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Am Fam Physician. 2006;73(1):167

See editorial on page 37.

The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians, and the American Academy of Pediatrics have released the 2006 recommended immunization schedule for children and adolescents. ( see accompanying charts)

A key change this year is the recommendation for all children one year of age to be vaccinated against hepatitis A. In October 2005, a CDC advisory committee recommended that all children in the United States receive hepatitis A vaccine. Vaccination previously had been recommended only in children from states with the highest rates of hepatitis A. However, approximately two thirds of cases now are reported from states in which hepatitis A vaccination was not recommended. The ACIP recommends that children receive the first dose of a two-dose series of hepatitis A vaccine between one and two years of age.

In 1999, the ACIP recommended routine hepatitis A vaccination for children living in 11 states with the highest rates of hepatitis A (i.e., Alaska, Arizona, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah, and Washington). During the period before vaccine was available, the average incidence of hepatitis A in these states had been at least 20 cases per 100,000 persons, about twice the national average. In 1999, the ACIP also recommended that vaccination be considered in an additional six states in which the average incidence had been at least 10 but less than 20 cases per 100,000 persons (i.e., Arkansas, Colorado, Missouri, Montana, Texas, and Wyoming). During the period before the vaccine was available, approximately two thirds of all cases of hepatitis A infection nationwide were reported in these 17 states.

Another change in the 2006 recommendations is the replacement of tetanus and diphtheria toxoid vaccine with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis absorbed (Tdap) vaccine in children 11 years and older. The U.S. Food and Drug Administration recently licensed two Tdap vaccines for adolescents and adults. Boostrix, manufactured by GlaxoSmithKline, was licensed in May 2005 for use in adolescents 10 through 18 years of age. Adacel, manufactured by Sanofi Pasteur, was licensed in June 2005 for use in persons 11 through 64 years of age. Boostrix and Adacel are the first pertussis vaccines licensed for use in adolescents and adults.

Reported cases of pertussis have increased from 1,020 cases in 1976 to 25,827 cases in 2004, a 40-year high. Reported pertussis-related deaths among infants increased from approximately 10 per year in the 1990s to about 20 per year since 2000.

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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