Focus Area 14: Immunization and Infectious Diseases Progress Review

1. August 20, 2003 Focus Area 14:Immunization and Infectious Diseases Progress Review

2. Healthy People 2010 Immunization and Infectious Disease Objectives Immunization objectives 14-1 Cases of vaccine-preventable diseases. 14-22 Vaccination coverage levels for universally recommended vaccines among young children. 14-23 Vaccination coverage levels for children in licensed day care facilities and children in kindergarten through first grade. 14-24 Proportion of young children who receive all vaccines that have been recommended for universal administration for at least 5 years. 14-25 Proportion of providers who have measured the vaccination coverage level among children in their practice population within the past 2 years. 14-26 Proportion of children who participate in fully operational population-based registries. 14-27 Routine vaccination coverage levels of adolescents. 14-29 Proportion vaccinated against influenza and pneumococcal disease 14-30 Vaccine-associated adverse events 14-31 Persons under surveillance for vaccine safety

3. Healthy People 2010 Immunization and Infectious Disease Objectives Infectious Disease objectives 14-2 Chronic Hepatitis B virus infections in infants and young children 14-3 Hepatitis B infections 14-4 Bacterial meningitis in young children 14-5 Invasive pneumococcal infections 14-6 Hepatitis A 14-7 Meningococcal disease 14-8 Lyme disease 14-9 Hepatitis C 14-10 Chronic Hepatitis C infection identified by state and local health departments 14-15 International travelers who receive preventive services 14-16 Invasive early onset group B strep disease 14-17 Hospitalizations caused by peptic ulcer disease 14-18 Course of antibiotics for ear infections for young children 14-19 Courses of antibiotics prescribed for sole diagnosis of common cold 14-20 Hospital-acquired infections in intensive care unit patients 14-21 Anti-microbial use among intensive care unit patients 14-28 Hepatitis B vaccine coverage among high-risk groups

4. Healthy People 2010 Immunization and Infectious Disease Objectives Tuberculosis objectives 14-11 Rates of Tuberculosis. 14-12 Proportion of tuberculosis patients completing curative therapy. 14-13 Proportion of contacts and other high-risk persons with latent tuberculosis infection completing curative therapy. 14-14 Average time for a laboratory to confirm and report tuberculosis cases.

5. Comparison of 20th Century Average Annual Morbidity and 2002 Morbidity, Vaccine-Preventable Diseases For 2002 record lows for: smallpox, measles, mumps, polio, rubella and tetanus According to the Hib section, the Hib issue is not straight forward and it would not be possible right now to say that the “Hib and ‘unknown serotypes’ combined in kids under age 5 years”  were at an all-time low in 2002. It will not be determined until sometime this summer. Record lows for 2000 – polio 0, measles 86, mumps 338, tetanus 26 Record lows for 2001 – polio 0 , mumps 352, rubella 26, (still unknowns for Hib for 2001) *Slide taken from Walt Orenstein presentation at the 37th Annual National Immunization Conference, Chicago, IL, March 17-20, 2003* For 2002 record lows for: smallpox, measles, mumps, polio, rubella and tetanus According to the Hib section, the Hib issue is not straight forward and it would not be possible right now to say that the “Hib and ‘unknown serotypes’ combined in kids under age 5 years”  were at an all-time low in 2002. It will not be determined until sometime this summer. Record lows for 2000 – polio 0, measles 86, mumps 338, tetanus 26 Record lows for 2001 – polio 0 , mumps 352, rubella 26, (still unknowns for Hib for 2001) *Slide taken from Walt Orenstein presentation at the 37th Annual National Immunization Conference, Chicago, IL, March 17-20, 2003*

6. *Slide taken from Sudip Parik’s presentation, December 2002, presented by Walt Orenstein* Data checked by DMD, Lawrence Barker, May 28, 2003.*Slide taken from Sudip Parik’s presentation, December 2002, presented by Walt Orenstein* Data checked by DMD, Lawrence Barker, May 28, 2003.

7. *Slide taken from Sudip Parik’s presentation, December 2002, presented by Walt Orenstein* Data checked by DMD, Lawrence Barker, May 28, 2003.*Slide taken from Sudip Parik’s presentation, December 2002, presented by Walt Orenstein* Data checked by DMD, Lawrence Barker, May 28, 2003.

