National Immunization Survey 2005

National Immunization Survey Stephen L. Cochi, M.D., M.P.H. Acting Director National Immunization Program, CDC National Press Club July 27, 2005 2005 Department of Health and Human Services Centers for Disease Control and Prevention Vaccines are one of the most important tools we have to protect the health of our nation's most vulnerable citizens, our children. Vaccines are Highly Cost Effective For every $1 spent*:  DTaP saves. . . . . . . . . . . . . . . .  MMR saves . . . . . . . . . . . . . . . .  Perinatal Hep B saves . . . . . . .  Varicella saves . . . . . . . . . . . . .  Inactivated Polio (IPV) saves. . *direct and indirect savings (including work loss, death, and disability) $27.00 $26.00 $14.70 $ 5.40 $ 5.45 Childhood Immunization Program Successes  Vaccine-preventable diseases at an all time low  Record high coverage rates  Measles is no longer endemic in the U.S. and Western Hemisphere  Rubella Eliminated Immunization is one of the most important ways parents can protect their children against serious diseases. Comparison of 20th Century Annual Morbidity and Current Morbidity, Vaccine-Preventable Diseases (pre-1990 Vaccines) Disease Smallpox Diphtheria 20th Century Annual Morbidity† 48,164 175,885 2004* 0 0 Percent Decrease 100% 100% Measles Mumps Pertussis Polio (paralytic) 503,282 152,209 147,271 16,316 37 236 18,957 0 99.99% 99.84% 87.13% 100% Rubella Congenital Rubella Syndrome Tetanus † 47,745 823 1,314 12 0 27 99.97% 100% 97.95% Source: CDC. MMWR April 2, 1999. 48: 242-264 * Provisional 2004 Data Numbers in yellow indicate at or near record lows in 2004 Comparison of Pre-Vaccine Era Estimated Annual Morbidity and Current Morbidity, Vaccine-Preventable Diseases (post-1990 Vaccines) Disease Hepatitis A Hepatitis B (acute) Hib (invasive) Pneumococcus (invasive) Varicella Influenza (<5 years) Pre-Vaccine Era Estimated Annual Morbidity 117,333 66,232 20,000 63,067 4,085,120 N/A 2003 32,711 21,030 40 39,800 817,024 N/A Percent Decrease 72.1% 68.2% 99.8% 36.9% 80.0% --- Meningococcus (invasive) N/A = not available 2,183 N/A --- We now have the means to protect our nation’s children against 13 diseases that in the past caused great suffering, disability and premature death. Number of Vaccines in the Routine Childhood Immunization Schedule 1985 (7) Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio 1995 (10) Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) HepB Varicella 2005 (13) Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) HepB Varicella Pneumococcal Disease Influenza Meningococcal Pertussis-related Deaths that have been Reported to CDC This Year 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. A 52-day-old African-American male from MS. An infant from MT. A 2-month-old Native American female from NM. A 6-week-old infant from OR. A 96-day-old, white female from WI. A 4-week-old, white Hispanic female from CA. A 2-month-old, white Hispanic male from CO. A 27-day-old white female infant from NC. A 29-day-old female infant from AZ. A 3-month-old African-American male infant from FL. A 13-day-old Hispanic male infant from CA. A 14-day-old Hispanic female from CA. A 16-week-old white male from IL. A 36-day-old white male from WI. A White male infant from Jefferson Parish, LA Vaccines on the Horizon New Vaccine/Indication Timeframe Meningococcal conjugate (adolescents) TDaP (adolescents/adults) February 2005 June 2005 Rotavirus (infants) MMRV February 2006 2006 2nd dose of varicella Varicella to prevent zoster 2006 2006 Universal hepatitis A Human Papillomavirus (adolescents) Expanding influenza vaccine use 2006 2006 2006 Vaccine-Specific Coverage Rates Among Pre-school Aged Children Percent 100 2010 Target DTP(3+)† Hep B (3+) 