This policy statement updates recommendations of the American Academy of Pediatrics (AAP) for the use of respiratory syncytial virus (RSV) immunization for the prevention of lower respiratory tract infection (LRTI) caused by RSV in infants and children. The AAP recommends RSV immunization for all infants under 8 months of age born during or entering their first RSV season, unless the infant has documented protection from vaccination of their pregnant parent; and for infants and children 8 through 19 months of age who are at high risk of severe RSV disease and entering their second RSV season. A review of evidence supports expanding the high-risk criteria for administration of RSV immunization in infants and children 8 through 19 months of age entering their second RSV season. A discussion of the evidence supporting the AAP recommendations and additional details on infants and children included in the expanded recommendations are in the accompanying technical report (https://doi.org/10.1542/peds.2026-079049).
Hydrocephalus is a complex neurological condition characterized by derangements in cerebrospinal fluid (CSF) dynamics including disrupted CSF flow/absorption and/or excess CSF production that leads to ventricular enlargement and presents both diagnostic and therapeutic challenges. Its origins span from congenital anomalies to acquired cases following hemorrhage, infection, or tumors. Hydrocephalus is suspected in the setting of appropriate clinical signs/symptoms, and the diagnosis is confirmed with brain imaging and, in rare cases, invasive intracranial pressure monitoring. Surgical intervention is the mainstay of modern hydrocephalus management, with CSF diversion via an implanted shunt being the most common management strategy. However, for a subset of patients, endoscopic third ventriculostomy can also effectively manage hydrocephalus without the need for an implanted device. This article highlights both genetic and acquired forms of hydrocephalus, reviews the surgical interventions for managing hydrocephalus and commercially available shunt technologies, discusses the shortcomings of current management strategies, and explores the ongoing development of next-generation shunt technology including smart shunts and antifouling catheter coatings that aim to reduce shunt malfunction rates. Additionally, we review current bench research investigating the cellular/molecular mechanisms involved in hydrocephalus induction including studies on ventricular lining disruption and the role of aquaporins in hydrocephalus.
BACKGROUND AND OBJECTIVES PHH-1V, a protein-based, non-mRNA, bivalent, adjuvanted COVID-19 vaccine, has demonstrated strong immunogenicity and favorable safety as a booster in adults. This study evaluated PHH-1V as a heterologous booster in adolescents. METHODS HIPRA-HH-3 was a phase IIb, open-label, multicenter, noninferiority trial assessing the immunogenicity and safety of PHH-1V in 240 healthy adolescents (≥ 12 to < 18 years) primed with BNT162b2. Immunogenicity (N = 90) was assessed by measuring neutralizing antibodies against SARS-CoV-2 variants and total binding antibodies in adolescent participants vs young adults (≥ 18 to ≤ 25 years) (N = 81) from a previous trial, who had also been boosted with PHH-1V. T-cell responses at day 14 post booster were also evaluated. Antibody durability and adverse events (AEs) were assessed through day 336. RESULTS Neutralizing titers—against Omicron BA.1 (primary endpoint), WH1, Beta, and Delta variants—and total binding antibodies were significantly higher in adolescents than in young adults (P < .001), demonstrating noninferiority (margin < 1.5). T-cell responses against BA.1 and Beta also increased significantly (P < .001). Cross-variant antibody titers remained above baseline (day 0) through day 336. AEs were mostly mild/moderate, primarily injection-site pain and headache within 28 days. No related serious AEs were reported. CONCLUSIONS As a heterologous booster in adolescents, PHH-1V is safe and elicits cellular and sustained humoral responses with cross-variant immune recognition, which support the use of PHH-1V in adolescent vaccination strategies. Data in younger and specific risk groups are still needed.
BACKGROUND AND OBJECTIVES Evidence-based vaccine communication from clinicians is associated with improved parental vaccine acceptance. However, vaccine communication practices of frontline staff, including medical assistants (MAs) and receptionists, remain largely unknown. We aimed to characterize these practices during well-child encounters in pediatric primary care. METHODS We conducted a mixed-methods study with direct observations of frontline staff in 2 pediatric practices in Denver, CO, during well-child encounters in the summer (no influenza vaccine available) and fall (influenza vaccine available) of 2024, recording the frequency and format of vaccine communication. Following the observations, we conducted semi-structured interviews with MAs to explore their vaccine communication practices, perceived roles, comfort, and training. RESULTS We observed 174 encounters (127 MA–parent, 47 receptionist–parent interactions). Vaccine communication occurred in at least 51% (95% CI, 43%–60%) of MA interactions vs 6% of receptionist interactions (P < .001). When vaccines were recommended, MAs used a presumptive format in 46% (95% CI, 34%–59%) of encounters overall, but far less during influenza season (21% vs 76%; P < .001). Interviews revealed that MA communication styles evolved through on-the-job experience and peer-to-peer learning rather than formal training, with influenza vaccines treated as optional rather than routinely recommended. CONCLUSIONS MAs frequently communicate with parents about vaccines during well-child encounters but underutilize evidence-based presumptive communication, particularly for influenza vaccines. Communication practices are learned informally through peer-to-peer learning, highlighting a significant opportunity for targeted training to support team-based vaccine communication in pediatric primary care.
