ACIP Meeting

The Advisory Committee on Immunization Practices (ACIP) has unanimously approved a series of changes to the adult immunization schedule for several vaccines.

The changes, which must next be approved by the director of the Centers for Disease Control and Prevention, will take effect in 2016. The biggest shifts are related to meningococcal B vaccinations, which are now listed separately in the schedule from vaccination recommendations for all other meningococcal strains.

Adults with asplenia “or complement deficiencies,” microbiologists, and those who routinely work in outbreak settings are recommended to get either a two-dose series of MenB-4C (Bexsero) or a three-dose series of MenB-FHbp (Trumenba) in the 2016 guidelines, according to Dr. David Kim of the CDC’s National Center for Immunization and Respiratory Diseases, who presented the changes at a meeting of the CDC’s ACIP on Oct. 21. The same vaccine type should be taken through an immunization series, as these are not interchangeable.

However, vaccination is not recommended for individuals who travel or live in countries where meningococcal disease is hyperendemic or epidemic, as the disease in these countries is generally not known to be caused by serogroup B. Also, young adults aged 16-23 years maybe receive the vaccine to provide short-term protection against most strains of MenB disease; however, it is mostly recommended for individuals aged 16-18 years. The recommendation for young adults is a Category B recommendation, which means it has not yet been fully integrated into the 2016 schedule and will be listed in the footnotes of the schedule.

For the human papillomavirus vaccine, all women aged 19-26 years are recommended to receive a three-dose series of either 2-valent, 4-valent, or 9-valent HPV vaccine unless they have been vaccinated previously or did not complete the previous series. Men aged 19-21 years should also get a three-dose series of either 4-valent or 9-valent HPV vaccine, according to the recommendations. Homosexual and immunocompromised men, including those with HIV infections, should receive a three-dose series of either 4-valent or 9-valent HPV vaccines through age 26.

Updates were also approved for pneumococcal virus vaccinations, as there are now changes in intervals for PCV13 and PPSV23. Immunocompetent adults 65 years and older should receive PPSV23 at least 1 year after PCV13, not 6-12 months afterward as recommended under the 2015 schedule.

[email protected]

The Advisory Committee on Immunization Practices (ACIP) has unanimously approved a series of changes to the adult immunization schedule for several vaccines.

The changes, which must next be approved by the director of the Centers for Disease Control and Prevention, will take effect in 2016. The biggest shifts are related to meningococcal B vaccinations, which are now listed separately in the schedule from vaccination recommendations for all other meningococcal strains.

Adults with asplenia “or complement deficiencies,” microbiologists, and those who routinely work in outbreak settings are recommended to get either a two-dose series of MenB-4C (Bexsero) or a three-dose series of MenB-FHbp (Trumenba) in the 2016 guidelines, according to Dr. David Kim of the CDC’s National Center for Immunization and Respiratory Diseases, who presented the changes at a meeting of the CDC’s ACIP on Oct. 21. The same vaccine type should be taken through an immunization series, as these are not interchangeable.

However, vaccination is not recommended for individuals who travel or live in countries where meningococcal disease is hyperendemic or epidemic, as the disease in these countries is generally not known to be caused by serogroup B. Also, young adults aged 16-23 years maybe receive the vaccine to provide short-term protection against most strains of MenB disease; however, it is mostly recommended for individuals aged 16-18 years. The recommendation for young adults is a Category B recommendation, which means it has not yet been fully integrated into the 2016 schedule and will be listed in the footnotes of the schedule.

For the human papillomavirus vaccine, all women aged 19-26 years are recommended to receive a three-dose series of either 2-valent, 4-valent, or 9-valent HPV vaccine unless they have been vaccinated previously or did not complete the previous series. Men aged 19-21 years should also get a three-dose series of either 4-valent or 9-valent HPV vaccine, according to the recommendations. Homosexual and immunocompromised men, including those with HIV infections, should receive a three-dose series of either 4-valent or 9-valent HPV vaccines through age 26.

Updates were also approved for pneumococcal virus vaccinations, as there are now changes in intervals for PCV13 and PPSV23. Immunocompetent adults 65 years and older should receive PPSV23 at least 1 year after PCV13, not 6-12 months afterward as recommended under the 2015 schedule.

