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National Center for Immunization & Respiratory Diseases
Immunization –Accomplishments and Challenges, 2017
Cindy Weinbaum MD MPH
Acting Director, Immunization Services Division
Texas Immunization Conference
San Antonio, Texas
November 28-30, 2017
SmallpoxPolio
DiphtheriaPertussisTetanusMeasles
1964 (6)Polio
DiphtheriaPertussisTetanusMeaslesRubellaMumps
1985 (7)
Polio
Diphtheria
Pertussis
Tetanus
Measles
Rubella
Mumps
Hib (infant)
HepB
HepA
Varicella
Pneumococcal
Influenza
Meningococcal
Rotavirus
HPV
PolioDiphtheriaPertussisTetanusMeaslesRubellaMumps
Hib (infant)HepB
Varicella
1995 (10)2017 (16)
Polio
Diphtheria
Pertussis
Tetanus
Measles
Rubella
Mumps
Hib (infant)
HepB
HepA
Varicella
Pneumococcal
Influenza
Meningococcal
Rotavirus
HPV
Number of Diseases Prevented by Vaccines Included in the Routine Child/Adolescent Immunization Schedule
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CDC estimates that vaccination of children born between 1994 and 2016:
▪ Prevent 381 million illnesses
▪ Prevent 24.5 million hospitalizations
▪ Help avoid 855,000 early deaths
▪ Save nearly $360 billion in direct costs and $1.65 trillion in total society costs
▪ Every dollar spent in childhood vaccination ultimately saves $10.10.
Childhood Immunization Provides Big SavingsVaccines for Children: 23 years of protecting America’s children
Updated March 2017 from previous article: Benefits from Immunization During the Vaccines for Children Program Era – United States, 1994-2013. MMWR. 25 April 2014
Comparison of 20th Century Annual Morbidity and Current Morbidity: Vaccine-Preventable Diseases
Disease
20th Century
Annual Morbidity†
2016
Reported Cases † †
Percent
Decrease
Smallpox 29,005 0 100%
Diphtheria 21,053 0 100%
Measles 530,217 85 > 99%
Mumps 162,344 6,369 96%
Pertussis 200,752 17,972 91%
Polio (paralytic) 16,316 0 100%
Rubella 47,745 1 > 99%
Congenital Rubella Syndrome 152 2 99%
Tetanus 580 34 94%
Haemophilus influenzae 20,000 30* > 99%
† JAMA. 2007;298(18):2155-2163
† † Centers for Disease Control and Prevention. National Notifiable Diseases Surveillance System, 2016 Annual Tables of Infectious Disease
Data. Atlanta, GA. Available at: www.cdc.gov/nndss/infectious-tables.html. NNDSS finalized annual data as of October 17, 2017.
* Haemophilus influenzae type b (Hib) < 5 years of age. An additional 9 cases of Hib are estimated to have occurred among the 187
notifications of Hi (< 5 years of age) with unknown serotype.
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Nationally, childhood immunization coverage is high and stable
Vaccine Coverage among Children 19-35 Months, National Immunization Survey, United States, 1994-2016
Hill HA, Elam-Evans LD, Yankey D, Singleton JA, Kang Y. Vaccination Coverage Among Children Aged 19–35 Months — United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:1171–1177
0
10
20
30
40
50
60
70
80
90
100
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
Pe
rce
nt
Vac
cin
ate
d
Year
MMR (1+)
DTP/DTaP (3+)
Polio (3+)
Hib (3+)
HepB (3+)
Varicella (1+)
PCV (4+)
Rotavirus
HepA (2+)
3+HepB
1+ Varicella4+ PCV 2+ HepA
Rotavirus
<1% of toddlers had received no vaccines
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≥1 dose MMR Vaccination Coverage, Age 19-35 Months, 2016
Source: National Immunization Surveys 1996 - 2017; Available from: https://www.cdc.gov/vaccines/vaxview/index.html.Abbreviations: MMR = measles, mumps, and rubella vaccine.
TexasUS median
, 2016
0
10
20
30
40
50
60
70
80
90
100
2011-12 2012-13 2013-14 2014-15 2015-16 2016-17
Perc
ent
Median MMR Coverage Median Exemption from Any Required Vaccination
Source: School Vaccination Assessment Program, 2011-12, 2012-13, 2013-14, 2014-15, 2015-16, and 2016-17; Available from: https://www.cdc.gov/vaccines/vaxview/index.html.Abbreviations: MMR = measles, mumps, and rubella vaccine.
