to the editor: I am writing about the article on current immunization recommendations.¹ I find it very distressing that the author gives outdated recommendations for the use of tetanus toxoid and influenza and pneumococcal vaccines. The author did not reference the guide for adult immunization from the American College of Physician's Task Force on Immunizations,² nor did he reference the Morbidity and Mortality Weekly Report's recommendations from the Advisory Committee on Immunization Practices (ACIP). The section on toxoid does not include the Task Force's recommendation for boosting, which is a single mid-life diphtheria toxoid (DT) booster at age 50 for patients who have completed the primary series.

The ACIP guide for adult immunizations³ recommends that the 50th birthday generally be used as a marker for reviewing the patient's immunization status. Patients at high risk for pneumonia should receive pneumococcal vaccination at age 50, and all patients with high-risk conditions should be reimmunized every six years.

The section on influenza vaccine in the AFP article also omits a discussion of health care workers of any age who come in close contact with patients who are at high risk, which I believe should have been included.

in reply: As I indicated in the article, it is important for all practicing physicians to keep abreast of the most recent recommendations for immunization practices. References that provide this information, including the Morbidity and Mortality Weekly Report, are listed on page 867 of my article.

The use of the single dose of DT in adults on their 50th birthday is one such recommendation. Providing booster doses of DT every 10 years is still acceptable and recommended by some groups.^1,2 Practitioners should decide how they will use DT to best care for their patients. Recommendation for booster doses of pneumococcal vaccine has been debated for several years. The recommendation to vaccinate every six years is reasonable for adult patients in high-risk groups.

At the institution where I work, all employees are offered and encouraged to receive the influenza vaccine. Individuals who are not in the health care profession but who have close contact with patients in high-risk groups should also be considered for routine influenza immunization. I believe that this is common knowledge among practicing physicians and other health care workers.