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Notice to Readers Recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians: Use of Reminder and Recall by Vaccination Provide

This statement by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) presents and recommends a programmatic strategy -- the use of a reminder and/or recall (R/R) system by vaccination providers -- to increase vaccination rates. In 1992, a national survey indicated that 8% of pediatricians and 5% of family physicians had implemented a manual vaccination R/R system and 6% and 5%, respectively, used a computer-based system for vaccination R/R messages (1). In 1993, the National Vaccine Advisory Committee issued the "Standards for Pediatric Immunization Practices," which recommend that all public and private health-care providers use a vaccination R/R system (2). These standards were endorsed by ACIP, AAP, and AAFP. By 1995 a survey indicated that R/R systems were used by 35% of pediatricians and 23% of family physicians (R. Zimmerman, University of Pittsburgh School of Medicine, personal communication, 1995).

The reminder component consists of mail and/or telephone messages to remind parents or guardians of vaccination due dates for their children. Reminder messages can improve parents' awareness that vaccinations are due and the importance of keeping appointments, therefore increasing the up-to-date vaccination status of children. The recall component consists of mail and/or telephone messages to parents or guardians of children who are past due for one or more vaccinations. Recall messages can decrease vaccination drop-out rates and reduce the time children remain at risk for vaccine-preventable diseases. R/R systems can be operated manually (e.g., by monthly tickler file) or can be automated (e.g., by computer-generated mailings or telephone calls). Messages from automated systems can be modified to address special needs (e.g., language).

The implementation of vaccination R/R systems has potential benefits beyond improved vaccination coverage rates. Patients of all ages who are due or overdue for recommended vaccinations also may have fallen behind in health supervision visits and may experience barriers to health care in general. Vaccination R/R systems may help identify patients who are at risk for not receiving comprehensive primary care. R/R systems also can be established independently for improving attendance for child health supervision visits and other recommended preventive health service visits, including adult vaccination (3), cervical cancer screening (4), and lead screening. The cost-effectiveness of R/R systems for a provider can be dependent on the number of patients, the documented level of vaccination coverage, the provider's level of computerization, and the intensity with which the provider uses the R/R system (5,6).

Properly implemented, the R/R strategy contributes to high, sustainable vaccination coverage levels. Studies of the effectiveness of mail or telephone reminder messages generally have demonstrated improvements in patient compliance for a variety of scheduled health-care visits, including vaccinations (7-9). Among patients scheduled for a vaccination visit who received a single autodialer-based reminder call the night before a scheduled visit, attendance was 57% compared with 20% in the control group who received no reminder (6); 41% of patients who received a vaccination R/R message visited the provider within 30 days compared with 28% of those who did not receive a reminder (10).

The ACIP, AAFP, and AAP recommend the regular use of R/R systems by public and private health-care providers in settings that have not achieved high documented levels of age-appropriate vaccinations. For reminder systems, messages should be delivered close to the due date for vaccinations. In recall systems, messages should be delivered promptly if the scheduled visit is missed. Implementation of these recommendations can contribute substantially to improving vaccination coverage at the provider level.

Reported by: Advisory Committee on Immunization Practices, Atlanta, Georgia. American Academy of Family Physicians, Kansas City, Missouri. American Academy of Pediatrics, Elk Grove Village, Illinois. Immunization Svcs Div, National Immunization Program, CDC.


  1. Szilagyi PG, Rodewald LE, Humiston SG, et al. Immunization practices of pediatricians and family physicians in the United States. Pediatrics 1994;94:517-23.

  2. Ad Hoc Working Group for the Development of Standards for Pediatric Immunization Practices. Standards for pediatric immunization practices. JAMA 1993;269:1817-22.

  3. Barton MB, Schoenbaum SC. Improving influenza vaccination performance in an HMO setting: the use of computer-generated reminders and peer comparison feedback. Am J Public Health 1990;80:534-6.

  4. Austin SM, Balas EA, Mitchell JA, Ewigman BG. Effect of physician reminders on preventive care: meta-analysis of randomized clinical trials. Proc 18th Annu Symp Comput Appl Med Care 1994:121-4.

  5. Lieu TA, Black SB, Ray P, et al. Computer-generated recall letters for underimmunized children: how cost-effective? Pediatr Infect Dis J 1997; 16:28-33.

  6. Dini EF, Linkins RW, Chaney M. Effectiveness of computer-generated telephone messages in increasing clinic visits. Arch Pediatr Adolesc Med 1995;149:902-5.

  7. Campbell JR, Szilagyi PG, Rodewald LE, Doane C, Roghmann KJ. Patient-specific reminder letters and pediatric well-child-care show rates. Clinical Pediatrics 1994;33:268-72.

  8. Quattlebaum TG, Darden PM, Sperry JB. Effectiveness of computer-generated appointment reminders. Pediatrics 1991;88:801-5.

  9. Nazarian LF, Mechaber J, Charney E, Coulter MP. Effect of a mailed appointment reminder on appointment keeping. Pediatrics 1974;53:349-52.

  10. Linkins RW, Dini EF, Watson G, Patriarca PA. A randomized trial of the effectiveness of computer-generated telephone messages in increasing immunization visits among preschool children. Arch Pediatr Adolesc Med 1994;148:908-14.

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