MMWR/ACIP (advisory committee on immunization practices) just came out with 2014 adult immunization guidelines (see http://www.cdc.gov/mmwr/pdf/wk/mm63e0203a2.pdf ). also, article in annals of internal medicine with guidelines and charts (see http://annals.org/article.aspx?articleid=1819123). not a lot of changes, but:
–Hib vaccine recommendations updated — major change is not recommending Hib vaccine for HIV-positive (had been to consider Hib vaccination). (i have been giving Hib vaccine to HIV-positive patients because of older case studies suggesting higher incidence of invasive Hib infection in HIV-positive people. seems like this is really not indicated). also not include meningococcal vaccine for HIV-positive (there was a recommendation, though not reflected in the above documents, that HIV-positive MSM get meningococcal vaccine, given the recent meningococcal outbreak in new york in MSM). they do reinforce the combo of PCV-13 and PPSV23, the 2 pneumococcal vaccines, in HIV-positive patients.
–flu: okay to use RIV (recombinant influenza vaccine) and IIV (inactivated influenza vaccine) in egg-allergic patients with hives-only allergy (RIV contains no egg protein and can be used in adults aged 18-49)
–Tdap — no change really, just reinforced using once in people over age 11, followed by Td every 10 years. i wonder if they will change the once-only recommendation given serologic and clinical evidence of waning pertussis immunity within a few years after immunization. they do recommend Tdap vaccine in pregnant women for each pregnancy, esp in range of 27-36 wk gestation
geoff