Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules for Persons Aged 0 Through 18 years and Adults Aged 19 Years and Older — United States, 2013
Early Release
January 28, 2013 / 62(Early Release);1-19Introduction
Each year, recommendations for routine use of vaccines in children, adolescents, and adults in the United States are developed by the Advisory Committee on Immunization Practices (ACIP). This year, for the first time, recommended immunization schedules for persons aged 0 through 18 years and adults aged 19 years and older are being published together.Placing These Schedules on Your Website
CDC's National Center for Immunization and
Respiratory Diseases (NCIRD) maintains the most current immunization schedules
on the Vaccines and Immunizations pages of CDC's website (http://www.cdc.gov/vaccines/schedules),
including the schedules published in this supplement. If errors or omissions are
discovered after publication of the schedules, CDC posts revised versions on the
Vaccines and Immunizations Web pages.
CDC encourages organizations that have previously relied on copying and
posting PDFs of the schedules to their websites to instead use a safer method to
consistently display current schedules. This form of "content syndication"
ensures that the most current and accurate immunization schedule information is
on each organization's website. This one-time step assures that your website
displays current yearly schedules as soon as they are published, or revised.To place the schedules on a website, organizations simply include two lines of CDC-furnished computer code on their Web page. Each organization's Web developer places the code into their existing website; the code automatically loads the current CDC schedule and footnotes. The schedule is visible within the organization's Web page, and all other images and Web navigation display unchanged. Any CDC revisions or updates will automatically and immediately be reflected on the organization's Web page.
This form of content syndication also gives
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Staff members and Web visitors can print as well as view immunization schedules
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CDC offers technical assistance for organizations
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ACIP is chartered as a federal advisory committee to provide expert external
advice and guidance to the Director of the Centers for Disease Control and
Prevention (CDC) on use of vaccines and related agents for the control of
vaccine-preventable diseases in the civilian population of the United States.
Recommendations for routine use of vaccines in children and adolescents are
harmonized to the greatest extent possible with recommendations made by the
American Academy of Pediatrics (AAP), the American Academy of Family Physicians
(AAFP), and the American College of Obstetrics and Gynecology (ACOG).
Recommendations for routine use of vaccines in adults are reviewed and approved
by the American College of Physicians (ACP), AAFP, ACOG, and the American
College of Nurse-Midwives. ACIP recommendations adopted by the CDC Director
become agency guidelines on the date published in the Morbidity and Mortality
Weekly Report (MMWR).
Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Persons Aged 0 Through 18 Years — United States, 2013
Corresponding
contributor: Iyabode Akinsanya-Beysolow, iakinsanyabeysolow@cdc.gov,
404-639-5251.
Each year, the Advisory Committee on Immunization Practices (ACIP) reviews
the current recommended immunization schedules for persons aged 0 through 18
years to ensure that the schedule reflects current recommendations for licensed
vaccines. In October 2012, ACIP approved the recommended immunization schedules
for persons aged 0 through 18 years for 2013, which includes several changes
from 2012.
Health-care providers are advised to use both the
recommended schedule and the catch-up schedule (Figures 1
and 2) in combination with their footnotes (pages 6–8) and
not as stand-alones. For guidance on the use of all the vaccines in the
schedules, including contraindications and precautions to use of a vaccine,
providers are referred to the respective ACIP vaccine recommendations.
Printable versions of the regular and catch-up
schedules are available at http://www.cdc.gov/vaccines/schedules in
various formats, including landscape and pocket-sized, in regular paper or
laminated versions. A "parent friendly" regular schedule is available at http://www.cdc.gov/vaccines/schedules/easy-to-read/child.html#print.
For 2013, several new references and links to
additional information have been added, including one for travel vaccine
requirements and recommendations (1). New references also are provided
for vaccination of persons with primary and secondary immunodeficiencies.
Changes to the previous schedules (2) include the
following:
- Figure 1, "Recommended immunization schedule for persons aged 0 through 18
years" replaces "Recommended immunization schedule for persons aged 0 through 6
years" and "Recommended immunization schedule for persons aged 7 through 18
years."
— Wording was added to bars to represent the respective vaccine dose numbers in the series.
— The meningococcal conjugate vaccine (MCV4) purple bar was extended to age 6 weeks, to reflect licensure of Hib-MenCY vaccine.
— The hepatitis A (HepA) vaccine yellow bar was extended to better reflect routine age recommendations for use of HepA vaccine. New green and purple bars were added to reflect hepatitis A vaccine recommendations for older children.
— Abbreviations for influenza vaccine were updated with the anticipation of quadrivalent vaccine for the 2013–14 influenza season.
— Pneumococcal polysaccharide vaccine (PPSV23) was added to Figure 1. - Footnotes were combined and standardized formatting was used to provide
recommendations for each vaccine related to routine vaccination, catch-up
vaccination, and vaccination of persons with high-risk medical conditions or
under special circumstances.
— Meningococcal conjugate vaccine (MCV4) footnotes were updated to reflect recent recommendations (3).
— Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine footnotes were updated to reflect recent recommendations (4).
— Influenza vaccine footnotes were updated to provide dosing guidance for children aged 6 months through 8 years for the 2012–13 and 2013–14 influenza seasons (5). - Meningococcal conjugate (MCV4) vaccine minimum ages and intervals were updated in Figure 2, "Catch-up immunization schedule for persons aged 4 months through 18 years who start late or who are more than 1 month behind—United States, 2013," to reflect licensure of Hib-MenCY vaccine.
References
- CDC. Traveler's health: vaccinations. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://wwwnc.cdc.gov/travel/page/vaccinations.htm.
- CDC. Recommended immunization schedules for persons aged 0–18 years—United States, 2012. MMWR 2012;61(5).
- CDC, Advisory Committee on Immunization Practices. Resolution no. 10/12-2. Vaccines to prevent meningococcal disease. Atlanta, GA: US Department of Health and Human Services, CDC, Advisory Committee on Immunization Practices; 2012.
- CDC. Update on use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in pregnant women. Atlanta, GA: US Department of Health and Human Services, CDC.
- CDC, Advisory Committee on Immunization Practices. Resolution no. 10/12-3. Vaccines to prevent influenza. Atlanta, GA: US Department of Health and Human Services, CDC, Advisory Committee on Immunization Practices; 2012. Available at http://www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/1012-3-flu.pdf .
ACIP Childhood/Adolescent Immunization Work
Group
Work Group Chair: Renée Jenkins, MD, Washington, D.C.
(ACIP)Work Group Members: Ruth Karron, MD, Baltimore, Maryland (ACIP); Lorry G. Rubin, MD, New Hyde Park, New York (ACIP); H. Cody Meissner, MD, Boston, Massachusetts; Amy B. Middleman, MD, Houston, Texas; Susan Lett, MD, Boston, Massachusetts; Diane Peterson, Saint Paul, Minnesota; Chris Barry, PA-C, Raleigh, North Carolina; Everett Schlamm, MD, Verona, New Jersey; Katie Brewer, MSN, Silver Springs, Maryland; Patricia Stinchfield, MPH, St Paul, Minnesota; Rosemary Spence, MA, Denver, Colorado; Andrew Kroger, MD, Atlanta, Georgia; William L. Atkinson, MD, Harrisonville, Missouri; Jennifer Hamborsky, MPH, MCHES, Atlanta, Georgia.
Work Group Contributors (CDC): Charles Wolfe, Atlanta, Georgia; Donna Weaver, MN, Atlanta, Georgia; JoEllen Wolicki, Atlanta, Georgia; Melissa Barnett, MS, Atlanta, Georgia; Zunera Mirza, MPH, Atlanta, Georgia
Work Group Secretariat (CDC): Iyabode Akinsanya-Beysolow, MD, Atlanta, Georgia.
This schedule includes
recommendations in effect as of (month) (day), 2012. Any dose not administered
at the recommended age should be administered at a subsequent visit, when
indicated and feasible. The use of a combination vaccine generally is preferred
over separate injections of its equivalent component vaccines. Vaccination
providers should consult the relevant Advisory Committee on Immunization
Practices (ACIP) statement for detailed recommendations, available online at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
Clinically significant adverse events that follow vaccination should be reported
to the Vaccine Adverse Event Reporting System (VAERS) online (http://www.vaers.hhs.gov) or by telephone
(800-822-7967).Suspected cases of vaccine-preventable diseases should be
reported to the state or local health department. Additional information,
including precautions and contraindications for vaccination, is available from
CDC online (http://www.cdc.gov/vaccines) or by
telephone (800-CDC-INFO [800-232-4636]).
This schedule is approved by
the Advisory Committee on Immunization Practices (www.cdc.gov/vaccines/recs/acip), the
American Academy of Pediatrics (www.aap.org), and the American
Academy of Family Physicians (www.aafp.org).
NOTE: The above recommendations must be read
along with the footnotes on pages 4-5 of this schedule.
Alternate Text: The figure above shows the catch-up immunization
schedule for persons aged 4 months through 18 years who start late or who are
more than 1 month behind in the United States during 2013. Meningococcal
conjugate (MCV4) vaccine minimum ages and intervals were updated in Figure 2,
"Catch-up immunization schedule for persons aged 4 months through 18 years who
start late or who are more than 1 month behind-United States, 2013," to reflect
licensure of Hib-MenCY vaccine.
NOTE: The above
recommendations must be read along with the footnotes on pages
6–8.
