs................................................................................................ 930
Drugs for Parasitic Infections........................................................................................... 949
Systems-based Treatment Table...................................................................................... 990
MedWatch—The FDA Safety Information and Adverse Event-Reporting Program... 1004

SECTION 5
ANTIMICROBIAL PROPHYLAXIS
Antimicrobial Prophylaxis.............................................................................................. 1007
Infection-Prone Body Sites....................................................................................... 1007
Exposure to Specific Pathogens................................................................................ 1009
Vulnerable Hosts...................................................................................................... 1009
Antimicrobial Prophylaxis in Pediatric Surgical Patients............................................... 1010
Guidelines for Appropriate Use............................................................................... 1010
Indications for Prophylaxis....................................................................................... 1010
Surgical Site Infection Criteria................................................................................. 1012
Timing of Administration of Prophylactic Antimicrobial Agents........................... 1013
Dosing and Duration of Administration of Antimicrobial Agents.......................... 1013
Preoperative Screening and Decolonization............................................................ 1013
Recommended Antimicrobial Agents...................................................................... 1014
Prevention of Bacterial Endocarditis............................................................................. 1021
Neonatal Ophthalmia.................................................................................................... 1023
Primary Prevention.................................................................................................. 1023
Secondary Prevention............................................................................................... 1023
Legal Mandates for Topical Prophylaxis for Neonatal Ophthalmia........................ 1025
Pseudomonal Ophthalmia........................................................................................ 1026
Other Nongonococcal, Nonchlamydial Ophthalmia............................................... 1026

APPENDICES
I Directory of Resources.................................................................................... 1027
II Codes for Commonly Administered Pediatric Vaccines/Toxoids
and Immune Globulins.................................................................................... 1032
III Nationally Notifiable Infectious Diseases in the United States........................ 1033
IV Guide to Contraindications and Precautions to Immunizations..................... 1036
V Prevention of Infectious Disease From Contaminated Food Products............ 1037
VI Clinical Syndromes Associated With Foodborne Diseases.............................. 1041
VII Diseases Transmitted by Animals (Zoonoses).................................................. 1048

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 xxxv

Summary of Major Changes

in the 2021 Red Book
MAJOR CHANGES: GENERAL
1. All chapters in the last edition of the Red Book were assessed for relevance in the
dynamic environment that is the practice of pediatric medicine today. The School
Health chapter was noted to have significant overlap with the Children in Out-of-
Home Child Care chapter, so they were merged in the 2021 edition into a single
chapter titled Children in Group Child Care and Schools. In addition, the
Vaccine Injury Table appendix was deleted. Two chapters have been added to the
2021 edition: Pseudomonas aeruginosa Infections and a new Systems-
based Treatment Table that is designed to aid in initial antibiotic selections by
clinical condition, before the specific pathogen is known.
2. The 2018 Red Book had 9% fewer chapters compared with the 2015 edition, and
yet the total book was 60 pages longer. As we started work on the 2021 Red Book,
we therefore identified the 31 chapters that were 10 pages or longer in the 2018
edition, and made a targeted effort to trim them so that all relevant information
could more easily and quickly be located. Although some of these 31 chapters (eg,
the antibiotic or antiparasitic tables) could not be truncated, we overall achieved
our goal by decreasing the 2021 Red Book by 41 pages compared with the 2018
edition.
3. Every chapter in the 2021 Red Book has been modified since the last edition. The list-
ing below outlines the more major changes throughout the 2021 edition.
4. To ensure that the information presented in the Red Book is based on the most accu-
rate and up-to-date scientific data, the primary reviewers of each Red Book chapter
were selected for their specific academic expertise in each particular area. In this
edition of the Red Book, 32% of the primary reviewers were new for their assigned
chapters. This ensures that the Red Book content is viewed with fresh eyes with each
publication cycle.
5. Throughout the Red Book, the number of websites where additional current and
future information can be obtained has been updated. All websites are in bold type
for ease of reference, and all have been verified for accuracy and accessibility.
6. Reference to evidence-based policy recommendations from the American Academy
of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP) of
the Centers for Disease Control and Prevention (CDC), and other select professional
organizations have been updated throughout the Red Book.
7. Standardized approaches to disease prevention through immunizations, antimicro-
bial prophylaxis, and infection-control practices have been updated throughout the
Red Book.
8. Policy updates released after publication of this edition of the Red Book will be posted
on Red Book Online.

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 xxxvi SUMMARY OF MAJOR CHANGES IN THE 2021 RED BOOK

9. Appropriate chapters throughout the Red Book have been updated to be consistent
with 2021 AAP and CDC vaccine recommendations, CDC recommendations for
immunization of health care personnel, and drug recommendations from 2021
Nelson’s Pediatric Antimicrobial Therapy.1
10. Several tables and figures have been added for ease of information retrieval.

SECTION 1. ACTIVE AND PASSIVE IMMUNIZATION

1. Internet resources for vaccine information have been updated in Sources of
Information About Immunization.
2. The CDC’s new “Vaccinate with Confidence” program, launched in 2019, has been
added to the Discussing Vaccines With Patients and Parents chapter.
3. The table on “Vaccines Approved for Immunization and Distributed in the United
States and Their Routes of Administration” in the Active Immunization chapter
has been updated to include the newly approved dengue vaccine.
4. The Vaccine Ingredients chapter has been restructured to more clearly delineate
the excipients that may be present in vaccines.
5. Information on vaccine transport has been expanded in Vaccine Handling and
Storage.
6. In the Vaccine Administration chapter, information on needle length and site of
injection for intramuscularly administered vaccines is provided by age group.
7. Sequence and interval between PCV13 and PPSV23 has been added to the sec-
tion on administration of multiple vaccines in the Timing of Vaccines and the
Immunization Schedule chapter.
8. A link to the CDC’s General Best Practice Guidelines for Immunization docu-
ment has been added to Minimum Ages and Minimum Intervals Between
Vaccine Doses.
9. In the Interchangeability of Vaccine Products chapter, clarification has been
added that if different brands of a particular vaccine require a different number of
doses for series completion and a provider mixes brands in the primary series, then
the higher number of doses is recommended for series completion.
10. Data have been updated on the small increased risk of febrile seizure when IIV
and PCV13 are administered simultaneously in the chapter on Simultaneous
Administration of Multiple Vaccines.
11. The new hexavalent vaccine to prevent diphtheria, tetanus, pertussis, poliomyelitis,
hepatitis B, and invasive disease due to Haemophilus influenzae type b, Vaxelis, has been
added to the table in the Combination Vaccines chapter.
12. A link to the recommended intervals between vaccine doses has been added to
enhance discussion of Lapsed Immunizations.
13. In the Unknown or Uncertain Immunization Status chapter, a statement
has been added that serologic testing may not satisfy some school immunization
requirements.

1
Bradley JS, Nelson JD, Barnett ED, et al, eds. 2021 Nelson’s Pediatric Antimicrobial Therapy. 27th ed. Elk Grove
Village, IL: American Academy of Pediatrics; 2021

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 SUMMARY OF MAJOR CHANGES IN THE 2021 RED BOOK xxxvii

14. Table 1.11 (Recommended Intervals Between Receipt of Blood Products and
Administration of MMR, Varicella, or MMRV Vaccines) has been significantly
revised in the chapter on Active Immunization of People Who Recently
Received Immune Globulin and Other Blood Products.
15. The listing of the National Academy of Medicine’s causality conclusions regarding
evidence for a causal relationship between the specific vaccines and other adverse
event has been expanded in the National Academy of Medicine Reviews of
Adverse Events After Immunization chapter.
16. The Vaccine Adverse Event Reporting System chapter has updated informa-
tion on reporting of adverse events.
17. The description of the FDA’s active postmarket surveillance system, the
Biologics Effectiveness and Safety (BEST) Initiative, has been updated in the
chapter FDA CBER Sentinel Program.
18. Information about funding and award distribution of the Vaccine Injury
Compensation Program has been added to the Vaccine Injury Compensation
chapter.
19. Immune Globulin Intramuscular recommendations for hepatitis A prophylaxis
have been updated.
20. In the Immune Globulin Intravenous chapter, high-titer polyclonal RSV IGIV
preparation has been added, the impact on IGIV on ESR has been added, and
availability of an anti-IgA assay has been updated.
21. Utility of Immune Globulin Subcutaneous for immunomodulation in autoim-
mune neurologic conditions has been added.
22. Administration of rotavirus vaccine to patients while still in the NICU has been
added to Immunization in Special Clinical Circumstances.
23. Discussion of live vaccines and pregnancy, including cholera vaccine, has been
expanded in the Immunization in Pregnancy chapter.
24. In the chapter on Immunization and Other Considerations in
Immunocompromised Children, the timing of immunization following
resolution of severe immunization has been added. Meningococcal booster dose
information for some immunocompromising conditions has been added. Use of
penicillin or amoxicillin prophylaxis “can be considered” for duration of eculi-
zumab treatment and until immune competence has returned. And MenQuadfi
(meningococcal groups A, C, Y, W conjugate vaccine [Sanofi Pasteur Inc]) has
been added.
25. The small increased risk of febrile seizure when IIV and PCV13 or when IIV and
DTaP are administered simultaneously has been added to the Immunization
in Children With a Personal or Family History of Seizures chapter.
26. The CDC link with guidance on vaccinating people with increased bleeding risk
has been added to the Immunization in Children With Chronic Diseases
chapter.
27. The new PRP-OMP containing hexavalent combination vaccine (DTaP-IPV-Hib-
HepB) has been added to the chapter on Immunization in American Indian/
Alaska Native Children and Adolescents.

