Standards for immunization practice for vaccines in children and adults.

Administration of vaccines is a continuing challenge. In childhood immunizations, many of the goals for national coverage rates by 2000 were achieved and the goal of annual influenza immunization for adults 65 years of age and older was reached. These successes in childhood immunization rates have led to record low numbers of cases of many vaccine-preventable diseases, such as measles and Haemophilus influenzae, type b invasive disease. These diseases will recur, however, as evidenced by the measles epidemic of 1989-1991, if high immunization coverage is not maintained. The development of immunization delivery systems to sustain these high rates in young children is essential to ensure that the 11,000 infants born each day in the United States receive all recommended vaccines, as noted in the recent NVAC report on strategies to sustain success in childhood immunization. For adults, the total economic burden of treating these vaccine-preventable diseases is estimated to exceed $10 billion each year, reflecting in part widespread underuse of vaccines in adults and resulting missed opportunities to prevent diseases such as influenza and pneumococcal infection. The development of standards for immunization practices in children and adults has been an important component in meeting these challenges and ensuring appropriate delivery of vaccines. Periodic review and updating is necessary and revision of the standards for adults by the NCAI and NVAC, pediatric standards, and those of the IDSA currently are undergoing revision. Most importantly, however, standards for immunization practices should be promulgated widely to all health care professionals to ensure that all segments of the population benefit from the availability of highly effective and safe vaccines.