8. *From NFID Presentation in San Francisco, Walt Orenstein, 2001* *From NFID Presentation in San Francisco, Walt Orenstein, 2001*

9. 14-22. Universally recommended vaccination coverage among children 19-35 months, by race and ethnicity, 2002 *Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.

10. 14-22. Universally recommended vaccination coverage among children 19-35 months, by race and ethnicity, 2002 *Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.

11. 14-23. Vaccination coverage of children in daycare, kindergarten, and first grade, 2002† Patient evaluation of good provider-patient communication increases as patient’s age increases.Patient evaluation of good provider-patient communication increases as patient’s age increases.

12. 14-27. Universally recommended vaccination coverage among children 13-15 years, 2001 *Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.

13. 14-27a. 3 or more doses of Hepatitis B vaccination among adolescents 13-15 years *Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.

14. 14-27b. 1 or more doses of MMR vaccination among adolescents 13-15 years *Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.

15. 14-27c. 1 or more doses of Td vaccination among adolescents 13-15 years *Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.* Data was updated by Lawrence Barker, DMD, May 28, 2003.

16. 14-24a. Vaccination coverage with the 4:3:1:3:3† series, among children 19-35 months, 2002 The 2010 goal for the combined series is 80%. 3+DTP – 93.9 4+DTP – 81.5 3+Polio – 89.8 1+MMR – 91.0 3+Hib – 92.9 3+HepB – 88.3 1+Var – 78.6 *Slide taken from Walt Orenstein presentation at the 37th Annual National Immunization Conference, Chicago, IL, March 17-20, 2003* The 2010 goal for the combined series is 80%. 3+DTP – 93.9 4+DTP – 81.5 3+Polio – 89.8 1+MMR – 91.0 3+Hib – 92.9 3+HepB – 88.3 1+Var – 78.6 *Slide taken from Walt Orenstein presentation at the 37th Annual National Immunization Conference, Chicago, IL, March 17-20, 2003*

17. 14-29a. Influenza vaccination coverage during the past 12 months, among adults 65 years and older I’m first going to talk about coverage rates in the elderly, over 65 years of age. Why do we want to focus on this group? Influenza accounts for ~40,000 deaths each years, with ~90% occurring in those over 65 years of age. This chart shows the upward trend in self-reported influenza vaccination in the past year from 1989 through 2001 for >65 yr olds in the U.S. Data from both the NHIS (1989-2000) and BRFSS (1993-1999) are shown. Influenza vaccination coverage among persons aged 65 years or older has increased at a slower rate in recent years and may be approaching a plateau. Between 1997 and 2000, coverage increased 1 percentage point per year, while coverage nearly doubled from 30% in 1989 to 58% in 1995. The dip in coverage after 2000 was most likely due to the vaccine delay. Because of the 12 month recall period, coverage estimates by survey year primarily reflects vaccinations received for the prior season. I’m first going to talk about coverage rates in the elderly, over 65 years of age. Why do we want to focus on this group? Influenza accounts for ~40,000 deaths each years, with ~90% occurring in those over 65 years of age. This chart shows the upward trend in self-reported influenza vaccination in the past year from 1989 through 2001 for >65 yr olds in the U.S. Data from both the NHIS (1989-2000) and BRFSS (1993-1999) are shown. Influenza vaccination coverage among persons aged 65 years or older has increased at a slower rate in recent years and may be approaching a plateau. Between 1997 and 2000, coverage increased 1 percentage point per year, while coverage nearly doubled from 30% in 1989 to 58% in 1995. The dip in coverage after 2000 was most likely due to the vaccine delay. Because of the 12 month recall period, coverage estimates by survey year primarily reflects vaccinations received for the prior season.

18. 14-29a. Influenza vaccination coverage during the last 12 months of adults 65 years and older, by race/ethnicity Here we see differences by race/ethnicity for influenza vaccine for those >65 yrs. Non-hispanic whites have the highest rates while hispanics have lower rates and blacks have the lowest.Here we see differences by race/ethnicity for influenza vaccine for those >65 yrs. Non-hispanic whites have the highest rates while hispanics have lower rates and blacks have the lowest.

