The Childhood Immunization Schedule and the National Immunization Survey

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1 The Childhood Immunization Schedule and the National Immunization Survey Melinda Wharton, MD, MPH Deputy Director, National Center for Immunization & Respiratory Diseases Institute of Medicine 9 February 2012 National Center for Immunization & Respiratory Diseases

2 Advisory Committee on Immunization Practices THE CHILDHOOD IMMUNIZATION SCHEDULE

3

4 Morbid Mortal Wkly Rep 1995;43:

5 Advisory Committee on Immunization Practices Establishes the standard of practice for immunization in the United States Evidence-based recommendations that consider: FDA Licensed indications and schedule Disease burden overall and in high risk groups Data on safety and efficacy in general and in specific groups Feasibility in the context of existing recommendations Equity in access to vaccine and good use of public funds (cost effectiveness) Recommendations of other groups (i.e., AAP, AAFP, ACP, ACOG) Schedule represents a summation of individual vaccine recommendations, including recommendations for simultaneous administration

6 Why Do We Give Vaccines at the Ages We Do? To provide protection from vaccine preventable diseases at the earliest age possible, or before periods of increased risk Given concurrently with other vaccines to coincide with established schedule of well-child visits Reflect ages at which vaccines are tested in clinical Reflect ages at which vaccines are tested in clinical trials, and generally consistent with labeling

7 Missed Opportunities Definition: Healthcare encounter in which a child is eligible to receive a vaccination but is not vaccinated What causes missed opportunities? Referrals from immunization provider Deferrals of vaccination Provider unaware that vaccines are due Failure to provide simultaneous vaccinations Inappropriate contraindications Office policies/administrative barriers Non-vaccinating health care providers

8 Safety and Efficacy Issues Potentially Associated with the Childhood Vaccination Schedule Data generally available on concurrent administration at licensure Interference between concurrently administered vaccines theoretically possible but generally not observed Need for spacing of live virus vaccines Safety or efficacy issues associated with concurrent or antecedent exposure to vaccine components (e.g., diphtheria toxoid-containing vaccines) Cumulative exposure to vaccine components

9 Data on Simultaneous Administration for a Licensed Vaccine: ROTARIX 484 healthy infants randomized into two groups All received Pediarix, PCV7, and ActHib at 2, 4, and 6 months and either ROTARIX concurrently at 2 and 4 months or separately at 3 and 5 months Co-administration: n=249 Separate administration: n=235 Prespecified criteria for noninferiority of antibody response met for all antigens Abu-Elyazeed et al, ICAAC 2007

10 Events / 100,00 00 Doses Outpatient Visits for Fever by Day after Vaccine at Northern California Kaiser Permanente: Age months 6241 total fever visits after 302,670 MMR+V, 147,762 MMR, 46,390 MMRV, 38,251 VZV MMR MMR+V MMRV V Days after Immunization Vaccine Safety Datalink; Immunization Safety Office, CDC

11 The Science of Studying More than One Thing at a Time Rapid advances in multiple fields of biology have made it possible to study complex biological reactions at the cellular level These new systems biology approaches are beginning to be applied to questions about vaccines

12 Monitoring Childhood Immunization Coverage THE NATIONAL IMMUNIZATION SURVEY

13 National Immunization Survey (NIS) Primary coverage assessment tool for children months and adolescents years of age Random digit dialing survey Very large number of households contacted; for childhood survey ~1,000,000 households per year identified ~34,000 households per year complete interview ~22,000 households per year used in analysis Provider-verified immunization histories are collected Survey instruments are mailed to providers who mail or fax back responses Only provider-verified vaccinations are used for estimation of vaccine coverage

14

15 National Immunization Survey, 2010 Vaccine % MMR ( 1 dose) 91.5% DTaP ( 3 doses) 95.0% Varicella ( 1 dose) 90.4% Hib ( 3 doses) 91.8% PCV4 (4 doses) 83.3% Hep B ( 3 doses) 91.8% Rotavirus (2 or 3 doses) 59.2% Poliovirus 93.3% 4:3:1:3:3:1:4 70.2% No vaccines 0.7% Morbid Mortal Wkly Rep 2011;60 (34):

16 Comparing Vaccinated, Unvaccinated, and Undervaccinated Children and their Households Undervaccinated compared with fully vaccinated: More likely to be Black than Hispanic or non-hispanic white; young mother; less likely to be married; more likely to have 12 years education; more likely to be poor; 4 children compared with only child Unvaccinated compared with undervaccinated: More likely to be non-hispanic white; mother more likely to have college degree and be 30 years old; household income >$75K; 4 children compared with only child Unvaccinated compared with fully vaccinated: More likely to be non-hispanic white than Hispanic; more likely to have 4 children compared with only child A larger proportion of the unvaccinated were boys (57.3%) Smith PJ et al. Pediatrics 2004;114:

17 Percent Vacc cinated (95% CI) Cumulative percent of children born in 2007 vaccinated with 1 dose of MMR vaccine, by month of age, United States Age (months) Source: National Immunization Survey

18 Cumulative percent of children born in 2007 vaccinated with 1st dose of DTaP vaccine, by month of age, United States Percent vaccin nated (95% CI) Age (months) Source: National Immunization Survey

19 For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: 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. National Center for Immunization & Respiratory Diseases

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