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National Immunization Program (NIP) Overview Stephen L. Cochi, MD, MPH

National Immunization Program (NIP) Overview Stephen L. Cochi, MD, MPH Acting Director, National Immunization Program Centers for Disease Control and Prevention National Vaccine Advisory Committee June 2004. Successes - 2004 -. Expansion of Hepatitis A Vaccine Recommendations. Source:

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National Immunization Program (NIP) Overview Stephen L. Cochi, MD, MPH

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  1. National Immunization Program (NIP) Overview Stephen L. Cochi, MD, MPH Acting Director, National Immunization ProgramCenters for Disease Control and Prevention National Vaccine Advisory Committee June 2004

  2. Successes- 2004 -

  3. Expansion of Hepatitis A Vaccine Recommendations Source: Anthony Fiore Division of Viral Hepatitis National Center for Infectious Diseases

  4. Incremental Implementation of Routine Hepatitis A Vaccination of Children • 1996 - Children living in “high rate” communities • American Indian, Alaska Native, selected Hispanic, migrant, and religious communities • 1999- Children living in states/ communities with consistently elevated rates during “baseline period” (1987-1997) • All children nationwide (?)

  5. 8-11 0-1 2-3 4-5 6-7 Number of Years Reported Incidence of Hepatitis A Exceeded 10 Cases per 100,000, by County, 1987-1997

  6. 1999 ACIP Recommendations for Statewide Routine Hepatitis A Vaccination of Children* Rate > 20/100,000 Recommended Rate 10-20/100,000 Considered Rate < 10/100,000 Not statewide * Based on average incidence rate during baseline period (1987-1997)

  7. Hepatitis A Vaccine Coverage (>1 dose) Among 24-35 Month Old Children, National Immunization Survey, United States, Jan-Jun 2003* Coverage range among 11 states: 5-74% Coverage range among6 states: 0-30% % Received >1 Dose Hepatitis A Vaccine Source: L Barker, NIP. Provisional data, 2003 NIS

  8. 1995 vaccine licensure 1999 ACIP recommendations 2002 rate = 2.9 Hepatitis A Incidence, United States, 1980-2002 Source Wasley, DVH, CDC. Unpublished NNDSS data

  9. 1987-97 Average Incidence by County 2002 Incidence by County Rate per 100,000 > 20 10 - 19 5 - 9 0 - 4

  10. Incidence of Hepatitis A by Statewide ACIP Recommendation Status, 1966-2002 ACIP vaccine recommendations

  11. Hepatitis A Incidence by Race/Ethnicity, United States, 1990-2002

  12. ABCs as a Platform for Monitoring New Vaccines Source: Elizabeth R. Zell National Center for Infectious Diseases Atlanta, Georgia

  13. Areas OR (3 counties) CA (1 county) MN (7 counties) GA (20 counties) MD (6 counties) CT (entire state) NY (7 counties) TN (10 counties) CO (8 counties) NM (entire state) Active Bacterial Core Surveillance (ABCs)Emerging Infections Program Network Established New

  14. Pneumococcal Conjugate Vaccine Introduction in the U.S.

  15. U.S. Recommendations for Use of Pneumococcal Conjugate Vaccine • All children < 2 years • Children 2 - 4 years with chronic illness, immunocompromising conditions • Consider for all children 2-4 with priority to those • 24-35 months • Alaska Native, American Indian, African American • Attending day care Advisory Committee on Immunization Practices. MMWR 2000

  16. Receipt of PCV7 Among Children 19-35 Months*, U.S, 2002-2003 Number of Doses *Children were born between August 1999 & November 2001 National Immunization Survey, Q3/2002-Q2/2003

  17. Invasive Pneumococcal Disease Rates by Age and Year Children <5 Years, ABCs, 1998-2003 1 yr 2003 vs baseline - 77% (<1 yr) - 83% (1 yr) <1 yr - 64% (2 yr) - 60% (3 yr) - 48% (4 yr) 2 yrs 3 yrs 4 yrs Source: ABCs (April 2004), Observed Rates Sites: CA (SF co), CT, GA (20 co), MD (6 co), MN (7 co), NY (7 co), OR (3 co) 2003 data are preliminary

