Posts filed under ‘GUIDELINES’

Vaccinations for pregnant women.

Obstet Gynecol. 2015 Jan;125(1):212-26.

Swamy GK1, Heine RP.

Author information

1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Duke University, Durham, North Carolina.


In the United States, eradication and reduction of vaccine-preventable diseases through immunization has directly increased life expectancy by reducing mortality.

Although immunization is a public priority, vaccine coverage among adult Americans is inadequate.

The Institute of Medicine, the Community Preventive Services Task Force, and other public health entities have called for the development of innovative programs to incorporate adult vaccination into routine clinical practice.

Obstetrician-gynecologists are well suited to serve as vaccinators of women in general and more specifically pregnant women.

Pregnant women are at risk for vaccine-preventable disease-related morbidity and mortality and adverse pregnancy outcomes, including congenital anomalies, spontaneous abortion, preterm birth, and low birth weight.

In addition to providing direct maternal benefit, vaccination during pregnancy likely provides direct fetal and neonatal benefit through passive immunity (transplacental transfer of maternal vaccine-induced antibodies).

This article reviews: 1) types of vaccines; 2) vaccines specifically recommended during pregnancy and postpartum; 3) vaccines recommended during pregnancy and postpartum based on risk factors and special circumstances; 4) vaccines currently under research and development for licensure for maternal-fetal immunization; and 5) barriers to maternal immunization and available patient and health care provider resources.


December 4, 2016 at 10:52 am

2016 BHIVA GUIDELINES for the routine investigation and monitoring of Adult HIV-1-positive individuals 72 pags

British HIV Association

Writing Group: Brian Angus (Chair), Gary    Brook (Vice-chair), Funmi Awosusi, Gary Barker, Marta Boffito, Satyajit Das, Lucy Dorrell, Esther Dixon-Williams, Charlotte Hall, Bridie Howe, Sebastian Kalwij, Nashaba Matin, Eleni Nastouli, Frank Post, Melinda Tenant-Flowers, Erasmus Smit, Dan Wheals

NHS Evidence has accredited the process used by the British HIV Association (BHIVA) to produce guidelines.

Accreditation is valid for five years from July 2012 and is applicable to guidance produced using the processes described in the British HIV Association (BHIVA) Guideline Development Manual. More information on accreditation can be viewed at


December 3, 2016 at 9:35 am

2016 BHIVA GUIDELINES for the treatment of HIV-1-positive Adults with antiretroviral therapy

The British HIV Association

Writing Group

Laura Waters (Chair)

N Ahmed, B Angus, M Boffito, M Bower, D Churchill, D Dunn, S Edwards, C Emerson, S Fidler, †M Fisher, R Horne, S Khoo, C Leen, N Mackie, N Marshall, F Monteiro, M Nelson, C Orkin, A Palfreeman, S Pett, A Phillips, F Post, A Pozniak, I Reeves, C Sabin, R Trevelion, J Walsh, E Wilkins, I Williams, A Winston

†Professor Martin Fisher died in April 2015 – he made a significant contribution to these, many other guidelines and our speciality as a whole – he is greatly missed.


The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection on antiretroviral therapy (ART).

The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii) support of people living with HIV (PLWH) on treatment; (iii) management of individuals experiencing virological failure; and (iv) recommendations in specific populations where other factors need to be taken into consideration.

The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection, and at community advocates responsible for promoting the best interests and care of HIV-positive adults. They should be read in conjunction with other published BHIVA guidelines.

The 2016 interim update to the 2015 BHIVA antiretroviral guidelines has been published online to include tenofovir-alafenamide/emtricitabine as a preferred NRTI backbone for first-line therapy. Changes were based on new data and the consensus opinion of the writing committee. All changes to the guideline are highlighted and include updates to the chronic kidney disease and bone disease sections of special populations and some small changes to managing virological failure. The next formal update to the guidelines in anticipated in 2017.


