Medical Policy


Subject:  Preventive Health Guidelines
Policy #:  ADMIN.00002Current Effective Date:  07/15/2014
Status:RevisedLast Review Date:  05/15/2014

Description/Scope

Preventive services span a broad range of care for individuals of all ages. Several national organizations produce evidence-based guidelines for these services.

Note: Please see the following document for information related to immunizations:

Please see the following documents for additional information related to specific screenings for colorectal cancer:

Position Statement

Medically Necessary:

The following lists of sources of preventive services recommendations created by the referenced organizations listed below are considered medically necessary. 

When these recommendations are updated by their sponsoring organizations, the update is considered medically necessary as of the effective date of the update of the recommendation.

If there is a specific medical policy or clinical UM guideline that encompasses a topic addressed in any of these referenced guidelines, the specific medical policy or clinical UM guideline will take precedence.

References

Applicable for All Individuals (see categories listed below for additional guidelines)


HIV Screening:

U.S. Preventive Services Task Force. Screening for HIV. April 2013. http://www.uspreventiveservicestaskforce.org/uspstf/uspshivi.htm.

Preventive Health Services:

American Academy of Family Physicians. Summary of Recommendations for Clinical Preventive Services, March 2014. http://www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/cps-recommendations.pdf

Guide to Clinical Preventive Services, 2012. Recommendations of the U.S. Preventive Services Task Force. November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/index.html.

Sexually Transmitted Diseases:

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, MMWR 2010; 59(No. RR-12): 1-110. December 17, 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5912a1.htm?s_cid=rr5912a1_e.

Tobacco, Alcohol, and Other Drugs:

Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008. http://bphc.hrsa.gov/buckets/treatingtobacco.pdf.

U.S. Preventive Services Task Force. Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women. April 2009. http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac2.htm.

Maternity (see guidelines Applicable for All Individuals for additional guidelines)


Lead Screening:

Centers for Disease Control and Prevention. Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women. 2010. http://www.cdc.gov/nceh/lead/publications/LeadandPregnancy2010.pdf.

Perinatal Care:

American Academy of Pediatrics & American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, Sixth Edition. Elk Grove Village, Ill. October 2007.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. No.137: Gestational Diabetes Mellitus. Obstet Gynecol. 2013; 122(2):406-416.

Centers for Disease Control and Prevention. Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC. MMWR 2010; 59(RR10): 1-32. November 19, 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_e.

U.S. Preventive Services Task Force. Folic Acid for the Prevention of Neural Tube Defects. May 2009. http://www.uspreventiveservicestaskforce.org/uspstf/uspsnrfol.htm.

U.S. Preventive Services Task Force. Screening for Gestational Diabetes Mellitus. January 2014. http://www.uspreventiveservicestaskforce.org/uspstf/uspsgdm.htm.

U.S. Preventive Services Task Force. Primary Care Interventions to Promote Breastfeeding. October 2008. http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrfd.htm

0-18 years (see guidelines Applicable for All Individuals for additional guidelines)


Cancer Screening:

American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 463: Cervical cancer in adolescents: screening, evaluation, and management. Obstet Gynecol. 2010 Aug; 116(2 Pt 1):469-472.

Preventive Health Services:

American Academy of Pediatrics. Pediatrics Committee on Practice and Ambulatory Medicine and Bright Futures Steering Committee. Recommendations for Preventive Pediatric Health Care. Pediatrics 2007; 120(6):1376. Reaffirmed March 2011. http://pediatrics.aappublications.org/content/120/6/1376.full.pdf+html .

American Academy of Pediatrics. Recommendations for prevention of childhood obesity. Pediatrics. 2007; 120 Suppl 4:S229-253. http://pediatrics.aappublications.org/cgi/reprint/120/Supplement_4/S229.

American Academy of Pediatrics. The Committee on Nutrition. Clinical Report--Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age). Pediatrics. 2010; 126(5):1040-1050. http://pediatrics.aappublications.org/cgi/reprint/peds.2010-2576v1.

American Academy of Pediatrics. Ultraviolet Radiation: A Hazard to Children and Adolescents Council on Environmental Health and Section on Dermatology. Pediatrics. 2011; 127(3):588-597. http://pediatrics.aappublications.org/content/127/3/588.full.pdf+html?sid=ab98704f-1427-4476-94ea-015caee1379e.