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 xxxviii SUMMARY OF MAJOR CHANGES IN THE 2021 RED BOOK

28. In Immunization in Health Care Personnel, Heplisav-B has been added, and
a distinction has been made between numbers of doses for it versus Engerix-B or
Recombivax HB.
29. The new dengue vaccine is mentioned in the International Travel chapter.
Catch-up HepA administration has been added. The option of Heplisav-B for adults
is included. Information on yellow fever vaccine has been expanded in the text. And
MenQuadfi (meningococcal groups A, C, Y, W conjugate vaccine [Sanofi Pasteur
Inc]) has been added.

SECTION 2. RECOMMENDATIONS FOR CARE OF CHILDREN

IN SPECIAL CLINICAL CIRCUMSTANCES
1. The human milk chapter has been retitled as Breastfeeding and Human Milk.
Specific infections during which breastfeeding is not advised have been added.
Information on Ebola and breastfeeding has been added. Information on cholera
vaccine and breastfeeding has been added.
2. The School Health chapter and the Children in Out-of-Home Child Care
chapter have been merged into the new Children in Group Child Care and
Schools chapter. Content has been harmonized with the American Academy of
Pediatrics’ “Purple Book” (Managing Infectious Diseases in Child Care and Schools: A Quick
Reference Guide, 5th ed. Aronson SS, Shope TR, eds. Itasca, IL: American Academy
of Pediatrics; 2019).
3. Respiratory hygiene and cough etiquette have been added to the Standard
Precautions section of the Infection Control and Prevention for
Hospitalized Children chapter, and the chapter has been shortened.
4. CDC guidance on the appropriate use of serologic testing for assessing immunity
has been added to the Infection Control and Prevention in Ambulatory
Settings chapter.
5. The chapter on Sexually Transmitted Infections in Adolescents and
Children has been restructured and shortened. It also has been harmonized with
the CDC 2021 Sexually Transmitted Infections Treatment Guidelines.
6. Hepatitis C testing and malaria screening recommendations for international
adoptees have been updated in the Medical Evaluation for Infectious
Diseases for Internationally Adopted, Refugee, and Immigrant
Children chapter.
7. Data on infection risks from discarded needles have been updated in the Injuries
From Discarded Needles in the Community chapter.
8. Factors increasing risk for penetrating trauma to the cranium have been added to
the Bite Wounds chapter.
9. Discussion of dengue prevention has been expanded in the Prevention of
Mosquitoborne and Tickborne Infections chapter, and recommendations for
use of insect repellents have been updated.
10. In Prevention of Illnesses Associated With Recreational Water Use, inci-
dence data on infections associated with recreational water use have been updated.
Information on cyanobacteria has been added. Recommendations on when not to
swim in lakes, rivers, and oceans has been added.

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 SUMMARY OF MAJOR CHANGES IN THE 2021 RED BOOK xxxix

SECTION 3. SUMMARIES OF INFECTIOUS DISEASES

1. Actinomycosis disease in people receiving biologic response modifiers has been
added. The list of alternative antibiotics that can be used has been narrowed.
2. Treatment options for Adenovirus Infections are discussed in greater detail.
3. Molecular diagnostics for intestinal Amebiasis have been expanded. Dientamoeba
fragilis epidemiology, diagnosis, and treatment has been added to the chapter.
4. The sequence of diagnostic testing for Amebic Meningoencephalitis and
Keratitis is provided in greater detail. Miltefosine availability has been updated.
Sappinia has been removed from the discussion.
5. The clinical manifestations of Anthrax have been expanded.
6. Heartland virus has been added to the Arboviruses chapter, and Toscana virus has
been removed. Dengue and yellow fever vaccine availabilities have been updated.
Dosing in adults and booster dose in children for Japanese encephalitis vaccine has
been added.
7. Treatment options for Arcanobacterium haemolyticum Infections are dis-
cussed in greater detail.
8. Test of cure assessments of stool following treatment of Ascaris lumbricoides
Infections are presented in greater detail.
9. Discussion of intrinsic and acquired antifungal resistance for Aspergillosis has
been expanded, including empiric treatment options for areas with high levels of
azole resistance.
10. Viral shedding prior to onset of symptoms from Astrovirus Infections has been
added.
11. The Babesiosis chapter has been aligned with the IDSA babesiosis guidelines
released in 2020. Diagnostic options and treatment recommendations have been
updated.
12. The listing of foods implicated in Bacillus cereus outbreaks has been expanded.
13. The role of Gardnerella vaginalis in Bacterial Vaginosis has been updated.
Diagnostic options have been expanded.
14. Treatment options for Bacteroides, Prevotella, and Other Anaerobic Gram-
Negative Bacilli Infections have been expanded.
15. Treatment options for Balantidium coli Infections have been updated.
16. Clinical manifestations of Bartonella henselae are provided in greater detail.
Challenges with some diagnostic tests are discussed.
17. Clinical manifestations of Baylisascaris Infections are provided in greater detail.
18. Etiologic information on Blastocystis hominis has been updated.
19. The diagnostic section of the Blastomycosis chapter has been updated.
20. Interpretation of diagnostic test results for Bocavirus has been expanded.
21. Transmission and serologic detection of Borrelia Infections Other Than Lyme
Disease are provided in greater detail.
22. Serologic testing information for Brucellosis has been expanded.
23. Treatment options for Burkholderia Infections have been updated.
24. Molecular and antigenic testing for Campylobacter Infections has been
updated.
25. Treatment recommendations for Candidiasis have been modified.

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 xl SUMMARY OF MAJOR CHANGES IN THE 2021 RED BOOK

26. The diagnostic section of the Chancroid and Cutaneous Ulcers chapter has
been updated, and the chapter has been harmonized with the CDC 2021 Sexually
Transmitted Infections Treatment Guidelines.
27. Risk factors for long-term sequelae following Chikungunya have been added.
Epidemiologic data have been updated.
28. Isolation precautions for Chlamydia pneumoniae infections have been updated.
29. Control measures for Chlamydia psittaci infections have been expanded.
30. Epidemiologic data for Chlamydia trachomatis have been updated. Diagnostic
options have been expanded based upon newer tests. Possible need for retreatment
of neonatal infection has been added. Timing of test-of-cure in pregnant women
has been modified. The chapter has been harmonized with the CDC 2021 Sexually
Transmitted Infections Treatment Guidelines.
31. Diagnostic assessment for foodborne Botulism has been added.
32. Discussion of when testing is appropriate for Clostridioides difficile has been
expanded. Fidaxomicin is now approved for use in the pediatric population (6
months of age and older). Bezlotoxumab is approved in adults to reduce recurrence.
33. A recommended sequential approach to diagnostic evaluation of
Coccidioidomycosis has been added.
34. The Coronavirus chapter has been updated to include the worst global pandemic
in 100 years, with specific information on SARS-CoV-2.
35. Information on antifungal resistance has been added to the Cryptococcus neo-
formans and Cryptococcus gattii Infections chapter. Timing of antiretroviral
therapy after starting induction therapy for HIV-infected children with cryptococcal
meningitis, in order to avoid immune reconstitution inflammatory syndrome, has
been added.
36. Sources of Cryptosporidiosis infection have been updated to incorporate out-
breaks in recent years.
37. Treatment options for Cutaneous Larva Migrans have been expanded.
38. Sources of Cyclosporiasis infection have been updated to incorporate outbreaks
in recent years. Treatment options have been expanded.
39. Diagnostic tests for Cystoisosporiasis have been updated.
40. Role of race, ethnicity, and nonprimary infections in the incidence of congenital
Cytomegalovirus infections has been added. The role of human milk in CMV
transmission in preterm infants, and its prevention, has been expanded. Specific rec-
ommendations from Bright Futures for audiologic follow-up in congenital CMV have
been added.
41. WHO classification of Dengue presentation has been added. Vertical transmission
risks have been added. Dengue incidence rates in US states and territories have been
updated. Chimeric yellow fever dengue-tetravalent dengue vaccine (Dengvaxia),
approved on May 1, 2019, has been added to the chapter, along with detailed discus-
sion of the complexity of determining whether and when to use it.
42. Changes in national reporting implemented in 2019 have been added to the
Diphtheria chapter.
43. A taxonomy table has been added to the Ehrlichia, Anaplasma, and Related
Infections chapter. Discussions of Anaplasma and Ehrlichia have been separated
throughout chapter for ease of distinguishing between them.