1. Hepatitis B (HepB) vaccine. (Minimum age:
birth)
Routine vaccination:
At birth
•
Administer monovalent HepB vaccine to all newborns before hospital
discharge.
•
For infants born to hepatitis B surface antigen (HBsAg)–positive mothers,
administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within
12 hours of birth. These infants should be tested for HBsAg and antibody to
HBsAg (anti-HBs) 1 to 2 months after completion of the HepB series, at age 9
through 18 months (preferably at the next well-child visit).
• If
mother's HBsAg status is unknown, within 12 hours of birth administer HepB
vaccine to all infants regardless of birth weight. For infants weighing
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Doses following the birth dose
• The second dose should be administered at age 1 or
2 months. Monovalent HepB vaccine should be used for doses administered before
age 6 weeks.
• Infants who did not
receive a birth dose should receive 3 doses of a HepB-containing vaccine on a
schedule of 0, 1 to 2 months, and 6 months starting as soon as feasible. See Figure 2.
• The minimum interval between dose 1 and dose 2 is 4
weeks and between dose 2 and 3 is 8 weeks. The final (third or fourth) dose in
the HepB vaccine series should be administered no earlier than age 24 weeks, and
at least 16 weeks after the first dose.
• Administration of a total of 4 doses of HepB
vaccine is recommended when a combination vaccine containing HepB is
administered after the birth dose.
Catch-up vaccination:
• Unvaccinated persons should complete a 3-dose
series.
• A 2-dose series (doses separated by at least 4
months) of adult formulation Recombivax HB is licensed for use in children aged
11 through 15 years.
• For other catch-up issues,
see Figure 2.
2. Rotavirus (RV) vaccines. (Minimum age: 6 weeks for
both RV-1 [Rotarix] and RV-5 [RotaTeq]).
Routine vaccination:
•
Administer a series of RV vaccine to all infants as follows:
1.
If RV-1 is used, administer a 2-dose series at 2 and 4 months of age.
2.
If RV-5 is used, administer a 3-dose series at ages 2, 4, and 6 months.
3.
If any dose in series was RV-5 or vaccine product is unknown for any dose
in the series, a total of 3 doses of RV vaccine should be administered.
Catch-up vaccination:
• The maximum age for the first dose in the series is
14 weeks, 6 days.
• Vaccination should not be initiated for infants
aged 15 weeks 0 days or older.
• The maximum age for the final dose in the series is
8 months, 0 days.
• If RV-1(Rotarix) is administered for the first and
second doses, a third dose is not indicated.
• For other catch-up issues,
see Figure 2.
3. Diphtheria and tetanus toxoids and acellular
pertussis (DTaP) vaccine. (Minimum age: 6 weeks)
Routine vaccination:
• Administer a 5-dose series of DTaP vaccine at ages
2, 4, 6, 15–18 months, and 4 through 6 years. The fourth dose may be
administered as early as age 12 months, provided at least 6 months have elapsed
since the third dose.
Catch-up vaccination:
• The fifth (booster) dose of DTaP vaccine is not
necessary if the fourth dose was administered at age 4 years or older.
• For other catch-up issues,
see Figure 2.
4. Tetanus and diphtheria toxoids and acellular
pertussis (Tdap) vaccine. (Minimum age: 10 years for Boostrix, 11 years for
Adacel).
Routine vaccination:
• Administer 1 dose of Tdap vaccine to all
adolescents aged 11 through 12 years.
• Tdap can be administered regardless of the interval
since the last tetanus and diphtheria toxoid-containing vaccine.
• Administer one dose of Tdap vaccine to pregnant
adolescents during each pregnancy (preferred during 27 through 36 weeks
gestation) regardless of number of years from prior Td or Tdap vaccination.
Catch-up vaccination:
• Persons aged 7 through 10 years who are not fully
immunized with the childhood DTaP vaccine series, should receive Tdap vaccine as
the first dose in the catch-up series; if additional doses are needed, use Td
vaccine. For these children, an adolescent Tdap vaccine should not be given.
• Persons aged 11 through 18 years who have not
received Tdap vaccine should receive a dose followed by tetanus and diphtheria
toxoids (Td) booster doses every 10 years thereafter.
• An inadvertent dose of DTaP vaccine administered to
children aged 7 through 10 years can count as part of the catch-up series. This
dose can count as the adolescent Tdap dose, or the child can later receive a
Tdap booster dose at age 11–12 years.
• For other catch-up issues,
see Figure 2.
5. Haemophilus influenzae type b (Hib)
conjugate vaccine. (Minimum age: 6 weeks)
Routine vaccination:
• Administer a Hib vaccine primary series and a
booster dose to all infants. The primary series doses should be administered at
2, 4, and 6 months of age; however, if PRP-OMP (PedvaxHib or Comvax) is
administered at 2 and 4 months of age, a dose at age 6 months is not indicated.
One booster dose should be administered at age 12 through15 months.
• Hiberix (PRP-T) should only be used for the booster
(final) dose in children aged 12 months through 4 years, who have received at
least 1 dose of Hib.
Catch-up vaccination:
• If dose 1 was administered at ages 12-14 months,
administer booster (as final dose) at least 8 weeks after dose 1.
• If the first 2 doses were PRP-OMP (PedvaxHIB or
Comvax), and were administered at age 11 months or younger, the third (and
final) dose should be administered at age 12 through 15 months and at least 8
weeks after the second dose.
• If the first dose was administered at age 7 through
11 months, administer the second dose at least 4 weeks later and a final dose at
age 12 through 15 months, regardless of Hib vaccine (PRP-T or PRP-OMP) used for
first dose.
• For unvaccinated children aged 15 months or older,
administer only 1 dose.
• For other catch-up issues,
see Figure 2.
Vaccination of persons with high-risk
conditions:
• Hib vaccine is not routinely recommended for
patients older than 5 years of age. However one dose of Hib vaccine should be
administered to unvaccinated or partially vaccinated persons aged 5 years or
older who have leukemia, malignant neoplasms, anatomic or functional asplenia
(including sickle cell disease), human immunodeficiency virus (HIV) infection,
or other immunocompromising conditions.
6a. Pneumococcal conjugate vaccine (PCV).
(Minimum age: 6 weeks)
Routine vaccination:
• Administer a series of PCV13 vaccine at ages 2, 4,
6 months with a booster at age 12 through 15 months.
• For children aged 14 through 59 months who have
received an age-appropriate series of 7-valent PCV (PCV7), administer a single
supplemental dose of 13-valent PCV (PCV13).
Catch-up vaccination:
• Administer 1 dose of PCV13 to all healthy children
aged 24 through 59 months who are not completely vaccinated for their age.
• For other catch-up issues,
see Figure 2.
Vaccination of persons with high-risk
conditions:
• For children aged 24 through 71 months with certain
underlying medical conditions (see footnote 6c), administer 1 dose of PCV13 if 3
doses of PCV were received previously, or administer 2 doses of PCV13 at least 8
weeks apart if fewer than 3 doses of PCV were received previously.
• A single dose of PCV13 may
be administered to previously unvaccinated children aged 6 through 18 years who
have anatomic or functional asplenia (including sickle cell disease), HIV
infection or an immunocompromising condition, cochlear implant or cerebrospinal
fluid leak. See MMWR 2010;59 (No. RR-11), available at http://www.cdc.gov/mmwr/pdf/rr/rr5911.pdf .
• Administer PPSV23 at least 8 weeks after the last
dose of PCV to children aged 2 years or older with certain underlying medical
conditions (see footnotes 6b and 6c).
6b. Pneumococcal polysaccharide vaccine (PPSV23).
(Minimum age: 2 years)
Vaccination of persons with high-risk
conditions:
• Administer PPSV23 at least 8 weeks after the last
dose of PCV to children aged 2 years or older with certain underlying medical
conditions (see footnote 6c). A single revaccination with PPSV should be
administered after 5 years to children with anatomic or functional asplenia
(including sickle cell disease) or an immunocompromising condition.
6c. Medical conditions for which PPSV23 is indicated in
children aged 2 years and older and for which use of PCV13 is indicated in
children aged 24 through 71 months:
• Immunocompetent children with chronic heart disease
(particularly cyanotic congenital heart disease and cardiac failure); chronic
lung disease (including asthma if treated with high-dose oral corticosteroid
therapy), diabetes mellitus; cerebrospinal fluid leaks; or cochlear implant.
• Children with anatomic or functional asplenia
(including sickle cell disease and other hemoglobinopathies, congenital or
acquired asplenia, or splenic dysfunction);
• Children with immunocompromising conditions: HIV
infection, chronic renal failure and nephrotic syndrome, diseases associated
with treatment with immunosuppressive drugs or radiation therapy, including
malignant neoplasms, leukemias, lymphomas and Hodgkin disease; or solid organ
transplantation, congenital immunodeficiency.
7. Inactivated poliovirus vaccine (IPV). (Minimum age: 6
weeks)
Routine vaccination:
• Administer a series of IPV at ages 2, 4, 6–18
months, with a booster at age 4–6 years. The final dose in the series should be
administered on or after the fourth birthday and at least 6 months after the
previous dose.
Catch-up vaccination:
• In the first 6 months of life, minimum age and
minimum intervals are only recommended if the person is at risk for imminent
exposure to circulating poliovirus (i.e., travel to a polio-endemic region or
during an outbreak).
