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Am Fam Physician. 2009;79(1):56

Author disclosure: Nothing to disclose.

Guideline source: Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices

Literature search described? No

Evidence rating system used? No

Published source: Morbidity and Mortality Weekly Report. In press.

What a difference a year can make. The release of the 2009 child and adolescent immunization schedules is accompanied by a profound nationwide decline in rotavirus gastroenteritis and encouraging increases in adolescent vaccine coverage rates.

The rotavirus vaccine, Rotateq, was licensed for use in infants in February 2006 and was subsequently recommended for universal immunization by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention.1 Since that time, the use of the vaccine has increased, producing an estimated 56 percent first-dose coverage of the three-dose series.2 Despite these advances, family physicians have lagged behind pediatricians in their provision of this safe and effective vaccine. Notwithstanding, there has been an estimated 50 percent reduction in reports of rotavirus infection in persons of all ages to the National Respiratory and Enteric Virus Surveillance System.3 In June 2008, Rotarix, a two-dose rotavirus vaccine, was recommended by ACIP as an additional option to pre-vent rotavirus gastroenteritis.

The 2007 vaccine coverage rates for adolescents show promising signs for this somewhat elusive cohort in primary care. The percentage of adolescents who received two doses of measles, mumps, and rubella vaccine (88.9 percent) and three doses of hepatitis B vaccine (87.1 percent) are approaching the Healthy People 2010 target of 90 percent; varicella protection, by either a history of chickenpox or one dose of vaccine, now surpasses that goal. Well behind, but with very favorable trends, are the quadrivalent meningococcal vaccine (32.4 percent, compared with 11.7 percent in 2006), tetanus and diphtheria toxoids and acellular pertussis vaccine (30.4 percent, compared with 10.8 percent in 2006) and the human papillomavirus vaccine (25.1 percent of adolescent females have received at least one dose).4

Family physicians are in a unique position that allows them to provide immunizations to persons of all ages and to all members of a family. This relationship comes with a responsibility to provide appropriate immunization services to all patients. The 2009 schedules serve as a wonderful clinical reminder of this responsibility.

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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