U.S. Preventive Services Task Force. Screening for Obesity in Children and Adolescents. January 2010. http://www.uspreventiveservicestaskforce.org/uspstf/uspschobes.htm.

U.S. Preventive Services Task Force. Screening for Visual Impairment in Children Ages 1 to 5 Years. January 2011. http://www.uspreventiveservicestaskforce.org/uspstf11/vischildren/vischildrs.htm.

Lead Screening:

American Academy of Pediatrics Committee on Environmental Health. Lead exposure in children: prevention, detection, and management. Pediatrics. 2005; 116(4):1036-1046. http://pediatrics.aappublications.org/content/116/4/1036.full.pdf+html?sid=5e33b25c-c3d7-4ccc-9aba-f514a90c548d.

Centers for Disease Control and Prevention. Recommendations for Blood Lead Screening of Medicaid-Eligible Children Aged 1--5 Years: an Updated Approach to Targeting a Group at High Risk. MMWR 2009; 58(RR09):1-11.August 7, 2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5809a1.htm?s_cid=rr5809a1_e.

Tobacco, Alcohol, and Other Drugs:

American Academy of Pediatrics. Committee on Substance Abuse. Clinical Report. Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse. Pediatrics. 2005; 115(3):816-821. http://pediatrics.aappublications.org/content/115/3/816.full.pdf+html.

U.S. Preventive Services Task Force. Primary Care Interventions to Prevent Tobacco Use in Children and Adolescents. August 2013. http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac.htm.

19 years and older (see guidelines Applicable for All Individuals for additional guidelines)


Cancer Screening:

American Cancer Society. Cancer Detection Guidelines. http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp?sitearea=PED. (NOTE: Specific medical policies, RAD.00029 CT Colonography (Virtual Colonoscopy) as a Screening or Diagnostic Test for Colorectal Cancer and GENE.00008 Analysis of Fecal DNA for Colorectal Cancer Screening and Surveillance take precedence over this ACS guideline recommendation for CT Colonography and stool DNA test (sDNA).

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. No.122: Breast cancer screening. Obstet Gynecol. 2011; 118(2):372-382.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. No. 131: Screening for cervical cancer. Obstet Gynecol. 2012; 120(5):1222-1238.

Heleno B1, Thomsen MF, Rodrigues DS, et al. Quantification of harms in cancer screening trials: literature review. BMJ. 2013; 347:f5334.

U.S. Preventive Services Task Force. Behavioral Counseling to Prevent Skin Cancer. May 2012. http://www.uspreventiveservicestaskforce.org/uspstf/uspsskco.htm.

U.S. Preventive Services Task Force. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women. December 2013. http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrgen.htm.

U.S. Preventive Services Task Force. Screening for Breast Cancer. November 2009. http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm.

U.S. Preventive Services Task Force. Screening for Colorectal Cancer. October 2008. http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm.

U.S. Preventive Services Task Force. Screening for Lung Cancer. December 2013. http://www.uspreventiveservicestaskforce.org/uspstf/uspslung.htm.

Cholesterol/Lipids:

National Cholesterol Education Program (NECP). Third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel III). 2002. http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm.

U.S. Preventive Services Task Force. Screening for Lipid Disorders in Adults. June 2008. http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm.

Preventive Health Services:

American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 518: Intimate partner violence. Obstet Gynecol. 2012; 119(2 Pt 1):412-417.

American Heart Association. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2011 Update. Circulation. 2011; 123(11):1243-1262. http://circ.ahajournals.org/cgi/reprint/CIR.0b013e31820faaf8.

U.S. Preventive Services Task Force. Screening for Hepatitis C Virus Infection in Adults. June 2013. http://www.uspreventiveservicestaskforce.org/uspstf/uspshepc.htm.

U.S. Preventive Services Task Force. Screening for Impaired Visual Acuity in Older Adults. July 2009. http://www.uspreventiveservicestaskforce.org/uspstf/uspsviseld.htm.

U.S. Preventive Services Task Force. Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults. January 2013. http://www.uspreventiveservicestaskforce.org/uspstf/uspsipv.htm.

U.S. Preventive Services Task Force. Screening for Osteoporosis. January 2011. http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm.

Wegwarth O, Schwartz LM, Woloshin S, et al. Do physicians understand cancer screening statistics? A national survey of primary care physicians in the United States. Ann Intern Med. 2012; 156(5):340-349.