Median and Range of Measles, Mumps, and Rubella Vaccine (MMR) Coverage, and Exemptions from Any Required Vaccination among KindergartnersUnited States, 2011-12 to 2016-17 School Years
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Source: School Vaccination Assessment Program, 2011-12, 2012-13, 2013-14, 2014-15, 2015-16, and 2016-17; Available from: https://www.cdc.gov/vaccines/vaxview/index.html.Abbreviations: MMR = measles, mumps, and rubella vaccine.
TexasUS median
School Assessment: MMR Vaccination among kindergartnersCoverage for 2016-17
Conclusions:There was an increase in nonmedical exemption rates through the 2012–2013 school year; however, rates stabilized through the 2015–2016 school year, showing an important shift in trend.
Saad B Omer, Rachael M Porter, Kristen Allen, Daniel A Salmon, Robert A Bednarczyk. Trends in Kindergarten Rates of Vaccine Exemption and State-Level Policy, 2011–2016. Open Forum Infectious Diseases. 15 November 2017
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Nationally, disparities in childhood vaccination by race and income level persist
Vaccination Coverage by Race/Ethnicity, NIS-Child, United States, 2016
Vaccine NH Black Hispanic Asian AI/AN NHOPI Multiracial
3+ DTaP
4+DTaP
3+ Polio
1+ MMR
Hib-PS
Hib-FS
3+ HepB
HepB birth dose
1+ Varicella
3+ PCV
4+ PCV
2+ HepA
Rotavirus
4:3:1:3*:3:1:4
= Significantly higher coverage estimate relative to that for Non-Hispanic White (p < 0.05)
= Significantly lower coverage estimate relative to that for Non-Hispanic White (p < 0.05)
Comparison group is Non-Hispanic White
MMWR Morb Mortal Wkly Rep 2017;66:1171–1177
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Vaccination Coverage by Poverty Level, NIS-Child, United States, 2016
Vaccine Below Poverty Level Percentage Point Difference
3+ DTaP 3.0
4+DTaP 5.9
3+ Polio
1+ MMR 3.1
Hib-PS 3.5
Hib-FS 6.2
3+ HepB
HepB (birth dose) 4.8
1+ Varicella
3+ PCV 3.1
4+ PCV 7.4
2+ HepA 5.0
Rotavirus 12.7
4:3:1:3*:3:1:4 6.5
Comparison group is At or Above Poverty Level = Significantly higher coverage estimate relative to that for At or Above Poverty Level (p < 0.05) = Significantly lower coverage estimate relative to that for At or Above Poverty Level (p < 0.05)
MMWR Morb Mortal Wkly Rep 2017;66:1171–1177
Vaccination Coverage by Insurance Status, NIS-Child, United States, 2016
VaccineAny Medicaid
(n=5,757)
Other Insurance
(n=567)
Uninsured
(n=380)
3+ DTaP (3.4) (15.7)
4+DTaP (6.1) (24.1)
3+ Polio (2.5) (14.2)
1+ MMR (3.0) (15.8)
Hib-PS (4.2) (17.3)
Hib-FS (5.9) (24.0)
3+ HepB (12.4)
HepB birth dose (6.3)
1+ Varicella (2.5) (16.4)
3+ PCV (3.6) (14.8)
4+ PCV (8.5) (24.9)
2+ HepA (20.1)
Rotavirus (12.0) (20.8)
4:3:1:3*:3:1:4 (6.8) (23.9)
No vaccinations (2.8)
Comparison group is Private Insurance Only (n=8,284)
= Significantly higher coverage estimate relative to that for Private Insurance Only (p < 0.05)
= Significantly lower coverage estimate relative to that for Private Insurance Only (p < 0.05)
MMWR Morb Mortal Wkly Rep 2017;66:1171–1177
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Mumps outbreaks continue to occur
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From January 1 to November 4, 2017, 47 states* and the District of Columbia in the U.S. reported mumps infections in 4,980** people to CDC.
*AL,AK, AZ, AR, CA, CO, CT, DC, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NM, NV, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, UT, VA, VT, WA, and WI**Preliminary data reported to CDC. Mumps outbreaks are not reportable.
https://www.cdc.gov/mumps/outbreaks.html
https://www.cdc.gov/mumps/outbreaks.html
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Adult immunization rates have plateaued
Estimated proportion of adults aged ≥19 years who received selected vaccines, by age group and increased risk status — National Health Interview Survey, United States, 2010–2015
Williams WW, Lu P, O’Halloran A, et al. Surveillance of Vaccination Coverage among Adult Populations — United States, 2015. MMWR Surveill Summ 2017;66(No. SS-11):1–28.
