New Adult Immunization Schedule Due

The Advisory Committee on Immunization Practices, or ACIP, is set to release its 2006 adult immunization schedule on Oct. 14. There are no dramatic changes, said American Academy of Family Physicians liaison member Jon Temte, M.D., but the reference chart has been simplified.

Basic recommendations include:

• Td immunizations renewed every 10 years.

• MMR for everyone age 10?49 if not already immune.

• Varicella for everyone age 19?49 if not already immune.

• Influenza for everyone aged 50 or above

• Pneumococcal for everyone aged 65 or above.

Health care workers should receive the entire adult vaccine list except hepatitis A and meningococcal, Dr. Temte told the AAFP Scientific Assembly. Physicians and others who can expect to be exposed to Hep A or meningitis should also receive those vaccines.

Another special category this year is homeless and displaced persons. Homeless adults should be vaccinated at every encounter because they fall largely outside the health care system.

Hurricane evacuees and others living in crowded conditions are at increased risk for influenza, varicella, MMR, and hepatitis A. All who are eligible and cannot document prior vaccination should receive all four vaccines at the first opportunity.

Two new vaccines are likely to appear in the near future, Dr. Temte said, adult pertussis vaccination and varicella for anyone age 60 or older.

Immunizing adults against pertussis should protect infants under one year old, the most vulnerable population. Half of the cases of infantile pertussis can be traced to an infected parent, so immunizing parents will boost protection for children.

The expected varicella recommendation is based on a trial of 38,546 adults aged 60 or older reported in the New England Journal of Medicine earlier this year. Live attenuated Varicella zoster vaccine reduced herpes zoster illness by 61.1% and cut post-herpetic neuralgia by 66.5%.

Planning is also under way to cope with a potential avian influenza pandemic.

"We have been lucky so far that the virus has been very inefficient in person-to-person transmission," Dr. Temte said.

If the current avian pandemic jumps to humans, the death toll would likely fall between 180 million and 360 million worldwide.

CDC has designed a preliminary vaccination priority schedule. The military heads the list, Dr. Temte reported, followed physicians and other health care workers plus their support staffs.

Next on the list are persons over 64 years with at least one high risk condition and those aged 2?64 with two high risk conditions, household contacts of the first two groups, pandemic responders, those over the age of 64 without high risk conditions, critical infrastructure support workers, government health care decision makers and mortuary workers, and everyone else.

"The primary goal is to minimize hospitalization and death while keeping the national infrastructure functional," Dr. Temte explained. After recent hurricane experiences, he added, critical infrastructure and public protection personnel may be moved up the priority list.