Adult immunization guidelines: a patient safety and quality-of-care issue.

Vaccines are among the most effective public health and medical strategies for protecting and preserving health. Along with other public health measures, the control of infectious diseases, primarily by vaccines, doubled the life span during the 20th century (1). Still, almost 50 000 Americans die of vaccine-preventable diseases each year (99% of them are adults), and hundreds of thousands more are hospitalized. Physicians should know the Adult Immunization Schedule and should develop policies and procedures to ensure that adult patients receive the appropriate vaccines. Toolkits for accomplishing this are available from the American College of Physicians (ACP) Adult Immunization Initiative (www.acponline.org/aii/index.html) and from the Centers for Disease Control and Prevention (CDC) (www.cdc.gov/vaccines). The core knowledge in these toolkits is the Adult Immunization Schedule, one lynchpin of public health programs in the United States. This issue marks the first time that Annals has published the recommended Adult Immunization Schedule (2). The purpose of the schedule is to guide practitioners in the use of vaccines. The schedule is the product of a federal advisory committee (Advisory Committee on Immunization Practices [ACIP]), which consists of experts in vaccinology, public health, infectious diseases, and related disciplines. The committee released the first schedule in 2002 and publishes annual updates. Annals readers should note that the ACP Board of Regents, on the recommendation of its Adult Immunization Initiative Physician Advisory Board, has endorsed the 2007 Adult Immunization Schedule. Annals plans to publish annual updates to the schedule. The authority of the schedule rests on a solid base of expertise. In addition to committee members, ACIP is assisted by a cadre of liaison representatives designated by professional societies and federal agencies. The liaison representatives contribute to the deliberations but do not vote. The ACIP, in conjunction with CDC staff members, develop and disseminate these recommendations after a systematic review of the data available. The recommendations are informed by data on disease epidemiology, vaccine safety and efficacy, cost-effectiveness, and feasibility. These diverse inputs mean that the Adult Immunization Schedule incorporates the principles of clinical and public health practice, which denotes that it mirrors the dual function of most vaccines against communicable diseases: to protect both the individual and the community. The recommendations describe the vaccines and identify the populations to be vaccinated. The schedule consists of 2 tables—1 table listing the vaccines recommended for different age groups, and the other listing vaccines recommended for different medical (for example, patients with asplenia) and lifestyle indications (for example, health care workers). The reader can access the full texts of the recommendations for each vaccine at www.cdc.gov/vaccines/recs /default.htm. The full Adult Immunization Schedule is available at www.cdc.gov/vaccines/recs/schedules/adult -schedule.htm, and it includes all routinely recommended vaccines—but not travel-related vaccines.