[email protected]

The Advisory Committee on Immunization Practices (ACIP) has unanimously approved a series of changes to the adult immunization schedule for several vaccines.

The changes, which must next be approved by the director of the Centers for Disease Control and Prevention, will take effect in 2016. The biggest shifts are related to meningococcal B vaccinations, which are now listed separately in the schedule from vaccination recommendations for all other meningococcal strains.

Adults with asplenia “or complement deficiencies,” microbiologists, and those who routinely work in outbreak settings are recommended to get either a two-dose series of MenB-4C (Bexsero) or a three-dose series of MenB-FHbp (Trumenba) in the 2016 guidelines, according to Dr. David Kim of the CDC’s National Center for Immunization and Respiratory Diseases, who presented the changes at a meeting of the CDC’s ACIP on Oct. 21. The same vaccine type should be taken through an immunization series, as these are not interchangeable.

However, vaccination is not recommended for individuals who travel or live in countries where meningococcal disease is hyperendemic or epidemic, as the disease in these countries is generally not known to be caused by serogroup B. Also, young adults aged 16-23 years maybe receive the vaccine to provide short-term protection against most strains of MenB disease; however, it is mostly recommended for individuals aged 16-18 years. The recommendation for young adults is a Category B recommendation, which means it has not yet been fully integrated into the 2016 schedule and will be listed in the footnotes of the schedule.

For the human papillomavirus vaccine, all women aged 19-26 years are recommended to receive a three-dose series of either 2-valent, 4-valent, or 9-valent HPV vaccine unless they have been vaccinated previously or did not complete the previous series. Men aged 19-21 years should also get a three-dose series of either 4-valent or 9-valent HPV vaccine, according to the recommendations. Homosexual and immunocompromised men, including those with HIV infections, should receive a three-dose series of either 4-valent or 9-valent HPV vaccines through age 26.

Updates were also approved for pneumococcal virus vaccinations, as there are now changes in intervals for PCV13 and PPSV23. Immunocompetent adults 65 years and older should receive PPSV23 at least 1 year after PCV13, not 6-12 months afterward as recommended under the 2015 schedule.

[email protected]

Changes to meningococcal B, DTaP, polio, and human papillomavirus (HPV) vaccination recommendations were among those unanimously approved at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) for child and adolescent immunization schedules.

Meningococcal B vaccine has now been added to the 2016 immunization schedule, and is recommended for high-risk children beginning at age 10 years. The schedule also includes recommendations for adolescents age 16 years and older in “not high-risk groups that may receive this vaccine subject to individual clinical decision-making,” according to Dr. Candice Robinson of the CDC’s National Center for Immunization and Respiratory Diseases, Atlanta. Relevant information for administration of meningococcal B vaccination has been added to the footnotes and routine vaccination sections as well.

In the footnotes section, DTaP recommendations have been revised to add Quadracel to the minimum age exception line, and administration instructions of inadvertent doses have been clarified. The new instructions will now read: “If the fourth dose of DTaP was administered at least 4 months, but less than 6 months, after the third dose of DTaP, it need not be repeated [and] the 4-day grace period may not be used for the fourth dose given less than 6 months after the third dose of DTaP.”

“We use the description of ‘inadvertent dose’ to indicate that this shortened interval between doses should not be used prospectively; however, the dose could be counted as valid after the fact,” Dr. Robinson explained.

Footnotes for inactivated polio vaccine (IPV) will now include guidance for IPV use in patients who have previously received only oral polio vaccine (OPV) and did not receive any doses after their fourth birthday. This addition, which was added after repeated inquiries from providers, will read: “If only OPV were administered, and all doses were given prior to 4 years of age, one dose of IPV should be given at 4 years or older at least 4 weeks after the last dose of [OPV].”

©dina2001/thinkstockphotos.com

For HPV, children aged 9-10 years will now be recommended for vaccination if they are “high risk” – indicated by a purple bar on Figure 1 of the 2016 immunization schedule – due to a history of sexual abuse in their youth. Furthermore, all HPV nomenclature in the 2016 recommendations will be updated to reflect currently accepted naming formats; for example, HPV4 will now be called 4-valent or 4V HPV. In the footnotes, the 9-valent HPV vaccine is now included along with the 5-valent and 4-valent variants, along with restructured language to clarify administration instructions.

