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From the Centers for Disease Control and Prevention
November 13, 2002

Recommended Adult Immunization Schedule—United States, 2002-2003

JAMA. 2002;288(18):2258-2260. doi:10.1001/jama.288.18.2258

MMWR. 2002;51:904-908

1 figure omitted

Although the childhood immunization program in the United States has reduced the burden of vaccine-preventable disease substantially among children, substantial vaccine-preventable morbidity and mortality from diseases such as hepatitis A, hepatitis B, influenza, and pneumococcalinfections continue to occur among adults. In February 2002, the Advisory Committee on Immunization Practices (ACIP) approved for the first time a schedule for the routine vaccination of persons aged ≥19 years. The Adult Immunization Schedule has been accepted by the American Academy of Family Physicians (AAFP) and the American College of Obstetricians and Gynecologists (ACOG). ACIP will review and approve annually both the recommended adult and childhood immunization schedules. Together, these schedules provide a comprehensive summary of recommendations for prevention of vaccine-preventable diseases during the life span of persons in the United States.

The Adult Immunization Schedule is based on published recommendations of ACIP,1 AAFP,2 ACOG,3 and the American College of Physicians–American Society of Internal Medicine (ACP-ASIM) with the Infectious Diseases Society of America4 and was developed by members of these organizations and CDC. The schedule presents a tabular, color-coded summary of vaccine indications by age group (Figure 1) and medical condition. Footnotes included in Figure 1 are summaries of the ACIP recommendations for specific vaccines since 1991. Figure 2 includes special considerations or contraindications for vaccinating persons with specific medical conditions. Licensed combination vaccines can be used whenever any components of the combination are indicated and the vaccine's other components are not contraindicated. Providers should consult manufacturers' package inserts for detailed recommendations. CDC and ACIP will update the schedule annually through collaboration with members of AAFP, ACOG, and ACP-ASIM.

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Figure 1. Recommended Adult Immunization Schedule—United States, 2002-2003
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1. American College of Physicians. Guide for adult immunization. 3rd ed. Philadelphia, Pennsylvania: American College of Physicians, 1994.
2. CDC. Prevention of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2002;51 (No. RR-3).
3. CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-8).
4. CDC. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(No. RR-13).
5. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-12).
6. CDC. Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1998;47(No. RR-8).
7. CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45 (No. RR-11).
8. CDC. Prevention of varicella: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-6).
9. CDC. Control and prevention of meningococcal disease and control and prevention of serogroup C meningococcal disease: evaluation and management of suspected outbreaks: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-5).

Providers should report all postvaccination reactions to the Vaccine Adverse Event Reporting System (VAERS), telephone 800-822-7967. Reporting forms and instructions on filing a VAERS report are available at http://www.vaers.org. Tetanus-diphtheria (Td); hepatitis B; measles, mumps, and rubella (MMR); and varicella vaccines are covered by the Vaccine Injury Compensation Program (VICP). Health-care providers are required to give adult patients copies of the Vaccine Information Statements developed by CDC before administering each dose of the vaccines covered by VICP. Information on how to file a claim with VICP is available at 800-338-2382.

The schedule provides an up-to-date tool for family physicians, gynecologists, internists, and other health-care providers to assess the vaccine needs of patients during office visits and to administer the appropriate vaccines. Providers can use the schedule to promote the use of standing orders, patient-reminder/recall systems, provider-reminder systems, and other strategies that reduce missed opportunities to vaccinate their patients. The notes accompanying the age-based table and the footnotes for highlighting issues unique to chronic disease groups provide information for providers who might be unfamiliar with the dosage or contraindications of a particular vaccine.

Because adult vaccination requires the participation of health-care providers in three medical specialties (internal medicine, family practice, and obstetrics and gynecology) that do not include vaccinations in clinical training, tools such as the adult immunization schedule could play an important role in educating health-care providers who want to vaccinate their adult patients.

A printable, annotated, color version of the schedule will be available at http://www.cdc.gov/nip. Additional information on adult immunization and ordering instructions for Increasing Adult Vaccination Rates: What Works, a CD-ROM–based continuing education program offering primary-care providers strategies for increasing vaccination rates among their adult patients, also will be available at this website.

References: 4 available