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
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).
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
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