  18. Invasive Pneumococcal DiseaseBlack and White Children <5, 1998–2003 Black Conjugate vaccine 2.9 X White 2.0 X Source: ABCs (April 2004), Observed Rates Sites: CA (SF co), CT, GA (20 co), MD (6 co), MN (7 co), NY (7 co), OR (3 co) Healthy People 2010 target: 46 per 100 000 2003 data are preliminary

  19. Herd Effect Invasive Disease Rates for Vaccine Serotypes ABCs 1998/99 vs. 2003 Number of cases =8 in 1998, 14 in 1999 and 6 in 2003 2003 data are preliminary

  20. Invasive Pneumococcal Disease Rates in Adults by Age Group and Year – ABCs, 1998-2003 2003 vs baseline 65+ years - 31% 40-64 yrs - 20% 20-39 yrs - 41% Source: ABCs (April 2002), Observed Rates Sites: CA (SF co), CT, GA (20 co), MD (6 co), MN (7 co), NY (7 co), OR (3 co) 2003 data are preliminary

  21. Challenges- 2004 -

  22. Federal Contract Vaccine Prices For Vaccines Recommended Universally for Children, 1985 – 2004* $472 $114 $45 Federal contract price shown for one year is an average that accounts for price changes within the year. An estimate is provided for 2004 since contract prices may change in August 2004 As of April 14, 2004

  23. Public Sector Vaccine Cost to Fully Vaccinate a Child

  24. Percent Increase of the Cost of Full Series vs. Percent Increase of Appropriation Percentage Calculations: % increases are cumulative using 1999 as the base year.

  25. Number of Children Who Could Potentially Receive Full Series with Section 317 Funds

  26. Pneumococcal Conjugate Vaccine (PCV) Two-Tier Policies, by State, United States* D.C. *As of February 2003 States with a two-tiered PCV policy (19 states are not implementing PCV with 317 funds) States without a two-tiered PCV policy If all States implemented PCV and flu, the 2004 funding shortfall would be $55 Million

  27. CustomersPeople Whose Health We Can Improve Alliances Channels Partners Stakeholders Public Health Systems and Communities Business Education Health Care Delivery FederalAgencies Coordinating Center for Health Information and Services National Center for Health Marketing National Center for Public Health Informatics National Center for Health Statistics Coordinating Center for Infectious Diseases NCID, NCHSTP, NIP Coordinating Center for Health Promotion NCCDPHP, NCBDDD, Genomics Coordinating Center for EIO NCEH/ATSDR NCIPC, NIOSH Office of Global Health Office of Terrorism Preparedness & Emergency Response Executive Leadership Team Management Council Executive Board Office of Strategy and Innovation Office of the Chief of Science Office of the Chief of Public Health Improvement Office of Human Capital and Professional Development Office of the Chief of Staff Director Office of the Chief Operating Officer CDC Washington Office

  28. Health Protection Goals • Health Promotion & Prevention of Disease, Injury, and Disability: All people will achieve their optimal lifespan with the best possible quality of health in every stage of life. • Preparedness: People in all communities will be protected from infectious, environmental, and terrorist threats.

  29. Blue Ribbon Panel on Vaccine Safety – Objectives • Review the structure, function, credibility, effectiveness, efficiency, and support of CDC’s vaccine safety program and assess how it can be maximized and sustained. • Review the intramural and extramural collaborative activities of the vaccine safety program and determine their effectiveness and efficiency.

  30. Blue Ribbon Panel on Vaccine Safety – Objectives (continued) • Determine the optimal organizational location for vaccine safety activities within the CDC to ensure scientific objectivity, transparency, and oversight while at the same time ensuring that program priorities are established appropriately and are relevant to the immunization program and stakeholder needs.

  31. Panel Composition - 1 Non-government professional organizations: • AMA • AAP • AAFP • AAHIP • PhRMA • Vanderbilt University School of Medicine

  32. Panel Composition - 2 Advocacy groups and/or other professional groups: • Autism Society of America • Cure Autism Now • National Vaccine Information Center • Public Citizen’s Health Research Group

  33. Panel Composition - 3 Government Advisory Committees: - ACIP - NVAC Government Agencies: - FAA - FDA - HHS/NVPO - HRSA - NTSB

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