Controversial Issues
Update on Adult Immunization Recommendations of the Immunization Practices Advisory Committee (ACIP)
(For full report visit: http://www.cdc.gov/mmwr/preview/mmwrhtml/00025228.htm)
March 15, 1991: -This statement on adult immunization is a supplement to the "General Recommendations on Immunization" of the Immunization Practices Advisory Committee (ACIP) (1) and updates the previous supplement published in September 1984. This statement presents an overview on immunization for adults and makes specific immunization recommendations. The statement provides information on vaccine-preventable diseases; indications for use of vaccines, toxoids, and immune globulins recommended for adults; and specific side effects, adverse reactions, precautions, and contraindi- cations associated with use of these immunobiologics. It also gives immunization recommendations for adults in specific age groups and for those who have special immunization requirements because of occupation, life-style, travel, environmental situations, and health status.
This statement is a compendium of ACIP recommendations and will not be updated regularly. The ACIP periodically reviews individual immunization statements that are published in the MMWR. The reader must use the detailed, up-to-date individual statements in conjunction with this compendium to keep abreast of current information. A list of the current ACIP recommendations for specific diseases and vaccines can be found in Appendix 1.
INTRODUCTION
General Considerations
Immunization policies have primarily been directed towards vaccinating infants, children, and adolescents. Although vaccination is routine in pediatric practice, it is not commonplace in the practice of physicians who treat adults.
The widespread implementation of childhood vaccination programs has substantially reduced the occurrence of many vaccine-preventable diseases. However, successful childhood vaccination alone will not eliminate specific disease problems. A substantial proportion of the remaining morbidity and mortality from vaccine-preventable diseases presently occurs among older adolescents and adults. Persons who escaped natural infection or were not vaccinated with toxoids or vaccines against diphtheria, tetanus, measles, mumps, rubella, and poliomyelitis may be at risk of these diseases and their complications. Many factors have influenced the use of vaccines among adults, including lack of awareness of safe vaccines and vaccine- preventable health burdens, unfounded concerns about adverse reactions, and missed opportunities by health-care providers to vaccinate adults during office, clinic, or hospital visits. To improve adult immunization levels, the National Coalition for Adult Immunizati on (NCAI) was formed in 1988. The coalition consists of professional, private, public, and voluntary organizations with the common goal of improving vaccine use among adults by educating health-care providers and patients. A listing of member organizations is provided in Appendix 2.
To reduce further the unnecessary occurrence of these vaccine- preventable diseases, health-care providers for older adolescents and adults should provide vaccinations as a routine part of their practice. In addition, the epidemiology of other vaccine-preventable diseases (e.g., hepatitis B, rabies, influenza, and pneumococcal disease) indicates that persons in certain age, occupational, environmental, and life-style groups and those with special health problems are at increased risk of these illnesses and should be vaccinated. Travelers to some countries may also be at increased risk of exposure to vaccine-preventable illnesses. Finally, foreign students, immigrants, and refugees may be susceptible to these diseases.
A systematic approach to vaccination is necessary to ensure that every adult is appropriately protected against vaccine-preventable diseases. Every visit by an adult to a health-care provider should be an opportunity to provide this protection. However, several factors need to be considered before any patient is vaccinated. These include the susceptibility of the patient, the risk of exposure to the disease, the risk from the disease, and the benefits and risks of the immunizing agent.
Physicians should maintain detailed records containing information about each person's previous vaccinations. The National Childhood Vaccine Injury Act of 1986 (NCVIA) requires physicians and other health-care providers who administer vaccines to maintain permanent vaccination records and to report occurrences of certain adverse events specified in the Act for all vaccines containing measles, mumps, rubella, poliomyelitis, diphtheria, tetanus, and pertussis antigens for all patients, adults as well as children. Ideally, information for all vaccines and toxoids should be recorded. Information should also include the person's history of vaccine-preventable illnesses, occupation, and life-style. Vaccines and toxoids administered at appropriate ages and intervals should be documented in writing.
(For full report visit: http://www.cdc.gov/mmwr/preview/mmwrhtml/00025228.htm)