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 SUMMARY OF MAJOR CHANGES IN THE 2021 RED BOOK xli

44. Treatment of carbapenemase-producing gram negative organisms has

been expanded in the Serious Bacterial Infections Caused By
Enterobacteriaceae chapter. Discussion of pseudomonal infections has been
removed and placed in a new Pseudomonas Infections chapter.
45. Discussion of acute flaccid myelitis (AFM) has been expanded in the Enterovirus
(Nonpoliovirus) Infections chapter. Therapeutic options have been updated.
46. Genetic mutations that impede control of Epstein-Bar Virus Infections have
been expanded. Rituximab treatment for post-transplant lymphoproliferative disor-
der (PTLD) has been added.
47. Discussion of atypical EPEC strains has been added to the Escherichia coli
Diarrhea chapter. Challenges interpreting culture-independent diagnostic methods
that detect EAEC, EPEC, and ETEC on multiplex panels are discussed.
48. Otogenic and nonotogenic clinical manifestations of infection have been expanded
in the Fusobacterium Infections chapter.
49. Descriptions of clinical manifestations of Giardia intestinalis have been exten-
sively rewritten. Treatment of recurrent Giardia infections has been expanded.
50. The Gonococcal Infections chapter has been extensively revised, shortening by
approximately one third. Specific dosages of antibiotics largely have been removed
from the chapter, with cross-refencing of the STI Treatment Table 4.4 in Section 4.
Use of gentamicin in neonates receiving intravenous calcium (in whom ceftriaxone
is contraindicated) for prevention of neonatal ophthalmia has been added. The
chapter has been harmonized with the CDC 2021 Sexually Transmitted Infections
Treatment Guidelines.
51. The evolving epidemiology of Hia has been updated in the Haemophilus influ-
enzae Infections chapter. The new PRP-OMP containing hexavalent combina-
tion vaccine (DTaP-IPV-Hib-HepB) has been added to the chapter.
52. Data on the geographic distribution of Hantavirus Pulmonary Syndrome has
been added. A diagnostic criteria screening tool has been added.
53. Tables with treatment options for first-line treatment and rescue therapies for chil-
dren with Helicobacter pylori Infections have been added to the chapter. The
risks for peptic ulcer disease and gastric cancer have been added.
54. The number of viruses mentioned in the Hemorrhagic Fevers Caused by
Arenaviruses chapter has been expanded.
55. The list of countries with recent outbreaks of Hemorrhagic Fevers Caused by
Bunyaviruses has been expanded.
56. Discussion of in utero transmission has been expanded in the Hemorrhagic
Fevers Caused by Filoviruses: Ebola and Marburg chapter. The recent
licensure of the first Ebola vaccine, for use in adults, has been added to the chapter.
57. HIV and homelessness have been added as risk groups for Hepatitis A infection.
The recommendation of catchup immunization with HepA vaccine in people 2 to
18 years of age has been added. Use of HepA vaccine in 6- through 11-month-olds
traveling internationally (in whom MMR also is being administered) has been added.
58. The Hepatitis B chapter extensively revised, shortening by approximately one
quarter. A figure has been added for administration of the birth dose of hepatitis B
vaccine by maternal HBsAg status. The new hexavalent vaccine, Vaxelis, has been
added to Table 3.21: Recommended Dosages of Hepatitis B Vaccines.

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 xlii SUMMARY OF MAJOR CHANGES IN THE 2021 RED BOOK

59. Testing recommendations for Hepatitis C have been aligned with recom-
mendations from the US Preventive Services Task Force. IDSA and AASLD
recommendations for universal testing of pregnant women have been added.
Antiviral therapies for HCV infection are now approved and recommended for
people 3 years and older.
60. Specific examples of when Hepatitis D testing should be conducted have been
added.
61. A recommendation has been added to discourage breastfeeding among confirmed
Hepatitis E virus-infected mothers until further data are available.
62. Clarification has been added that suppressive therapy is not indicated following pre-
emptive antiviral treatment to prevent Herpes Simplex Virus exposure at deliv-
ery from developing into neonatal HSV disease.
63. Using both urine and blood antigen testing to increase sensitivity of
Histoplasmosis testing has been added to chapter.
64. Diagnostic methods to increase sensitivity for Hookworm Infections have been
added.
65. Diagnostic approaches to distinguish chromosomally integrated HHV-6 DNA
versus acute HHV-6 infection have been added to the Human Herpesvirus 6
(Including Roseola) and 7 chapter.
66. Clinical manifestations of Human Herpesvirus 8 in young children have been
added.
67. The Human Immunodeficiency Virus Infection chapter has been extensively
revised, shortening by approximately one third. The diagnostic approach following
perinatal exposure has been summarized in 2 new figures.
68. The Influenza chapter has been shortened by approximately one third and harmo-
nized with the most recent AAP and CDC recommendations as well as IDSA antivi-
ral treatment guidelines.
69. Differences in aspirin dosing in the United States versus Japan and Western Europe
have been added to the Kawasaki Disease chapter.
70. Discussion of antibiotics to use in Kingella kingae Infections has been
expanded.
71. Sources of transmission of Legionella pneumophila have been expanded, as
have prevention strategies.
72. Discussion of post-kala-azar dermal Leishmaniasis has been expanded.
Worldwide geographic distribution has been updated.
73. Discussion of the varied presentations of the skin lesions of Leprosy is provided.
Treatment recommendations now reference contact of the National Hansen’s
Disease Program.
74. Recommendations for convalescent serologic testing for Leptospirosis have been
broadened.
75. Risks during pregnancy for acquiring Listeria monocytogenes Infections have
been updated.
76. The Lyme Disease chapter has been harmonized with 2020 IDSA Lyme
Guidelines. Management of partial therapeutic response of Lyme arthri-
tis has been expanded. Options for second tier diagnostic testing have been
expanded.

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 SUMMARY OF MAJOR CHANGES IN THE 2021 RED BOOK xliii

77. Hematologic manifestations of Malaria have been expanded. Impact of prema-

ture discontinuation of malaria prophylaxis on timing of disease presentation has
been added. Quinidine has been removed as a treatment option because it has been
removed from the US market. Tafenoquine has been added as a prophylaxis option.
78. Measles inclusion body encephalitis has been added. Newer estimates of incidence
of SSPE have been added. Immunologic amnesia following measles infection has
been added. A new table summarizing postexposure prophylaxis recommendations
has been created.
79. Booster dosing for MenB vaccines has been added to the Meningococcal
Infections chapter. The newly approved MenQuadfi has been added to the chapter.
80. Cross-reference to the AAP clinical practice guideline on bronchiolitis has been
added to the management section of the Human Metapneumovirus chapter.
81. Treatment options for Microsporidia Infections have been expanded.
82. A preferential ranking of treatment options for Molluscum Contagiosum has
been added.
83. Epidemiologic data on Mumps outbreaks among college-aged young adults and
people previously receiving 2 doses of MMR vaccine have been updated.
84. Mycoplasma genitalium has been added to the Mycoplasma pneumoniae and
Other Mycoplasma Species Infections chapter, including diagnosis and
treatment.
85. Diagnostic methods for Nocardiosis have been updated.
86. Discussion of coinfection with other gastrointestinal tract pathogens has been added
to the Norovirus and Sapovirus Infections chapter.
87. Moxidectin has been added to the treatment section for Onchocerciasis (River
Blindness).
88. Discussion of screening programs for Human Papillomavirus-associated cancers
has been expanded. Age ranges for use of HPV vaccines have been standardized.
89. Treatment options for Paracoccidioidomycosis have been updated.
90. Extrapulmonary manifestations of Paragonimiasis in children have been added.
Access to triclabendazole has been updated in the chapter.
91. Diagnostic approaches for Parainfluenza Viral Infections have been updated.
92. The table of Parasitic Diseases has been updated with diagnostic testing and
clinical manifestations.
93. The propensity for neurologic sequelae following Parechovirus Infections has
been emphasized.
94. Management of Parvovirus B19 in the immunocompromised host has been
expanded.
95. The need to assess for rabies prophylaxis when diagnosing Pasteurella Infections
has been added to chapter.
96. The table “Pediculicides for the Treatment of Head Lice” has been updated in the
Pediculosis Capitis chapter, including the newly approved abametapir by pre-
scription and the availability of ivermectin lotion over the counter.
97. Follow-up assessments and possible retreatment have been added to the
Pediculosis Pubis chapter.
98. The Pelvic Inflammatory Disease chapter has been harmonized with the CDC
2021 Sexually Transmitted Infections Treatment Guidelines. The polymicrobial

