On the eve of the First Annual Conference on Vaccine Research in May 1998, the National Coalition for Adult Immunization (NCAI) hosted a day-long roundtable discussion entitled "The Need for Immunization Guidelines for High-Risk Populations." Roundtable participants included professionals representing the Advisory Committee on Immunization Practices (ACIP); the American Academy of Allergy, Asthma, and Immunology; the American Geriatric Society; the American Liver Foundation; the American Lung Association; the American Medical Directors Association; the Arthritis Foundation; the Centers for Disease Control and Prevention; the National Council on Aging; the National Kidney Foundation; the SPRY Foundation; the Immunodeficiency Foundation; and the National Foundation for Infectious Diseases.

The purpose of the roundtable was to evaluate and support development and discussion of adult immunization guidelines targeted at high-risk groups. Adults considered to be at high risk for complications of vaccine preventable diseases include those with diseases or other conditions that increase their risk of complications such as diabetes mellitus; chronic liver, renal, or lung disease; chronic cardiac disease/heart failure; HIV infection; cancer; organ transplant recipients; recipients of immunosuppressive therapies; and the elderly. Others at risk for these complications, not because of underlying disease, but because of under-immunization, include minorities, those with low socioeconomic level, those with low education level, those living in inner cities, those lacking medical services, and those with a misperception of risk and co-morbid disease.

Currently, the primary focus for these high-risk populations is on the provision of care during the disease state. Gregory A. Poland, MD, Mayo Clinic Foundation, Rochester, MN, and chair of the NCAI Steering Committee, reviewed data on the prevalence of infectious disease cases among high-risk groups. "Although general ACIP recommendations exist, there is clearly a need to support the development of immunization policy to professionals and consumers, and the development of more specific guidelines for high-risk groups, as appropriate," noted Dr. Poland.

Roundtable participants explored ways to increase awareness among voluntary and/or professional health organizations of the need to endorse specific immunization guidelines for their respective high-risk patient populations. The formal incorporation of existing ACIP guidelines into policy was also discussed, and the advancement of specific guidelines for high-risk patient populations were also considered. Potential barriers to immunization guideline development, and possible ways to overcome these barriers were addressed.