Tony Aragon, MSEpidemiologistImmunization BranchMay 20, 2010

Vaccine Coverage

Vaccine CoverageObjectiveExplain the differences between the different vaccination coverage levels for children, adolescents, and adults

Review National and State SurveysData collectedWhat is measuredAgesArea When

Current Immunization Data Sources

SurveyData collectedAgesAreaWhenNIS Children(CDC)Dates of vaccinations, race/ethnicity, other, demographics19-35 monthsTexas, Dallas County, El Paso County, City of Houston, and Bexar County Annually (Summer)NIS Teens(CDC)Dates of vaccinations race/ethnicity, other, demographics13-17 yrsUnited StatesAnnuallyTCRISS(DSHS)Dates of vaccinations, total enrollment of school, exemption dataKindergarten studentsCounty levelOngoingTexas School Immunization Validation Survey(DSHS)Dates of vaccinations, total enrollment of school, exemption dataStatewide sample of kindergarten and 7th Grade studentsState of TexasAnnually(Fall)Child Care Assessment(DSHS)Dates of vaccinations, total enrollment of Child care facility, exemption data19-59 monthsLicensed childcare facilitiesAnnually(Fall)BRFSS(CDC)Vaccination rates, race ethnicity, other demographicsAdults 18 and overUS and StatewideAnnuallyTexas Annual School ReportVaccination rates, exemption dataKindergarten and 7thGrade studentsCounty Level and State LevelAnnually(Fall)

Vaccine Coverage....OutlineSurveysNational Immunization Survey (NIS)Texas County Retrospective Immunization School Survey (TCRISS)Texas School Immunization Validation SurveyTexas Childcare Immunization AssessmentThe Annual Survey of Immunization StatusThe Behavioral Risk Factor Surveillance System (BRFSS)

Vaccine Coverage for Children2008 National Immunization Survey (NIS)Texas County Retrospective Immunization School Survey (TCRISS)2008-09 Annual Report of Immunization Status2007 Texas School Immunization Validation Survey2007 Texas Childcare Immunization Assessment

Vaccine Coverage for ChildrenNational Immunization Survey (NIS)Provides vaccination coverage levels of children aged 19 35 monthsProvides immunization coverage by state, select local areas as well as the nation Bexar Co.City of HoustonDallas Co.El Paso Co.Provides a national standard for vaccine coverage 2008 4:3:1:3:3:1 vaccines series 2009 - 4:3:1:3:3:1:4, pneumococcal conjugate vaccine will be added.

4:3:1:3:3:1* Estimated Vaccination Coverage Levels in Children 19-35 Months, US and Texas, NIS 2002-2008

*4:3:1:3:3:1 4+ doses DTP, 3+ doses Polio, 1+ dose MMR, 3+ doses of Hib, 3+ doses Hep B, and 1+ doses of varicella

Chart1

6565.5

69.872.5

69.376

76.876.1

74.777

77.377.4

77.876.1

Texas

US

NIS Year

Estimated Coverage (%)

Sheet1

2002200320042005200620072008

Texas6569.869.376.874.777.377.8

US65.572.57676.17777.476.1

Estimated Vaccination Coverage Levels in Children19-35 Months by State and Local Area, NIS 2008*

*Based on 2008 US NIS Report (Q1/2008-Q4/2008)

Chart1

7670.9

7264.1

74.269

74.966.8

79.872.1

77.870.5

76.168.4

4:3:1:3:3:1

4:3:1:3:3:1:4

Estimated Coverage (%)

Sheet1

Bexar CoCity of HoustonDallas CoEl Paso CoRest of StateTXUS

4:3:1:3:3:1767274.274.979.877.876.1

4:3:1:3:3:1:470.964.16966.872.170.568.4

Vaccine Coverage for ChildrenTexas County Retrospective Immunization School Survey (TCRISS)Provides county level estimates of vaccination coverageSchool-based study that measures vaccination coverage levels of kg retrospectively at 24 months Measures Hep A vaccine, prospectivelyFulfills a need for county specific vaccination coverage level estimates

Vaccine Coverage for Children2008-09 Annual Report of Immunization Status

Texas requires a report of immunization status annually from public schools and accredited private schools Texas Administrative Code,Title 25 Health Services, 97.61-97.72

The Annual Report of Immunization Status is a self report survey

Used to measure immunization coverage among students entering kindergarten and middle school (7th grade)

Percent of Texas Kindergarten Students Completely Vaccinated by Vaccine Antigen, 2008-09 Annual Report of Immunization Status

Chart1

97.3

97.5

97.9

97.5

97.1

97.8

96.4

98.1

% Vaccinated

Sheet1

DTP/DTaPHep BMeasles 1Measles 2MumpsPolioRubellavaricella

200797.397.597.997.597.197.896.498.1

Vaccine Coverage for Children2007 Texas School Immunization Validation Survey

Conducted annually to validate the results of the Annual Report of Immunization Status