Red_Book_2020_FM.indd 43 30/03/21 11:58 AM

 xliv SUMMARY OF MAJOR CHANGES IN THE 2021 RED BOOK

nature of PID has been emphasized. Treatment tables have been moved from this
chapter and merged into Table 4.4.
99. In the Pertussis (Whooping Cough) chapter, allowance has been added for
using either Tdap or Td in situations where previously only Td would have been
permitted.
100. Treatment of refractory or recurrent Pinworm Infections has been addressed.
101. Diagnostic approaches for Pityriasis Versicolor have been expanded.
102. Recommendations for management of Plague have been harmonized with
2020 CDC guidance. These include recommendations for combination therapy.
Treatment of neonates whose mothers have plague also has been added.
103. The epidemiology of Pneumococcal Infections in the PCV13 era has been
updated.
104. Discussion of prophylaxis for Pneumocystis jirovecii Infections in solid organ
transplant recipients has been expanded.
105. Global eradication efforts for Poliovirus Infections have been updated, including
the vaccines being used.
106. Members of the family Polyomaviridae have been expanded in the Polyomaviruses
chapter.
107. The mechanism by which abnormal protein folding occurs in Prion Diseases is
explained in greater detail.
108. Pseudomonas aeruginosa Infections is an entirely new chapter.
109. Association of anticardiolipin antibodies with severe complications of Q Fever has
been added. Situations that increase aerosolization risks have been added.
110. KEDRAB Rabies Immune Globulin has been added to the Rabies chapter.
111. The diagnostic section of Rat-Bite Fever has been updated to include 16S ribo-
somal RNA gene sequencing and matrix-assisted laser desorption/ionization time-
of-flight (MALDI-TOF) mass spectrometry.
112. Discussion of isolation precautions in Respiratory Syncytial Virus infections
have been expanded. The chapter has been harmonized with the forthcoming
technical report. Although the overall recommendations for palivizumab have not
changed, the basis for maintaining those recommendations now includes recent
publications.
113. The role of Rhinovirus Infections as a major viral cause of exacerbations
of asthma, cystic fibrosis, and chronic obstructive pulmonary disease has been
expanded.
114. Rickettsia akari has been added to the Rickettsial Infections chapter, and a CDC
website is provided for information on spotted fevers occurring outside of the United
States.
115. Duration of doxycycline therapy for Rickettsialpox has been made more precise.
116. The proportion of Rocky Mountain Spotted Fever cases not reporting tick bites
(approximately half) has been added. Serologic testing has been updated to indicate
IgM being relatively less specific.
117. Administration of rotavirus vaccine to patients while still in the NICU has been
added to the Rotavirus Infections chapter. Rotavirus vaccine use in HIV-infected
people has been added. Vaccination of infants who have had rotavirus gastroenteritis
has been addressed.

