Review and Special Articles

Standards for Adult Immunization Practices

Gregory A. Poland, MD, Abigail M. Shefer, MD, Mary McCauley, MTSC, Peggy S. Webster, MD,
Patricia N. Whitley-Williams, MD, Georges Peter, MD, and the National Vaccine Advisory Committee,
Ad Hoc Working Group for the Development of Standards for Adult Immunization Practices

Abstract: Since the Standards for Adult Immunization Practices were first published in 1990,
healthcare researchers and providers have learned important lessons on how to better
achieve and maintain high vaccination rates in adults. The success rate of childhood
immunization far exceeds the success rate of adult immunization. Thus, information and
practices that will produce higher success rates for adult vaccination are crucial, resulting
in overall societal cost savings and substantial reductions in hospitalizations and deaths.
The Standards, which were developed to encourage the best immunization practices,
represent the collective efforts of more than 100 people from more than 60 organizations.
The revised Standards are more comprehensive than the 1990 Standards and focus on the
accessibility and availability of vaccines, proper assessment of patient vaccination status,
opportunities for patient education, correct procedures for administering vaccines,
implementation of strategies to improve vaccination rates, and partnerships with the
community to reach target patient populations. The revised Standards are recommended
for use by all healthcare professionals and all public and private sector organizations that
provide immunizations for adults. All who are involved in adult immunization should strive
to follow the Standards in order to create the same level of success achieved by childhood
vaccination programs and to meet the Healthy People 2010 goals.
(Am J Prev Med 2003;25(2):144 –150)

Introduction 66% for influenza vaccine and 50% for pneumococcal

vaccine.2

I
n the United States, years of clinical and program-
Increasing the use of these two vaccines among older
matic experience have been translated into success- adults could have tremendous health impacts. Influ-
ful childhood immunization practices. As a result, enza and its complications kill approximately 40,000
vaccination rates among infants and children are near individuals every year in the United States.3 Another
or at all-time highs. Today, most childhood vaccine- 100,000 individuals suffer so severely from influenza
preventable diseases rarely occur or are non-existent. that hospitalization is required.4 The overwhelming
However, similar success in vaccinating adults has not majority of these deaths and hospitalizations occur in
been achieved. the elderly. When vaccine viruses are well matched to
Goals for adult immunization feature prominently in circulating viruses, vaccination lowers the risk of infec-
Healthy People 2010,1 a comprehensive, nationwide tion among healthy adults by up to 90%.4,5 Although
health promotion and disease prevention agenda from influenza vaccination is somewhat less effective among
the U.S. Department of Health and Human Services. the elderly, vaccination has been estimated to reduce
The target is 90% coverage for annual influenza immu- their risk of influenza-related hospitalization and death
nization among adults aged ⱖ65 years and 90% for one by up to 70%.4,6 – 8 The Centers for Disease Control and
dose of pneumococcal vaccine. Success will require a Prevention (CDC)9 estimate that for each additional 1
dramatic increase from rates in 2000, which were only million elderly people vaccinated each year, 900 deaths
and 1300 hospitalizations would be averted. Further-
more, economic studies find overall societal cost sav-
From the Mayo Vaccine Research Group, Mayo Clinic (Poland), ings and substantial reductions in hospitalizations and
Rochester, Minnesota; National Immunization Program, Centers for
Disease Control and Prevention (Shefer, McCauley), Atlanta, Geor- deaths if people aged ⱖ65 years receive the influenza
gia; Abott Laboratories (Webster), Abbott Park, Illinois; University of vaccine.4,6,7
Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical In recent years, pneumococcal infections have ac-
School (Whitney-Williams), New Brunswick, New Jersey; Brown Med-
ical School (Peter), Providence, Rhode Island. counted for ⬎100,000 hospitalizations for pneumonia,
Address correspondence and reprint requests to: National Vaccine ⬎60,000 cases of bacteremia and other forms of inva-
Program Office, Centers for Disease Control and Prevention, 4770 sive disease, and about 7000 deaths from invasive
Buford Highway, MS K-77, Chamblee GA 30341.
The full text of this article is available via AJPM Online at pneumococcal disease.10 –12 In 1998, ⬎50% of these
www.ajpm-online.net. deaths occurred among people aged ⱖ65 years. Over-

