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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

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94

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97

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99

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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

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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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