Red_Book_2020_FM.indd 44 30/03/21 11:58 AM

Other documents randomly have
different content
 226 HOW TO LIVE IN THE WOODS a few days' use. It is
very convenient, however, and well worth consideration. A 4-ounce
package of the stuff will make approximately 30 cups of beverage;
just about the amount provided by a pound of ground coffee.
INSTANT POSTUM is a pretty good substitute for coffee and very
easily prepared. TEA is best made in the cup, using a tea ball and
pouring boiling water over it. Individual tea balls run 100 to the half
pound. COCOA preparations vary somewhat and directions on the
package should be followed. Before you try any particular brand,
make sure the directions require nothing you'll be without in camp.
MILK is available in two forms, so far as the camper is concerned:
evaporated and powdered. Nearly everyone is familiar with
evaporated milk and has an established prejudice for or against it. If
you plan to use it on cereal, without previous experience, make an
experiment at home, to determine how much, if any, you'll need for
each meal. It is heavy stuff to carry, in any quantity. The tall cans of
evaporated milk contain 141/^ ounces (by weight) and gross 17
ounces. Small cans contain 6 ounces (by weight) and gross 7
ounces. If you will open milk tins by piercing a small pouring hole on
one side, just below the top rim, and an air vent in the same
position on the opposite side, both openings may be closed with a
large rubber band or a strip of adhesive tape. Thus you may carry
the partially used contents without much danger of spilling. It is
much easier, of course, to jab two holes in the top of the can and
hope to plug them for transit, but the plugs will usually work loose if
not secured with tape or rubber band. POWDERED MILK requires
quite a bit of mixing with water, to produce a palatable beverage,
but most people prefer it to evaporated milk, for use on cereals.
You'll need
 FOOD 227 a fairly deep vessel, such as a cook pot, to mix it
properly, as it must be whipped very briskly with a fork or egg-
beater, KLIM is the best brand I know of and full directions are on
each can. The cans come in various sizes, but are none too handy to
carry, after being opened. The covers fall off easily. Probably a
screw-top aluminum butter can should be provided for transport of
the loose supply. Synthetic milk, such as CAROLENE, affords the
advantage of being easy to whip, for fancy desserts, and such. It
comes in cans similar to those containing evaporated milk. Salads
SALADS help greatly to relieve the monotony of camp meals and are
easy to prepare when kitchen facilities are at hand. Fruits — fresh,
cooked or dried — may be mixed with nuts and celery, to make tasty
salads. Nearly all raw vegetables, except potatoes, combine to good
effect. Mayonnaise or French dressing will lend flavor to either fruit
or vegetable salads, but vinegar is relished by most people on
vegetables only. Salmon or tuna fish may be mixed with chopped
onions and celery, as it comes out of the can, and made to serve as
the base of an entire meal. Try this one, some hot night when the
cook stove has no appeal. Supper Salad Making use of leftover
vegetables: 1 cup cooked kidney or Lima beans — drained 1 cup
cooked peas — drained 1 small onion diced finely 1/^ cup diced
celery or 1/4 teaspoon celery salt 1/^ cup or more of diced cheese
Enough mayonnaise to hold salad together — mixed lightly with fork
to avoid mashing vegetables 2 hard-boiled eggs cut in large pieces
— added as a garnish L
 228 HOW TO LIVE IN THE WOODS Desserts DESSERTS are
simple enough. Prepared pudding mixes are sold in small packages
bearing full directions for use and require no more preparation than
mixing with milk and brief cooking. The chocolate items are
especially good when nut meats are added. Heinz offers plum, fig
and date puddings in small cans just right for two diners. You may
heat them in the can, with about 20 minutes of boiling, and serve
with hard sauce made of butter and sugar. There are all kinds of
canned fruit, as you know, but it is difficult to find anything other
than fruit salad in very small cans. Leftover fruit and juice are
awkward to transport, as you can imagine, and a No. 1 can of fruit is
usually more than enough for a twosome meal. In permanent
quarters, a good scheme is to eat part of a No. 2 can for supper
dessert and carry over the balance, for breakfast. Any of the canned
fruits will top off a split biscuit, to afford a version of shortcake.
PACKAGED COOKIES may be carried successfully for quite a while, if
reasonable care is exercised to keep them dry. GINGERBREAD may
be produced from prepared mixtures when oven facilities are at
hand. Follow directions on the package. Dried Fruits Apricots,
prunes, figs, dates and raisins I reckon as diet essentials and for that
reason do not list them as desserts. You should eat some of one or
the other every day, while in the woods, for the good of your soul
and the benefit of your bowels. DRIED APRICOTS usually run about
48 to the pound; enough for 6 or 8 portions. Unless directions on
the pack 
 FOOD 229 age state otherwise, they require thorough
washing in cold water, a start in hot water to cover and about 40
minutes of simmering. You may want to add sugar, to sweeten them.
The tenderized brands generally require less cooking. DRIED
PRUNES may also be figured for 6 or 8 portions per pound. They
require the same preparation as apricots and about an hour of
simmering. Part of a lemon, sliced into a batch of cooking prunes,
vastly improves the flavor, or a few drops of lemon extract will do
nearly as well. Sugar may be added while cooking, if you think it is
needed. If you buy tenderized or other packaged fruit, read the
directions on the package — they may differ from mine. You'll find it
most handy to cook apricots and prunes in the evening, when time
is not at a premium. Carry-overs, for breakfast, are best guarded in
screw-top cans or jars, when out of doors. RAISINS, DATES and
FIGS may be eaten as they come out of the package, or chopped
and added to cereals in the last few minutes of cooking. Preparation
of Fish and Game Having delved into the mysteries of grocery store
and butcher shop victuals, let us now explore the possibilities of fish
and game. A desperately hungry man will find some food value in
nearly any creature he can bring to bag from aquatic or sylvan
haunts, the principal exception being a few tropical fish which are
poisonous. There are degrees of palatability in wild flesh, however,
and I shall deal only with such quarry as affords the prospect of
good eating, without attempting to cover the full range of edible wild
life. Several
 230 HOW TO LIVE IN THE WOODS items of common
knowledge will be treated and you may go on from there, if
experimentation appeals to you, or is forced upon you. Fish Any fish
will depreciate in food value if treated as rubbish between the time
of taking and the moment of serving. How often do you see a
fisherman dump a mess of stiff and withered trout from his creel, or
retrieve several sun-dried bass from the filthy bottom of a boat? Too
often — and only because of careless disregard for decent handling.
Trout should be killed, with a sharp rap on the head from knife
handle, priest or stick, before going into the creel. If it is
impracticable to wrap the fish in waxed or parchment paper, as
creeled, green leaves or grass should be placed around them, to
retain moisture and preserve freshness. Damp cloth or paper will
serve the same purpose. Heavier fish deserve similar treatment.
Unless you can keep them alive, on a stringer or in a live box, kill
them when caught and at least keep them out of the sun and dirt.
Certainly, you should clean fish before putting them under
refrigeration and refrain from laying them directly on ice, where they
will absorb too much moisture. Frozen fish should be thawed in very
cold water before cooking. It is not good practice to wash fish before
frying, as the wet flesh will absorb excessive grease. It is better to
wipe them clean with a clean cloth or absorbent paper. SMALL
TROUT require no scaling or skinning and are easily cleaned. Cut off
the head, just back of the forward fins; slit the belly from the vent
forward and clean out the cavity. Run your thumbnail or the back of
a knife blade up the backbone, to remove the blood, and wipe clean,
inside and out. Cut through the backbone in one or two places to
prevent
 FOOD 231 curling, and fry in plenty of very hot grease or
oil until nice and brown. Keep your grease hot by dropping in only
one fish at a time. Season with salt and pepper as the skin begins to
brown. Rolling trout in corn meal or flour, before frying, detracts
from the flavor. Save that technique for bass or pike. Any small fish,
such as trout, may be cooked over a bed of coals, without utensils,
by skewering several on a stiff stick of green wood, with thin strips
of bacon or fat pork between them. Turn the stick constantly as it is
held over the coals, so that the melting fat will baste the fish and not
drop into the fire. PAN FISH, other than trout, require scaling or
skinning, and for my money the skinning process is best on all
counts. Cut deep on either side of the top fins and remove them by
catching the rear end between the knife edge and thumb and pulling
up, toward the head. Then cut through the skin — up the back, from
head to tail, and back of the forward fin, on either side, from spine
to belly. Cut off the tail, or cut through the skin in front of it, on
