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From the Centers for Disease Control and Prevention
November 19, 2003

Recommended Adult Immunization Schedule—United States, 2003-2004

JAMA. 2003;290(19):2536-2539. doi:10.1001/jama.290.19.2536-a

MMWR. 2003;52:965-969

In June 2003, the Advisory Committee on Immunization Practices (ACIP) approved the revised Adult Immunization Schedule for 2003-2004. The format has been revised to better represent the schedule's two components, by age group and by medical condition (Figure 1 and Figure 2) and better indicate how the footnotes apply to both figures.

Revisions to the schedule and footnotes include (1) additional information regarding use of tetanus-diphtheria toxoids as prophylaxis in wound management; (2) clarification regarding the number of doses of the measles component of the measles-mumps-rubella vaccine; (3) guidance regarding the use of intranasally administered, live, attenuated influenza vaccine for healthy persons aged 5-49 years; (4) recommendations regarding administering influenza vaccination to pregnant women with or without pre-existing chronic diseases or conditions; and (5) added information regarding influenza and consideration of Haemophilus influenzae type b vaccine for asplenic persons.

Two measures initiated by the Centers for Medicare and Medicaid Services (CMS) are expected to increase vaccination among Medicare and Medicaid beneficiaries. First, in 2002, CMS enacted a new regulation allowing for the use of standing orders at Medicare- and Medicaid-participating hospitals, long-term–care facilities, and home-health agencies to deliver influenza and pneumococcal vaccinations1 as recommended by ACIP2 and the Task Force on Community Preventive Services.3 Second, CMS increased reimbursement rates for administering hepatitis, influenza, and pneumococcal vaccines from a national average of $3.98 in 2002 to $7.72 in 2003.4 In addition, expansion of the National Committee for Quality Assurance's Health Plan Employer Data and Information Set to include quality indicators on influenza vaccinations for persons aged 50-64 years in 2001 and pneumococcal vaccinations for persons aged ≥65 years in 2002 might improve vaccination-delivery services at managed-care organizations.5,6

Health-care providers are reminded they should administer influenza vaccinations to all persons aged ≥50 years, regardless of preexisting medical conditions.7 Family physicians, internists, obstetrician/gynecologists, and other providers in private practice are urged to use the Adult Immunization Schedule in conjunction with the Standards for Adult Immunization Practices.8 Evidence indicates that chart reminders, patient reminders/recalls, and standing orders will reduce missed opportunities to vaccinate.9,10

General information regarding adult immunization and vaccinating immunosuppressed persons can be obtained from state and local health departments and from CDC's National Immunization Program at The 2003-2004 Adult Immunization Schedule is available at Vaccine information statements are available at ACIP statements for each recommended vaccine are available at In addition, instructions for reporting adverse events after vaccination to the Vaccine Adverse Event Reporting System are available at or by telephone, 800-822-7967.