MMWR Clinical Pearls

February 2024

Think Horses First

2024 Immunization Schedules

MMWR recently published ACIP-approved 2024 immunization schedules. Changes from the 2023 schedules include new or updated recommendations for influenza, RSV, pneumococcal, mpox, and other vaccines. A new addendum section was added to each schedule to summarize new and updated ACIP recommendations that occur before the next annual update to the immunization schedules. Clinicians are advised to use the cover page, tables, notes, appendix, and addendum when vaccinating patients.

Don’t Forget Zebras

Vibrio vulnificus

Vibrio vulnificus can infect open wounds through contact with salt/ brackish water or raw seafood or cause infections after eating undercooked seafood. Eleven cases of severe infection were reported among residents of three eastern U.S. states after heat waves. Ten patients had underlying conditions, and six patients experienced either septic shock (four) or died (five). As coastal water temperatures increase, these infections are expected to become more common.

Tianeptine

Tianeptine, an antidepressant not approved in the U.S., is sold online or at convenience stores and is informally called “gas station heroin.” Twenty cases of tianeptine ingestion in New Jersey were associated with severe clinical effects, including altered mental status, seizure, arrhythmias, and cardiac arrest. Clinicians and the public need to be aware that Tianeptine is an unregulated drug that can cause adverse effects and can also be adulterated with other substances.

Opportunities to Improve Clinical Outcomes

COVID-19 Antivirals

Fungal infections

Antifungal-resistant skin infections are a growing problem, and approximately one in eight Medicare beneficiaries received a topical antifungal prescription. Clinicians should be judicious in prescribing topical antifungals for suspected superficial fungal infections and use testing when feasible to confirm diagnoses.

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