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 Please note: An erratum has been published for this article. To view the erratum, please click here.

Notice to Readers: Recommended Adult Immunization Schedule --- United States, 2003--2004

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 (Figures 1 and 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 vaccinations (1) as recommended by ACIP (2) 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 http://www.cdc.gov/nip. The 2003--2004 Adult Immunization Schedule is available at http://www.cdc.gov/nip/recs/adult-schedule.htm. Vaccine information statements are available at http://www.cdc.gov/nip/publications/vis. ACIP statements for each recommended vaccine are available at http://www.cdc.gov/nip/publications/acip-list.htm. In addition, instructions for reporting adverse events after vaccination to the Vaccine Adverse Event Reporting System are available at http://www.vaers.org or by telephone, 800-822-7967.

References

  1. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare and Medicaid programs; conditions of participation: immunization standards for hospitals, long-term care facilities, and home health agencies. Federal Register 2002;67:61808--14. Available at http://www.cms.gov/providerupdate/regs/cms3160fc.pdf.
  2. CDC. Facilitating influenza and pneumococcal vaccination through standing orders programs. MMWR 2003;52:68--9.
  3. Task Force on Community Preventive Services. Recommendations regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(suppl):92--140.
  4. Centers for Medicare & Medicaid Services. 2003 administration rate allowances. Baltimore, Maryland: Centers for Medicare and Medicaid Services, 2003. Available at http://www.cms.hhs.gov/preventiveservices/2.asp.
  5. Ahmed F, Harris J, Shih S, Pawlson G. New HEDIS performance measure on influenza immunization for 50- to 64-year-old adults. Prev Med Manag Care 2001;2:215--21.
  6. Ahmed F, Elbasha EE, Thompson BL, Harris JR, Sneller VP. Cost-benefit analysis of a new HEDIS performance measure for pneumococcal vaccination. Med Decis Making 2002;22(suppl):S58--S66.
  7. CDC. Prevention and control of influenza: recommendations of the Advisory Committee for Immunization Practices. MMWR 2003;52(No. RR-8).
  8. Poland GA, Shefer AM, McCauley M, et al. Standards for adult immunization practices. Am J Prev Med 2003;25:144--50.
  9. CDC. Vaccine-preventable diseases: improving vaccination coverage in children, adolescents, and adults. MMWR 1999;48(No. RR-8).
  10. Rhew D, Glassman PA, Goetz MB. Improving pneumococcal vaccine rates: nurse protocols versus clinical reminders. J Gen Intern Med 1999;14:351--6.

 

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Figure 2
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Figure 2a         Figure 2b
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References

  1. CDC. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(No. RR-10).
  2. CDC. Prevention and control of influenza: recommendations of the Advisory Committee for Immunization Practices. MMWR 2003;52(No. RR-8).
  3. CDC. Using live, attenuated influenza vaccine for prevention and control of influenza: supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2003;52(No. RR-13).
  4. CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;47(No. RR-8).
  5. 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).
  6. 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).
  7. 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).
  8. CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45
    (No. RR-11).
  9. CDC. Prevention of varicella: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-6).
  10. CDC. Prevention and control of meningococcal disease and meningococcal disease and college students: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-7).

 

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