Texas Immunization Coverage Levels TVFC Conference-Permian Basin April 20, 2016

Transcription

1 Texas Immunization Coverage Levels TVFC Conference-Permian Basin April 20,

2 Impact of Immunization Programs The routine childhood immunization program* of 4.3 million children (born in the US in 2009) is expected to prevent: ~20 million VPD cases ~42,000 VPD deaths Vaccinating this cohort will save: ~$13.5 billion in direct costs ~$68.8 billion from societal perspective *(DtaP, Polio, Hep B, PCV, Rotavirus, Hib, MMR, Hep B and Varicella) Zhou F, Shefer A, Wenger J, et al. Economic evaluation of the routine childhood immunization program in the U.S., Pediatrics 2014;133:

3 Importance of Measuring Vaccination Coverage Monitor the performance of immunization services Guide strategies for the eradication, elimination and control of vaccine-preventable diseases Identify areas of immunization systems that may require additional resources and focused attention Assess the need to introduce new vaccines into national and local immunization systems

4 SCHOOL IMMUNIZATION COVERAGE

5 KG Immunization Coverage Region DTaP Hepatitis A Hepatitis B MMR 2 Polio Varicella % 96.9% 98.1% 97.0% 97.1% 95.9% % 97.3% 98.5% 97.4% 97.2% 96.9% % 97.0% 97.9% 97.5% 97.5% 97.2% % 97.1% 98.5% 97.9% 97.8% 97.7% % 98.0% 98.9% 97.9% 98.1% 97.8% % 96.7% 97.6% 96.8% 96.6% 96.6% % 95.8% 96.4% 95.8% 95.9% 95.3% % 97.8% 98.5% 98.1% 98.0% 97.6% % 97.1% 98.4% 97.5% 97.5% 96.8% % 97.3% 98.3% 98.0% 97.9% 97.5% % 98.8% 99.6% 99.4% 99.3% 99.0%

6 Seventh Grade Immunization Coverage Region Tdap Hepatitis B MCV MMR 2 Polio Varicella % 96.5% 99.3% 99.2% 96.5% 97.3% % 96.6% 99.0% 99.1% 96.2% 97.1% % 98.0% 99.1% 99.0% 98.1% 98.0% % 98.5% 99.5% 99.4% 98.4% 98.6% % 97.1% 99.7% 99.5% 97.1% 98.6% % 93.3% 98.6% 98.2% 95.2% 95.9% % 95.4% 97.8% 97.6% 95.6% 96.1% % 98.0% 99.4% 99.3% 98.1% 98.5% % 98.1% 99.1% 99.1% 98.2% 98.0% % 98.5% 99.7% 99.4% 98.7% 97.6% % 98.7% 99.7% 99.6% 98.7% 99.1%

7 Number of CO s Number of Conscientious Exemptions Among K-12 Students Reported at Schools, ,000 41,000 36,000 31,000 26,000 Texas began allowing exemptions from immunizations Exemptions were allowed to be requested via the internet 0.79% of Texas K-12 students 21,000 16,000 11,000 6,000 1, School Year

8 Conscientious Exemptions in Public vs. Private Schools, Grade(s) Overall Exemption % Public School Exemption % Private School Exemption % Kindergarten 1.3% 1.2% 3.0% 7 th 0.87% 0.84% 1.87% K-12 th 0.79% 0.74% 1.98%

9 Conscientious Exemption Rates for Select Counties Total Conscientious Exemptions Filed at the District, Texas Annual Report of Immunization Status, All Grades County Total District Conscientious Exemptions % of Students with a Conscientious Exemption ANDREWS % BORDEN % DAWSON % ECTOR % GAINES % MIDLAND % Texas 40, %

10 NATIONAL IMMUNIZATION SURVEY

11 2014 Child and Teen National Immunization Survey (NIS) Assess immunization levels among Pre-school children, months old Adolescents years of age Conducted annually by CDC Population-based, random-digit dial sample of phone numbers followed by reviewing the child s vaccination record from the provider Provides a Report Card to let us know how well we are doing in protecting our nation s children against vaccine-preventable diseases The NIS provides national and state estimates of vaccination coverage-including new vaccines as they are licensed and recommended for use

12 NIS Vaccination Coverage Estimates -- US and Texas, 2014 Antigen Texas 2013 Texas to 2014 Texas Change (+/-) U.S. National Average 2014 Hepatitis A 64.2% 61.2% % Varicella 93.6% 89.9% % Hepatitis B birth dose 81.8% 77.4% % 4:3:1:3:3:1:4 series 72.5% 64.0% % MMR 92.7% 90.4% % Rotavirus 73.8% 68.5% % Pneumococcal 82.8% 78.6% % Hib 82.1% 76.2% % 4 doses of DTaP 81.5% 78.2% % Polio 91.3% 90.4% % 3 doses of Hepatitis B 89.5% 86.5% %

13 Percent vaccinated Vaccination Coverage Estimates from NIS, Texas Healthy people 2020 target* DTaP 3+ Polio 1+ MMR Hib 3+ HepB HepB birth dose 1+ Var 4+ PCV 2+ HepA Rotavirus 4:3:1:3*:3:1:4# Year * HP2020 target for HepA and the birth dose of HepB is 85%. Target for rotavirus and the 4:3:1:3*:3:1:4 series is 80%.