either side. Hold the fish by the head; loosen a generous corner of
skin at the backbone, back of the head; catch it firmly between knife
and thumb and rip off the entire side. Turn the fish and skin the
other side in similar manner. A slash of the knife along the belly will
complete the skinning and serve to remove entrails. Cut off the head
as a final operation. I like to fillet all fish but small trout, if they are
to be broiled or fried. This is accomplished by using the framework
of the fish as a guide for the flat of your knife. Insert the blade,
edge toward tail, at the head end of the backbone. Keeping the
blade as close to the bone as possible, cut back toward the tail,
about an inch deep. Fold back the flesh, as you repeat this cut
several times, and the eventual reward will be a fine solid fillet of
fish, free of bones. Such fillets will fry or broil very quickly. You will
probably botch
 232 HOW TO LIVE IN THE WOODS your first attempt at
filleting and wind up with broken pieces of fish, which will taste just
as good, however, for all their ragged appearance. Brief experience
will make you an expert, no doubt. Skinned fillets of BASS, PIKE and
PICKEREL have none of the "muddy" taste sometimes noticed in
these fish. BULLHEADS and CATFISH respond to the same
treatment, but somewhat stubbornly, because of their slipperiness.
Watch out for their spines, in forward and top fins! They can give
you a painful wound. If you possess a reflector oven, you may enjoy
roasted fish. Rub the dressed carcass, or fillets, lightly with butter or
bacon grease; place in the pan; dab in a few half-teaspoons of
butter or grease, here and there; and cook in front of a good fire, as
you would bake biscuits. The fish will be done when it is brown on
top. A baking pan similarly filled with fish will produce good results
in a stove oven, if you are careful not to dry out the fish by
overcooking. Very large fish may be cut into steaks, for convenience
in cooking. Roast these as suggested, or broil them on a lightly
greased griddle over a moderate fire. EELS may be skinned and
filleted in the same manner as that prescribed for fish. The flesh is
too oily for successful frying, but may be rolled in meal and broiled,
with good results. Frog Legs Frogs, both big and little, provide a
tasty supplement to camp fare which is well worth looking into. A
majority of camp cooks prepare only the legs of frogs, but in some
sections of the country the back meat of a bullfrog is considered a
delicacy of equal merit. In any event, skin the portion you decide to
use and soak
 FOOD 233 for an hour in cold water, to which vinegar or
salt has been added. Two tablespoons of either vinegar or salt to a
quart of water should be about right. After soaking, wipe dry; roll in
flour seasoned lightly with salt and pepper and fry slowly in butter or
other shortening until a nice brown crust encases the meat. Game
Most game affords better eating than the average hunter suspects.
Better than he deserves, in fact, unless each carcass is treated with
decent consideration for cleanliness and edibility. I find no merit in
the general practice of keeping game for hours, and sometimes
days, before cleaning. The contents of intestines will certainly
commence to sour shortly after natural processes are stopped by
death, and it seems senseless to risk the spoilage of good meat by
failure to remove them. Acquire the habit of cleaning your game as
you kill it. The task will be easier when the carcass is still warm, and
your reward will be finer food when the meat reaches the table.
Carry a modest supply of cheesecloth or waxed paper with you when
hunting small game, and wrap your kill after dressing it, for the sake
of cleanliness. The flesh of any warm-blooded creature is not fit to
eat until it has cooled thoroughly. More often than not it will sicken
you if eaten too soon, and in any event will be tough and tasteless.
Let your game hang for at least two days, well protected from bugs
and dirt, before you cook it. Liver may be excepted from this rule
and cooked as soon as you please. The sooner the better, in fact, as
it is quite perishable. In all animals except those of the deer family,
and in all fowls except pheasant, a comparatively small, dark-
greenish sac will be found attached to the liver, usually near the
center. This is the gall bladder, containing an
 234 HOW TO LIVE IN THE WOODS extremely bitter fluid
certain to spoil any meat it touches. Remove it very carefully,
sacrificing a fairly generous portion of the liver adjacent to the point
of attachment for the sake of safety. If the liver has been taken from
an old animal, it should be parboiled before frying. Place it in a pot
with sufficient water to cover; simmer gently for about half an hour;
skim off such scum as arises to the surface; fish it out and wipe it
dry. Cut the parboiled liver into slices and fry in a hot skillet, well
greased. Sliced or chopped onions may be added, if your skillet is
large enough, and fried with the liver. Some cooks skin liver before
cooking. Others dredge it with seasoned flour, brown it quickly on
both sides, add a little water and let it simmer in a covered skillet for
20 or 25 minutes. Many hunters spit deer liver on a green stick,
together with a bit of fat, and roast it over an open fire, with no
thought of parboiling, soaking or other preparation. RABBIT has
fallen into some disrepute as table game, because of the wide
publicity given tularemia, or "rabbit fever." The fact is, however, that
diseased animals are comparatively rare, and if sick-looking or weak-
acting rabbits are avoided, little danger will be incurred. The peppy
rabbit is usually healthy. Tularemia may be contracted by humans,
through cuts or abrasions on the hands, while handling infected
animals, so it is a wise precaution to wear rubber gloves when
dressing rabbits. The skin and viscera should be burned, to eliminate
the possibility of foraging dogs being infected. If you discover white
spots on the li\'er of a rabbit, you may be quite certain of the
presence of tularemia, but cooking will destroy the bacteria and
render the flesh safe for eating. The warty growths sometimes found
on the skins of cottontail rabbits do not indicate disease and you
may ignore them. I
 FOOD 235 Clean your rabbit by slitting the skin of his belly
with a sharp knife. Avoid ripping through the intestines, which will
make a messy and unsanitary job of the cleaning. Once the
abdominal cavity is open, you may take a backhanded grip on fore
and hind legs and, with a snappy slinging motion, downward and
away from you, remove all the entrails in one operation. If the
carcass is still warm, you can skin it by tearing the skin on the back
of the neck and peeling it off clear to the feet. Needless to say, you
will use your knife to remove head, feet and tail. Look for a waxy
gland under each front leg, right up where it joins the body, and cut
it out. After the dressed rabbit has hung for at least 24 hours in cool
weather, or longer if the temperature is fairly high, cut the carcass
into 6 or 8 pieces, wipe them dry and simmer in enough water to
cover for about 10 minutes. Skim off such scum as may appear. A
spoonful of vinegar or lemon juice in the water is desirable, if you
have it, or an onion will serve just as well, to add a bit of flavor. For
fried rabbit, drain these parboiled pieces; roll them in flour and fry
on both sides until brown, in a very hot pan, lightly greased. You
may roast disjointed rabbit in a folding reflector oven by laying a
strip of raw bacon over each piece and basting frequently with the
grease that trickles out into the pan. The meat will be done when it
is brown on top. Stewed rabbit is prepared by simmering the cut-up
carcass until tender — which takes from one to two hours,
depending on the critter's condition and size. This is a continuation
of the parboiling process previously mentioned and you should be
careful to avoid hard boiling, which will toughen the meat. Put in an
onion or two after the meat becomes tender, and give some thought
to adding dumplings.
 236 HOW TO LIVE IN THE WOODS SQUIRRELS are
prepared for the table in much the same manner as rabbits. An old,
tough squirrel may require as much as half an hour of parboiling
(gentle simmering in water) before frying, but young ones are often
fried or fricasseed without such preliminary cooking. To fricassee a
squirrel, season each piece of the cut-up carcass with salt and
pepper; roll in flour and fry in a pan with chopped-up bacon for
about 30 minutes, or until well browned. (Two slices of bacon should
be enough for each squirrel.) Then add chopped onion and enough
water to half cover the meat; cover the pan and cook slowly for
nearly 3 hours. Game Birds Game birds are not so very different
from domestic fowl, so far as preparation and cooking are
concerned. Their meat is dryer, as a general rule, and usually
benefits from the addition of fat in the form of butter or bacon
grease. The practice of skinning game birds, rather than plucking
them, appears to be gaining in popularity. Some hunters believe part
of the flavor is lost in this manner, but I haven't noticed any
difference important enough to worry about. The principles of
skinning a bird are about the same as those applying to small
animals. Cut off the head; slit the skin up the belly, from vent to
neck; peel it down the back and over the wings as far as possible;
cut off the last joints on the wings; continue peeling down the back