Tobacco, Alcohol, and Other Drugs:

U.S. Preventive Services Task Force. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse. June 2013. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrin.htm.

Rationale

Multiple government and medical professional organizations have developed guidelines for the provision of preventive health care. Included in this document are guidelines for preventive health care which have been reviewed and found to be credible with the understanding that there may be differences in recommendation among the various bodies.

Cervical Cancer Screening

Human papilloma virus (HPV) is a virus spread by sex and causes an infection in the cervix. The infections are acquired by young women shortly after initiation of vaginal intercourse. The infection is usually self-limiting due to the body's ability to fight the infection and is usually cleared by the immune system within 1-2 years without producing neoplastic changes. There are no symptoms of HPV and most people will never know if they have HPV. If the HPV doesn't go away it can cause the cervix cells to change and become precancerous. Most of the precancerous cells return to normal on their own. If the precancerous cells are not found and treated, they can turn into cancer, but very few HPV infections lead to cervical cancer. There is a test for HPV called the HPV test. HPV infections consistently show a high prevalence in sexually active teenagers and peak in the third decade of life. For this reason the HPV test can be done at the same time as a Pap test for women age 30 or older. Because most women who have HPV do not get cervical cancer and very few HPV infections lead to cervical cancer, some women may not wish to know if they have HPV.

Colorectal Cancer Screening

Current recommendations regarding colorectal cancer screening from various organizations differ. The two major recommendations come from the 2008 joint panel of the American Cancer Society (ACS), the US Multi Society Task Force (USMSTF) on Colorectal Cancer, and the American College of Radiology (ACR) and from the 2008 updated recommendation from the U.S. Preventive Services Task Force (USPSTF). These recommendations have been either adopted or amended. See the following documents for certain tests: RAD.00029 CT Colonography (Virtual Colonoscopy) as a Screening or Diagnostic Test for Colorectal Cancer, and GENE.00008 Analysis of Fecal DNA for Colorectal Cancer Screening and Surveillance.

The American Cancer Society (ACS), the US Multi Society Task Force (USMSTF) on Colorectal Cancer, and the American College of Radiology (ACR) consensus guidelines for the screening and surveillance for the early detection of colorectal cancer (CRC) and adenomatous polyps in asymptomatic adults aged 50 years or older recommend the following testing strategies: (1) flexible sigmoidoscopy every 5 years, or (2) colonoscopy every 10 years, or (3) double-contrast barium enema every 5 years, or (4) computed tomographic colonography (CTC) every 5 years. Testing options for tests that primarily detect cancer include (1) annual guaiac-based fecal occult blood test with high test sensitivity for cancer, or (2) annual fecal immunochemical test with high test sensitivity for cancer, or (3) stool DNA (sDNA) test with high sensitivity for cancer, interval uncertain.

The USPSTF published updated recommendations on Screening for Colorectal Cancer (October 2008). These recommendations do not apply to individuals with specific inherited syndromes (Lynch Syndrome or Familial Adenomatous Polyposis) or those with inflammatory bowel disease. The recommendations include: (1) Adults age 50 to 75 be screened for colorectal cancer using annual high-sensitivity fecal occult blood testing, sigmoidoscopy every five years with high-sensitivity fecal occult blood testing every 3 years, or screening colonoscopy every 10 years. (2) Routine colorectal cancer screening in adults age 76 to 85 years is not recommended because the benefits of regular screening were small compared with the risks. There may be considerations that support colorectal cancer screening in an individual. (3) Adults over the age of 85 years should not be screened at all because the harms of screening may be significant, and other conditions may be more likely to affect their health or well-being. The USPSTF found insufficient evidence to assess the benefits and harms of computed tomographic colonography (CTC) and fecal DNA testing as screening methods for the disease. In its previous recommendation, the USPSTF recommended screening for colorectal cancer, but noted that evidence was insufficient to recommend one screening method over another. In addition, the USPSTF did not previously indicate age that people should stop being screened for colorectal cancer. While the updated USPSTF recommendations were reviewed, the use of colonoscopy, CTC and fecal DNA testing, are addressed in CG-SURG-01 Colonoscopy, RAD.00029 CT Colonography (Virtual Colonoscopy) as a Screening or Diagnostic Test for Colorectal Cancer, and GENE.00008 Analysis of Fecal DNA for Colorectal Cancer Screening and Surveillance, which take precedence.