14 Percent Vaccinated (%) Estimated Coverage with 4:3:1:3:3:1:4* Series NIS 2014, US and areas in Texas U.S. National Texas TX-Bexar County TX-City of Houston TX-El Paso County TX-Rest of State *The combined 7-vaccine series (4:3:1:3**:3:1:4) includes 4 doses of DTaP, 3 doses of Polio, 1 dose of measles-containing vaccine, **Hib full series, 3 HepB, 1 Var, and 4 PCV.

15 Below Poverty Coverage - At or Above Poverty Coverage (percentage points) Poverty Level Disparities in Vaccine Coverage NIS 2014, Texas

16 Texas Decline in Full Series Coverage Texas series coverage fell from 72.5% in 2013 to 64.0% in 2014 Statistically significant decrease Below 2014 national average of 71.6% Suboptimal coverage with DTaP, the full series of Hib, and PCV Coverage for second-to-last dose is high Issue lies with final dose The final dose for these vaccines is often scheduled during the second year of life Less frequent healthcare visits Importance of catch-up schedule Increase use of combination vaccines

17 Percent Vaccinated (%) Adolescent Vaccination Rates in Texas NIS-Teen, Tdap 1 MenACWY 1 HPV F 3 doses HPV F * 2014 *methodology changed

18 Percent Vaccinated (%) NIS-Teen Vaccination Coverage Estimates -- US and Texas, United States Texas Tdap 1 MenACWY 1 HPV Female 3 HPV Female 1 HPV Male 3 HPV Male

19 Percent Vaccinated (%) NIS-Teen Estimated One Dose HPV Coverage among Females aged years US and Texas, United States Texas * 2014 *Survey methodology changed *Survey methodology changed

20 Below Poverty Coverage - At or Above Poverty Coverage (percentage points) Poverty Level Disparities in Vaccine Coverage NIS-teen 2014, Texas HPV F 3 HPV F 1 HPV M 3 HPV M -0.2

21 HPV Vaccination Coverage from ImmTrac ImmTrac can provide local level immunization coverage estimates to assist in targeting interventions and evaluating program effectiveness. Data limitations include underreporting and provider participation HPV Dose 1 Coverage by County Among Female Adolescents Aged Years -- ImmTrac, 2014 Dose 1 Received (%) County Ector 23.2 Midland 36.3 HSR 9/ Texas 36.5

22 STRATEGIES TO INCREASE VACCINATION COVERAGE

23 DSHS Strategies to Increase HPV Vaccination Promote and encourage health care providers to make a strong recommendation for HPV vaccine Increase HPV vaccination coverage through partnerships with providers and professional clinical organizations Expand access to vaccines through the Texas Vaccines for Children Program Developing and providing educational materials to clinicians to increase awareness and strengthen provider recommendation Promote system based interventions including the use of ImmTrac, AFIX, standing orders, and reminder/recall Increase community demand for ACIP-recommended adolescent vaccines Re-launching adolescent immunization campaigns during the Back To School season

24 Importance of Provider HPV Recommendation Studies consistently show that a strong recommendation from a healthcare provider is the single best predictor of HPV vaccination. Less than half of adolescents in Texas have had HPV vaccine recommended to them (2013 NIS-Teen) Top three reasons Texas parents did not intend vaccinate their child against HPV include: HPV vaccine was not recommended Vaccine was perceived as not necessary or needed Lack of knowledge

25

26 Adolescent Vaccine Ordering Provider Profiles 2014 vaccine ordering data was analyzed to compare Tdap and HPV vaccine among TVFC providers Ideal ratio 3.0 (meaning for every 1 Tdap, 3 HPV are administered) Customized adolescent vaccine ordering profiles were sent to over 2,300 providers Communication stressed the importance of a strong recommendation for HPV vaccine HPV Vaccine Ordering Ratio Average (Goal: >3.0) HSR Ector Midland / State Average

27 Evaluation of the Provider Vaccine Ordering Project TVFC program observed a statistically significant increase in our HPV to Tdap vaccine ordering ratio for the entire state 142 providers went from ordering no HPV vaccine in June- September of 2014, to placing at least one HPV order in June- September of TVFC providers increased their HPV to Tdap ordering ratio

28 Drama :15 Television English

29 QUESTIONS?

30 Contact Information Kenzi Guerrero Texas Department of State Health Services Immunization Branch