144 Am J Prev Med 2003;25(2) 0749-3797/03/$–see front matter

Published by Elsevier Inc. doi:10.1016/S0749-3797(03)00120-X
all, vaccine effectiveness against invasive pneumococcal Table 1. Standards for adult immunization practices
disease among immunocompetent people aged ⱖ65
years is 75%,13 and the vaccine has been shown to be Make vaccinations available.
1. Adult vaccination services are readily available.
cost effective for people in this age group as well.14
2. Barriers to receiving vaccines are identified and
Based on 1998 projections, annually 76% of invasive minimized.
pneumococcal disease cases and 87% of resulting 3. Patient “out-of-pocket” vaccination costs are minimized.
deaths occurred in people who were eligible for pneu- Assess patients’ vaccination status.
mococcal vaccine in the United States.12 4. Healthcare professionals routinely review the
vaccination status of patients.
Additional health benefits could also be gained by
5. Healthcare professionals assess for valid
reaching immunization targets for younger high-risk contraindications.
adults. Healthy People 20101 targets are 60% coverage Communicate effectively with patients.
with influenza and pneumococcal vaccines among 6. Patients are educated about risks and benefits of
high-risk adults aged 18 to 64 years. In 1999, only 31% vaccination in easy-to-understand language.
Administer and document vaccinations properly.
of these adults reported receiving influenza vaccine,
7. Written vaccination protocols are available at all
and only 17% received pneumococcal vaccine (Centers locations where vaccines are administered.
for Disease Control and Prevention, unpublished data, 8. Persons who administer vaccines are properly trained.
1999). In 1998, 41% of deaths attributed to invasive 9. Healthcare professionals recommend simultaneous
pneumococcal disease occurred among individuals administration of indicated vaccine doses.
10. Vaccination records for patients are accurate and easily
aged 18 to 64 years who had a medical indication for
accessible.
the pneumococcal vaccine.12 11. All personnel who have contact with patients are
Despite the availability of a vaccine that is ⬎95% appropriately vaccinated.
effective in preventing hepatitis B, approximately Implement strategies to improve vaccination rates.
80,000 individuals, mostly adolescents and adults, are 12. Systems are developed and used to remind patients and
healthcare professionals when vaccinations are due and
infected annually in the United States.15,16 About 6% of
to recall patients who are overdue.
newly infected people become chronically infected and 13. Standing orders for vaccinations are employed.
face a 15% to 25% lifetime risk of death from chronic 14. Regular assessments of vaccination coverage levels are
liver disease. Annually, an estimated 4000 to 5000 conducted in a provider’s practice.
chronically infected people die prematurely from Partner with the community.
15. Patient-oriented and community-based approaches are
chronic liver disease.17 Without an improvement in
used to reach target populations.
vaccinating adults at increased risk of hepatitis B infec-
tion, transmission of hepatitis B will continue for
decades. provider incentives and reimbursement for preventive
Vaccines also remain underutilized among other services. Also in the past decade, healthcare researchers
groups of adults, especially among certain racial/ethnic and providers have learned many valuable lessons
populations. For example, the rates of influenza and about what is needed to achieve and maintain high
pneumococcal vaccination in African-American and vaccination rates among adults.
Hispanic populations are significantly lower than those This revision of the Standards for Adult Immuniza-
among whites.18 In addition, adult immunization is not tion Practices (Table 1) reflects the experience of the
limited to pneumococcal, influenza, and hepatitis B past 10 years. The Standards represent the collective
vaccines. All adults should be immune to measles, efforts of more than 100 people from more than 60
mumps, rubella, tetanus, diphtheria, and varicella, and organizations, including professional societies, state
adults who are susceptible to hepatitis A and polio and local health departments, immunization programs,
should be vaccinated if they are at risk for exposure. and immunization providers. The National Vaccine
Further, certain vaccines, such as travel vaccines or Advisory Committee (NVAC) led this effort. As the
vaccines occupationally required, should be reviewed Federal Advisory Committee is charged by the Secretary
and provided if appropriate. The CDC’s Advisory Com- of Health and Human Services to ensure the adequate
mittee on Immunization Practices (ACIP) has recently delivery of safe and effective vaccination products in
published an Adult Immunization Schedule (http:// the United States, the NVAC itself is composed of
cdc.gov/nip/recs/adult-schedule.htm). people who represent the spectrum of those with an
interest in immunization, including physicians, re-
searchers, developers, manufacturers, state and public
Revising the Standards
health agencies, and more than 20 federal agencies.
The Standards for Adult Immunization Practices, de- The revised Standards also incorporate information
veloped to encourage best practices, were first pub- from two important reports published by NVAC in the
lished in 1990.19 Since then, the healthcare system has last decade on the status of adult immunization20 and
changed dramatically. For example, there has been a on adult immunization programs in nontraditional
shift toward managed care, resulting in a change in settings.21

