This family covers two problems that a pediatrician meets constantly and that are usually taught apart. The first is pharyngitis, meaning inflammation of the pharynx and tonsils. It is most often viral, so the clinical task is not to recognise the illness but to find the minority of children whose sore throat is caused by group A Streptococcus (GAS) and to treat them with the narrowest antibiotic that works. The second is pediatric vaccination: the routine schedule that has made most of the severe childhood infections rare, and the reasoning about vaccine types, timing and coverage that keeps them rare.
The two are the same argument at two scales. For one child, the question is whether an antibiotic is justified and which one, so that the drug still works next time; this discipline is called antibiotic stewardship. For a population, the question is what proportion must be immune for a pathogen to stop circulating, so that the people who cannot be vaccinated are protected anyway; this indirect protection is called herd immunity. Both come down to intervening precisely: not more than the situation requires, and not less.
The sore throat: from differential to treatment
Start here if the problem in front of you is a child with a sore throat. The four notes are meant to be read in order, because each answers the question the previous one raises.
- Pediatric Pharyngitis: Pathogens and Clinical Picture sets out which viruses and bacteria cause a sore throat, how the presentation changes with the child’s age, and why the examination cannot separate them. It leaves the question of why one organism deserves the whole effort.
- Pediatric Group A Streptococcus: Virulence and Complications answers it: what the organism does after it reaches the throat, the two complications that appear weeks later, and the invasive form of the disease.
- Pediatric GAS Pharyngitis: Diagnosis explains how to establish that the organism is present: how to take a throat swab so that it means something, what a rapid antigen test can and cannot rule out, what a culture adds, and where clinical scores help.
- Pediatric GAS Pharyngitis: Treatment and Antibiotic Stewardship applies stewardship to the confirmed case: amoxicillin at the streptococcal dose rather than the pneumococcal one, the ten-day course and why it exists, the treatment window, and the drugs that should not be used.
Vaccines: from the product to the population
These four notes can be read without the pharyngitis notes. In the order listed, they move from how a vaccine works to what the schedule prevents and then to what happens when a population stops following it.
- Pediatric Vaccines: Types and the Italian Schedule explains the six vaccine platforms and why each pathogen demands a particular one, what adjuvants and excipients are, and what the Italian calendar gives at each age.
- Pediatric Vaccine-Preventable Diseases: The Mandatory Schedule takes the ten diseases the mandatory vaccinations prevent, each with its mechanism, the complication that justifies prevention and the vaccine detail.
- Pediatric Vaccines Outside the Mandatory Schedule does the same for the six diseases prevented by the vaccines Italy offers but does not require, from pneumococcus and meningococcus to rotavirus, HPV, influenza and hepatitis A.
- Pediatric Vaccination Coverage and Herd Immunity explains how much of a population has to be immune, why the threshold differs between diseases, and what has followed falling coverage in Italy and Europe.
Two related topics sit alongside this family and are worth reading about if the febrile child is the clinical problem in front of you: Scarlet Fever for the same organism presenting with a rash, and community-acquired pneumonia for the lower-airway presentation that pneumococcal vaccination helps prevent.