September 22, 2009 — An Expert Panel of the Infectious Diseases Society of America (IDSA) has prepared updated, evidence-based guidelines for immunization of infants, children, adolescents, and adults. The new guidelines, which are published in the September 15 issue of Clinical Infectious Diseases, replace the previous IDSA clinical practice guideline for quality standards for immunization, published in 2002.
"The IDSA updates its guidelines when new data or publications change prior recommendations or when the Expert Panel decides that clarification or additional guidance is warranted," write Larry K. Pickering, from the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues. "For the 2009 guidelines, vaccine licensure, approval, recommendations, safety, financing, barriers, and implementation issues were reviewed. This report does not include issues involving vaccines and autism and other potential adverse events."
These guidelines are intended to assist clinicians who care for either immunocompetent or immunocompromised people of all ages to provide recommended vaccinations. Since the previous clinical practice guideline was published in 2002, there have been significant improvements in the ability to prevent more infectious diseases.
New Vaccines, Recommendations
New vaccines that have been licensed since 2002 include human papillomavirus vaccine; live, attenuated influenza vaccine; meningococcal conjugate vaccine; rotavirus vaccine; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine; and zoster vaccine. New combination vaccines that have become available are measles, mumps, rubella, and varicella vaccine; tetanus, diphtheria, and pertussis and inactivated polio vaccine; and tetanus, diphtheria, and pertussis and inactivated polio/Haemophilus influenzae type b vaccine.
For young children, hepatitis A vaccines are now universally recommended. All children aged 6 months through 18 years and adults who are 50 years or older should receive annual administration of influenza vaccines. The routine childhood and adolescent immunization schedule now includes a second dose of varicella vaccine. The adolescent and adult immunization schedules have expanded to accommodate many of these new recommendations.
Other areas highlighted in the updated guidelines include the need to remove barriers to immunization, to eliminate racial and ethnic disparities in access to and compliance with vaccine recommendation, to address issues regarding vaccine safety, and to fund the cost of implementing recommended vaccinations.
The updated guidelines also provide specific recommendations for vaccination of special groups, including healthcare providers, immunocompromised patients, pregnant women, international travelers, and internationally adopted children. If the 46 standards featured in these guidelines are followed, it is hoped that vaccination in multiple population groups should facilitate optimal disease prevention while maintaining high levels of safety.
Specific vaccine recommendations for infants, children, adolescents, and adults, and their accompanying level of evidence rating, are as follows:
Infants, children, adolescents, and adults should be given all age-appropriate vaccines as recommended by the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American Academy of Pediatrics (level of evidence, A-1).
When a vaccine dose is not given at the recommended age, it should be given at any subsequent medical visit when indicated and feasible, without restarting the series (level of evidence, A-3).
For people who have delayed immunizations or who want to accelerate their vaccination schedule, recommendations for the minimum interval between doses should still be followed (level of evidence, B-3).
All indicated vaccines should be administered simultaneously when appropriate and feasible (level of evidence, B-3).
Licensed combination vaccines may be given provided the following conditions apply: any components of the combination are indicated, other components are not contraindicated, and the US Food and Drug Administration (FDA) has licensed the vaccine for that dose of the series (level of evidence, A-1).
For childcare, schools and colleges, and nursing homes, specific immunization requirements should be followed (level of evidence, A-2).
Vaccinations delivery should be coordinated with other preventive healthcare services recommended for children, adolescents, and adults (level of evidence, B-3).
Storage and administration of all vaccines should follow recommendations of the manufacturer and licensing requirements from the FDA (level of evidence, B-2).
Performance measures and goals recommended in the updated guidelines are as follows:
Reduce incidence of vaccine-preventable diseases, as monitored through postlicensure surveillance, in accordance with Healthy People 2010 and 2020 goals.
Implement new vaccines recommended for routine use by the Advisory Committee on Immunization Practices within 6 months of a published recommendation, and reach coverage levels of at least 90% within 5 years of a published recommendation.
Monitor immunization coverage for vaccines recommended for routine use in the general population in each of the 50 states and among people of different racial or ethnic backgrounds.
Regularly measure the immunization rates of patients in each clinical practice.
Implement quality standards in each complementary setting offering immunizations.
Enter data regarding immunizations into state or community population-based immunization information systems. Immunizations administered in complementary settings should be included.
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