The major differences between these two recommendations are that the ACS/USMSTF/ACR recommendation regarding routine use of sDNA and CTC screening whereas the USPSTF did not recommend those tests on a routine basis. Based in part on these conflicting recommendations, two documents have been developed, GENE.00008 Analysis of Fecal DNA for Colorectal Cancer Screening and Surveillance and RAD.00029 CT Colonography (Virtual Colonoscopy) as a Screening or Diagnostic Test for Colorectal Cancer. Detailed discussion regarding the coverage position and rationale are addressed in those specific documents.

Epidemiologic and Statistical Considerations

Wegwarth (2012) published the results of a survey on primary care physician understanding of screening statistics. This study revealed a low rate of understanding the important statistical considerations when considering the impact of screening services and emphasized the potential for the wrong data to lead to erroneous conclusions. The authors used clinical scenarios and online surveys to evaluate the issues of lead-time bias and overdiagnosis.

Lead-time bias occurs when a condition is detected early, but the outcome is unchanged. In this case, a comparison of survival after diagnosis would seemingly favor those individuals diagnosed earlier, even though there was no actual difference in survival. The authors used the example of a cancer which began at some undefined age (earlier than 60) and was detected at age 67 with uniform mortality by age 70. The 5 year survival from symptom-based diagnosis was 0%. If screening were introduced at age 60, the cancer would be present and detected. These individuals also succumbed to the illness at age 70; however the apparent 5 year survival was now 100%. Since both groups died at age 70, there was no survival benefit from screening since both groups had 100% mortality at age 70. This example demonstrates the importance in considering absolute survival, which can only be determined through randomized controlled trials comparing screened to unscreened groups.

Overdiagnosis is the concept that some cancers detected at screening do not progress or the individual affected succumbs to an alternative illness and the cancer detected had no impact on survival. In this example, the authors used a hypothetical population in which symptom-based diagnoses resulted in a 40% five year survival. In a population of 1000 individuals, 600 individuals would have died at 5 years from the cancer. An artificially high rate of overdiagnosis was used to emphasize the point. In their example, 2000 additional cases were identified which were overdiagnosed. Since these were overdiagnosed, at 5 years of the 3000 total, 2400 would be alive with a 5 year survival rate of 80% (2400/3000). However, in both scenarios, 600 deaths would have occurred. In general, the overdiagnosis risk is much smaller, but nevertheless a real concern when large groups of asymptomatic individuals are screened.

Cancer screening can lead to harm as well as benefit. Harm related to screening can be somatic or psychosocial. Harm can result from the screening test itself, from investigations because of false positive findings, and from overdiagnosis with subsequent overtreatment. A literature review by Heleno and colleagues (2013) assessed how often harm is quantified in randomized trials of cancer screening. In their search for studies, the authors included seven types of harms related to cancer screening: overdiagnosis, false positive findings, somatic complications caused by screening or follow-up procedures, negative psychosocial consequences caused by screening test or follow-up procedures, the additional number of participants subjected to invasive procedures, all cause mortality, and withdrawals because of adverse events. A total of 4,590 articles were identified with 57 of them having published results that met inclusion criteria. The 57 trials assessed ten different screening interventions. Overall the authors found that cancer specific mortality and cancer specific incidence were quantified more than harm-related outcomes. From the 57 screening trials, 7% quantified overdiagnosis, 4% quantified false positive results, 9% reported negative psychosocial consequences, 11% quantified somatic complications, 47% reported the use of invasive follow-up procedures, 34% quantified all-cause mortality, and one trial (2%) reported the number of withdrawals due to harmful events. The effect of cancer screening on cancer specific mortality was reported in 89% of trials.

There are many considerations when deciding whether or not to screen for cancer or any other disease. The screening test characteristics (predictive value), the utility of screening (is there an effective treatment available), and the harm of the treatment (does the treatment result in more deaths than waiting for symptoms to occur). These clinical considerations are addressed between the individual and physician. To accurately educate the individual about the benefits and harms of screening requires a clear understanding of lead-time bias and overdiagnosis amongst many other considerations.

