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Am Fam Physician. 2009;79(2):152-162

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

The 2009 recommended adult immunization schedule is unveiled in this issue of American Family Physician . Underlying this schedule are some obvious changes—particularly those dealing with the formatting and appearance of the table—and the less obvious evidence supporting the recommendations. Two recent developments are of significant interest to family physicians and their patients and should be added to the physician’s working knowledge: (1) the value of vaccinating women against influenza during pregnancy, and (2) the addition of cigarette smoking as an indication for pneumococcal vaccine.

A recent randomized controlled trial strongly supports the recommendation to vaccinate pregnant women against influenza.1 Immunization is associated with a 36 percent decrease in maternal febrile respiratory illnesses and, more significantly, a 63 percent reduction in confirmed influenza infections in their infants during the first 24 weeks of life. Influenza-related morbidity and mortality rates are high during the newborn period, and infants younger than six months cannot receive influenza vaccine.

In October 2008, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention recommended adding cigarette smoking to the list of high-risk conditions for which the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended. This is the first time that smoking has been designated an indication for immunization. Accordingly, all persons between 19 and 64 years of age who smoke should receive PPSV23. Epidemiologic studies have shown a 4.1-fold increase in invasive pneumococcal disease for persons who smoke, which is higher than the risk for persons with asthma.2 ACIP also suggested that in addition to vaccination with PPSV23, persons who smoke should be strongly advised to stop. Such efforts are consistent with AAFP efforts to encourage the reduction and elimination of tobacco use.

As essential components of the adult health care system, family physicians should take the lead in applying the ACIP recommendations in their practices. Special emphasis is needed to reduce the health risks of smokers and to enhance the coverage of influenza vaccine during pregnancy.

editor’s note: The author is a member of ACIP.

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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Copyright © 2009 by the American Academy of Family Physicians.

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