Other changes to Figure 1 of next year’s immunization schedules include moving the Tdap recommendations to a lower section of the table, and moving the pneumococcal polysaccharide vaccination schedule toward the bottom of the chart because it is “not routinely recommended for any population.” Haemophilus influenzae type b (Hib) vaccinations are now recommended for certain high-risk groups in patients aged 5-18 years, in accordance with text in the recommendations’ footnotes that suggested vaccination in this age group for those who had previously been vaccinated or have other high-risk conditions.

The catch-up schedule will have one minor change – “in the Tdap line’s Dose 2-3 column, we added Tdap and Td to the list of possible previous vaccines,” Dr. Robinson said.

Revisions will be made to be submitted for approval by Dr. Tom Frieden, CDC director. The edited copy of these updated recommendations will be submitted to the American Academy of Pediatrics, American Academy of Family Physicians, and American Congress of Obstetricians and Gynecologists by Jan. 1, 2016, with publication by the CDC and partner publications following in January and February.

Changes to meningococcal B, DTaP, polio, and human papillomavirus (HPV) vaccination recommendations were among those unanimously approved at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) for child and adolescent immunization schedules.

Meningococcal B vaccine has now been added to the 2016 immunization schedule, and is recommended for high-risk children beginning at age 10 years. The schedule also includes recommendations for adolescents age 16 years and older in “not high-risk groups that may receive this vaccine subject to individual clinical decision-making,” according to Dr. Candice Robinson of the CDC’s National Center for Immunization and Respiratory Diseases, Atlanta. Relevant information for administration of meningococcal B vaccination has been added to the footnotes and routine vaccination sections as well.

In the footnotes section, DTaP recommendations have been revised to add Quadracel to the minimum age exception line, and administration instructions of inadvertent doses have been clarified. The new instructions will now read: “If the fourth dose of DTaP was administered at least 4 months, but less than 6 months, after the third dose of DTaP, it need not be repeated [and] the 4-day grace period may not be used for the fourth dose given less than 6 months after the third dose of DTaP.”

“We use the description of ‘inadvertent dose’ to indicate that this shortened interval between doses should not be used prospectively; however, the dose could be counted as valid after the fact,” Dr. Robinson explained.

Footnotes for inactivated polio vaccine (IPV) will now include guidance for IPV use in patients who have previously received only oral polio vaccine (OPV) and did not receive any doses after their fourth birthday. This addition, which was added after repeated inquiries from providers, will read: “If only OPV were administered, and all doses were given prior to 4 years of age, one dose of IPV should be given at 4 years or older at least 4 weeks after the last dose of [OPV].”

©dina2001/thinkstockphotos.com

For HPV, children aged 9-10 years will now be recommended for vaccination if they are “high risk” – indicated by a purple bar on Figure 1 of the 2016 immunization schedule – due to a history of sexual abuse in their youth. Furthermore, all HPV nomenclature in the 2016 recommendations will be updated to reflect currently accepted naming formats; for example, HPV4 will now be called 4-valent or 4V HPV. In the footnotes, the 9-valent HPV vaccine is now included along with the 5-valent and 4-valent variants, along with restructured language to clarify administration instructions.

Other changes to Figure 1 of next year’s immunization schedules include moving the Tdap recommendations to a lower section of the table, and moving the pneumococcal polysaccharide vaccination schedule toward the bottom of the chart because it is “not routinely recommended for any population.” Haemophilus influenzae type b (Hib) vaccinations are now recommended for certain high-risk groups in patients aged 5-18 years, in accordance with text in the recommendations’ footnotes that suggested vaccination in this age group for those who had previously been vaccinated or have other high-risk conditions.

The catch-up schedule will have one minor change – “in the Tdap line’s Dose 2-3 column, we added Tdap and Td to the list of possible previous vaccines,” Dr. Robinson said.

Revisions will be made to be submitted for approval by Dr. Tom Frieden, CDC director. The edited copy of these updated recommendations will be submitted to the American Academy of Pediatrics, American Academy of Family Physicians, and American Congress of Obstetricians and Gynecologists by Jan. 1, 2016, with publication by the CDC and partner publications following in January and February.