• If 4 or more doses are administered before age 4
years, an additional dose should be administered at age 4 through 6 years.
• A fourth dose is not necessary if the third dose
was administered at age 4 years or older and at least 6 months after the
previous dose.
• If both OPV and IPV were administered as part of a
series, a total of 4 doses should be administered, regardless of the child's
current age.
• IPV is not routinely recommended for U.S. residents
aged 18 years or older.
• For other catch-up issues,
see Figure 2.
8. Influenza vaccines. (Minimum age: 6 months for
inactivated influenza vaccine [IIV]; 2 years for live, attenuated influenza
vaccine [LAIV])
Routine vaccination:
• Administer influenza
vaccine annually to all children beginning at age 6 months. For most healthy,
nonpregnant persons aged 2 through 49 years, either LAIV or IIV may be used.
However, LAIV should NOT be administered to some persons, including 1) those
with asthma, 2) children 2 through 4 years who had wheezing in the past 12
months, or 3) those who have any other underlying medical conditions that
predispose them to influenza complications. For all other contraindications to
use of LAIV see MMWR 2010; 59 (No. RR-8), available at http://www.cdc.gov/mmwr/pdf/rr/rr5908.pdf .
• Administer 1 dose to persons aged 9 years and
older.
For children aged 6 months through 8
years:
• For the 2012–13 season,
administer 2 doses (separated by at least 4 weeks) to children who are receiving
influenza vaccine for the first time. For additional guidance, follow dosing
guidelines in the 2012 ACIP influenza vaccine recommendations, MMWR 2012; 61:
613–618, available at http://www.cdc.gov/mmwr/pdf/wk/mm6132.pdf .
• For the 2013–14 season, follow dosing guidelines in
the 2013 ACIP influenza vaccine recommendations.
9. Measles, mumps, and rubella (MMR) vaccine. (Minimum
age: 12 months for routine vaccination)
Routine vaccination:
• Administer the first dose of MMR vaccine at age 12
through 15 months, and the second dose at age 4 through 6 years. The second dose
may be administered before age 4 years, provided at least 4 weeks have elapsed
since the first dose.
• Administer 1 dose of MMR vaccine to infants aged 6
through 11 months before departure from the United States for international
travel. These children should be revaccinated with 2 doses of MMR vaccine, the
first at age 12 through 15 months (12 months if the child remains in an area
where disease risk is high), and the second dose at least 4 weeks later.
• Administer 2 doses of MMR vaccine to children aged
12 months and older, before departure from the United States for international
travel. The first dose should be administered on or after age 12 months and the
second dose at least 4 weeks later.
Catch-up vaccination:
• Ensure that all school-aged children and
adolescents have had 2 doses of MMR vaccine; the minimum interval between the 2
doses is 4 weeks.
10. Varicella (VAR) vaccine. (Minimum age: 12 months)
Routine vaccination:
• Administer the first dose of VAR vaccine at age 12
through 15 months, and the second dose at age 4 through 6 years. The second dose
may be administered before age 4 years, provided at least 3 months have elapsed
since the first dose. If the second dose was administered at least 4 weeks after
the first dose, it can be accepted as valid.
Catch-up vaccination:
• Ensure that all persons
aged 7 through 18 years without evidence of immunity (see MMWR 2007;56 [No.
RR-4], available at http://www.cdc.gov/mmwr/pdf/rr/rr5604.pdf ) have 2
doses of varicella vaccine. For children aged 7 through 12 years the recommended
minimum interval between doses is 3 months (if the second dose was administered
at least 4 weeks after the first dose, it can be accepted as valid); for persons
aged 13 years and older, the minimum interval between doses is 4 weeks.
11. Hepatitis A vaccine (HepA). (Minimum age: 12
months)
Routine vaccination:
• Initiate the 2-dose HepA vaccine series for
children aged 12 through 23 months; separate the 2 doses by 6 to 18 months.
• Children who have received 1 dose of HepA vaccine
before age 24 months, should receive a second dose 6 to 18 months after the
first dose.
• For any person aged 2 years and older who has not
already received the HepA vaccine series, 2 doses of HepA vaccine separated by 6
to 18 months may be administered if immunity against hepatitis A virus infection
is desired.
Catch-up vaccination:
• The minimum interval between the two doses is 6
months.
Special populations:
• Administer 2 doses of Hep A vaccine at least 6
months apart to previously unvaccinated persons who live in areas where
vaccination programs target older children, or who are at increased risk for
infection.
12. Human papillomavirus (HPV) vaccines. (HPV4
[Gardasil] and HPV2 [Cervarix]). (Minimum age: 9 years)
Routine vaccination:
• Administer a 3-dose series of HPV vaccine on a
schedule of 0, 1-2, and 6 months to all adolescents aged 11-12 years. Either
HPV4 or HPV2 may be used for females, and only HPV4 may be used for males.
• The vaccine series can be started beginning at age
9 years.
• Administer the second dose 1 to 2 months after the
first dose and the third dose 6 months after the first dose (at
least 24 weeks after the first dose).
Catch-up vaccination:
• Administer the vaccine series to females (either
HPV2 or HPV4) and males (HPV4) at age 13 through 18 years if not previously
vaccinated.
• Use recommended routine dosing intervals (see
above) for vaccine series catch-up.
13. Meningococcal conjugate vaccines (MCV). (Minimum
age: 6 weeks for Hib-MenCY, 9 months for Menactra [MCV4-D], 2 years for Menveo
[MCV4-CRM]).
Routine vaccination:
• Administer MCV4 vaccine at age 11–12 years, with a
booster dose at age 16 years.
• Adolescents aged 11
through 18 years with human immunodeficiency virus (HIV) infection should
receive a 2-dose primary series of MCV4, with at least 8 weeks between doses.
See MMWR 2011; 60:1018–1019 available at: http://www.cdc.gov/mmwr/pdf/wk/mm6030.pdf .
• For children aged 9 months through 10 years with
high-risk conditions, see below.
Catch-up vaccination:
• Administer MCV4 vaccine at age 13 through 18 years
if not previously vaccinated.
• If the first dose is administered at age 13 through
15 years, a booster dose should be administered at age 16 through 18 years with
a minimum interval of at least 8 weeks between doses.
• If the first dose is administered at age 16 years
or older, a booster dose is not needed.
• For other catch-up issues,
see Figure 2.
Vaccination of persons with high-risk
conditions:
• For children younger than 19 months of age with
anatomic or functional asplenia (including sickle cell disease), administer an
infant series of Hib-MenCY at 2, 4, 6, and 12-15 months.
• For children aged 2 through 18 months with
persistent complement component deficiency, administer either an infant series
of Hib-MenCY at 2, 4, 6, and 12 through 15 months or a 2-dose primary series of
MCV4-D starting at 9 months, with at least 8 weeks between doses. For children
aged 19 through 23 months with persistent complement component deficiency who
have not received a complete series of Hib-MenCY or MCV4-D, administer 2 primary
doses of MCV4-D at least 8 weeks apart.
• For children aged 24
months and older with persistent complement component deficiency or anatomic or
functional asplenia (including sickle cell disease), who have not received a
complete series of Hib-MenCY or MCV4-D, administer 2 primary doses of either
MCV4-D or MCV4-CRM. If MCV4-D (Menactra) is administered to a child with
asplenia (including sickle cell disease), do not administer MCV4-D until 2 years
of age and at least 4 weeks after the completion of all PCV13 doses. See MMWR
2011;60:1391–2, available at http://www.cdc.gov/mmwr/pdf/wk/mm6040.pdf .
• For children aged 9 months
and older who are residents of or travelers to countries in the African
meningitis belt or to the Hajj, administer an age appropriate formulation and
series of MCV4 for protection against serogroups A and W-135. Prior receipt of
Hib-MenCY is not sufficient for children traveling to the meningitis belt or the
Hajj. See MMWR 2011;60:1391–2, available at http://www.cdc.gov/mmwr/pdf/wk/mm6040.pdf .
• For children who are present during outbreaks
caused by a vaccine serogroup, administer or complete an age and
formulation-appropriate series of Hib-MenCY or MCV4.
• For booster doses among
persons with high-risk conditions refer to http://www.cdc.gov/vaccines/pubs/acip-list.htm#mening.
Additional Vaccine Information
• For contraindications and
precautions to use of a vaccine and for additional information regarding that
vaccine, vaccination providers should consult the relevant ACIP statement
available online at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
• For the purposes of calculating intervals between
doses, 4 weeks = 28 days. Intervals of 4 months or greater are determined by
calendar months.
• Information on travel
vaccine requirements and recommendations is available at http://wwwnc.cdc.gov/travel/page/vaccinations.htm.
• For vaccination of persons
with primary and secondary immunodeficiencies, see Table 13, "Vaccination of
persons with primary and secondary immunodeficiencies," in General
Recommendations on Immunization (ACIP), available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm;
and American Academy of Pediatrics. Passive immunization. In: Pickering LK,
Baker CJ, Kimberlin DW, Long SS eds. Red book: 2012 report of the Committee on
Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of
Pediatrics.
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Footnotes: Recommended Immunization Schedule for Persons Aged
0 Through 18 Years — United States, 2013
Additional guidance for use of
the vaccines described in this publication is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm
Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Adults Aged 19 Years and Older — United States, 2013
Corresponding contributor:
Carolyn B. Bridges, cbridges@cdc.gov, 404-639-8689.