Am J Prev Med 2003;25(2) 145

 Information published from the Guide to Community pede appropriate vaccination of certain populations.
Preventive Services reviews strategies to improve immuni- For example, although Medicare ensures coverage ben-
zation service delivery and provides a broader base of efits for vaccines for those aged ⱖ65 years, in 2001 an
evidence to support the Standards.22,23 Based on re- estimated 17% and 13% of adults aged 35 to 44 years
search published in the 1990s concerning techniques and 45 to 64 years, respectively, did not have health
proven to improve immunization rates among adults, insurance.2 In addition, even though many adults may
three new standards were constructed and require the have insurance coverage, the medical insurance may
following: (1) systems that remind patients and provid- not cover vaccination.
ers when an immunization is due, (2) standing orders Overall improvement in our healthcare system will
from physicians that enable other personnel to pre- take time. However, we can do much now to improve
scribe and deliver vaccinations, (3) regular assessments the delivery of vaccination services for adults. The
of coverage rates at clinics, and (4) pertinent informa- following Standards for Adult Immunization Practices
tion provided to clinic staff to ensure current patient and the accompanying discussion are intended to ad-
immunizations. dress these issues.
The Standards supplement research with expert con-
sensus in areas where research does not offer guidance
but experience does. The revised Standards are more The Standards
comprehensive than the previous version and orga- Make Vaccinations Available
nized to focus on the provider’s ongoing process of Standard 1: Adult vaccination services are readily avail-
minimizing barriers that prevent patients from receiv- able. Primary care healthcare professionals who serve
ing vaccines, assessing for valid indications and contra- adults should always include routinely recommended
indications, keeping patients’ immunizations current, vaccinations as part of their care. Specialists, whose
and communicating effectively with patients about patients may be at increased risk of vaccine-preventable
vaccines. diseases, should also include routinely recommended
Today, more tools are available to support immuni- vaccinations as part of their care. For selected vaccines
zation providers. The revised Standards include links to (e.g., meningococcal vaccine for college entrants and
websites that contain information on model standing- vaccines for international travelers), patients may be
order policies, instructions for setting up reminder/ referred to another provider.
recall systems, and templates for personal vaccination
records. The tools are currently available free on CD- Standard 2: Barriers to receiving vaccines are identified
ROM, but will soon be available online. In addition, and minimized. Barriers to receiving vaccines may in-
information about federal requirements and programs, clude requiring a physical examination before vaccina-
including Vaccine Information Statements, the Vaccine tion, requiring an additional visit for vaccination, long
Adverse Event Reporting System (VAERS), and the waiting periods, and lack of educational materials that
National Vaccine Injury Compensation Program are culturally appropriate. Prior to vaccine administra-
(VICP) is current and has been made easily accessible tion, simply observing the patient, asking if the patient
in the Standards. is well and questioning the patient/guardian about
vaccine contraindications is sufficient.