Changes to meningococcal B, DTaP, polio, and human papillomavirus (HPV) vaccination recommendations were among those unanimously approved at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) for child and adolescent immunization schedules.

Meningococcal B vaccine has now been added to the 2016 immunization schedule, and is recommended for high-risk children beginning at age 10 years. The schedule also includes recommendations for adolescents age 16 years and older in “not high-risk groups that may receive this vaccine subject to individual clinical decision-making,” according to Dr. Candice Robinson of the CDC’s National Center for Immunization and Respiratory Diseases, Atlanta. Relevant information for administration of meningococcal B vaccination has been added to the footnotes and routine vaccination sections as well.

In the footnotes section, DTaP recommendations have been revised to add Quadracel to the minimum age exception line, and administration instructions of inadvertent doses have been clarified. The new instructions will now read: “If the fourth dose of DTaP was administered at least 4 months, but less than 6 months, after the third dose of DTaP, it need not be repeated [and] the 4-day grace period may not be used for the fourth dose given less than 6 months after the third dose of DTaP.”

“We use the description of ‘inadvertent dose’ to indicate that this shortened interval between doses should not be used prospectively; however, the dose could be counted as valid after the fact,” Dr. Robinson explained.

Footnotes for inactivated polio vaccine (IPV) will now include guidance for IPV use in patients who have previously received only oral polio vaccine (OPV) and did not receive any doses after their fourth birthday. This addition, which was added after repeated inquiries from providers, will read: “If only OPV were administered, and all doses were given prior to 4 years of age, one dose of IPV should be given at 4 years or older at least 4 weeks after the last dose of [OPV].”

©dina2001/thinkstockphotos.com

For HPV, children aged 9-10 years will now be recommended for vaccination if they are “high risk” – indicated by a purple bar on Figure 1 of the 2016 immunization schedule – due to a history of sexual abuse in their youth. Furthermore, all HPV nomenclature in the 2016 recommendations will be updated to reflect currently accepted naming formats; for example, HPV4 will now be called 4-valent or 4V HPV. In the footnotes, the 9-valent HPV vaccine is now included along with the 5-valent and 4-valent variants, along with restructured language to clarify administration instructions.

Other changes to Figure 1 of next year’s immunization schedules include moving the Tdap recommendations to a lower section of the table, and moving the pneumococcal polysaccharide vaccination schedule toward the bottom of the chart because it is “not routinely recommended for any population.” Haemophilus influenzae type b (Hib) vaccinations are now recommended for certain high-risk groups in patients aged 5-18 years, in accordance with text in the recommendations’ footnotes that suggested vaccination in this age group for those who had previously been vaccinated or have other high-risk conditions.

The catch-up schedule will have one minor change – “in the Tdap line’s Dose 2-3 column, we added Tdap and Td to the list of possible previous vaccines,” Dr. Robinson said.

Revisions will be made to be submitted for approval by Dr. Tom Frieden, CDC director. The edited copy of these updated recommendations will be submitted to the American Academy of Pediatrics, American Academy of Family Physicians, and American Congress of Obstetricians and Gynecologists by Jan. 1, 2016, with publication by the CDC and partner publications following in January and February.

Changes to meningococcal B, DTaP, polio, and human papillomavirus (HPV) vaccination recommendations were among those unanimously approved at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) for child and adolescent immunization schedules.

Meningococcal B vaccine has now been added to the 2016 immunization schedule, and is recommended for high-risk children beginning at age 10 years. The schedule also includes recommendations for adolescents age 16 years and older in “not high-risk groups that may receive this vaccine subject to individual clinical decision-making,” according to Dr. Candice Robinson of the CDC’s National Center for Immunization and Respiratory Diseases, Atlanta. Relevant information for administration of meningococcal B vaccination has been added to the footnotes and routine vaccination sections as well.

In the footnotes section, DTaP recommendations have been revised to add Quadracel to the minimum age exception line, and administration instructions of inadvertent doses have been clarified. The new instructions will now read: “If the fourth dose of DTaP was administered at least 4 months, but less than 6 months, after the third dose of DTaP, it need not be repeated [and] the 4-day grace period may not be used for the fourth dose given less than 6 months after the third dose of DTaP.”