Vaccines are recommended for adults on the basis of
age, prior vaccinations, health conditions, lifestyle, occupation, and travel.
Current levels of vaccination coverage among adults are low (1).
Health-care providers should be aware of the importance of routinely assessing
patients' vaccination histories and recommending and providing routinely
recommended vaccines. A strong recommendation from a health-care provider is
associated with increased uptake of vaccines (2,3). Other
interventions shown to increase vaccine uptake, such as implementation of
reminder/recall systems and standing orders, have been summarized by the
Community Guide (3).
The Advisory Committee on Immunization Practices
(ACIP) annually reviews and updates the adult immunization schedule, which is
designed to provide vaccine providers with a summary of existing ACIP
recommendations regarding the routine use of vaccines for adults (Figures 1 and 2). The adult schedule
also includes a table summarizing the primary contraindications and precautions
for routinely recommended vaccines (Table). In October 2012, ACIP
approved the adult immunization schedule for 2013. This schedule also
incorporates changes to vaccine recommendations voted on by ACIP at its October
24–25, 2012 meeting.
The primary updates include adding information for
the first time on the use of 13-valent pneumococcal conjugate vaccine (PCV13)
and the timing of administration of PCV13 relative to the 23-valent pneumococcal
polysaccharide vaccine (PPSV23) in adults (4). PCV13 is
recommended for adults aged 19 years and older with immunocompromising
conditions (including chronic renal failure and nephrotic syndrome), functional
or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. The
schedule also clarifies which adults need 1 or 2 doses of PPSV23 before age 65
years. Other changes to the PPSV23 footnote include adding information regarding
recommendations for vaccination when vaccination status is unknown.
For tetanus, diphtheria, and acellular pertussis
(Tdap) vaccine, recommendations have been expanded to include routine
vaccination of adults aged 65 years and older and for pregnant women to receive
Tdap vaccine with each pregnancy. The ideal timing of Tdap vaccination during
pregnancy is during 27–36 weeks' gestation. This recommendation was made to
increase the likelihood of optimal protection for the pregnant woman and her
infant during the first few months of the infant's life, when the child is too
young for vaccination but at highest risk for severe illness and death from
pertussis (5,6).
Manufacturers of the live, attenuated influenza vaccine (LAIV) have obtained
Food and Drug Administration (FDA) approval for a quadrivalent influenza vaccine
that contains one influenza A (H3N2), one influenza A (H1N1) and two influenza B
vaccine virus strains, one from each lineage of circulating influenza B viruses.
In approximately half of the recent influenza seasons, the trivalent influenza
vaccine has included an influenza B vaccine virus from the lineage different
from the predominant circulating influenza B strains (7). Inclusion of
both lineages of influenza B virus is intended to increase the likelihood that
the vaccine provides cross-reactive antibody against a higher proportion of
circulating influenza B viruses. For LAIV, beginning with the 2013–14 season, it
is expected that only the quadrivalent formulation will be available and
manufacture of the trivalent formulation will cease. It is possible that
quadrivalent inactivated influenza vaccine formulations might be available for
the 2013–14 season as well. Because a mix of quadrivalent and trivalent
influenza vaccines might be available in 2013–14, the abbreviation for
inactivated influenza vaccine has been changed from trivalent inactivated
influenza vaccine (TIV) to inactivated influenza vaccine (IIV). The abbreviation
for LAIV remains unchanged.
Minor wording changes, clarifications, or
simplifications have been made to footnotes for measles, mumps, rubella vaccine
(MMR), human papillomavirus vaccine (HPV), zoster vaccine, and hepatitis A and
hepatitis B vaccines. A correction has been made to Figure 1 for MMR vaccine:
the bar that indicated the vaccine might be used in certain situations by
persons born before 1957 has been removed. Persons born before 1957 are
considered immune, and routine vaccination is not recommended. Considerations
for the possible use of MMR vaccine in outbreak situations are included in the
2011 MMWR publication on vaccination of health-care personnel (8). In addition, a correction was made
to Figure 2 for PPSV23. This vaccine is indicated for men who have sex with men
if they have another risk factor (e.g., age or underlying condition); the bar
has been changed from yellow to purple to more accurately reflect the
recommendation.
Vaccine providers are reminded to consult the full
ACIP vaccine recommendations if they have questions and to bear in mind that
additional updates might be made for specific vaccines during the year between
updates to the adult schedule. Printable versions of the 2013 adult immunization
schedule and other information is available at http://www.cdc.gov/vaccines/schedules/hcp/adult.html.
Information about adult vaccination is available at http://www.cdc.gov/vaccines/default.htm.
ACIP statements and information for specific vaccines is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
Adverse events from vaccination should be reported at http://www.vaers.hhs.gov or by telephone,
800-822-7967. This schedule has been approved by the American Academy of Family
Physicians, the American College of Physicians, the American College of
Obstetrics and Gynecology, and the American College of Nurse-Midwives. The adult
immunization schedule is published in the Annals of Internal Medicine at
the same time that it is published in MMWR.
Changes for 2013
Footnotes
- Information was added to footnote #1 to direct readers to additional information regarding recommendations for vaccination when vaccination status is unknown.
- The influenza vaccination footnote (#2) now uses the abbreviation IIV for inactivated influenza vaccine and drops the abbreviation TIV for trivalent inactivated vaccine (TIV). For the 2013–14 influenza season, it is expected that the LAIV will be available only in a quadrivalent formulation; IIV might be available in both trivalent and quadrivalent formulations.
- The tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination footnote (#3) is updated to include the recommendation to vaccinate pregnant women with Tdap during each pregnancy, regardless of the interval since prior Td/Tdap vaccination and to include the recommendation for all other adults, including persons aged 65 years and older, to receive 1 dose of Tdap vaccine.
- The varicella (#4) and HPV (#5) footnotes were simplified; no changes in recommendations were made. Additional information was added to the HPV footnote regarding HPV vaccination and pregnancy.
- The zoster footnote (#6) was changed to clarify that ACIP recommends vaccination of persons beginning at age 60 years both for persons with and without underlying health conditions for whom the vaccine is not contraindicated.
- The measles, mumps, rubella (MMR) vaccine footnote (#7) was modified to reflect the new recommendation that a provider diagnosis of measles, mumps, or rubella is not considered acceptable evidence of immunity. Previously, a provider diagnosis of measles or mumps, but not rubella, was considered acceptable evidence of immunity.
- Information was added to the pneumococcal polysaccharide (PPSV23) vaccination footnote (#8) and PPSV23 revaccination footnote (#9) to clarify that persons with certain medical conditions are recommended to receive 2 doses of PPSV23 before age 65 years. In addition, even those who receive 2 doses of PPSV23 before age 65 years are recommended to receive PPSV23 at age 65 years, as long as it has been 5 years since the most recent dose. The PPSV23 footnote refers to footnote #10 for pneumococcal conjugate 13-valent vaccine (PCV13) regarding the timing of PCV13 vaccine relative to PPSV23 for those persons recommended to be vaccinated with both pneumococcal vaccines.
- A new footnote (#10) was added for PCV13 vaccine. This vaccine is recommended for adults aged 19 years and older with immunocompromising conditions (including chronic renal failure and nephrotic syndrome), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants. Those not previously vaccinated with PCV13 or PPSV23 should receive a single dose of PCV13, followed by a dose of PPSV23 at least 8 weeks later. Those previously vaccinated with PPSV23 should be vaccinated with PCV13 one year or more after PPSV23 vaccination (4).
- The hepatitis A vaccine footnote (#12) was updated to clarify that vaccination is recommended for persons with a history of either injection or noninjection illicit drug use.
- The hepatitis B vaccine footnote (#13) includes minor wording changes and adds information on the vaccine schedule for hepatitis B vaccine series for the Recombivax HB vaccine. The dosing schedules for other hepatitis B vaccines were included in prior years' schedules.
Figures
- For figure 1, the bar for Tdap/Td for persons aged 65 years and older has been changed to solid yellow because all adults, including those 65 years and older, are now recommended to receive one dose of Tdap vaccine (5).
- The bar for MMR vaccine for persons born before 1957 has been removed. MMR vaccine is not recommended routinely for persons born before 1957. Considerations for vaccination in measles or mumps outbreak settings are discussed in the ACIP recommendations for health-care personnel (8).
- A new row for PCV13 vaccine has been added.
- For Figure 2, the recommendation for Tdap vaccination with each pregnancy is included, with a single dose of Tdap recommended for all other groups (6).
- A correction was made to change the color for PPSV23 from yellow to purple for men who have sex with men (MSM). PPSV23 is recommended for MSM who have another risk factor such as age group or medical condition.
- A row for PCV13 was added (4).
Contraindications and Precautions Table
- The inactivated influenza vaccine precautions were updated to indicate that persons who experience only hives with exposure to eggs should receive IIV rather than LAIV.
- Pregnancy was removed as a precaution for hepatitis A vaccine. This is an inactivated vaccine, and similar to hepatitis B vaccines, is recommended if another high risk condition or other indication is present.
- Language was clarified regarding the precaution for use of antiviral medications and vaccination with varicella or zoster vaccines.
References
- CDC. Noninfluenza vaccination coverage among adults—United States, 2011. MMWR 2013;62(4).
- CDC. Influenza vaccination coverage among pregnant women—2011–12 influenza season, United States. MMWR 2012;61:758–63.
