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Am Fam Physician. 2004;69(10):2471-2472

The Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians, and the American Academy of Pediatrics have released the Recommended Childhood and Adolescent Immunization Schedule (see accompanying chart on page 2472) for July to December 2004. This year is the first time in many years that separate January to June and July to December schedules have been issued.

The primary reason for the second schedule this year was the addition of a formal recommendation that infants six to 23 months of age routinely be immunized against influenza. This recommendation replaces the language contained in the schedule for the past several years that vaccination was encouraged, when feasible, in this age group.

In addition to immunizing infants six to 23 months of age unless contraindications are present, immunization of household contacts and out-of-home caregivers of children less than 24 months of age is recommended. This immunization of household contacts is especially important for infants younger than six months of age because there is not currently any vaccine licensed for this age group.

The recommendation for using immunizations to protect infants less than 24 months of age comes from scientific studies showing that young children have a risk of complications, hospitalizations, and deaths comparable with other high-risk groups such as the elderly and persons with specific underlying health conditions. These data are nicely summarized by the ACIP in their recommendations for the prevention and control of influenza.1 Vaccination is particularly important for children in this age group who are at higher than normal risk for complications of influenza because of comorbidities. An updated paper from the ACIP is expected this month.

The Vaccine for Children program is a federally funded program that covers influenza vaccine for infants six to 23 months of age, children and adolescents two to 18 years of age who have risk factors, and children who are household contacts of people with risk factors.

In preparation for implementing the new recommendations, physicians will need to order their vaccine as early as possible. They also should remember that children who are younger than nine years and are receiving the vaccine for the first time require two doses. The second immunization should be given one month or more after the first dose. The ACIP states that children at high risk for the complications of influenza, including those who are six to 23 months of age, can be immunized at the same time they receive other recommended immunizations.1

Information about influenza for health care professionals and patients, including patient education materials in multiple languages, is available from the CDC at:

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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