70 public schools with kindergarteners and seventy schools with 7th graders are randomly selected statewide

Statewide vaccination coverage levels are available for Kindergarten and 7th grade students attending public school in Texas

Estimated Coverage Levels of Students in Texas Public School for Kindergarten Students, 2007 Texas School Immunization Validation Survey

Vaccine RequirementPercent of Students VaccinatedKindergartenDiphtheria, Tetanus, Pertussis Vaccine (DTP, DTaP, DT)94.3Polio Vaccine (OPV or IPV)94.8Measles, Mumps, Rubella (MMR) vaccine 1st dose99.8MMR (or measles) vaccine 2nd dose98.2Varicella Vaccine98.1Hepatitis B vaccine98.0

Vaccine Coverage for Children2007 Texas Childcare Immunization Assessment Conducted biennially to assess vaccination coverage levels of children attending a childcare facility Used to monitor compliance vaccine requirements at licensed child care centers (LCCC) and registered child care homes (RCCH) in TexasApproximately 2400 children from approximately 120 child-care facilities per HSR are selected and examined for immunizations and their dates of administrationStatewide and regional vaccination coverage levels are estimated for children ages 19 59 months of age attending childcare facilities in Texas

Estimated Vaccination Coverage Levels Among Child Care Attendees by Health Service Region and Texas, 4:3:1:3:3:1* Series, 2007 Texas Childcare Immunization Assessment

Chart1

82.5

81.9

93.7

78.9

83

83.8

83.3

85

82.3

*4:3:1:3:3:1 4+ doses DTP, 3+ doses Polio, 1+ dose MMR, 3+ doses of Hib, 3+ doses Hep B, and 1+ doses of varicella

2007

% Vaccinated

Sheet1

12/34/5N6/5S789/1011State

200782.581.993.778.98383.883.38582.3

Vaccination Coverage Level Estimates Among Child Care Attendees by HSR and Texas, 4 Doses of DTaP 2007 Texas Childcare Immunization Assessment

Vaccination Coverage for Adolescents2008 NIS-Teen Survey2007 Texas School Immunization Validation 2008-09 Annual Report of Immunization Status

Vaccine Coverage for AdolescentsNational Immunization Survey (NIS)-Teen

Provides an on-going, consistent data set for analyzing vaccination levels among adolescents 13 to 17 years old

The NIS-Teen provides national, state, and selected area estimates of vaccination coverageBexar Co.City of HoustonRest of State

Provides a national standard for vaccine coverage among adolescents

Estimated Vaccination Coverage Among Adolescents 13-17 Years of Age, 2008 National Immunization Survey-Teen

Chart1

72.279.3

40.840.8

41.837.4

37.231.6

17.99.7

US

TX

Vaccines

% Vaccinated

Sheet1

1 Td or Tdap 1 Tdap 1 MCV4 1 HPV4 3 doses HPV4

US72.240.841.837.217.9

TX79.340.837.431.69.7

Estimated Vaccine Coverage Level in Texas Public School for 7th Grade Students, 2007 Texas School Immunization Validation Survey

Vaccine Requirement*% of 7th Grade Students VaccinatedDiphtheria, Tetanus, Pertussis Vaccine (DTP, DTaP, Tdap, or Td)97.1Polio Vaccine (OPV or IPV)92.4Measles, Mumps, Rubella (MMR) vaccine 1st dose94.4MMR (or measles) vaccine 2nd dose93.4Varicella Vaccine96.2Hepatitis B vaccine98.2

Percent of 7th Grade Students Completely Vaccinated with Individual Vaccine by Health Service Region, 2008-09 Annual Report of Immunization Status

HSRTdapHepatitis BMMRPolioVaricella136.5%99.6%99.7%99.3%99.7%247.9%99.5%99.5%99.6%99.5%372.3%98.9%98.8%99.0%98.9%455.0%99.6%99.5%99.6%99.6%572.6%99.5%99.5%98.7%93.4%657.8%99.2%99.2%99.1%99.1%753.8%99.1%90.4%99.2%99.1%874.1%99.3%99.3%99.4%99.4%955.7%99.6%99.7%99.8%99.7%1076.8%99.3%99.6%99.3%99.5%1160.2%99.5%99.7%99.8%99.8%

Vaccination Coverage for AdultsThe Behavioral Risk Factor Surveillance System (BRFSS)

Adult Immunization Data SourcesThe Behavioral Risk Factor Surveillance System (BRFSS)

BRFSS is an ongoing data collection program designed to measure behavioral risk factors in the adult population 18 years of age or older