- Community Preventive Services Task Force. Vaccinations to prevent diseases: universally recommended vaccinations. Available at http://www.thecommunityguide.org/vaccines/universally/index.html. Accessed December 21, 2012.
- CDC. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2012;61:816–9.
- CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in adults aged 65 years and older — Advisory Committee on Immunization Practices (ACIP), 2012. MMWR 2012;61:468–70.
- CDC. Update on use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in pregnant women. Atlanta, GA: US Department of Health and Human Services, CDC. Available at http://www.cdc.gov/vaccines/recs/provisional/downloads/tdap-pregnant-oct-2012.pdf . Accessed December 21, 2012.
- Reed C, Meltzer MI, Finelli L, Fiore A. Public health impact of including two lineages of influenza B in a quadrivalent seasonal influenza vaccine. Vaccine 2012;30:1993–8.
- CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-7).
ACIP Adult Immunization Work Group
Work Group Members: Tammy Clark, Jackson, Mississippi; Kathleen Harriman, PhD, Richmond, California; Molly Howell, MPH, Bismarck, North Dakota; Laura Pinkston Koenigs, MD, Springfield, Massachusetts; Marie-Michele Leger, MPH, Alexandria, VA; Susan M. Lett, MD, Boston, Massachusetts; Robert Palinkas, MD, Urbana, Illinois; Diane Peterson, Saint Paul, Minnesota; Gregory Poland, MD, Rochester, Minnesota; Laura E. Riley, MD, Boston, Massachusetts; William Schaffner, MD, Nashville, Tennessee; Kenneth Schmader, MD, Durham, North Carolina; Litjen Tan, PhD, Chicago, Illinois; Jonathan L. Temte, MD, PhD, Madison, Wisconsin; Richard Zimmerman, MD, Pittsburgh, Pennsylvania.
Work Group Contributors (CDC): Lisa Grohskopf, MD, Craig Hales, MD, Charles LeBaron, MD; Jennifer L. Liang, DVM, Lauri Markowitz, MD; Matthew Moore, MD; Amy Parker Fiebelkorn, MSN, MPH; Sarah Schillie, MD; Raymond A. Strikas, MD, MPH; and Walter W. Williams, MD, Atlanta, Georgia.
Work Group Secretariat (CDC): Carolyn B. Bridges, MD, Atlanta, Georgia
These recommendations must be read with the footnotes that follow.
Alternate Text: The figure above shows recommended adult immunization
schedule, by vaccine and age group. For Figure 1, the bar for Tdap/Td for
persons aged 65 years and older has been changed to solid yellow because all
adults, including those 65 years and older, are now recommended to receive one
dose of Tdap vaccine. The bar for MMR vaccine for persons born before 1957 has
been removed. MMR vaccine is not recommended routinely for persons born before
1957. Considerations for vaccination in measles or mumps outbreak settings are
discussed in the ACIP recommendations for health-care personnel. A new row for
PCV13 vaccine has been added.
Alternate Text: The figure above shows recommended vaccinations
indicated for adults based on medical and other indications. For Figure 2, the
recommendation for Tdap vaccination with each pregnancy is included, with a
single dose of Tdap recommended for all other groups. A correction was made to
change the color for PPSV23 from yellow to purple for men who have sex with men
(MSM). PPSV23 is recommended for MSM who have another risk factor such as age
group or medical condition. A row for PCV13 was added.
Executive Secretary: Larry Pickering, MD, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
Members: Nancy Bennett, MD, University of Rochester School of Medicine and Dentistry, Rochester, New York; Joseph Bocchini, Jr., MD, Louisiana State University Health Sciences Center, Shreveport, Louisiana; Douglas Campos-Outcalt, MD, University of Arizona College of Medicine, Phoenix, Arizona; Tamera Coyne-Beasley, MD, University of North Carolina, Chapel Hill, North Carolina; Jeffrey Duchin, MD, University of Washington, Seattle, Washington; Kathleen Harriman, PhD, California Department of Public Health, Richmond, CA; Lee Harrison, MD, University of Pittsburgh, Pittsburgh, Pennsylvania; Renée Jenkins, MD, Howard University School of Medicine, District of Columbia; Ruth Karron, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Wendy Keitel, MD, Baylor College of Medicine, Houston, Texas; Sara Rosenbaum, JD, Georgetown University, District of Columbia; Lorry Rubin, MD, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York; Mark Sawyer, MD, University of California at San Diego, California; Marietta Vázquez, MD, Yale University School of Medicine, New Haven, Connecticut.
Ex Officio Members: Vito Caserta, MD, MPH, Health Resources and Services Administration, Rockville, Maryland; Jesse Geibe, MD, Department of Defense, CDC, Atlanta, Georgia; Bruce Gellin, MD, National Vaccine Program Office, District of Columba; Richard Gorman, MD, National Institutes of Health, Bethesda, Maryland; Amy Groom, MPH, Indian Health Service, Albuquerque, New Mexico; Mary Beth Hance, Centers for Medicare and Medicaid Services, Baltimore, Maryland; Linda Kinsinger, MD, Department of Veterans Affairs, Durham, North Carolina; Wellington Sun, MD, Food and Drug Administration, Bethesda, Maryland.
Liaison Representatives: American Academy of Family Physicians, Jamie Loehr, MD, Cayuga Family Medicine, Ithaca, New York; American Academy of Pediatrics, Michael Brady, MD, Ohio State University, Columbus, Ohio, David Kimberlin, MD, University of Alabama School of Medicine, Birmingham, Alabama; American Academy of Physician Assistants, Marie-Michèle Léger, MPH, Alexandria, Virginia; American College Health Association, James C. Turner, MD, University of Virginia School of Medicine, Charlottesville, Virginia; American College of Obstetricians and Gynecologists, Laura Riley, MD, Harvard Medical School, Boston, Massachusetts; American College of Physicians, Gregory Poland, MD, Mayo Clinic, Rochester, Minnesota; American College of Physicians, Sandra Fryhofer, MD, Emory University School of Medicine, Atlanta, Georgia; American Geriatrics Society, Kenneth Schmader, MD, Duke University and Durham VA Medical Centers, Durham, North Carolina; America›s Health Insurance Plans, Mark Netoskie, MD, CIGNA, Houston, Texas; American Medical Association, Litjen Tan, PhD, Chicago, Illinois; American Nurses Association, Katie Brewer, MSN, Silver Springs, Maryland; American Osteopathic Association, Stanley Grogg, DO, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma; American Pharmacists Association, Stephan L. Foster, PharmD, University of Tennessee Health Sciences Center, College of Pharmacy, Memphis, Tennessee; Association of Immunization Managers, Kelly Moore, MD, Tennessee Department of Health, Nashville, Tennessee; Association for Prevention Teaching and Research, W. Paul McKinney, MD, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky; Association of State and Territorial Health Officials, José Montero, MD, New Hampshire Department of Health and Human Services, Concord, New Hampshire; Biotechnology Industry Organization, Clement Lewin, PhD, Novartis Vaccines and Diagnostics, Cambridge, Massachusetts; Canadian National Advisory Committee on Immunization, Bryna Warshawsky, MDCM, Middlesex-London Health Unit, London, Ontario, Canada; Council of State and Territorial Epidemiologists, Christine Hahn, MD, Idaho Department of Health and Welfare, Boise, Idaho; Department of Health, United Kingdom, David M. Salisbury, MD, London, United Kingdom; Healthcare Infection Control Practices Advisory Committee, Alexis Elward, MD, Washington University School of Medicine, St Louis, Missouri; Infectious Diseases Society of America, Kathleen Neuzil, MD, University of Washington School of Medicine, Seattle, Washington; Infectious Diseases Society of America, Carol Baker, MD, Baylor College of Medicine, Houston, Texas; National Association of County and City Health Officials, Matthew Zahn, MD, Orange County Health Care Agency, Santa Ana, California; National Association of Pediatric Nurse Practitioners, Patricia Stinchfield, MPH, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota; National Foundation for Infectious Diseases, William Schaffner, MD, Vanderbilt University School of Medicine, Nashville, Tennessee; National Medical Association, Patricia Whitley-Williams, MD, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; National Vaccine Advisory Committee, Walter Orenstein, MD, Emory University School of Medicine, Atlanta, Georgia; Pharmaceutical Research and Manufacturers of America, Damian A. Braga, Swiftwater, Pennsylvania; Society for Adolescent Health and Medicine, Amy Middleman, MD, Baylor College of Medicine, Houston, Texas; Society for Healthcare Epidemiology of America, Harry Keyserling, MD, Emory University School of Medicine, Atlanta, Georgia.
Footnotes: Recommended Immunization Schedule for Adults Aged
19 Years and Older — United States, 2013
1. Additional information
• Additional guidance for
the use of the vaccines described in this supplement is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
• Information on vaccination
recommendations when vaccination status is unknown and other general
immunization information can be found in the General Recommendations on
Immunization at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6002a1.htm.
• Information on travel
vaccine requirements and recommendations (e.g., for hepatitis A and B,
meningococcal, and other vaccines) are available at http://wwwnc.cdc.gov/travel/page/vaccinations.htm.
2. Influenza vaccination
• Annual vaccination against influenza is recommended
for all persons aged 6 months and older.
• Persons aged 6 months and older, including pregnant
women, can receive the inactivated influenza vaccine (IIV).
