Am Fam Physician. 2012 Feb 1;85(3):281.
Guideline source: Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices
Evidence rating system used? No
Literature search described? No
Guideline developed by participants without relevant financial ties to industry? Not reported
Published source: Morbidity and Mortality Weekly Report. In press
This issue of American Family Physician introduces the 2012 immunization schedules for young children (birth through six years of age) , older children and adolescents (seven through 18 years of age), and adults, as well as the catch-up immunization schedule for persons who have not received a recommended vaccination on time or at the appropriate intervals. A few changes this year are especially pertinent to family physicians.
With regard to pertussis, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention now recommends that health care professionals and pregnant women receive a single dose of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine—regardless of the time since the previous tetanus and diphtheria vaccine—if they have not received a dose of Tdap previously. In pregnant women, the preferred time for Tdap administration is during the late second or early third trimester.
Based on studies that have shown an increased incidence of hepatitis B infection in persons with diabetes mellitus, the ACIP now recommends routine hepatitis B vaccination for all adults younger than 60 years who have diabetes. For older adults with diabetes, the ACIP agreed to a Category B recommendation (formerly known as a permissive recommendation) for hepatitis B vaccination, which allows for individualized decision-making by the physician and patient about the appropriateness of the vaccine.
The most complicated recommendations from the ACIP this year involve the administration of quadrivalent human papillomavirus (HPV4) vaccine (Gardasil) for boys and young men. These recommendations are specific to the quadrivalent vaccine, and do not apply to the bivalent vaccine (Cervarix). The ACIP now recommends routine HPV4 vaccination in boys 11 to 12 years of age, with catch-up vaccinations at 13 to 21 years of age. It is acceptable to begin HPV4 vaccination as young as nine years of age. HPV4 vaccination is also recommended at 22 to 26 years of age in men who have human immunodeficiency virus infection and in men who have sex with men. For other men 22 to 26 years of age, the ACIP makes a Category B recommendation for HPV4 vaccination.
Finally, the ACIP recommends that children six months to eight years of age receive two doses of influenza vaccine during the current season if they did not receive at least one dose of the vaccine during the 2010–2011 season. This is a departure from past recommendations, which stated that two doses in any previous season meant the child needed only one dose for the current season.
Editor's Note: The author serves as liaison to the ACIP for the AAFP.
Address correspondence to Jamie Loehr, MD, at JamieCFM@choiceonemail.com. Reprints are not available from the author.
Author disclosure: No relevant financial affiliations to disclose.
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.
Copyright © 2012 by the American Academy of Family Physicians.
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