Index

Cancer Detection
Childhood Obesity
Group B Streptococcal
Hep A
Hep B
Hepatitis A
Hepatitis B
Hepatitis C
HIV
HPV
Human Papilloma Virus
Intimate Partner Violence
Lead Screening
Lyme Disease
Pregnancy
Substance Abuse
Tobacco
Ultraviolet Radiation

The use of specific product names is illustrative only.  It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

Document History
StatusDateAction
Revised05/15/2014Medical Policy & Technology Assessment Committee (MPTAC) review. Updated ACOG Practice Bulletin Gestational Diabetes Mellitus, 2013. Added USPSTF recommendation for Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women, 2013; added USPSTF recommendation Gestational Diabetes Mellitus, 2014; added USPSTF recommendation Screening for Lung Cancer, 2013. Updated Rationale.
Revised11/14/2013MPTAC review. Added USPSTF recommendation Primary Care Interventions to Prevent Tobacco Use in Children and Adolescents, 2013.
Revised08/08/2013MPTAC review. Added USPSTF recommendation Screening for HIV, 2013; added USPSTF recommendation for Hepatitis C screening in adults, 2013; added USPSTF recommendation Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse, 2013.
Revised05/09/2013MPTAC review. Added USPSTF Screening for Intimate Partner Violence and Abuse of Elderly and Vulnerable Adults, 2013. Updated Index.
Revised02/14/2013MPTAC review. Updated USPSTF Guide to Preventive Clinical Services, 2012. Added American Academy of Pediatrics Policy Statement—Ultraviolet Radiation: A Hazard to Children and Adolescents, 2011. Added USPSTF Behavioral Counseling to Prevent Skin Cancer, 2012. Added ACOG Practice Bulletin Screening for cervical cancer, 2012.
Revised11/08/2012MPTAC review. Added Centers for Disease Control and Prevention Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965, 2012. Updated Index.
Revised05/10/2012MPTAC review. Updated American Cancer Society Guidelines for the Early Detection of Cancer. Added ACOG Practice Bulletin Gestational Diabetes, 2001. Added USPSTF Primary Care Interventions to Promote Breastfeeding Recommendation Statement, 2008. Added ACOG Committee Opinion Intimate partner violence, 2012. Added reference for Epidemiologic and Statistical Considerations. Updated Rationale.
Revised11/17/2011MPTAC review. Removal of Immunizations from References and moved to ADMIN.00007. Updated ACOG Practice Bulletin on Breast Cancer Screening. Removed U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans, U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, Centers for Disease Control and Prevention, Folic Acid and Prevention of Spina Bifida and Anencephaly, American Academy of Pediatrics Council on Sports Medicine and Fitness, Council on School Health. Active healthy living: prevention of childhood obesity through increased physical activity, American Heart Association Dietary recommendations for children and adolescents, and ACS/ADA/AHA Scientific Statement. Preventing Cancer, Cardiovascular Disease, and Diabetes. Updated Index.
Revised08/18/2011MPTAC review. American Academy of Pediatrics Recommendation for Preventive Pediatric Healthcare Reaffirmed January 2011, American Cancer Society Guidelines for the Early Detection of Cancer update.
Revised05/19/2011MPTAC review. Added updated US HHS and USDA Dietary Guidelines for Americans, 2010; CDC Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women. 2010, AHA Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2011 Update.
Revised02/17/2011MPTAC review. Added ACIP Adult and Childhood and Adolescent Immunization Schedules, 2011; CDC updated Sexually Transmitted Diseases Treatment Guidelines, CDC updated Recommendations for Use of Meningococcal Conjugate Vaccines, CDC updated Recommendations for Use of Tdap Vaccine, CDC updated Prevention of Perinatal Group B Streptococcal Disease guidelines, ACIP recommendations for Prevention of Invasive Pneumococcal Disease Among Infants and Children --- Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine and USPSTF updated Screening for Visual Impairment in Children Ages 1 to 5 Years and USPSTF updated Screening for Osteoporosis.
Revised11/18/2010MPTAC review. Added ACIP Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23), ACOG Committee opinion no. 463: Cervical cancer in adolescents: screening, evaluation, and management and AAP Clinical Report--Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age).Updated USPSTF Guide to Clinical Preventive Services, 2010-2011.