• Healthy, nonpregnant persons aged 2–49 years
without high-risk medical conditions can receive either intranasally
administered live, attenuated influenza vaccine (LAIV) (FluMist), or IIV.
Health-care personnel who care for severely immunocompromised persons (i.e.,
those who require care in a protected environment) should receive IIV rather
than LAIV.
• The intramuscularly or intradermally administered
IIV are options for adults aged 18–64 years.
• Adults aged 65 years and older can receive the
standard dose IIV or the high-dose IIV (Fluzone High-Dose).
3. Tetanus, diphtheria, and acellular pertussis
(Td/Tdap) vaccination
• Administer one dose of Tdap vaccine to pregnant
women during each pregnancy (preferred during 27–36 weeks' gestation),
regardless of number of years since prior Td or Tdap vaccination.
• Administer Tdap to all other adults who have not
previously received Tdap or for whom vaccine status is unknown. Tdap can be
administered regardless of interval since the most recent tetanus or
diphtheria-toxoid containing vaccine.
• Adults with an unknown or incomplete history of
completing a 3-dose primary vaccination series with Td-containing vaccines
should begin or complete a primary vaccination series including a Tdap dose.
• For unvaccinated adults, administer the first 2
doses at least 4 weeks apart and the third dose 6–12 months after the second.
• For incompletely vaccinated (i.e., less than 3
doses) adults, administer remaining doses.
• Refer to the Advisory Committee on Immunization
Practices (ACIP) statement for recommendations for administering Td/Tdap as
prophylaxis in wound management (see footnote #1).
4. Varicella vaccination
• All adults without evidence of immunity to
varicella (as defined below) should receive 2 doses of single-antigen varicella
vaccine or a second dose if they have received only 1 dose.
• Special consideration for vaccination should be
given to those who have close contact with persons at high risk for severe
disease (e.g., health-care personnel and family contacts of persons with
immunocompromising conditions) or are at high risk for exposure or transmission
(e.g., teachers; child care employees; residents and staff members of
institutional settings, including correctional institutions; college students;
military personnel; adolescents and adults living in households with children;
nonpregnant women of childbearing age; and international travelers).
• Pregnant women should be assessed for evidence of
varicella immunity. Women who do not have evidence of immunity should receive
the first dose of varicella vaccine upon completion or termination of pregnancy
and before discharge from the health-care facility. The second dose should be
administered 4–8 weeks after the first dose.
• Evidence of immunity to varicella in adults
includes any of the following:
- documentation of 2 doses of varicella vaccine at least 4 weeks apart;
- U.S.-born before 1980 except health-care personnel and pregnant women;
- history of varicella based on diagnosis or verification of varicella disease by a health-care provider;
- history of herpes zoster based on diagnosis or verification of herpes zoster disease by a health-care provider; or
- laboratory evidence of immunity or laboratory confirmation of disease.
5. Human papillomavirus (HPV) vaccination
• Two vaccines are licensed for use in females,
bivalent HPV vaccine (HPV2) and quadrivalent HPV vaccine (HPV4), and one HPV
vaccine for use in males (HPV4).
• For females, either HPV4 or HPV2 is recommended in
a 3-dose series for routine vaccination at age 11 or 12 years, and for those
aged 13 through 26 years, if not previously vaccinated.
• For males, HPV4 is recommended in a 3-dose series
for routine vaccination at age 11 or 12 years, and for those aged 13 through 21
years, if not previously vaccinated. Males aged 22 through 26 years may be
vaccinated.
• HPV4 is recommended for men who have sex with men
(MSM) through age 26 years for those who did not get any or all doses when they
were younger.
• Vaccination is recommended for immunocompromised
persons (including those with HIV infection) through age 26 years for those who
did not get any or all doses when they were younger.
• A complete series for either HPV4 or HPV2 consists
of 3 doses. The second dose should be administered 1–2 months after the first
dose; the third dose should be administered 6 months after the first dose (at
least 24 weeks after the first dose).
• HPV vaccines are not recommended for use in
pregnant women. However, pregnancy testing is not needed before vaccination. If
a woman is found to be pregnant after initiating the vaccination series, no
intervention is needed; the remainder of the 3-dose series should be delayed
until completion of pregnancy.
• Although HPV vaccination is not specifically
recommended for health-care personnel (HCP) based on their occupation, HCP
should receive the HPV vaccine as recommended (see above).
6. Zoster vaccination
• A single dose of zoster vaccine is recommended for
adults aged 60 years and older regardless of whether they report a prior episode
of herpes zoster. Although the vaccine is licensed by the Food and Drug
Administration (FDA) for use among and can be administered to persons aged 50
years and older, ACIP recommends that vaccination begins at age 60 years.
• Persons aged 60 years and older with chronic
medical conditions may be vaccinated unless their condition constitutes a
contraindication, such as pregnancy or severe immunodeficiency.
• Although zoster vaccination is not specifically
recommended for HCP, they should receive the vaccine if they are in the
recommended age group.
7. Measles, mumps, rubella (MMR) vaccination
• Adults born before 1957 generally are considered
immune to measles and mumps. All adults born in 1957 or later should have
documentation of 1 or more doses of MMR vaccine unless they have a medical
contraindication to the vaccine, or laboratory evidence of immunity to each of
the three diseases. Documentation of provider-diagnosed disease is not
considered acceptable evidence of immunity for measles, mumps, or rubella.
Measles component:
• A routine second dose of MMR vaccine, administered
a minimum of 28 days after the first dose, is recommended for adults who
- are students in postsecondary educational institutions;
- work in a health-care facility; or
- plan to travel internationally.
• Persons who received inactivated (killed) measles
vaccine or measles vaccine of unknown type during 1963–1967 should be
revaccinated with 2 doses of MMR vaccine.
Mumps component:
• A routine second dose of MMR vaccine, administered
a minimum of 28 days after the first dose, is recommended for adults who
- are students in a postsecondary educational institution;
- work in a health-care facility; or
- plan to travel internationally.
• Persons vaccinated before 1979 with either killed
mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps
infection (e.g., persons who are working in a health-care facility) should be
considered for revaccination with 2 doses of MMR vaccine.
Rubella component:
• For women of childbearing age, regardless of birth
year, rubella immunity should be determined. If there is no evidence of
immunity, women who are not pregnant should be vaccinated. Pregnant women who do
not have evidence of immunity should receive MMR vaccine upon completion or
termination of pregnancy and before discharge from the health-care facility.
HCP born before 1957:
• For unvaccinated health-care personnel born before
1957 who lack laboratory evidence of measles, mumps, and/or rubella immunity or
laboratory confirmation of disease, health-care facilities should consider
vaccinating personnel with 2 doses of MMR vaccine at the appropriate interval
for measles and mumps or 1 dose of MMR vaccine for rubella.
8. Pneumococcal polysaccharide (PPSV23) vaccination
• Vaccinate all persons with the following
indications:
- all adults aged 65 years and older;
- adults younger than age 65 years with chronic lung disease (including chronic obstructive pulmonary disease, emphysema, and asthma); chronic cardiovascular diseases; diabetes mellitus; chronic renal failure; nephrotic syndrome; chronic liver disease (including cirrhosis); alcoholism; cochlear implants; cerebrospinal fluid leaks; immunocompromising conditions; and functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]);
- residents of nursing homes or long-term care facilities; and
- adults who smoke cigarettes.
• Persons with immunocompromising conditions and
other selected conditions are recommended to receive PCV13 and PPSV23 vaccines.
See footnote #10 for information on timing of PCV13 and PPSV23 vaccinations.
• Persons with asymptomatic or symptomatic HIV
infection should be vaccinated as soon as possible after their diagnosis.
• When cancer chemotherapy or other immunosuppressive
therapy is being considered, the interval between vaccination and initiation of
immunosuppressive therapy should be at least 2 weeks. Vaccination during
chemotherapy or radiation therapy should be avoided.
• Routine use of PPSV23 is not recommended for
American Indians/Alaska Natives or other persons younger than age 65 years
unless they have underlying medical conditions that are PPSV23 indications.
However, public health authorities may consider recommending PPSV23 for American
Indians/Alaska Natives who are living in areas where the risk for invasive
pneumococcal disease is increased.
• When indicated, PPSV23 should be administered to
patients who are uncertain of their vaccination status and there is no record of
previous vaccination. When PCV13 is also indicated, a dose of PCV13 should be
given first (see footnote #10).
9. Revaccination with PPSV23
• One-time revaccination 5 years after the first dose
is recommended for persons aged 19 through 64 years with chronic renal failure
or nephrotic syndrome; functional or anatomic asplenia (e.g., sickle cell
disease or splenectomy); and for persons with immunocompromising conditions.
• Persons who received 1 or 2 doses of PPSV23 before
age 65 years for any indication should receive another dose of the vaccine at
age 65 years or later if at least 5 years have passed since their previous dose.
• No further doses are needed for persons vaccinated
with PPSV23 at or after age 65 years.
10. Pneumococcal conjugate 13-valent vaccination (PCV13)
• Adults aged 19 years or older with
immunocompromising conditions (including chronic renal failure and nephrotic
syndrome), functional or anatomic asplenia, CSF leaks or cochlear implants, and
who have not previously received PCV13 or PPSV23 should receive a single dose of
PCV13 followed by a dose of PPSV23 at least 8 weeks later.
