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 Number of Diseases Prevented by Vaccines Included in the Routine Child/Adolescent Immunization Schedule 1964 (6) Smallpox Polio Diphtheria Pertussis Tetanus Measles 1985 (7) Polio Diphtheria Pertussis Tetanus Measles Rubella Mumps 1995 (10) 2017 (16) Polio Polio PolioHepB HepB Diphtheria Diphtheria HepA Pertussis Diphtheria HepA Pertussis Varicella Tetanus Pertussis Varicella Tetanus Pneumococcal Measles Measles Tetanus Influenza Pneumococcal Rubella Mumps Rubella Measles Meningococcal Influenza Hib (infant) Mumps Rubella Rotavirus Meningococcal HepB Hib (infant) HPV Mumps Rotavirus Varicella Hib (infant) HPV 1
Childhood Immunization Provides Big Savings Vaccines for Children: 23 years of protecting America s children 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. 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 20 th Century Annual Morbidity and Current Morbidity: Vaccine-Preventable Diseases Disease 20th Century 2016 Annual Morbidity 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. 2
Percent Vaccinated 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 12/4/2017 Nationally, childhood immunization coverage is high and stable Vaccine Coverage among Children 19-35 Months, National Immunization Survey, United States, 1994-2016 100 90 80 70 60 50 40 30 20 10 0 Rotavirus 1+ Varicella 4+ PCV 2+ HepA 3+HepB <1% of toddlers had received no vaccines MMR (1+) DTP/DTaP (3+) Polio (3+) Hib (3+) HepB (3+) Varicella (1+) PCV (4+) Rotavirus HepA (2+) Year 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 3
Percent 12/4/2017 1 dose MMR Vaccination Coverage, Age 19-35 Months, 2016 Texas US median, 2016 Source: National Immunization Surveys 1996-2017; 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 Kindergartners United States, 2011-12 to 2016-17 School Years 100 90 80 70 60 50 40 30 20 10 0 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 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. 4
School Assessment: MMR Vaccination among kindergartners Coverage for 2016-17 Texas US median 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. 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 5
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 Comparison group is Non-Hispanic White = 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) MMWR Morb Mortal Wkly Rep 2017;66:1171 1177 6
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 Vaccine Any Medicaid Other Insurance Uninsured (n=5,757) (n=567) (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 7
Mumps outbreaks continue to occur 8
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 9
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. 10
Pneumococcal Vaccination Coverage, Age 18-64 years at increased risk Texas and US median, 2008-2015 Texas US median, 2015 TX Racial/Ethnic Vaccination Disparities -- NHIS 2015 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. 11
Association of Health Insurance Status and Usual Place of Health Care with Vaccination Coverage, 2015 NHIS 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. BUT Partnerships and collaborations increase adult immunization 12
Texas Adult Immunization Project 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 13
IT systems are improving 14
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 15
Modernizing Immunization Practices: 2D barcodes Scanner How do you like to get your information off the vaccine vial or syringe? Old school New recommendations from the ACIP 16
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FDA approves new 2-dose hepatitis B vaccine for adults Want to See Experts Answering Questions? www.vaccinateyourbaby.org/faq 18
Resources for Parents www.cdc.gov/vaccines/partners/childhood/multimedia.html Thank you! For more information, contact CDC 1-800-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. 19
Percent Vaccinated Number of HPV-attributable cancers averted 12/4/2017 10 Years of HPV Vaccination 100 90 80 88.0 82.2 Tdap 70 60 50 40 30 20 65.1 60.4 56.0 43.0 31.5 MCV4 1 HPV girls 3 HPV girls 1 HPV boys 3 HPV boys 1 HPV girls & boys 10 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Survey Year *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 Total US population 1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 2014 coverage (Females 39.7%, Males 21.6%) Higher male and female coverage (80%) 1.27 million 1.23 million 1.56 million 600,000 400,000 709,000 200,000 0 HPV cancers averted total (excluding herd immunity) HPV cancers averted total 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). 20
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. 21
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