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
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.
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
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
Recommended Adult Immunization Schedule—United States, 2002-2003. JAMA. 2002;288(18):2258-2260. doi:10.1001/jama.288.18.2258