Provides adult immunization rates onInfluenzaPneumococcal

Flu Vaccine Coverage Level, US & TX BRFSS 2002-2009, 65 Years and Older

Chart1

66.461

69.267.7

67.667.1

63.361.6

67.166.4

70.266.7

69.571.1

067.3

US

TX

Year

% Vaccinated

Sheet1

USTX

200266.461.0

200369.267.7

200467.667.1

200563.361.6

200667.166.4

200770.266.7

200869.571.1

200967.3

Flu Vaccine Coverage Level, US & TX18 Years and Older, BRFSS 2003-2009

Chart1

32.932.5

3333.9

26.827

32.230.9

37.136.4

36.736.1

200938.2

US

TX

Year

% Vaccinated

Sheet1

USTX

200332.932.5

200433.033.9

200526.827.0

200632.230.9

200737.136.4

200836.736.1

200938.2

Pneumonia Shot, US & TX65 Years and Older, BRFSS 2002-2009

Chart1

61.856.9

63.662

63.461.4

63.762.2

6563.7

65.363.4

65.463.9

066

US

TX

Year

Percent Vaccinated

Sheet1

USTX

200261.856.9

200363.662.0

200463.461.4

200563.762.2

200665.063.7

200765.363.4

200865.463.9

20090.066.0

Other Immunization Data

Conscientious ExemptionsConscientious Objections (COs)

Sources for Conscientious Exemption Data

Number of affidavit forms requestedNumber of requestsNumber of children for whom exemptions are requestedNumber of affidavit forms per childZip Code

Number of exemptions reported via school surveys & child-care audits

Yearly Comparison of the Number of Individuals Requesting Conscientious Exemptions, 2004 - 2009

Chart1

3613675975798811203672

29230049762395710151229

35838648262189812641593

372364454665135716171878

33833662275712381794Apr

36631145061210411564May

64666891288015132608Jun

180218771845241035236510Jul

74288972591716912781Aug

450593552106215171678Sep

3516044046749231073Oct

199396357437828460Nov

2004

2005

2006

2008

2009

2009

2010

Month

Number

Sheet1

YearJanFebMarAprMayJunJulAugSepOctNovDec

20043612923583723383666461802742450351199

20053673003863643363116681877889593604396

20065974974824546224509121845725552404357

200757962362166575761288024109171062674437

20088819578981357123810411513352316911517923828

200912031015126416171794156426086510278116781073460

2010672122915931878

2008-09 Annual Report of Immunization Status: Kindergarten Conscientious Exemptions

Kindergarten Conscientious ExemptionsVaccine CategoryNumber(%)DTP/DTaP13830.43Hepatitis B12150.38Measles 112410.38Measles 214070.38Mumps13160.41Polio13680.42Rubella13150.41Varicella12370.38

2008-09 Annual Report of Immunization Status: 7th Grade Conscientious Exemptions

7th Grade Conscientious ExemptionsVaccine CategoryNumber(%)Tdap4310.14Hepatitis B5030.16MMR5160.16Polio4980.16Varicella5280.17

Annual Report of Immunization Status: Total Number of Conscientious Exemptions Reported, School Year 2003-2008

SchoolYearNumber of Students Enrolled with a Conscientious ExemptionPercent of Students Enrolled with a Conscientious Exemption2003-042,3140.08%2004-052,7220.09%2005-066,9910.15%2006-079,6060.21%2007-0810,4040.23%2008-0912,6330.28%

Annual School Report: Total Number of Conscientious Exemptions Reported, School Year 2003-2008

Chart1

2314

2722

6991

9606

10404

12633

Year

Number of Exemptions

Sheet1

200320042005200620072008

23142722699196061040412633

Independent School Districts and Accredited Private Schools Reporting Conscientious Exemptions by County, School Year 2007-08 Disclaimer: This data is self reported data and may vary from year to year.Data Source: Annual School report of ImmunizationStatus, School Year 2007-08DSHS, Immunization BranchMap Created by: DSHS Center for Health Statistics

Questions?Tony Aragon, MSEpidemiologistTony.aragon@dshs.state.tx.us

*The purpose of the presentation is to give you a snapshot of the types of immunization coverage data that we currently have.4:3:1:3:3:14 doses of DTaP, 3 doses of polio, 1 dose of measles-containing vaccine, 3 doses of hepatitis B, 3 doses of Haemophilus influenzae type b, and 1 dose of varicella

**All antigens are looked at retrospectively except for hep a. Start adding TVFC providers and immtrac providers in county.*Normal levels above 95*The validation shows that the rates are slightly lower than the rates in the annual report. Sample of 70 schools*The rates shown are based on the childcare assessment data and not the audits. It only reflects a sample of 20 records, 19-59 month olds. 14491 children 120 facilities per region.*.

*MCV4 meningococcal conjugteThe NIS teen results are only at the national level.4:3:1:3:3:14 doses of DTaP, 3 doses of polio, 1 dose of measles-containing vaccine, 3 doses of hepatitis B, 3 doses of Haemophilus influenzae type b, and 1 dose of varicella

***Our*Number of affidavit forms mailedIndividuals requesting exemption forms may request up to five forms per child. Number of requests A request may list more than one child for whom an affidavit form is needed.

*The annual report is the only source of CO data by antigen.*Total COs for the district for grades K-12