“We use the description of ‘inadvertent dose’ to indicate that this shortened interval between doses should not be used prospectively; however, the dose could be counted as valid after the fact,” Dr. Robinson explained.

Footnotes for inactivated polio vaccine (IPV) will now include guidance for IPV use in patients who have previously received only oral polio vaccine (OPV) and did not receive any doses after their fourth birthday. This addition, which was added after repeated inquiries from providers, will read: “If only OPV were administered, and all doses were given prior to 4 years of age, one dose of IPV should be given at 4 years or older at least 4 weeks after the last dose of [OPV].”

©dina2001/thinkstockphotos.com

For HPV, children aged 9-10 years will now be recommended for vaccination if they are “high risk” – indicated by a purple bar on Figure 1 of the 2016 immunization schedule – due to a history of sexual abuse in their youth. Furthermore, all HPV nomenclature in the 2016 recommendations will be updated to reflect currently accepted naming formats; for example, HPV4 will now be called 4-valent or 4V HPV. In the footnotes, the 9-valent HPV vaccine is now included along with the 5-valent and 4-valent variants, along with restructured language to clarify administration instructions.

Other changes to Figure 1 of next year’s immunization schedules include moving the Tdap recommendations to a lower section of the table, and moving the pneumococcal polysaccharide vaccination schedule toward the bottom of the chart because it is “not routinely recommended for any population.” Haemophilus influenzae type b (Hib) vaccinations are now recommended for certain high-risk groups in patients aged 5-18 years, in accordance with text in the recommendations’ footnotes that suggested vaccination in this age group for those who had previously been vaccinated or have other high-risk conditions.

The catch-up schedule will have one minor change – “in the Tdap line’s Dose 2-3 column, we added Tdap and Td to the list of possible previous vaccines,” Dr. Robinson said.

Revisions will be made to be submitted for approval by Dr. Tom Frieden, CDC director. The edited copy of these updated recommendations will be submitted to the American Academy of Pediatrics, American Academy of Family Physicians, and American Congress of Obstetricians and Gynecologists by Jan. 1, 2016, with publication by the CDC and partner publications following in January and February.

[email protected]

Changes to meningococcal B, DTaP, polio, and human papillomavirus (HPV) vaccination recommendations were among those unanimously approved at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) for child and adolescent immunization schedules.

Meningococcal B vaccine has now been added to the 2016 immunization schedule, and is recommended for high-risk children beginning at age 10 years. The schedule also includes recommendations for adolescents age 16 years and older in “not high-risk groups that may receive this vaccine subject to individual clinical decision-making,” according to Dr. Candice Robinson of the CDC’s National Center for Immunization and Respiratory Diseases, Atlanta. Relevant information for administration of meningococcal B vaccination has been added to the footnotes and routine vaccination sections as well.

In the footnotes section, DTaP recommendations have been revised to add Quadracel to the minimum age exception line, and administration instructions of inadvertent doses have been clarified. The new instructions will now read: “If the fourth dose of DTaP was administered at least 4 months, but less than 6 months, after the third dose of DTaP, it need not be repeated [and] the 4-day grace period may not be used for the fourth dose given less than 6 months after the third dose of DTaP.”

“We use the description of ‘inadvertent dose’ to indicate that this shortened interval between doses should not be used prospectively; however, the dose could be counted as valid after the fact,” Dr. Robinson explained.

Footnotes for inactivated polio vaccine (IPV) will now include guidance for IPV use in patients who have previously received only oral polio vaccine (OPV) and did not receive any doses after their fourth birthday. This addition, which was added after repeated inquiries from providers, will read: “If only OPV were administered, and all doses were given prior to 4 years of age, one dose of IPV should be given at 4 years or older at least 4 weeks after the last dose of [OPV].”

©dina2001/thinkstockphotos.com

For HPV, children aged 9-10 years will now be recommended for vaccination if they are “high risk” – indicated by a purple bar on Figure 1 of the 2016 immunization schedule – due to a history of sexual abuse in their youth. Furthermore, all HPV nomenclature in the 2016 recommendations will be updated to reflect currently accepted naming formats; for example, HPV4 will now be called 4-valent or 4V HPV. In the footnotes, the 9-valent HPV vaccine is now included along with the 5-valent and 4-valent variants, along with restructured language to clarify administration instructions.