Applying the Standards Standard 3: Patient “out-of-pocket” vaccination costs

are minimized. Resources should be identified to keep
Once the revised Standards are implemented on a patient vaccination costs as low as possible, specifically
practice-by-practice or program-by-program basis, im- for those patients aged ⱖ65 years and for vaccines not
mediate results can be expected for improved adult covered by Medicare Part B. In the public sector,
immunization. Long-term sustainable improvement in patient fees should include only the cost of vaccine and
adult immunization necessitates an infrastructure to administration that cannot be funded through another
organize immunization efforts by providers and federal source. In the private sector, routinely recommended
agencies, as well as state and local health departments. vaccination services should be included in basic bene-
Such an infrastructure is lacking.24 Partnerships among fits packages. System and policy changes should be
healthcare professionals, state and local health depart- addressed to provide adequate reimbursement to pro-
ments, medical and nursing organizations, and insur- viders for delivering vaccinations to their adult
ance companies will need to be strengthened. Factors population.
that cause low vaccination coverage among adults must
be addressed. These factors include provider behaviors
Assess Patients’ Vaccination Status
and practices that may affect accurate identification of
patients in need of vaccination, attitudes toward the Standard 4: Healthcare professionals routinely review
healthcare system that may impact adults seeking and the vaccination status of patients. Healthcare profes-
accepting vaccines, and financial issues that may im- sionals should review and document the vaccination

146 American Journal of Preventive Medicine, Volume 25, Number 2

status of all new patients during initial office visits and porting of adverse events, and record maintenance and
also review vaccination status on an annual basis there- accessibility. These protocols should be consistent with
after. Healthcare professionals should ascertain if the established guidelines. CDC-recommended storage and
patient has medical risk factors, lifestyle risk factors, or handling procedures are available on the Internet at
an occupation for which certain vaccines may be indi- http://gravity.lmi.org/lmi_cdc/geninfo.htm.
cated. Healthcare professionals should record this in- Healthcare professionals should promptly report all
formation in the patient’s chart and preventive health clinically significant adverse events following vaccina-
summary. Healthcare professionals should also rou- tion to VAERS, even if the healthcare professional does
tinely review pneumococcal vaccination status at the not believe that the vaccine caused the event. Report-
time of influenza vaccination. ing is required for those vaccines given to adults and
medical conditions covered by the National Childhood
Standard 5: Healthcare professionals assess for valid Vaccine Injury Act of 1986, as amended. Healthcare
contraindications. Failure to differentiate between professionals should be aware that patients may report
valid and invalid contraindications often results in the to VAERS; if they choose to do so, they are encouraged
needless deferral of indicated vaccinations. Healthcare to seek the help of their healthcare professional. Re-
professionals should ask about prior adverse events in port forms and assistance are available by calling 1-800-
connection with a vaccination and about any conditions 822-7967 or on the Internet at www.fda.gov/cber/
or circumstances that might indicate vaccination vaers/vaers.htm.
should be withheld or delayed. Healthcare profession- The VICP is a no-fault system that compensates