• Adults aged 19 years or older with the
aforementioned conditions who have previously received one or more doses of
PPSV23 should receive a dose of PCV13 one or more years after the last PPSV23
dose was received. For those that require additional doses of PPSV23, the first
such dose should be given no sooner than 8 weeks after PCV13 and at least 5
years since the most recent dose of PPSV23.
• When indicated, PCV13 should be administered to
patients who are uncertain of their vaccination status history and there is no
record of previous vaccination.
• Although PCV13 is licensed by the Food and Drug
Administration (FDA) for use among and can be administered to persons aged 50
years and older, ACIP recommends PCV13 for adults aged 19 years and older with
the specific medical conditions noted above.
11. Meningococcal vaccination
• Administer 2 doses of meningococcal conjugate
vaccine quadrivalent (MCV4) at least 2 months apart to adults with functional
asplenia or persistent complement component deficiencies.
• HIV-infected persons who are vaccinated also should
receive 2 doses.
• Administer a single dose of meningococcal vaccine
to microbiologists routinely exposed to isolates of Neisseria
meningitidis, military recruits, and persons who travel to or live in
countries in which meningococcal disease is hyperendemic or epidemic.
• First-year college students up through age 21 years
who are living in residence halls should be vaccinated if they have not received
a dose on or after their 16th birthday.
• MCV4 is preferred for adults with any of the
preceding indications who are aged 55 years and younger; meningococcal
polysaccharide vaccine (MPSV4) is preferred for adults aged 56 years and older.
• Revaccination with MCV4 every 5 years is
recommended for adults previously vaccinated with MCV4 or MPSV4 who remain at
increased risk for infection (e.g., adults with anatomic or functional asplenia
or persistent complement component deficiencies).
12. Hepatitis A vaccination
• Vaccinate any person seeking protection from
hepatitis A virus (HAV) infection and persons with any of the following
indications:
- men who have sex with men and persons who use injection or noninjection illicit drugs;
- persons working with HAV-infected primates or with HAV in a research laboratory setting;
- persons with chronic liver disease and persons who receive clotting factor concentrates;
- persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A; and
- unvaccinated persons who anticipate close personal contact (e.g., household or regular babysitting) with an international adoptee during the first 60 days after arrival in the United States from a country with high or intermediate endemicity. (See footnote #1 for more information on travel recommendations). The first dose of the 2-dose hepatitis A vaccine series should be administered as soon as adoption is planned, ideally 2 or more weeks before the arrival of the adoptee.
• Single-antigen vaccine formulations should be
administered in a 2-dose schedule at either age 0 and 6–12 months (Havrix), or
age 0 and 6–18 months (Vaqta). If the combined hepatitis A and hepatitis B
vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 months;
alternatively, a 4-dose schedule may be used, administered on days 0, 7, and
21–30, followed by a booster dose at month 12.
13. Hepatitis B vaccination
• Vaccinate persons with any of the following
indications and any person seeking protection from hepatitis B virus (HBV)
infection:
- sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months); persons seeking evaluation or treatment for a sexually transmitted disease (STD); current or recent injection-drug users; and men who have sex with men;
- health-care personnel and public-safety workers who are potentially exposed to blood or other infectious body fluids;
- persons with diabetes younger than age 60 years as soon as feasible after diagnosis; persons with diabetes who are age 60 years or older at the discretion of the treating clinician based on increased need for assisted blood glucose monitoring in long-term care facilities, likelihood of acquiring hepatitis B infection, its complications or chronic sequelae, and likelihood of immune response to vaccination;
- persons with end-stage renal disease, including patients receiving hemodialysis; persons with HIV infection; and persons with chronic liver disease;
- household contacts and sex partners of hepatitis B surface antigen-positive persons; clients and staff members of institutions for persons with developmental disabilities; and international travelers to countries with high or intermediate prevalence of chronic HBV infection; and
- all adults in the following settings: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; health-care settings targeting services to injection-drug users or men who have sex with men; correctional facilities; end-stage renal disease programs and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with developmental disabilities.
• Administer missing doses to complete a 3-dose
series of hepatitis B vaccine to those persons not vaccinated or not completely
vaccinated. The second dose should be administered 1 month after the first dose;
the third dose should be given at least 2 months after the second dose (and at
least 4 months after the first dose). If the combined hepatitis A and hepatitis
B vaccine (Twinrix) is used, give 3 doses at 0, 1, and 6 months; alternatively,
a 4-dose Twinrix schedule, administered on days 0, 7, and 21–30 followed by a
booster dose at month 12 may be used.
• Adult patients receiving hemodialysis or with other
immunocompromising conditions should receive 1 dose of 40 µg/mL
(Recombivax HB) administered on a 3-dose schedule at 0, 1, and 6 months or 2
doses of 20 µg/mL (Engerix-B) administered simultaneously on a 4-dose
schedule at 0, 1, 2, and 6 months.
14. Selected conditions for which Haemophilus
influenzae type b (Hib) vaccine may be used
• 1 dose of Hib vaccine should be considered for
persons who have sickle cell disease, leukemia, or HIV infection, or who have
anatomic or functional asplenia if they have not previously received Hib
vaccine.
15. Immunocompromising conditions
• Inactivated vaccines
generally are acceptable (e.g., pneumococcal, meningococcal, and influenza
[inactivated influenza vaccine]), and live vaccines generally are avoided in
persons with immune deficiencies or immunocompromising conditions. Information
on specific conditions is available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
TABLE. Contraindications and precautions to commonly used
vaccines in adults1*†
| ||
---|---|---|
Vaccine
|
Contraindications
|
Precautions
|
Influenza, inactivated vaccine (IIV)
|
Severe allergic reaction (e.g., anaphylaxis) after
previous dose of any influenza vaccine or to a vaccine component, including egg
protein.
|
Moderate or severe acute illness with or without fever.
History of Guillain-Barré Syndrome (GBS) within 6 weeks
of previous influenza vaccination.
Persons who experience only hives with exposure to eggs
should receive IIV with additional safety precautions.2
|
Influenza, live attenuated (LAIV)3
|
Severe allergic reaction (e.g., anaphylaxis) after
previous dose of any influenza vaccine or to a vaccine component, including egg
protein.
Conditions for which the Advisory Committee on
Immunization Practices (ACIP) recommends against use, but which are not
contraindications in vaccine package insert: immune suppression, certain chronic
medical conditions such as asthma, diabetes, heart or kidney disease. and
pregnancy.4
|
Moderate or severe acute illness with or without fever.
History of GBS within 6 weeks of previous influenza
vaccination.
Receipt of specific antivirals (i.e., amantadine,
rimantadine, zanamivir, or oseltamivir) 48 hours before vaccination. Avoid use
of these antiviral drugs for 14 days after vaccination.
|
Tetanus, diphtheria, pertussis (Tdap);
tetanus, diphtheria (Td)
|
Severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component.
For pertussis-containing vaccines: encephalopathy (e.g.,
coma, decreased level of consciousness, or prolonged seizures) not attributable
to another identifiable cause within 7 days of administration of a previous dose
of Tdap or diphtheria and tetanus toxoids and pertussis (DTP) or diphtheria and
tetanus toxoids and acellular pertussis (DTaP) vaccine.
|
Moderate or severe acute illness with or without fever.
GBS within 6 weeks after a previous dose of tetanus
toxoid–containing vaccine.
History of arthus-type hypersensitivity reactions after
a previous dose of tetanus or diptheria toxoid–containing vaccine; defer
vaccination until at least 10 years have elapsed since the last tetanus
toxoid-containing vaccine.
For pertussis-containing vaccines: progressive or
unstable neurologic disorder, uncontrolled seizures, or progressive
encephalopathy until a treatment regimen has been established and the condition
has stabilized.
|
Varicella2
|
Severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component.
Known severe immunodeficiency (e.g., from hematologic
and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or
long-term immunosuppressive therapy5 or patients
with human immunodeficiency virus (HIV) infection who are severely
immunocompromised).
Pregnancy.
|
Recent (within 11 months) receipt of antibody-containing
blood product (specific interval depends on product).6,7
Moderate or severe acute illness with or without fever.
Receipt of specific antivirals (i.e., acyclovir,
famciclovir, or valacyclovir) 24 hours before vaccination; avoid use of these
antiviral drugs for 14 days after vaccination.
|
Human papillomavirus (HPV)
|
Severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component.
|
Moderate or severe acute illness with or without fever.
Pregnancy.
|
Zoster
|
Severe allergic reaction (e.g., anaphylaxis) to a
vaccine component.
Known severe immunodeficiency (e.g., from hematologic
and solid tumors, receipt of chemotherapy, or long-term immunosuppressive
therapy5 or patients with HIV infection who are
severely immunocompromised).
Pregnancy.
|
Moderate or severe acute illness with or without fever.
Receipt of specific antivirals (i.e., acyclovir,
famciclovir, or valacyclovir) 24 hours before vaccination; avoid use of these
antiviral drugs for 14 days after vaccination.
|
Measles, mumps, rubella (MMR)3
|
Severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component.
Known severe immunodeficiency (e.g., from hematologic
and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or
long-term immunosuppressive therapy5 or patients
with HIV infection who are severely immunocompromised).
Pregnancy.
|
Moderate or severe acute illness with or without fever.
Recent (within 11 months) receipt of antibody-containing
blood product (specific interval depends on product).6,7
History of thrombocytopenia or thrombocytopenic purpura.