and over the legs until you have to cut off the feet. It might be well
to mention, right here, that game birds should not be skinned, or
plucked, until safely in the kitchen and ready for the cook. Loss of
feathers is loss of identity in the bird department and conservation
officers are sometimes very narrow-minded about it.
 FOOD 237 Anyhow, skin your bird or pluck him dry, as you
see fit, and, in the case of waterfowl, remove the oil sac from the
vicinity of the tail. Wipe out the emptied abdominal cavity with a
clean dry cloth and make up your mind on the mode of cooking. If
you intend to fry, cut the bird into 6 or 8 pieces; simmer these,
gently, in enough water to cover, until tender; then remove and
drain. Roll the pieces in flour seasoned with salt and pepper and fry
in a hot, well-greased pan until crispy and brown on the outside. To
roast a partridge, prairie chicken or pheasant, leave the bird whole,
after dressing. Rub a little salt on the outside and lay in the roasting
pan, back down. Fasten 2 or 3 strips of bacon across the breast and
roast in an oven or reflector for about 40 minutes. Baste the bird,
from time to time, with such juice as accumulates in the pan. You
could chop up celery and onions, if available, and place them in the
cavity before cooking. Wild duck is roasted in the same manner, but
usually requires no bacon. Roast duck suits most people best when
slightly rare, and 20 to 30 minutes of roasting, per pound of duck, in
a moderate oven, will serve the purpose. You may fill the duck with
sliced apples and sew the cavity shut before cooking, if you wish,
but I prefer the natural flavor. Fancy cooks sometimes baste roasting
duck with orange juice. Large birds, such as turkeys and geese,
present quite a problem to camp cooks with limited facilities, but
there is nothing to prevent the frying or roasting of slices from the
carcass. A fairly large wild goose will roast in a moderate oven in
about 2 hours. Prepare as suggested for ducks. A large turkey
requires close to 3 hours of roasting in a moderate oven (375° F.) .
 238 HOW TO LIVE IN THE WOODS Venison Venison, no
doubt, suffers more from amateur butchering than any other game.
Perhaps the excitement of downing such noble quarry causes some
hunters to lose their common sense, but whatever the reason, a lot
of scandalous abuse is visited upon dead deer. Let us hope that your
deer has died quickly and painlessly, from a well-placed shot, so that
the fever of protracted pain will not have affected his flesh. Drag the
carcass into position where you can work on it, with rump lower
than the rest of the body, and get about the dressing immediately.
Roll the deer on his back and spread the hind legs. Tie one to a tree
or bush, if you can't keep it out of the way in any other manner. Cut
out the genitals. Cut around the anus, so that later it will come free
with the intestines. Insert the point of your knife in the hide, as far
down on the belly as practicable, and slit the hide only clear to the
breast bone, being very careful not to puncture the paunch. This is
most easily done with a small blade, holding it edge up on the first
two fingers and steadied by the thumb. Thus the two fingers serve
as a guide, while the back of the hand presses down the intestines.
Peel back the hide from the belly and cut through the thin wall of
muscles which hold the intestines in place. Again be careful not to
puncture the paunch. With the intestines exposed, reach into the
chest cavity with your knife and cut off the windpipe and large
arteries ahead of the lungs. You should now be able to roll out the
lungs, liver, heart, paunch and intestines with a little assistance from
one hand and perhaps a cut or two with the knife blade where
severance from the body is incomplete.
 FOOD 239 Clean out all remaining scraps of lung and
intestine from the cavity, and remove any foreign matter which may
be present. Pick up the liver for camp meat, and if you have nothing
to wrap it in, place it in the cavity for transport back to camp. A deer
hunter should be equipped with 15 or 20 feet of stout clothesline or
small Manila rope, to aid in getting his game out of the woods. The
best method, for short distances, is to drag the animal on his back,
head foremost. Tie the forelegs to the head, before starting. Back-
packing a deer carcass is fairly dangerous business, in heavily
hunted territory. Some fool may be attracted by the antlers or color
of the hide and pitch a few shots at what he thinks is a fair target. A
bush or small tree serves nicely as a sled on which to drag out a
deer. Hang your deer, head up, when you get him into camp, and
prop open the cavity with a stick 8 or 10 inches long, sharpened on
both ends. Wipe the cavity with a clean, dry cloth. Open the vent for
drainage, and protect the raw flesh from bugs if there are any about.
Now you are well on the way toward a winter supply of good
venison. If you can, get the carcass into cold storage or a deep-
freeze locker at the earliest possible moment. Otherwise, have your
butcher cut up the carcass and store the cuts until you are ready to
use them. Venison improves under cold storage just as beef does.
You'll find that professional butchering pays dividends in good meat.
An amateur usually spoils as much as he saves and rarely gets the
cuts into the best form for proper cooking. Young and tender
venison affords fine roasts, steaks and chops. As a general rule,
loins, rounds, shoulders and rumps
 240 HOW TO LIVE IN THE WOODS provide the best roasts,
in the order listed; loins and rounds are the source of steaks and
chops are cut from the ribs. Neck, shanks, breasts and flanks serve
best for stews and ground meat offerings. To roast young venison,
trim most of the fat from the meat; rub lightly with salt and pepper;
place in an uncovered pan, fat side up, and lay 6 or 8 strips of raw
bacon over the top. Add no water. Roast slowly in an oven no hotter
than 350° F., allowing about 25 minutes of cooking, per pound of
meat. Old or tough venison will not dry-roast too successfully and
should be considered first for pot roasts. Trim off as much fat as
possible; sprinkle liberally with flour, seasoned with salt and pepper;
brown on all sides, in a very hot, wellgreased pan; place in a pot
with about 1 cup of water; cover tightly and cook very slowly, over
the fire, for 2 or 3 hours. Turn the roast occasionally and when it is
tender add onions, potatoes, carrots and celery in the quantity
desired. Cook until the vegetables are done. Stir flour into the juice
left in the pan, for gravy. Tender steaks and chops from young
venison may be broiled or fried. Try the broiling over glowing coals,
in the' event you have no broiling oven. Simply brown on the fire
side; turn and repeat the process. For each side 8 or 10 minutes of
cooking is required. Season after cooking. Steaks and chops should
be fried in a very hot pan, lightly greased with butter or bacon fat.
Get the pan good and hot before putting in the meat; cook one side
about 8 minutes; turn and cook the other side the same. Season
after cooking. Tough venison steaks are best prepared in the same
manner as pot roasts. Rub both sides with flour, seasoned with salt
and pepper. Brown both sides quickly in a very hot frying pan, well
greased. Then add half a cup of water; cover the pan and cook
slowly, over the fire, until tender. When
 FOOD 241 tender (after about 1 hour of cooking) add
onions, celery and a cup of canned tomatoes. Cook until the
vegetables are done. Venison unsuitable for roasting, broiling or
frying should be stewed or ground. To stew, cut the meat into small
pieces; sprinkle with seasoned flour; brown quickly in hot grease;
cover with boiling water and simmer gently in a covered pot until
tender. Vegetables and dumpling dough may be added, then, and
the cooking continued until they are done. Ground venison may be
cooked in the same manner as chopped steak or hamburger. Good
Camp Cookery The essentials of good camp cookery may be
summarized about as follows — not necessarily in order of
'importance: Clean and convenient utensils. Steady heat. Quality
groceries. Careful measurements. Thorough preparation. Scheduling,
with regard to slow- and rapid-cooking items. Consistent attention.
Frequent testing. Notes for future reference. Bear in mind that:
Different brands of foodstuff^s may vary in characteristics. Cooking
is slower in high altitudes. Water varies greatly in mineral content
and flavor. It is better to use too little, rather than too much,
seasoning.
 INDEX Acid, boric, 173 hydrochloric, 149 Ammonia, 173
Ammunition, 20-24, 26 Apparel, 6 Apricots, 228-229 Arch supports,
8 Army bread. 217 Arteries, 168 Artificial respiration, 177 Ash,
poison, 172 Asparagus, 225 Automobile cruising, 72 outfit for, 72-75
Ax, use of, 149-150 Axes, 59 Back-packer's ration, 204 Back-packing,
113 outfit, 110-113 Bacon, 14, 206-207 Canadian, 207 slicing, 14
Bags, bacon, 61 browse, 13, 37 duffel, 62, 84 fishing tackle, 29, 31
food, 61-62 shoes, 9 sleeping, 33-35 spare clothing, 13 water, 65
Baits, casting, 30-31 live, 190 Baker, folding aluminum, 52 Baking,
52, 159 Baking soda, 166, 173-174, 180 Ballistics, 23 Bandages,
167-168, 170 Bandannas, 11, 16 Baseball stitch, 129 Bass,
preparation of, 232 Batteries, flashlight, 60 Beans, 221-222 Bed,
portable, 36 browse, 36, 103-104 Bedding, 32-37 Bee stings,
treatment of, 166 Beef, dried chipped, 189, 210-211 steak, 208 stew,
208-209 Belts, 11 Beverages, 225-227 Bicarbonate of soda, 166,
173-174, 180 Billfold, 14 Birds, preparation of, 236-237 Biscuits,
