National Center for Immunization & Respiratory Diseases WHY WE RE HERE Melinda Wharton, MD, MPH Director, Immunization Services Division AIM Leadership Conference February 8, 2017
Vaccines save lives.
507,300 diphtheria deaths 20,300 pertussis deaths 57,300 measles deaths 59,700 hepatitis B deaths 55,000 pneumococcal deaths 13,700 Haemophilus influenzae type b deaths 14,800 polio deaths
Nationally, vaccination of young children continues to be the norm.
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Percent Vaccinated Vaccine-specific Coverage* among Children 19-35 Months, National Immunization Survey, United States, 1994-2014 100 90 80 70 60 50 40 30 20 10 0 3+ 1+ 4+ PCV 3 2+ HepA Rotavir MMR (1+) DTP/Dtap (3+ ) Polio (3+) Hib (3+) HepB (3+) Varicella (1+) PCV (4+) Rotavirus* HepA (2+)* Year * The Healthy People 2020 target for coverage is 90% for all vaccines with the exception of rotavirus (80%) and HepA (85%). DTP (3+) is not a Healthy People 2020 objective. DTaP (4+) is used to assess Healthy People 2020 objectives. Reflects 3+ doses through 2008, and Full Series (3 or 4 doses depending on type of vaccine received) 2009 and later.
http://www.culturalcognition.net/browse-papers/vaccine-risk-perceptions-and-ad-hoc-risk-communication-an-em.html
But there s still room for improvement.
Results - Vaccination Coverage by Poverty Status, NIS 2014 Vaccine and Doses Below Poverty Level Percentage Point Difference 3+ DTaP 2.8 4+ DTaP 8.3 3+ Polio 2.5 1+ MMR 3.3 Hib-Primary Series 4.1 Hib-Full Series 9.2 3+ HepB HepB-birth dose 1+ Varicella 3+ PCV 3.1 4+ PCV 10.0 2+ HepA 5.2 Rotavirus 14.1 4:3:1:3*:3:1:4 series 9.7 Comparison group is at or above poverty level included in series
Not all outbreaks of vaccine-preventable disease are caused by lack of vaccination.
We cannot prevent outbreaks of pertussis with our current pertussis vaccine.
Number of cases Reported NNDSS pertussis cases: 1922-2015* 300,000 250,000 200,000 150,000 DTP 60,000 50,000 40,000 30,000 20,000 10,000 0 1990 1995 2000 2005 2010 2015* 100,000 50,000 DTaP Tdap 0 *2015 data are provisional Year SOURCE: CDC, National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System and 1922-1949, passive reports to the Public Health Service
Shifting the Timing of Mother s Tdap Dose: Postpartum to Pregnancy Provides earlier protection to mother Transfers high levels of transplacental maternal antibodies to infants Likely provides direct immunity to infant Pregnancy Postpartum
We now know how to improve HPV vaccine coverage.
Percent Vaccinated 100 90 80 70 60 50 40 30 20 10 Estimated HPV Vaccination Coverage among Adolescents Aged 13-17 Years, NIS-Teen, United States, 2006-2015 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Survey Year Source: Reagan-Steiner, et al. MMWR; August 26, 2016 / 65(33);850 858 86.4 81.3 62.8 56.1 49.8 41.9 28.1 Tdap MCV4 1 HPV girls 3 HPV girls 1 HPV boys
SYSTEMS STRATEGIES TO IMPROVE HPV VACCINE COVERAGE Establish standing orders for HPV vaccination beginning at age 11-12 years in your practice Conduct reminder/recall beginning at 11-12 years of age Assess HPV vaccine coverage at every visit and prompt clinical staff to give HPV vaccine at that visit Schedule return visit for next dose before the patient leaves the office Document each dose in the child s medical record and the state s immunization information system
TACTICS FOR SUCCESSFUL HPV VACCINE DELIVERY, DENVER HEALTH Routine use of a robust immunization registry for multiple functions, including recording vaccine history and recommended needed vaccines at every visit Medical assistants check vaccine registry for recommended vaccines at every visit Standing order for routine immunizations Vaccines are given early in the visit when possible Education for providers to present Tdap, MCV, and HPV as a standard bundle of adolescent immunizations Provider-level report cards with adolescent vaccination coverage rates Vaccination drives at school-based health centers Farmer et al, Pediatrics 2016
Immunization Rates for Adolescents Denver Health, 2004-2014 Farmer et al, Pediatrics 2016
We need a modern information systems for immunization.
It s too big a job (and too important) for any of us alone; all of us need to work on it, together.
State Health Department Local Health Departments
Immunization Coalitions Other Payers State AAP Chapter School Nurses Local Health Departments Medicaid Medicaid Managed Care Organizations Integrated Healthcare Systems State Health Department Federally Qualified Health Centers Primary Care Association State AFP Chapter Public Health Nurses
Academic Cancer Centers Cancer Coalitions Immunization Coalitions Other Payers State Comprehensive Cancer Control Program State AAP Chapter School Nurses Local Health Departments American Cancer Society Medicaid Medicaid Managed Care Organizations Integrated Healthcare Systems State Health Department Federally Qualified Health Centers Primary Care Association State AFP Chapter Public Health Nurses
Employee Health Programs Medicare Academic Cancer Centers Cancer Coalitions Pharmacies Immunization Coalitions Other Payers State Comprehensive Cancer Control Program State AAP Chapter School Nurses Local Health Departments American Cancer Society Medicaid Medicaid Managed Care Organizations Integrated Healthcare Systems State Health Department Federally Qualified Health Centers Primary Care Association State AFP Chapter Public Health Nurses
Thank you For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov www.cdc.gov/vaccines 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.