December 3, 2016 at 9:33 am

2015 UK National GUIDELINE for the Use of HIV PEP Following Sexual Exposure

The British HIV Association


We present the updated British Association for Sexual Health and HIV (BASHH) guidelines which aim to provide evidence-based recommendations for the most appropriate use of HIV post-exposure prophylaxis following sexual exposure (PEPSE).

The aim of PEPSE is to prevent HIV transmission. Risk of transmission, timing of PEP, preferred regimen, drug-drug interactions, follow-up, risk reduction and special scenarios are discussed. Consideration is given to the role of PEPSE within the broader context of HIV prevention and sexual health.

The guideline is intended to be complementary to existing Department of Health and Expert Advisory Group on AIDS (EAGA) guidance on PEP (1).

It is aimed primarily at clinicians and policymakers in sexual health, sexual assault referral centres (SARCs), and primary and emergency care providers within the UK who should consider the development of appropriate local pathways.

It is likely that this guideline will also be used for information provision by voluntary sector agencies to provide information for individuals.

The recommendations are aimed primarily at individuals aged 16 or older and may not be appropriate for use in all situations, including occupational exposures.

Decisions to follow these recommendations must be based on the professional judgment of the clinician and consideration of individual patient circumstances and available resources.


December 3, 2016 at 9:31 am

2015 BHIVA GUIDELINES on the use of vaccines in HIV-positive Adults

Writing Group

Chair and Editor: Prof Anna Maria Geretti

Members (in alphabetic order):

Dr Gary Brook, Central Middlesex Hospital, London

Ms Claire Cameron, Public Health England, London

Dr David Chadwick, James Cook University Hospital, Middlesbrough

Prof Neil French, University of Liverpool

Prof Robert Heyderman, University College London

Dr Antonia Ho, University of Liverpool

Dr Michael Hunter, Belfast Health and Social Care Trust

Dr Shamez Ladhani, Public Health England, London

Dr Mark Lawton, Royal Liverpool University Hospital

Dr Eithne MacMahon, Guy’s & St Thomas’ NHS Foundation Trust & King’s College London, London

Dr John McSorley, Central Middlesex Hospital, London

Dr Anton Pozniak, Chelsea and Westminster Hospital, London

Dr Alison Rodger, University College London


These guidelines provide updated, GRADE-based recommendations on the use of vaccines in HIV-positive adults. Several factors have made the updating of HIV-specific vaccination guidelines important: effective antiretroviral therapy (ART) has substantially modified the natural history of HIV infection, vaccination practices are evolving, and a large number of novel vaccines are becoming available in clinical care.

The update contains important new guidance regarding the use of new vaccines against human papillomavirus (HPV), shingles (herpes zoster) and pneumococcus. Further key updates are related to the use of hepatitis B, meningococcus and pertussis vaccines.

Compared with HIV-negative individuals, HIV-positive adults often have an increased risk of infection or experience more severe morbidity following exposure to vaccine-preventable diseases, and therefore a lower threshold for extending indications and offering vaccination may be appropriate relative to the general population.

Improved health and prognosis mean that HIV-positive adults are also increasingly likely to engage in travel or occupations that carry a risk of exposure to infectious agents, and these otherwise healthy individuals should not be denied protection or engagement with such activities if evidence indicates vaccination is safe and immunogenic.

Immune responses to vaccination are often sub-optimal in HIV-positive patients, and while these improve with ART, they often remain lower and decline more rapidly than in HIV-negative individuals.

However, many of these vaccines still afford protection and for some vaccines it is possible to improve immunogenicity by offering modified vaccine schedules, with higher or more frequent doses, without compromising safety.

Since their publication, these guidelines have been endorsed by the British Infection Association (BIA), European Clinical AIDS Society (EACS) and the Royal College of General Practitioners (RCGP).


December 3, 2016 at 9:28 am

European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection.

Clin Microbiol Infect. August 2016 V.22 Suppl 4 S63-81.

Crobach MJ1, Planche T2, Eckert C3, Barbut F3, Terveer EM1, Dekkers OM4, Wilcox MH5, Kuijper EJ6.

Author information

1Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.

2Department of Medical Microbiology, St. George’s Hospital, London, UK.