19. 14-29b. Pneumococcal vaccination coverage ever received among adults 65 years and older, by race/ethnicity Here we see bigger differences in coverage rates by race/ethnicity than we saw for flu. Rates seem to be beginning to level off, at least in the white population.Here we see bigger differences in coverage rates by race/ethnicity than we saw for flu. Rates seem to be beginning to level off, at least in the white population.

20. 14-29c. Influenza vaccination in past 12 months among adults with high risk conditions†, ages 18-64 This chart shows the trend in self-reported influenza vaccination from 1996 – 2000 for those 18-64 years. Higher coverage is among persons aged 50-64 (purple lines) compared to those aged 18-49 years (orange lines) but still below HP2010. This chart shows the trend in self-reported influenza vaccination from 1996 – 2000 for those 18-64 years. Higher coverage is among persons aged 50-64 (purple lines) compared to those aged 18-49 years (orange lines) but still below HP2010.

21. 14-29c. Influenza vaccine coverageamong adults with high risk conditions†, ages 18-64, by race/ethnicity Here we see influenza vaccination coverage for those 18-64 yrs by race/ethnicity. You can see that whites have higher coverage compared to other races, but the differences are much less in this group (18-64 yrs) compared to the 65+ group. Here we see influenza vaccination coverage for those 18-64 yrs by race/ethnicity. You can see that whites have higher coverage compared to other races, but the differences are much less in this group (18-64 yrs) compared to the 65+ group.

22. 14-29d. Pneumococcal vaccination ever received, among adults with high risk conditions†, ages 18-64 years This chart shows the trend in self-reported pneumococcal vaccination from 1996 – 2000 for those 18-64 years. Higher coverage is among persons aged 50-64 (purple lines) compared to those aged 18-49 years (orange lines) but still below HP2010 of 60%. This chart shows the trend in self-reported pneumococcal vaccination from 1996 – 2000 for those 18-64 years. Higher coverage is among persons aged 50-64 (purple lines) compared to those aged 18-49 years (orange lines) but still below HP2010 of 60%.

23. 14-29d. Pneumococcal vaccine ever received among adults with high risk conditions†, 18- 64 years, by race/ethnicity Here we see pneumococcal vaccination coverage for those 18-64 yrs by race/ethnicity. You can see that whites have higher coverage compared to other races, but the rates are so low overall that it is difficult to see differences in this group. Here we see pneumococcal vaccination coverage for those 18-64 yrs by race/ethnicity. You can see that whites have higher coverage compared to other races, but the rates are so low overall that it is difficult to see differences in this group.

24. 14-6. Reduce Hepatitis A

25. As you know, the incidence of hepatitis A has generally be cyclic, with peaks every 10-15 years. [click] In 1995 hepatitis A vaccine was licensed by FDA and became available in the United States, and [click] in 1996 the Advisory Committee on Immunization Practices (ACIP) published the first national recommendations for its use in hepatitis A prevention. These recommendations were updated [click] and extended in 1999. As you can see, hepatitis A incidence has been falling, beginning in 1998 to dip below recorded historic lows, even if we look all the way back to when national hepatitis surveillance first began in the 1960’s. The 2001 rate [click] of 3.8/100,000 is well below the previously-recorded lowest rate of about 9/100,000. This overall rate is an indicator of truly transformed hepatitis A epidemiology, some examples of which I’ll show you in a moment. To put this in context, though, first I’d like to to describe the epidemiologic rationale behind the recommendations, which, as you’ll see, represent a somewhat novel approach to childhood vaccination.As you know, the incidence of hepatitis A has generally be cyclic, with peaks every 10-15 years. [click] In 1995 hepatitis A vaccine was licensed by FDA and became available in the United States, and [click] in 1996 the Advisory Committee on Immunization Practices (ACIP) published the first national recommendations for its use in hepatitis A prevention. These recommendations were updated [click] and extended in 1999. As you can see, hepatitis A incidence has been falling, beginning in 1998 to dip below recorded historic lows, even if we look all the way back to when national hepatitis surveillance first began in the 1960’s. The 2001 rate [click] of 3.8/100,000 is well below the previously-recorded lowest rate of about 9/100,000. This overall rate is an indicator of truly transformed hepatitis A epidemiology, some examples of which I’ll show you in a moment. To put this in context, though, first I’d like to to describe the epidemiologic rationale behind the recommendations, which, as you’ll see, represent a somewhat novel approach to childhood vaccination.