Revised08/19/2010MPTAC review. Removed the ACIP provisional HPV recommendations and replaced with the official published recommendations in the MMWR. Added ACIP Recommendations for Prevention and Control of Influenza with Vaccines.
Revised05/13/2010MPTAC review. Added ACIP Provisional Recommendations for the Use of Influenza Vaccines and Licensure of a 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and Recommendations for Use Among Children --- ACIP.
Revised02/25/2010MPTAC review. Added ACIP Adult and Childhood and Adolescent Immunization Schedules, 2010; ACIP Provisional Recommendations for HPV Vaccine, ACOG Practice Bulletin on Cervical Cytology Screening and USPSTF recommendations for Screening for Obesity in Children and Adolescents. Recommendations reviewed and updated as indicated.
Reviewed11/19/2009MPTAC review. Added USPSTF recommendations for Screening for Breast Cancer, Screening of Infants for Hyperbilirubinemia and Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment. Added ACIP provisional recommendation for Use of Combination Vaccines. Recommendations reviewed and updated as indicated.
Reviewed08/27/2009MPTAC review. Added USPSTF updated recommendation for Folic Acid for the Prevention of Neural Tube Defects and Screening for Impaired Visual Acuity in Older Adults. Added ACIP recommendations for Prevention and Control of Seasonal Influenza with Vaccines and Use of Influenza A (H1N1).  Added ACIP Resolutions for Measles, Mumps, Rubella, and Varicella, Meningococcal Disease, and Poliomyelitis.
Reviewed05/21/2009MPTAC review. Added ACIP provisional recommendation for the 2009-2010 influenza season, the U.S. HHS 2008 Physical Activity Guidelines for Americans and Dietary Guidelines for Americans, 2005. Recommendations reviewed and updated as indicated.
Reviewed02/26/2009MPTAC review. Added ACIP resolution for Use of Pneumococcal Vaccines. Recommendations reviewed and updated as indicated.
 Reviewed11/20/2008MPTAC review. Added USPSTF updated recommendation on Screening for Lipid Disorders in Adults and USPSTF updated recommendation on Screening for Colorectal Cancer Screening. Websites reviewed and updated.
Reviewed08/28/2008MPTAC review. Added USPSTF recommendation on Screening for Prostate Cancer, Treating Tobacco Use and Dependence: 2008 Update, and USPSTF recommendation on universal screening hearing loss in newborns. Updated Influenza and Rotavirus recommendations. Websites reviewed and updated.
Reviewed06/04/2008Added USPSTF recommendation on screening for type 2 diabetes in adults. Effective June 2008. Removed American Medical Association. Improving Colorectal Cancer: Screening reference – no longer available.
Reviewed05/15/2008MPTAC review. Added rationale on colorectal cancer screening and ACIP recommendation on Prevention of Pertussis, Tetanus, and Diphtheria Among Pregnant and Postpartum Women and Their Infants and Prevention of Herpes Zoster.
Reviewed03/03/2008Added ACIP resolution on influenza, adopted February 27, 2008 and effective July 1, 2008.
Revised02/21/2008MPTAC review. Clarified position statement for updating effective date for updated recommendations. Recommendations reviewed and updated.
Revised11/29/2007MPTAC review. ACIP resolutions for Meningococcus and Influenza Vaccines added. Websites reviewed and updated.
Revised08/23/2007MPTAC review. CDC guide on Screening Young Children for Lead Poisoning and CDC recommendation for varicella prevention added. Websites reviewed and updated.
Revised05/17/2007MPTAC review. Added AHA recommendation for Cardiovascular Disease Prevention in Women. Updated ACOG Committee Opinion on Primary and Preventive Care. Websites reviewed and updated.
Reviewed03/12/2007Provisional recommendation for Quadrivalent Human Papillomavirus Vaccine updated. 
Reviewed01/05/2007The link for the 2007 Childhood and Adolescent Immunization Schedule and the link for the Recommendations for the Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine updated.
Revised12/07/2006MPTAC review.  Recommendations for childhood obesity, HIV testing, prenatal care, hepatitis B, rotavirus, and "shingles" vaccination added.  Websites reviewed and updated.
Revised09/14/2006MPTAC review. Websites updated for HPV, Rotavirus, Mumps, Pertussis and Varicella Vaccines.
Reviewed06/08/2006MPTAC review. Websites updated.
Revised07/14/2005MPTAC review. Revision based on Policy Harmonization: Pre-merger Anthem and Pre-merger WellPoint.