Vaccination in adults: should it be systematic or 'a la carte'?

In developed countries, through more and more personalized, vaccination in newborns and young infants is governed by immunization schedules implemente d by the various states. 'Basic' vaccines must be administered and their ad ministration can only be systematic with respect to compliance with the imm unization schedule. To maintain protection in teenagers and adults, the imm unization schedule recommends systematic booster injections. To provide bet ter immunization in adults, 'a la carte vaccination' has also been proposed , i.e., vaccination as a function of need rather than a function of the imm unization schedule. As acquired immunity may sometimes be rapidly lost, a b ooster injection may have to be prescribed earlier than the foreseen date. On the contrary, hyperimmunization with potential complications may be obse rved if the immunization schedule is followed. As the various specific anti body titers may be easily assessed using current assay procedures, physicia ns could thus prescribe, during routine visits, immunoassays according to t he patient's age and history, and possibly advocate a booster injection. Ei ther personalizing booster injections in adults, while preserving - and no doubt improving - immunization in the community, or conforming to a strict immunization schedule identical from one individual to the other - is the c hoice that we must consider, beginning today.