Each year the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention updates the recommended immunization schedules for children, adolescents, and adults. These schedules describe the immunizations recommended for routine administration in each age group and include revisions and new recommendations adopted by ACIP in the previous 12 months.

There are only a few new recommendations in this year's schedules, most notably universal administration of influenza vaccine for all persons six months and older, and the replacement of the 7-valent pneumococcal conjugate vaccine (Prevnar) with a 13-valent product (Prevnar 13) for infants and children.^1,2

ACIP has incorporated several other changes to the schedules, even though they have not yet been published. These changes include:

• Administration of quadrivalent meningococcal conjugate vaccine (MCV4) in a two-dose primary series, instead of a single dose, for children with high-risk immunocompromising conditions.

• Administration of a booster dose of MCV4 at age 16 for persons who were vaccinated at 11 to 12 years of age, or four to five years after the first dose for persons vaccinated at 13 to 15 years of age.

• Administration of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) for adults 65 years and older who are in close contact with infants. This is an off-label recommendation.

• Administration of Tdap for children seven to 10 years of age who have not completed a series of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). This is an off-label recommendation.

• Elimination of the recommended interval between administration of tetanus and diphtheria toxoids vaccine (Td) and Tdap.

There are several clarifications in the footnotes of this year's schedules, including explanations for the spacing of the three-dose primary series of hepatitis B vaccine (HepB) for infants who did not receive a dose immediately after birth; the timing of the third HepB dose; situations in which children younger than nine years need two doses of influenza vaccine; the availability of two human papillomavirus vaccines to prevent cervical cancer (quadrivalent and bivalent)³; and the availability of the quadrivalent human papillomavirus vaccine for prevention of genital warts in men.

Over time, vaccines have been one of the most effective public health interventions. Many of today's physicians have never seen a patient with measles, rubella, polio, or other diseases that in the past were leading causes of morbidity and mortality. One could say that vaccines are a victim of their own success—the better they work, the less they are appreciated. With the absence of vaccine-preventable diseases, the benefit of vaccines goes unnoticed, while exaggerated and false claims of harm receive increasing attention and concern about safety becomes the most important issue to parents. Family physicians now need to spend more time reassuring patients and families of the safety and effectiveness of vaccines.

As more vaccines are licensed and protection against more infectious diseases becomes available, the increasing complexity of the vaccination schedules is a challenge for family physicians, as are the logistics of maintaining a full array of vaccines in the clinical setting.⁴ Hopefully, family physicians will find creative ways to continue providing vaccines in the medical home. If not, others will step in to provide this effective and essential service.

editor's note: The author serves as liaison to ACIP for the AAFP.