als should refer to current ACIP recommendations on people of any age for injuries or conditions that may
valid and invalid contraindications as well as on valid have been caused by a vaccine recommended by CDC
indications for vaccine use (www.cdc.gov/nip). for routine administration to children. Healthcare pro-
fessionals should be aware of the VICP in order to
Communicate Effectively with Patients address questions raised by patients. Information about
Standard 6: Patients are educated about risks and bene- the VICP is available on the Internet at www.hrsa.gov/
fits of vaccination in easy-to-understand language. Health- bhpr/vicp.htm or by calling 1-800-338-2382.
care professionals should discuss with the patient the Since VAERS and VICP are separate programs, a
benefits of vaccines, the diseases that the vaccines report of an event to VAERS does not result in the
prevent, and any known risks from vaccines. These submission of a compensation claim to VICP. Such a
issues should be discussed in the patient’s native lan- claim must be filed independently in the U.S. Court of
guage, whenever possible. Printed materials, accurately Federal Claims. A brief description and contact infor-
translated into the patient’s language, should be pro- mation for both programs are provided on each Vac-
vided. For most commonly used vaccines, the U.S. cine Information Statement for vaccines covered by the
federal government has developed Vaccine Informa- VICP.
tion Statements for use by both public and private Standard 8: People who administer vaccines are prop-
healthcare professionals to give to potential vaccine erly trained. All people who administer vaccinations
recipients. For vaccines covered by the National Child- should be fully trained in vaccine storage and handling,
hood Vaccine Injury Act, including those vaccines used vaccine schedules, contraindications, administration
in children, these forms are required. These statements techniques, management and reporting of adverse
are available in English and other languages. Health- events, and record maintenance and accessibility. Of-
care professionals should allot ample time with patients fice staff should receive continuing education on these
to review written materials and address questions and issues annually. With appropriate training, people
concerns. Information and assistance can be obtained other than physicians and nurses can administer vac-
by calling the Immunization Hotline (1-800-232-2522) cines. Healthcare professionals should contact public
or accessing the website (www.cdc.gov/nip). health authorities or other medical authorities in their
Healthcare professionals should respect each pa- state for more information concerning which individu-
tient’s right to make an informed decision to accept or als are permitted to administer vaccines.
reject a vaccine or to defer vaccination until more
information is collected. Standard 9: Healthcare professionals recommend si-
multaneous administration of all indicated vaccine dos-
es. Administering indicated vaccines simultaneously is
Administer and Document Vaccinations Properly
safe and effective. Simultaneous administration de-
Standard 7: Written vaccination protocols are available creases the number of required visits and the potential
at all locations where vaccines are administered. The for missed doses. Measles, mumps, and rubella (MMR)
medical protocol should detail procedures for vaccine vaccine and tetanus and diphtheria (Td) toxoids
storage and handling, vaccine schedules, contraindica- should always be administered in their combined prod-
tions, administration techniques, management and re- uct. Giving influenza and pneumococcal vaccine at the

