Download 2007-08 Adult Immunization Schedule to Stay Current

You won't find many outright surprises in the newly released Recommended Adult Immunization Schedule for October 2007-September 2008 (2-page PDF; About PDFs), particularly if you've been tracking the individual vaccine recommendation changes made throughout the past year.

The updated schedule, which was jointly developed by the CDC's Advisory Committee on Immunization Practices, or ACIP; the AAFP; the American College of Obstetricians and Gynecologists; and the American College of Physicians, reflects the addition of one new vaccine -- the herpes zoster vaccine -- and includes primarily modest changes to others.

As in years past, the 2007-08 schedule is presented in two parts: "Recommended schedule for adult immunization, by vaccine and age group," and "Vaccines that may be indicated for adults based on medical and other conditions." Within the first of these segments, recommendations are based on patient age and general health status (i.e., presence of specific risk factors); in the second, patient populations are further subdivided by medical or other conditions, with contraindications clearly shown.

Key modifications to the overall schedule include

Two other vaccine recommendations included in the revised schedule also deserve special emphasis, says Doug Campos-Outcalt, M.D., M.P.A., associate chair of the Department of Family and Community Medicine at the University of Arizona College of Medicine, Phoenix, and an AAFP liaison to the ACIP. They are

The specifics of this second recommendation are important, says Campos-Outcalt, particularly the fact that the second dose is recommended for people born in 1980 or later with no other evidence of immunity -- except for health care personnel and other selected patients. Because of the potential for close contact with people at high risk for severe disease, all health care workers should receive a second dose of varicella at least four weeks after the first dose.

"You should consider catch-up doses for those who've only had one dose, which would be those born in 1980 and after, as well as health care workers, pregnant women (note restrictions below) and some immunosuppressed patients," says Campos-Outcalt. (For specific guidance on immunization of immunocompromised patients, visit the CDC's ACIP Recommendations Web page.)

Although administration of the varicella vaccine is contraindicated during pregnancy, "You need to screen pregnant women now, and if they're not immune, vaccinate them after pregnancy," Campos-Outcalt advises. Regardless of their year of birth, these women should receive the full two-dose regimen in the absence of other evidence of immunity to varicella, such as a history of physician-diagnosed disease. "Add varicella to your prenatal panel, just as you screen for MMR," says Campos-Outcalt, referring to recommendations on screening pregnant women for measles-mumps-rubella immunity.

The real take-home message, Campos-Outcalt notes, is to start the immunization process early. "Varicella now requires two doses; kids should be vaccinated for varicella at the same time they get MMR. That's one (dose) at age 12 to 15 months and one (dose) at 4 to 6 years."

Visit the AAFP's Immunization Resources Web page for more information about adult immunizations, as well as other immunization schedules and information.