Other changes to Figure 1 of next year’s immunization schedules include moving the Tdap recommendations to a lower section of the table, and moving the pneumococcal polysaccharide vaccination schedule toward the bottom of the chart because it is “not routinely recommended for any population.” Haemophilus influenzae type b (Hib) vaccinations are now recommended for certain high-risk groups in patients aged 5-18 years, in accordance with text in the recommendations’ footnotes that suggested vaccination in this age group for those who had previously been vaccinated or have other high-risk conditions.

The catch-up schedule will have one minor change – “in the Tdap line’s Dose 2-3 column, we added Tdap and Td to the list of possible previous vaccines,” Dr. Robinson said.

Revisions will be made to be submitted for approval by Dr. Tom Frieden, CDC director. The edited copy of these updated recommendations will be submitted to the American Academy of Pediatrics, American Academy of Family Physicians, and American Congress of Obstetricians and Gynecologists by Jan. 1, 2016, with publication by the CDC and partner publications following in January and February.

[email protected]

Changes to meningococcal B, DTaP, polio, and human papillomavirus (HPV) vaccination recommendations were among those unanimously approved at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) for child and adolescent immunization schedules.

Meningococcal B vaccine has now been added to the 2016 immunization schedule, and is recommended for high-risk children beginning at age 10 years. The schedule also includes recommendations for adolescents age 16 years and older in “not high-risk groups that may receive this vaccine subject to individual clinical decision-making,” according to Dr. Candice Robinson of the CDC’s National Center for Immunization and Respiratory Diseases, Atlanta. Relevant information for administration of meningococcal B vaccination has been added to the footnotes and routine vaccination sections as well.

In the footnotes section, DTaP recommendations have been revised to add Quadracel to the minimum age exception line, and administration instructions of inadvertent doses have been clarified. The new instructions will now read: “If the fourth dose of DTaP was administered at least 4 months, but less than 6 months, after the third dose of DTaP, it need not be repeated [and] the 4-day grace period may not be used for the fourth dose given less than 6 months after the third dose of DTaP.”

“We use the description of ‘inadvertent dose’ to indicate that this shortened interval between doses should not be used prospectively; however, the dose could be counted as valid after the fact,” Dr. Robinson explained.

Footnotes for inactivated polio vaccine (IPV) will now include guidance for IPV use in patients who have previously received only oral polio vaccine (OPV) and did not receive any doses after their fourth birthday. This addition, which was added after repeated inquiries from providers, will read: “If only OPV were administered, and all doses were given prior to 4 years of age, one dose of IPV should be given at 4 years or older at least 4 weeks after the last dose of [OPV].”

©dina2001/thinkstockphotos.com

For HPV, children aged 9-10 years will now be recommended for vaccination if they are “high risk” – indicated by a purple bar on Figure 1 of the 2016 immunization schedule – due to a history of sexual abuse in their youth. Furthermore, all HPV nomenclature in the 2016 recommendations will be updated to reflect currently accepted naming formats; for example, HPV4 will now be called 4-valent or 4V HPV. In the footnotes, the 9-valent HPV vaccine is now included along with the 5-valent and 4-valent variants, along with restructured language to clarify administration instructions.

Other changes to Figure 1 of next year’s immunization schedules include moving the Tdap recommendations to a lower section of the table, and moving the pneumococcal polysaccharide vaccination schedule toward the bottom of the chart because it is “not routinely recommended for any population.” Haemophilus influenzae type b (Hib) vaccinations are now recommended for certain high-risk groups in patients aged 5-18 years, in accordance with text in the recommendations’ footnotes that suggested vaccination in this age group for those who had previously been vaccinated or have other high-risk conditions.

The catch-up schedule will have one minor change – “in the Tdap line’s Dose 2-3 column, we added Tdap and Td to the list of possible previous vaccines,” Dr. Robinson said.

Revisions will be made to be submitted for approval by Dr. Tom Frieden, CDC director. The edited copy of these updated recommendations will be submitted to the American Academy of Pediatrics, American Academy of Family Physicians, and American Congress of Obstetricians and Gynecologists by Jan. 1, 2016, with publication by the CDC and partner publications following in January and February.

[email protected]