Need for tuberculin skin testing.8
|
TABLE. (Continued) Contraindications and
precautions to commonly used vaccines in adults1*†
| ||
Vaccine
|
Contraindications
|
Precautions
|
Pneumococcal polysaccharide (PPSV)
|
Severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component.
|
Moderate or severe acute illness with or without
fever.
|
Pneumococcal conjugate (PCV13)
|
Severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component, including to any vaccine containing
diphtheria toxoid.
|
Moderate or severe acute illness with or without
fever.
|
Meningococcal, conjugate, (MCV4);
meningococcal, polysaccharide (MPSV4)
|
Severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component.
|
Moderate or severe acute illness with or without
fever.
|
Hepatitis A (HepA)
|
Severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component.
|
Moderate or severe acute illness with or without
fever.
|
Hepatitis B (HepB)
|
Severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component.
|
Moderate or severe acute illness with or without
fever.
|
1. Vaccine package inserts and the full
ACIP recommendations for these vaccines should be consulted for additional
information on vaccine-related contraindications and precautions and for more
information on vaccine excipients. Events or conditions listed as precautions
should be reviewed carefully. Benefits of and risks for administering a specific
vaccine to a person under these circumstances should be considered. If the risk
from the vaccine is believed to outweigh the benefit, the vaccine should not be
administered. If the benefit of vaccination is believed to outweigh the risk,
the vaccine should be administered. A contraindication is a condition in a
recipient that increases the chance of a serious adverse reaction. Therefore, a
vaccine should not be administered when a contraindication is present.
2. CDC. Prevention and control of
influenza with vaccines: recommendations of the Advisory Committee on
Immunization Practices (ACIP) — United States, 2012–13 influenza season. MMWR
2012;61:613-8.
3. LAIV, MMR, and varicella vaccines
can be administered on the same day. If not administered on the same day, these
live vaccines should be separated by at least 28 days.
4. For a
complete list of conditions that CDC considers to be reasons to avoid getting
LAIV, see CDC. Prevention and control of influenza with vaccines:
recommendations of the Advisory Committee on Immunization Practices (ACIP),
2010. MMWR 2010;59(No. RR-8). Available at http://www.cdc.gov/vaccines/pubs/acip-list.htm.
5. Immunosuppressive steroid dose is
considered to be 2 or more weeks of daily receipt of 20 mg prednisone or the
equivalent. Vaccination should be deferred for at least 1 month after
discontinuation of such therapy. Providers should consult ACIP recommendations
for complete information on the use of specific live vaccines among persons on
immune-suppressing medications or with immune suppression because of other
reasons.
6. Vaccine should be deferred for the
appropriate interval if replacement immune globulin products are being
administered.
7. See CDC.
General recommendations on immunization: recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-2). Available at
http://www.cdc.gov/vaccines/pubs/acip-list.htm.
8. Measles vaccination might suppress
tuberculin reactivity temporarily. Measles-containing vaccine may be
administered on the same day as tuberculin skin testing. If testing cannot be
performed until after the day of MMR vaccination, the test should be postponed
for at least 4 weeks after the vaccination. If an urgent need exists to skin
test, do so with the understanding that reactivity might be reduced by the
vaccine.
| ||
* Adapted from
CDC. Table 6. Contraindications and precautions to commonly used vaccines.
General recommendations on immunization: recommendations of the Advisory
Committee on Immunization Practices. MMWR 2011;60(No. RR-2):40–41 and from
Atkinson W, Wolfe S, Hamborsky J, eds. Appendix A. Epidemiology and prevention
of vaccine preventable diseases. 12th ed. Washington, DC: Public Health
Foundation, 2011. Available at http://www.cdc.gov/vaccines/pubs/pinkbook/index.html.
†
Regarding latex allergy. Consult the package insert for any vaccine
administered.
|
See footnotes on page 18.
Advisory Committee on Immunization
Practices
Membership List, October 2012
Chair: Jonathan Temte, MD, PhD, University of Wisconsin School
of Medicine and Public Health, Madison, WisconsinExecutive Secretary: Larry Pickering, MD, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
Members: Nancy Bennett, MD, University of Rochester School of Medicine and Dentistry, Rochester, New York; Joseph Bocchini, Jr., MD, Louisiana State University Health Sciences Center, Shreveport, Louisiana; Douglas Campos-Outcalt, MD, University of Arizona College of Medicine, Phoenix, Arizona; Tamera Coyne-Beasley, MD, University of North Carolina, Chapel Hill, North Carolina; Jeffrey Duchin, MD, University of Washington, Seattle, Washington; Kathleen Harriman, PhD, California Department of Public Health, Richmond, CA; Lee Harrison, MD, University of Pittsburgh, Pittsburgh, Pennsylvania; Renée Jenkins, MD, Howard University School of Medicine, District of Columbia; Ruth Karron, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Wendy Keitel, MD, Baylor College of Medicine, Houston, Texas; Sara Rosenbaum, JD, Georgetown University, District of Columbia; Lorry Rubin, MD, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York; Mark Sawyer, MD, University of California at San Diego, California; Marietta Vázquez, MD, Yale University School of Medicine, New Haven, Connecticut.
Ex Officio Members: Vito Caserta, MD, MPH, Health Resources and Services Administration, Rockville, Maryland; Jesse Geibe, MD, Department of Defense, CDC, Atlanta, Georgia; Bruce Gellin, MD, National Vaccine Program Office, District of Columba; Richard Gorman, MD, National Institutes of Health, Bethesda, Maryland; Amy Groom, MPH, Indian Health Service, Albuquerque, New Mexico; Mary Beth Hance, Centers for Medicare and Medicaid Services, Baltimore, Maryland; Linda Kinsinger, MD, Department of Veterans Affairs, Durham, North Carolina; Wellington Sun, MD, Food and Drug Administration, Bethesda, Maryland.
Liaison Representatives: American Academy of Family Physicians, Jamie Loehr, MD, Cayuga Family Medicine, Ithaca, New York; American Academy of Pediatrics, Michael Brady, MD, Ohio State University, Columbus, Ohio, David Kimberlin, MD, University of Alabama School of Medicine, Birmingham, Alabama; American Academy of Physician Assistants, Marie-Michèle Léger, MPH, Alexandria, Virginia; American College Health Association, James C. Turner, MD, University of Virginia School of Medicine, Charlottesville, Virginia; American College of Obstetricians and Gynecologists, Laura Riley, MD, Harvard Medical School, Boston, Massachusetts; American College of Physicians, Gregory Poland, MD, Mayo Clinic, Rochester, Minnesota; American College of Physicians, Sandra Fryhofer, MD, Emory University School of Medicine, Atlanta, Georgia; American Geriatrics Society, Kenneth Schmader, MD, Duke University and Durham VA Medical Centers, Durham, North Carolina; America›s Health Insurance Plans, Mark Netoskie, MD, CIGNA, Houston, Texas; American Medical Association, Litjen Tan, PhD, Chicago, Illinois; American Nurses Association, Katie Brewer, MSN, Silver Springs, Maryland; American Osteopathic Association, Stanley Grogg, DO, Oklahoma State University-Center for Health Sciences, Tulsa, Oklahoma; American Pharmacists Association, Stephan L. Foster, PharmD, University of Tennessee Health Sciences Center, College of Pharmacy, Memphis, Tennessee; Association of Immunization Managers, Kelly Moore, MD, Tennessee Department of Health, Nashville, Tennessee; Association for Prevention Teaching and Research, W. Paul McKinney, MD, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky; Association of State and Territorial Health Officials, José Montero, MD, New Hampshire Department of Health and Human Services, Concord, New Hampshire; Biotechnology Industry Organization, Clement Lewin, PhD, Novartis Vaccines and Diagnostics, Cambridge, Massachusetts; Canadian National Advisory Committee on Immunization, Bryna Warshawsky, MDCM, Middlesex-London Health Unit, London, Ontario, Canada; Council of State and Territorial Epidemiologists, Christine Hahn, MD, Idaho Department of Health and Welfare, Boise, Idaho; Department of Health, United Kingdom, David M. Salisbury, MD, London, United Kingdom; Healthcare Infection Control Practices Advisory Committee, Alexis Elward, MD, Washington University School of Medicine, St Louis, Missouri; Infectious Diseases Society of America, Kathleen Neuzil, MD, University of Washington School of Medicine, Seattle, Washington; Infectious Diseases Society of America, Carol Baker, MD, Baylor College of Medicine, Houston, Texas; National Association of County and City Health Officials, Matthew Zahn, MD, Orange County Health Care Agency, Santa Ana, California; National Association of Pediatric Nurse Practitioners, Patricia Stinchfield, MPH, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota; National Foundation for Infectious Diseases, William Schaffner, MD, Vanderbilt University School of Medicine, Nashville, Tennessee; National Medical Association, Patricia Whitley-Williams, MD, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey; National Vaccine Advisory Committee, Walter Orenstein, MD, Emory University School of Medicine, Atlanta, Georgia; Pharmaceutical Research and Manufacturers of America, Damian A. Braga, Swiftwater, Pennsylvania; Society for Adolescent Health and Medicine, Amy Middleman, MD, Baylor College of Medicine, Houston, Texas; Society for Healthcare Epidemiology of America, Harry Keyserling, MD, Emory University School of Medicine, Atlanta, Georgia.
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and does not imply endorsement by the U.S. Department of Health and Human
Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication. |
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