This issue of AFP offers for the first time a tear-out version of the updated childhood and adolescent immunization schedules. The perforated, fold-out schedules are printed in larger type and can be found in the “Practice Guidelines” section along with an editorial highlighting the changes in the schedules (see page 206), by Richard K. Zimmerman, M.D., M.P.H. Dr. Zimmerman is associate professor in the Department of Family Medicine and Clinical Epidemiology at the University of Pittsburgh School of Medicine and a voting member of the Advisory Committee on Immunization Practices (ACIP).

Dr. Zimmerman points out three changes in the 2004 Recommended Childhood and Adolescent Immunization Schedule. One change in the schedule reflects an expected update in recommendations regarding influenza vaccine use in young children. The published schedule covers only a six-month period, from January to June 2004, because it is anticipated that the schedule will be changed in the fall of 2004 to recommend routine influenza vaccination in children six through 23 months of age. Because of the significant hospitalization rates in young children with influenza, the high annual illness attack rate, and the demonstrated safety of vaccination in this age group, the ACIP voted in October 2003 to recommend routine annual vaccination of all children six to 23 months of age, effective in the fall of 2004.

Dr. Zimmerman, who serves as the chair of the Influenza Working Group that developed this recommendation for ACIP, notes that the delay in incorporating routine influenza vaccination recommendation in this age group is intended to give manufacturers enough time to make the vaccine and physicians enough time to order supplies. Also, the 2004 schedule is harmonized between the ACIP, the American Academy of Family Physicians, and the American Academy of Pediatrics, and the other organizations have not yet voted on routine influenza vaccination in this age group. Experts anticipate that the recommendation will be included in a harmonized schedule for the last part of 2004.

The two other major changes involve the tetanus and hepatitis B vaccines. The tetanus and diphtheria toxoids (Td) bar is now broken into two segments: recommendation for Td at 11 to 12 years of age, with catch-up from 13 to 18 years of age. The reason for the change is that compliance may be higher with Td given at 11 to 12 years of age, preventing a possible window of inadequate protection. For hepatitis B vaccine, the recommended minimum age for the third dose of the vaccine has been changed to 24 weeks to accommodate children who present for their six-month well-child visit slightly earlier than six months. The recommended age for the third dose has not changed and remains at six through 18 months of age, and the minimal intervals of eight weeks between the second and third doses and 16 weeks between the first and third doses remain unchanged.

Dr. Zimmerman's editorial also provides updates on the live attenuated influenza vaccine and the pneumococcal conjugate vaccine, and points out resources to keep you up to date throughout the year. We hope you find the new tear-out format of the immunization schedules in AFP to be a valuable tool.