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Pneumococcal Vaccination Coverage, Age 18-64 years at increased risk Texas and US median, 2008-2015
TexasUS median
, 2015
TX
▪ Racial/ethnic differences persisted for all seven vaccines assessed– widened for pneumococcal and herpes zoster
▪ Non-Hispanic black and Hispanic health care personnel had lower coverage than white HCP for influenza, Tdap, and HepB vaccinations.
Williams WW, Lu P, O’Halloran A, et al. Surveillance of Vaccination Coverage among Adult Populations — United States, 2015. MMWR Surveill Summ 2017;66(No. SS-11):1–28.
Racial/Ethnic Vaccination Disparities -- NHIS 2015
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▪ 89% surveyed adults reported health insurance coverage
▪ Immunization coverage 2-5 times higher for persons with health insurance for influenza, Tdap, herpes zoster, and HPV
▪ Even among insured persons with >10 physician contacts in past 12 months, 18.2%–85.6% missing a recommended vaccine
Williams WW, Lu P, O’Halloran A, et al. Surveillance of Vaccination Coverage among Adult Populations — United States, 2015. MMWR Surveill Summ 2017;66(No. SS-11):1–28.
Association of Health Insurance Status and Usual Place of Health Care with Vaccination Coverage, 2015 NHIS
BUT…Partnerships and collaborations increase adult immunization
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Accomplishments:
• Strong connections with 10 pharmacists• Working on pharmacy access to IIS to record adult immunizations
• Completed 281 adult AFIX visits
Challenge:
• IIS purges immunization records at age 26yo
Texas Adult Immunization Project
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IT systems are improving
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Number and percentage of Vaccines for Children program provider sites enrolled and participating in an Immunization Information System (IIS), by year —IIS Annual Report, United States, 2013–2016
Murthy N, Rodgers L, Pabst L, Fiebelkorn AP, Ng T. Progress in Childhood Vaccination Data in Immunization Information Systems —United States, 2013–2016. MMWR Morb Mortal Wkly Rep 2017;66:1178–1181
Percentage of Immunization Information Systems (IISs) with unidirectional and bidirectional information exchange functionality — United States, 2013–2016
Murthy N, Rodgers L, Pabst L, Fiebelkorn AP, Ng T. Progress in Childhood Vaccination Data in Immunization Information Systems —United States, 2013–2016. MMWR Morb Mortal Wkly Rep 2017;66:1178–1181
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Old school
Scanner
How do you like to
get your information
off the vaccine vial or
syringe?
Modernizing Immunization Practices: 2D barcodes
New recommendations from the ACIP
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FDA approves new 2-dose hepatitis B vaccine for adults
Want to See Experts Answering Questions?
www.vaccinateyourbaby.org/faq
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Resources for Parents
www.cdc.gov/vaccines/partners/childhood/multimedia.html
For more information, contact CDC1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.
Thank you!
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10 Years of HPV Vaccination
0
10
20
30
40
50
60
70
80
90
100
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Pe
rcen
t V
acci
nat
ed
Survey Year
Tdap
MCV4
1 HPV girls
3 HPV girls
1 HPV boys
3 HPV boys
1 HPV girls &boys
88.0
82.2
65.1
56.0
43.0
31.5
60.4
*Source Walker, et al. MMWR; August 25, 2017 / 66(33);874–882
Number of HPV-Attributable Cancers Averted over 100 Years of 9-Valent HPV Vaccination Program
Estimates calculated using published model (Chesson et al, Hum Vaccin Immunother 2016), with modified coverage assumptions. Coverage levels shown (39.7%, 21.6%, and 80%) refer to coverage among ages 13-17. For females, the annual probability of vaccination in the current coverage scenario was modeled as 20.9% for age 12, 8.9% for ages 13 to 18, and 0.89% for ages 19 to 26. For males, these values were 10.5%, 4.4%, and 0.44% (through age 21), respectively. In the 80% coverage scenario, the annual probability of vaccination was 73.8% for age 12, 8.9% for ages 13 to 18, and 0.89% for those 19 and older (through age 21 for men and age 26 for women).
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
HPV cancers averted total (excluding herd immunity) HPV cancers averted total
Nu
mb
er o
f H
PV
-att
rib
uta
ble
can
cers
ave
rted
2014 coverage (Females 39.7%, Males 21.6%)
Higher male and female coverage (80%)
709,000
1.23 million
Total US population
1.56 million
1.27 million
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How do we Communicate with Parents about Vaccines?
Completion of vaccination series by age, National Immunization Survey-Kindergarten (Oct, 2013 – Mar, 2014)
Smith et al. Vaccine. 2017;35:5346-5351.
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