In new guidelines issued by the American College of Rheumatology, evidence-based recommendations are presented for the use of vaccinations in children and adults with rheumatic and musculoskeletal diseases (RMDs), expanding indications for some vaccines and providing guidance on whether to hold immunosuppressive medications or delay vaccination in order to maximize vaccine immunogenicity.

According to the guidelines, high-dose or adjuvanted influenza vaccination is conditionally recommended over regular-dose vaccination for RMD patients aged 65 years or older and those aged older than 18 years and younger than 65 years who are on immunosuppressive medication.

Pneumococcal vaccination is strongly recommended for patients with RMD aged younger than 65 years on immunosuppressive medication. Administering the recombinant zoster vaccine is strongly recommended for RMD patients older than 18 years on immunosuppressive medication.

Vaccination against human papillomavirus is conditionally recommended for patients with RMD aged older than 26 years and younger than 45 years who are on immunosuppressive medication and not previously vaccinated. Giving multiple vaccinations on the same day is conditionally recommended for RMD patients over giving each individual vaccination on a different day.

"Patients worry about the safety of vaccines and the potential for inducing a disease flare. Providers are concerned whether rheumatic diseases and the medications used to treat them could blunt the effectiveness of vaccines," Anne R. Bass, M.D., from the Hospital for Special Surgery in New York, said in a statement. "This guideline was designed to address these issues."

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