Am J Prev Med 2003;25(2) 147

same time (but in separate arms) is also safe and mailed or communicated by telephone; an autodialer
effective. Healthcare professionals should respect the can be used to expedite telephone reminders. Patients
choices of patients and their caregivers. who might be at high risk for not complying with
medical recommendations may require more intensive
Standard 10: Vaccination records for patients are accu- follow-up.
rate and easily accessible. Patient vaccination histories Provider reminder/recall interventions inform those
should be recorded on a standard form in an easily who administer vaccinations that individual patients are
accessible location in the medical record to facilitate due or overdue for specific vaccinations. Reminders
rapid review of vaccination status. Accurate record can be delivered in patient charts, by computer, and/or
keeping helps ensure that needed vaccinations are by mail or other means, and content of the reminders
administered and unnecessary vaccinations are not can be specific or general. Information about these
administered. Records should indicate the vaccine, the strategies and resources to assist in their implementa-
date of administration, the vaccine manufacturer and tion are available on CD-ROM and can be ordered on
lot number, the signature and title of the person the Internet at www.atpm.org/Immunization/what-
administering the vaccine, and the address where the works.html. Model reminder recall templates are also
vaccine was administered. The medical record at the available at www.ahcpr.gov/ppip/postcard.pdf.
primary care provider’s office, clinic, or worksite should
include all vaccinations received (such as those re- Standard 13: Standing orders for vaccinations are em-
ceived at a specialist’s office, influenza vaccination ployed. Evidence shows that standing orders improve
clinic, or pharmacy). vaccination coverage among adults in a variety of
Record keeping may be paper-based or computer- healthcare settings, including nursing homes, hospitals,
ized. Computer systems make record maintenance, clinics, doctor’s offices, and other institutional settings.
retrieval, and review easier. Standing orders enable nonphysician personnel such as
Healthcare professionals should give patients a per- nurses and pharmacists to prescribe or deliver vaccina-
sonal record of vaccinations they have received, includ- tions by approved protocol without direct physician
ing the dates and places of administration. Patients involvement at the time of the interaction. Standing
should be encouraged to bring their vaccination orders overcome administrative barriers such as lack
records to all medical visits. of physician personnel to order vaccines. Further,
Information and a modifiable template of these the Centers for Medicare and Medicaid allow stand-
forms and records are available at www.ahcpr.gov/ ing order exemption from Medicare rules (www.cms.
ppip/adultflow.pdf and are also available on CD-ROM hhs.gov/medicaid/ltcsp/sc0302.pdf).
and can be ordered on the Internet at www.atpm.org/ Information about this strategy and its implementa-
Immunization/whatworks.html. tion is available on CD-ROM and can be ordered on the
Internet at www.atpm.org/Immunization/whatworks.
Standard 11: All personnel who have contact with html.
patients are appropriately immunized. Healthcare pro-
fessionals and other personnel (including first respond- Standard 14: Regular assessments of vaccination cover-
ers) who have contact with patients should be appro- age rates are conducted in a provider’s practice. Evi-
priately immunized (e.g., annual influenza vaccination, dence shows that assessment of vaccination coverage
hepatitis B vaccination). Institutions should have poli- and provision of the results to the staff in a practice
cies to review and maintain the appropriate vaccination improves vaccination coverage among adults. Opti-
of staff and trainees. mally, such assessments are performed annually. Pro-
ACIP recommendations for vaccinating healthcare vider assessment can be performed by the staff in the
workers are available on the Internet at www.cdc.gov/ practice or by other organizations, including state and
nip/publications/ACIP-list.htm. local health departments. Effective interventions that
include assessment and provision of results may also
Implement Strategies to Improve Vaccination incorporate incentives or compare performance to a
goal or standard. This process is commonly referred to
Rates
as AFIX (assessment, feedback, incentives, and ex-
Standard 12: Systems are developed and used to re- change of information). Coverage should be assessed
mind patients and healthcare professionals when vacci- regularly so that reasons for low coverage in the prac-
nations are due and to recall patients who are over- tice, or in a subgroup of the patients served, can be
due. Evidence shows that reminder/recall systems identified and interventions implemented to address
improve adult vaccination rates. Systems may be de- them.
signed to alert patients who are due (reminder) or Information about this strategy and its implementa-
overdue (recall) for specific vaccine doses or they may tion is available on CD-ROM and can be ordered on the
alert patients to contact their provider to determine if Internet at www.atpm.org/Immunization/whatworks.
vaccinations are needed. Reminders or recalls can be html. Software to assist in conducting coverage rate