216-217 Blankets, 33, 35 to fold, 35 Bleeding, treatment of, 168-169
Blisters, treatment of, 170 Boots, 7-8 bird shooter, 7 care of, 8, 19
drying, 19 fitting, 8 rubber, 7 spare, 9 Boric acid, 173
 244 Boxes, fly, 29 leader, 28-29, 31 spinner, 29 Bread, 14,
216-218 slicing, 14 Breeches, 9 Browse bag, 13, 37 bed, 36, 103-
104 Bruises, treatment of, 170 Bucket, canvas, 65 Bug in ear, 174
Bugs, protection against, 16, 66, 138 Bullet wounds, 177, 179
Bullheads, preparation of, 232 Burns, treatment of, 166-167 Butter,
187, 193, 199, 218-219 peanut, 219 Cabbage, 223 Caddis worms,
190 Calks, boot, 8 Camp, making, 149, 164 Camp sites, 83, 146-148
Campfire recipes, 206-229 Camping outfits, 38-39, 71-113 Candles,
60 Canned heat, 56 Canoe trip outfits, 83-103 Canoes, 91, 120-130
bailing, 130 carrying, 124-126 lining, 122, 127 loading, 83, 91, 122
navigation of, 122, 126-127 paddling, 122, 127 poling, 130 repairing,
127-129 trimming, 83, 122 Cans, butter, 61 grease, 50 Cap, knitted,
36 Carolene, 227 Cartons, egg, 213-214 Cartridges, 20-22, 24, 26
INDEX Catfish, preparation of, 232 Cereals, 185, 219-221 Cervelat,
210 Chafe, treatment of, 170 Cheese, 187, 213 Chigger bite,
treatment of, 166 Choke, shotgun, 24-25 Chopping, 149 Chores,
camp, 149, 162 Chowder, fish, 212-213 Clothing, 6-7, 9-13 changes
of, 10, 36 spare, 12 Cocoa, 226 Coffee, concentrated, 225-226
preparation of, 193, 199 Collodion, 166 Compass variation, 139
Compasses, 14, 134-135, 138-140, 144 use of, 140-141
Conservation Departments, addresses of, 115-116 Constipation,
treatment of, 166 Cookies, 228 Cooking, 52-57, i57-»59 fires, 155,
157-158 kits, 49-51, 111 menus, 182-184, 193, 199, 204 miscellany,
241 recipes, 206-241 utensils, 51 Corn, 224 fritters, 224 on the cob,
224 oysters, 224 pudding, 224 Corn meal bread, 217 mush, 220
Corned beef, 209 hash, 209 Cots, folding, 65 Crackers. 216 Crane,
pot, 157 Crickets, 190
 INDEX Croquettes, salmon, 211-212 Cuts, 167-168 Dates,
229 Deer, cleaning of, 238-239 Desserts, 228 Dingle sticks, 57, 157
Directions, compass, 134-136, 138139, 141, 144-145 Dishwashing,
160-161 Dishwater, 161 Dog sled travel, 132 Dog teams, 132
Dog^vood, poison, 172 Dressings, surgical, 167-168 Dried chipped
beef, 210-211 fruits, 228-229 Drinking water, 83, 89, 148-149
Drowning, 177 Duck, roasted, 237 DufFel bags, 62, 84 Dumplings,
218 Earache, treatment of, 174 Eels, preparation of, 232 Eggs, 190,
213-215 boiled, 215 dehydrated, 190, 214 deviled, 215 245 I fried,
214 poached, 214 scrambled, 215 Elder, poison, 172 Equipment,
camping, 38-39, 66-67 care of, 19 L cooking, 49-58 ■ military, 66-67
personal, 13-18 Extinguishing fires, 160, 164 Eye injuries, treatment
of, 173 Fabrics, clothing, 9 Feet, care of, 8 Figs, 229 Filters, water,
149 Fire irons, 57 Fireplace, 155, 158 Fires, 160, 162 building, 157-
160 cooking, 155, 157-158 putting out, 160, 164 starter, 56, 59
wood, 83, 149, 155 First-aid, kits, 16-17, 68-69, 180 textbook, 170
Fish, canned, 210-211 care of, 230 chowder, 212-213 fried, 231 hook
wound, 173 preparation of, 230-231 roasted, 232 Fishing, 15-16,
190-191 emergency, 15-16 tackle, 15-16, 19, 27-32 Flashlights, 60-
61 Food, 67, 181-241 canned, 67, 192 concentrated, 189-190
dehydrated, 189-190 emergency, 190-191 for hikers, 204 packing,
196-198, 202-203 Footwear, 7-9 Fracture, bone, 179 Frankfurters,
211 Freezing, 177 French toast, 215 Frog legs, preparation of, 232
Frostbite, treatment of, 177 Fruit, canned, 186, 228 dried, 228-229
Fuel, liquid, 54-55, 131 motor, 131 solid, 56 Game, cleaning of, 233-
235 preparation of, 233-241 Gangrene, 168, 177 Garbage, 161, 164
 246 Gauze, surgical, 168 Germicide, 167 Getting lost, 134-
139' i44-i45 Gill, net, 191 Gingerbread, 228 Gloves, 11 Goose,
roasted, 237 Grasshoppers, 190 Gravy, 211 Grease, boot, 8
Groceries, pack-sack, 189-192 Grocery lists, 185-188, 194-195, 197-
198, 200-201, 205 Ground cloth, 13 Guides, 119 Guns, 19-20, 24-27
case, 22 safe carrying, 26-27 sights, 22 Halazone, 148 Ham, 207
Hamburger, 207 Hammock, jungle, 46 Handkerchief, 16 Hangers,
pot, 57, 157 Hard sauce, 228 Hash, 209 Hat, 11 Head net, 11, 66
Heat, application of, 174, 177 Heatab-Cookit, Speaker, 56 Hobnails, 8
Honey, 219 Hooks, bass fishing, 31 minnow fishing, 16
Housekeeping, 161-162 Hunting, 134 camp outfit, 103-110
Hydrochloric acid, 149 Ice creepers, 8 Indigestion, treatment of, 166
Information, where to go, 115-119 INDEX Insect bites, protection
against, 16, 66, 138 treatment of, 166 Iodine, 167 Ivy, poison, 164,
172 Jackets, 10-11 carrying, 11 Jam, 219 Johnny cake, 218
Kerchiefs, 11 Kerosene, 54, 61 Kindling, 155, 164 Kits, cooking, 49-
51, 111 first-aid, 16-17, 68-69, 180 repair, 17-18, 70 snake-bite, 15,
175 toilet, 16, 68 Knives, 13-14 combination, 14 pocket, 14 sheath,
13 Lamps, 60-61 Lanterns, 60-61 Laundry, 162, 164 Laxative, 166
Leaders, fishing, bass, 31 trout, 28 wire, 31 Lettuce, 223 Lifting a
canoe, 124-125 Lights, 60 Lines, fishing, 28, 31 casting. 31 tapered,
28 Liver, preparation of, 233-234 Lost, getting, 134-139' H^'HB
Macaroni, 220-221 Making camp, 146, 149, 164 Maps, 15, 138-139,
141-142 sketching of, 135-136, 142-145 sources of, 117-118
 INDEX Marmalade, 219 Match safe, 14 Matches, 58, 138
Mattresses, 36-37 pneumatic, 36 Meat, 206 balls, 211 canned, 210-
211 Medical kit, 165 treatment, 165-179 Menu planning, 192 Menus,
182-184, 193, 199, 204 Milk, 226-227 Minnows, 191 Moccasins, 7
Motors, outboard, 130-131 Mush, 220 Navigation, 83, 122, 126-127
Net, gill, 191 head, 16, 66 landing, 29, 31 New Skin, 166 Notebook,
15 Oak, poison, 172 Oatmeal, 219-220 Ointment, ophthalmic, 173
Omelette, 215 Onions, 222, 223 Outboard motors, 130-131 Outfits,
camping, 38-39, 71-113 Outfitting, 5 featherw^eight, 39 Oven,
reflector, 52 Pack, animals, 132 board, 62 I cloth, 43 i harness, 62
Pack-sack groceries, 189-192 Pack-train travel, 132-133 Packing, 71,
119, 133 lists, 6, 73-82, 84-90, 92-102, 247 105-109, 111-113, 197-
198, 202-203 Pad, bed, 37 Pan fish, preparation of, 231-232
Pancakes, 217-218 Pants, 9 Partridge, roasted, 237 Patterns,
shotgun, 25 Pea meal back, 207 Peanut butter, 219 Pelvic injuries,
treatment of, 179 Personal equipment, 5-6, 13 Pheasant, roasted,
237 Pickerel, preparation of, 232 Plant poisoning, treatment of, 171-
173 Poison ivy, 164, 172 oak, 172 Poisonous plants, 171-173 Poles,
canoe, 130 shear, 151-154 telescopical, 48, 153 tent, 48, 83, 151-
155 Poncho, 13 Porridge, 219-220 Portable camping outfit, 75-82
hunting camp, 103-105 Portages, 83 Portaging, 90-91, 96, 102-103,
122-126 ' I Postum, 226 Pot crane, 157 hangers, 57, 157 roast, 240
Potatoes, 222 Pouch, tobacco, 16 Prairie chicken, roasted, 237
Preparation of fish and game, 229241 Pressure points, 168, 170
Pudding, 228 Pump, mattress, 36 Purse, 14 Quilts, 33, 37
 248 Rain cape, 13 Raisins, 229 Rapids, navigation of, 126-
127 Red Cross Text Book, 170 Reels, bait-casting, 30-31 fly-rod, 28-
29 Refrigeration, 58 Repair kits, 17-18, 70 Repairs, canoe, 127, 129
Repellent, insect, 16, 66 Respiration, artificial, 177 Rice, 220 Rifles,
19-21 Rigor mortis, 177 Rods, bait, 30-31 fly, 28 Ropes, 47, 63 Ry
Krisp, 216 Salads, 227 Salami, 210 Salmon, 211, 227 Sandwiches,
210-211 Sauce, hard, 228 white, 212 Sauerkraut, 223 Sausage, 210
Saw, camp, 60 Scalds, treatment of, 166 Serum, anti -venom, 174
Shears, tent, 151-154 Shelters, 13, 39-47 Shirts, 10 Shoe bag, 9
Shooting, 19-26 Shortcake, 228 Shotguns, 24-26 Shovel, 17 Sights,
gun, 22 Sleeping, 32-37 bags, 33-35 Slippers, 8 Slivers, treatment
of, 170 Snake-bite, kit, 15. 175 treatment of, 174-176 INDEX Soap
pads, 161 Socks, 7 Soda, baking, 166, 173-174, 180 Soup, 187, 212
Spaghetti, 220-221 Spine injuries, treatment of, 179 Spinners, 31
Splints, 179 Sprains, treatment of, 170-171 Springs, water, 148
Squirrel, preparation of, 236 Stakes, tent, 48-49, 151, 153 Steak,
beef, 207-208 chopped, 207 Sterilizing, bandage, 168-170 knife-
blade, 174 needle, 170 water, 168 Sterno, 56 Stew, beef, 208-209
chicken, 209 Stimulants, use of, 169, 175 Stove pipe, 57 Stoves,
gasoline, 54-55 Heatab, 56 heating, 56-57 one-burner, use of, 55
pocket, 54-55 Primus, 53-54 wood-burning, 56-57 Sumac, poison,
171 Sunburn, treatment of, 167 Supplies, replenishment of, 97, no
Suspenders, 10 Sweaters, 10 Sweets, 186-187, 2»9 Syrup, 219
Tackle, fishing, 15-16, 19, 27-32 fishing, emergency, 15-16 Tape,
adhesive, 170 Tarpaulin, 58 Tea, 226
 INDEX Telescopical poles. 48, 153 Tent materials, 47 poles,
48, 83, 151-155 shears, 151-154 stakes, 48-49, 151, 153 trenching
of, 60, 162 weights, 45-46 Tents, 39-46, 58 erection of, 150-155
Ticks, 166 Tinder, 59, 155 Toast, French, 215 Toilet kit, 16, 68 paper,
16 Tool roll, 51 Tools, 59-60 Toothache, treatment of, 174
Tourniquet, 168, 175-176 Trails, 134 Trajectory, 22 Transportation,
119 Trenching, tent, 60, 162 Triscuit, 216 Trout, preparation of, 230
Tube, aluminum, for bait rod, 31 for fly rod, 29 Tularemia, 234 Tump
line, 62 Tuna fish, 210, 227 Turkey, roasted, 237 ' ' ' Underwear, 6,
36 Unguentine, 166-167 Utensils, cooking, 49-51 Vaseline, 166-167,
170, 173 Veal loaf, 210 Vegetables, 186, 221-225 canned, 186, 225
dehydrated, 190, 209 fresh, 223-225, 227 Venison, preparation of,
238-241 Wading, 29 Wash basin, canvas, 65 Watches, 14, 139
Water, alkaline, 149 bag, 65 cress, 225 drinking, 83, 89, 148-149
Waterproofing, 37 Weapons, 19-26 Whipped cream, 227 Whisk
broom, 10 W^histle, 15, 134 White sauce, 212 Woolens, washing,
162, 164 Worms, caddis, 190 Wounds, 167-168, 173, 177, 179 Yoke,
canoe-carrying, 126
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