3National Reference Laboratory for Clostridium difficile, Paris, France.

4Departments of Clinical Epidemiology and Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.

5Department of Microbiology, Leeds Teaching Hospitals & University of Leeds, Leeds, UK.

6Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands. Electronic address:


In 2009 the first European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline for diagnosing Clostridium difficile infection (CDI) was launched.

Since then newer tests for diagnosing CDI have become available, especially nucleic acid amplification tests.

The main objectives of this update of the guidance document are to summarize the currently available evidence concerning laboratory diagnosis of CDI and to formulate and revise recommendations to optimize CDI testing.

This update is essential to improve the diagnosis of CDI and to improve uniformity in CDI diagnosis for surveillance purposes among Europe. An electronic search for literature concerning the laboratory diagnosis of CDI was performed.

Studies evaluating a commercial laboratory test compared to a reference test were also included in a meta-analysis. The commercial tests that were evaluated included enzyme immunoassays (EIAs) detecting glutamate dehydrogenase, EIAs detecting toxins A and B and nucleic acid amplification tests.

Recommendations were formulated by an executive committee, and the strength of recommendations and quality of evidence were graded using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. No single commercial test can be used as a stand-alone test for diagnosing CDI as a result of inadequate positive predictive values at low CDI prevalence.

Therefore, the use of a two-step algorithm is recommended. Samples without free toxin detected by toxins A and B EIA but with positive glutamate dehydrogenase EIA, nucleic acid amplification test or toxigenic culture results need clinical evaluation to discern CDI from asymptomatic carriage.


November 21, 2016 at 7:51 am

DENGUE – GUIA para la atención de enfermos en la Región de las Américas 2da edición 2015


Para enfrentar la compleja situación planteada por el dengue en las Américas  y en el mundo; en el 2003 la OPS/OMS con la participación de los países miembros, elaboró la Estrategia de Gestión Integrada para la prevención y control del dengue en las Américas (EGI-Dengue) la cual afronta la situación  del dengue a través de los siguientes componentes: laboratorio, comunicación  social, epidemiología, manejo integrado de vectores, medio ambiente y atención  al paciente.

Este último componente es vital, por esta razón la Organización le  ha asignado un carácter prioritario y se logró elaborar la primera edición de  las Guías de atención para enfermos de dengue en la región de las Américas  publicada en el 2010, que se basa en el documento que con el mismo propósito  edito la OMS en el 2009.

Luego de adoptar la información de esa 1ra  edición en las Américas, se realizó un extenso trabajo de capacitación del  personal de salud, específicamente en el diagnóstico oportuno, clasificación y  manejo de casos, con mayor énfasis en la atención primaria.

Actualmente, han  surgido avances en materia de procedimientos diagnósticos y manejo clínico, que  hacen necesario actualizar la información relacionada con la atención de los  pacientes con dengue.

Esta 2da edición de Dengue: guías para la atención de enfermos en la  Región de las Américas incluye información sobre las manifestaciones clínicas de  la enfermedad, su atención, tratamiento, bases de la vigilancia epidemiológica  y el diagnostico por laboratorio. Además incorpora nueva información para la  reorganización de los servicios de salud en situaciones de brote o epidemia,  que son de gran utilidad para los gerentes de las unidades de salud. La guía  contempla la experiencia propia de este continente y tiene un fundamento sólido  en la evidencia del más alto nivel científico.

La OPS/OMS ofrece a los países y territorios de las Américas esta segunda  edición, en el momento en que otras arbovirosis (chikungunya y Zika) se han  introducido en la Región, por lo cual cada vez es más imprescindible contar con el  diagnóstico oportuno y correcto de los casos de dengue, así como un seguimiento  clínico adecuado.

La guía puesta en sus manos es una herramienta esencial para  que el personal de salud pueda abordar correctamente la atención de los casos  de dengue que se presentan a diario en nuestros países, y tiene la finalidad de  prevenir la progresión de los casos a las formas graves del dengue y evitar así las  muertes causadas por la enfermedad.




November 12, 2016 at 10:26 am

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