148 American Journal of Preventive Medicine, Volume 25, Number 2

assessments and feedback is available at www.cdc. Medicine, American Pharmaceutical Association, American
gov/nip. Society for Health System Pharmacists, State of Maine Depart-
ment of Health, National Alliance for Hispanic Health,
Partner with the Community American Academy of Physician Assistants, National Associa-
tion of School Nurses, Memphis County Health Department,
Standard 15: Patient-oriented and community-based Maine Ambulatory Care Association, Institute for Advanced
approaches are used to reach target populations. Vac- Studies in Aging and Geriatric Medicine, The Arizona Part-
cination services should be designed to meet the needs nership for Adult Immunization, National Foundation for
of the population served. For example, interventions Infectious Diseases, and the National Partnership for
that include community education, along with other Immunization.
components such as extended hours, have been dem- The NVAC was charted in 1988 to advise and make
onstrated to improve vaccination coverage among recommendations to the director of the National Vaccine
adults. Vaccination providers can work with partners in Program and the assistant secretary for health, Department of
Health and Human Services, on matters related to the
the community, including other health professionals
prevention of infectious diseases through immunization and
(e.g., pharmacists), vaccination advocacy groups, man-
the prevention of adverse reactions to vaccines. The NVAC is
aged care organizations, service organizations, manu- composed of 15 members from public and private organiza-
facturers, and state and local health departments to tions representing vaccine manufacturers, physicians, par-
determine community needs and develop vaccination ents, and state and local health agencies, and public health
services to address them. organizations. In addition, representatives from government
agencies involved in health care of allied services serve as
ex-officio members of the NVAC.
Conclusion
Members of the National Vaccine Advisory Committee in
The revised Standards for Adult Immunization Prac- 2001 are listed below.
tices provide a concise, convenient summary of the Regular members: Georges Peter, MD (chair), Brown Medical
most desirable immunization practices. The Standards School, Providence RI; Bruce Gellin, MD, MPH, Executive
have been widely endorsed by major professional orga- Secretary (Martin G. Myers, MD, former Executive Secretary),
nizations. This revised version of the Standards for National Vaccine Program Office, Atlanta GA; Jeffrey P.
Davis, MD, State Epidemiologist, Wisconsin Division of
Adult Immunization Practices is recommended for use
Health, Madison WI; Michael D. Decker, MD, MPH, Vice
by all healthcare professionals and payers in the public
President, Scientific and Medical Affairs, Aventis Pasteur,
and private sectors who provide immunizations for Swiftwater PA; Patricia Fast, MD, PhD, Director, Medical
adults. Everyone involved in adult immunization Affairs, International AIDS Vaccine Initiative, New York City
should strive to follow these Standards. Not all practices NY; Mary desVignes-Kendrick, MD, Director, City of Houston
and programs have the resources necessary to fully Department of Health and Human Services, Houston TX;
implement the Standards; nevertheless, those lacking Amy Fine, Health Policy/Program Consultant, Washington
the resources should find the Standards useful to guide DC; Jerome O. Klein, MD, Professor of Pediatrics and Vice
current practice and to guide the process of defining Chairman for Academic Affairs, Boston University School of
immunization needs and obtaining additional re- Medicine, Boston MA; Yvonne A. Maldonado, MD, Associate
sources in the future. Professor, Department of Pediatrics, Stanford University
School of Medicine, Stanford CA; Stanley Plotkin, MD, Aven-
These Standards are approved by the National Vaccine Advi- tis Pasteur, Doylestown PA; Peter R. Paradiso, PhD, Vice
sory Committee (NVAC), the National Coalition for Adult President, Scientific Affairs, Wyeth-Lederle Vaccines and Pe-
Immunization (NCAI), the Advisory Committee on Immuni- diatric American Home Products, West Henrietta NY; Greg-
zation Practices (ACIP), and the U.S. Public Health Service, ory A. Poland, MD, Chief, Mayo Vaccine Research Group,
and endorsed, as of December 1, 2001, by the American Mayo Clinic and Foundation, Rochester MN; Marian Sokol,
Medical Association, Infectious Diseases Society of America, PhD, Founding Executive Director, Any Baby Can, Inc., San
American Academy of Family Physicians, American Academy Antonio TX; Donald E. Williamson, MD, State Health Officer,
of Pediatrics, American College of Obstetricians and Gyne- Alabama Department of Public Health, Montgomery AL; and
cologists, Society of Adolescent Medicine, Health Resources Patricia N. Whitley-Williams, MD, Associate Professor of Pe-
and Services Administration, National Medical Association, diatrics, University of Medicine and Dentistry of New Jersey–
National Association of County and City Health Officials, Robert Wood Johnson Medical School, New Brunswick NJ.
Association of State and Territorial Health Officers, Council Liaison representatives: Steven Black, MD, American Associa-
of State and Territorial Epidemiologists, Association of Pro- tion of Health Plans, Director, Vaccine Study Center, Kaiser
fessionals in Infection Control and Epidemiology, Inc., Chi- Permanente Study Center, Oakland CA; Jackie Noyes, Advi-
ron, State of Washington Department of Health, Society of sory Commission on Childhood Vaccines, Associate Director,
Teachers of Preventive Medicine, Immunization Action Coa- American Academy of Pediatrics, Washington DC; Robert
lition, Partnership for Prevention, National Coalition for Daum, MD, The Food and Drug Administration’s Vaccines
Adult Immunization, American Academy of Otolaryngology and Related Biologic Products Advisory Committee, Professor
Head and Neck Surgery, American Health Care Association, of Pediatrics, University of Chicago, Chicago IL; and John F.
Hepatitis B Foundation, American College of Preventive Modlin, MD, Advisory Committee on Immunization Practices,

Am J Prev Med 2003;25(2) 149

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liam A. Robinson, MD, Health Resources and Services Admin- 2000 – 01 season. MMWR Morb Mortal Wkly Rep 2000;49:888 –92.
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