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Am Fam Physician. 2006;74(12):2115

See related editorial on page 2027.

Guideline source: Advisory Committee on Immunization Practices, American College of Obstetricians and Gynecologists, American Academy of Family Physicians

Literature search described? No

Evidence rating system used? No

Published source: Morbidity and Mortality Weekly Report, October 13, 2006

Available at:

The recent licensure of the human papillomavirus (HPV) vaccine (Gardasil) and the approval of the combination tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis booster vaccine, adsorbed (Tdap; Adacel) resulted in the most significant changes to this year’s adult immunization schedule (see accompanying figure). Additional changes have been made to the schedule to reflect new recommendations from the Advisory Committee on Immunization Practices (ACIP) for varicella, influenza, hepatitis B, and measles, mumps, and rubella (MMR) vaccination.

HPV vaccination has been added to the age-based schedule and to the medical and other indications schedule, with a yellow bar to indicate that the vaccine is recommended for women up to 26 years of age with all indications except pregnancy. A one-time dose of Tdap vaccine, which is recommended in persons 64 years and younger, also has been added to the age-based schedule and to the medical and other indications schedule, with a hatched yellow bar indicating that the vaccine is recommended in all indications except pregnancy.

In anticipation of a new recommendation for the use of zoster vaccine in persons 60 years and older, the purple bar for varicella vaccine has been shortened. The varicella footnote has been reworded in accordance with ACIP recommendations for administering a routine second dose for all adults without evidence of immunity.

A new column has been added to the medical and other indications schedule to clarify indications for hepatitis A and B vaccines. The indications “chronic liver disease” and “recipients of clotting factor concentrates” have been combined into a new column with a yellow bar indicating that these vaccines are recommended for all persons with these medical indications. The hepatitis B footnote has been revised to reflect recommendations to vaccinate all adults seeking protection from hepatitis B virus infection and to vaccinate adults in specific settings (e.g., sexually transmitted disease clinics).

The MMR footnote has been reworded to reflect ACIP recommendations to administer a second dose of vaccine to adults in certain age groups and with certain risk factors, and the influenza footnote has been revised to reflect recent ACIP recommendations to vaccinate close contacts of children up to 59 months of age.

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