26. 14-6. Reduce Hepatitis A, by race and ethnicity

27. Hepatitis A Incidence, by age

28. Hepatitis B Incidence If we look at the incidence data by age group, we notice two things – first, that incidence has declined in all age groups, including persons younger than 12, seen on this inset Click …..because the incidence is so much lower. Second, that the decline has been greater among persons under age 20. In fact, there has been only a 65% decline Click …..in incidence among persons older than 20 since 1990, Click compared to the 85% decline among 12-19 year olds, and the 89% decline among children less than 12. In 2001, more than 96% of cases were among adults. The plateau noted in the overall incidence slide, and here, is because of a slowing of the decline in adult infections. Among 12 to 19 year olds, the decline since 1999 has been 37%, and among those less than 12 it has been 45%, compared to only 5% among those 20 and older. Pink it out Fonts, line up % If we look at the incidence data by age group, we notice two things – first, that incidence has declined in all age groups, including persons younger than 12, seen on this inset Click …..because the incidence is so much lower. Second, that the decline has been greater among persons under age 20. In fact, there has been only a 65% decline Click …..in incidence among persons older than 20 since 1990, Click compared to the 85% decline among 12-19 year olds, and the 89% decline among children less than 12. In 2001, more than 96% of cases were among adults. The plateau noted in the overall incidence slide, and here, is because of a slowing of the decline in adult infections. Among 12 to 19 year olds, the decline since 1999 has been 37%, and among those less than 12 it has been 45%, compared to only 5% among those 20 and older. Pink it out Fonts, line up %

29. 14-3. Hepatitis B Incidence, by race and ethnicity, 2001 Patients with public health insurance rate provider communication highest (esp. for listening carefully and spending enough time); patients with no health insurance rate provider communication lowest (esp. for listening carefully and explaining things clearly).Patients with public health insurance rate provider communication highest (esp. for listening carefully and spending enough time); patients with no health insurance rate provider communication lowest (esp. for listening carefully and explaining things clearly).

30. 14-11. Cases of Tuberculosis

31. 14-11. Rates of Tuberculosis, by race and ethnicity Patient evaluation of good provider-patient communication increases as patient’s age increases.Patient evaluation of good provider-patient communication increases as patient’s age increases.

32. 14-12. Proportion of Tuberculosis Patients Completing Curative Therapy Patient evaluation of good provider-patient communication increases as patient’s age increases.Patient evaluation of good provider-patient communication increases as patient’s age increases.

33. Percent of Tuberculosis labs using recommended procedures Patient evaluation of good provider-patient communication increases as patient’s age increases.Patient evaluation of good provider-patient communication increases as patient’s age increases.

34. Percent of Tuberculosis labs meeting turn-around time goal Patient evaluation of good provider-patient communication increases as patient’s age increases.Patient evaluation of good provider-patient communication increases as patient’s age increases.

35. Developmental Objectives 14-10. Increase the proportion of persons with chronic Hepatitis C infection identified by State and local health departments. (proposed source, National Electronic Telecommunications System for Surveillance) 14-15. Increase the proportion of international travelers who receive recommended preventive services when traveling in areas of risk for: hepatitis A, malaria, and typhoid. (proposed source, Travelers’ Health Survey) 14-22g. Achieve and maintain the levels of pneumococcal conjugate vaccination coverage among young children. (future source, National Immunization Survey)

36. Developmental Objectives 14-23d, e. Maintain vaccination coverage levels for children in licensed day care facilities- Hepatitis B and Varicella. (proposed source, National Immunization Survey) 14-23i, j. Maintain vaccination coverage levels for children in kindergarten and first grade- Hepatitis B and Varicella. (proposed source, The School Entry Immunization Assessment Report) 14-24b. Increase the proportion of adolescents who receive all vaccines that have been recommended for universal administration for at least 5 years (proposed source, National Immunization Survey)

37. Progress Review data and slides can be found on the web at: http://www.cdc.gov/nchs/hphome.htm