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 to maximize vaccine immunogenicity. According to Anne R. Bass, MD, high-dose or adjuvanted influenza vaccination is conditionally recommended by the guidelines over regular-dose vaccination for patients with RMDs aged 65 or older and those aged 18-65 who are on immunosuppressive medication. Pneumococcal vaccination
is strongly recommended for patients with RMD who are younger than 65 and on immunosuppressive medication. Administering the recombinant zoster vaccine is strongly recommended for patients with RMDs who are older than 18 and on immunosuppressive medication. Vaccination against HPV is conditionally recommended for patients with RMDs who are aged 26-45 who are on immunosuppressive medication and not previously vaccinated. Giving multiple vaccinations on the same day is conditionally recommended for patients with RMDs over giving each individual vaccination on a different day.