80 PCV 7 (3+) 60 MMR(1+) 40 Polio (3+) 20 Hib (3+) Varicella (1+) 0 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2004 † DTP(3+) is not a Healthy People 2010 objective. DTP(4) is used to assess Healthy People 2010 objectives. Note: Children in the USIS and NHIS were 24-35 months of age. Children in the NIS were 19-35 months of age. Source: USIS (1967-1985), NHIS (1991-1993) CDC, NCHS, and NIS (1994-December 2003), CDC, NIP and NCHS; No data from 1986-1990 due to cancellation of USIS because of budget reductions0 Estimated Vaccination Coverage with the 4:3:1:3:3* Series, by Coverage Level and State National Coverage = 81% 78 79 VT 85 85 83 86 83 82 81 82 78 81 82 86 82 82 83 68 81 71 79 77 79 82 80 87 86 81 82 78 72 79 82 NH MA RI CT NJ DE MD DC 86 89 87 88 83 86 80 83 84 73 82 75 84 80 85 89 75 8 1 *4+DTP, 3+Polio, 1+MCV, 3+Hib, 3+HepB  90% 80-89% 70-79%  69% Estimated Vaccination Coverage with Series Among Children 19-35 Months of Age, National Immunization Survey, 2000 & 2004 Percent 94.1 95.9 81.7 85.5 100 80 60 40 20 0 89.5 91.6 93.4 93.5 90.3 92.4 DTP 3+ DTP 4+ Polio 3+ 2000 Hib 3+ HepB 3+ 2004 Estimated Vaccination Coverage with Series Among Children 19-35 Months of Age, National Immunization Survey, 2000 - 2004 Percent 100 84.8 80.6 87.5 80 67.8 76.3 73.2 68.1 2000 2001 2002 2003 60 40.8 40 2004 20 0 0 0 Varicella 1+ doses PCV 3+ doses Challenges  Introducing new vaccines  Establishing and maintaining a steady vaccine supply  Vaccine financing  Reducing remaining racial/ethnic disparities in coverage  Addressing unfounded fears about vaccine safety Estimated Vaccination Coverage* Among Children 19-35 Months of Age by Race/Ethnicity† – US, National Immunization Survey, 2000-2004 4:3:1:3:3‡ US National 100 90 80 70 60 50 40 30 20 10 0 2000 2001 2002 2003 2004 * Estimate=NA (Not Available) if the unweighted sample size for the numerator was <30 or (CI half width)/Estimate >0.5 or (CI half width)>10 † Self-reported by respondent. Individual racial groups do not include Hispanic children. Children of Hispanic ethnicity may be o f any race ‡ 4 or more doses of DTP, 3 or more doses of poliovirus vaccine, 1 or more doses of any MCV, 3 or more doses of Hib, and 3 or more doses of HepB White only, non-Hispanic Hispanic Black only, non-Hispanic Children Receiving Autism Services by Quarter, California, 2002-2005 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 3-5 year olds 6-9 year olds 3Q2002 4Q2002 1Q2003 2Q2003 3Q2003 4Q2003 1Q2004 2Q2004 3Q2004 4Q2004 1Q2005 California Department of Developmental Services 2Q2005 Summary Protecting our Children  Record high coverage rates  2010 goal of 80% vaccination series complete by age 2 years already achieved  More needs to be done to sustain the immunization system and protect more children Department of Health and Human Services Centers for Disease Control and Prevention Estimated Vaccination Coverage with Series Among Children 19-35 Months of Age, National Immunization Survey, 2000 & 2004 2000 Vaccine 4:3:1 % (95% CI) 2001 % (95% CI) 2002 % (95% CI) 2003 % (95% CI) 2004 % (95% CI) 77.6 (±0.9) 78.6 (±0.9) 78.5 (±1.0) 82.2 (±0.9) 83.5 (±0.9) 4:3:1:3 76.2 (±0.9) 77.2 (±0.9) 77.5 (±1.0) 81.3 (±0.9) 82.5 (±0.9) 4:3:1:3:3 72.8 (±0.9) 73.7 (±0.9) 74.8 (±1.0) 79.4 (±0.9) 80.9 (±0.9) 4:3:1:3:3:1 54.1 (±1.0) 61.3 (±1.0) 65.5 (±1.1) 72.5 (±1.0) 76.0 (±1.0) Estimated Vaccination Coverage with Individual Vaccines Among Children 19-35 Months of Age, National Immunization Survey, 2002 & 2003 2000 Vaccine DTP/DT/DTaP ≥3 doses ≥4 doses Poliovirus Hib ≥3 doses MMR ≥1 dose Hepatitis B ≥3 doses Varicella ≥1 dose PCV % (95% CI) 2001 % (95% CI) 2002 % (95% CI) 2003 % (95% CI) 2004 % (95% CI) 94.1 (±0.5) 81.7 (±0.8) 89.5 (±0.6) 93.4 (±0.5) 90.5 (±0.6) 90.3 (±0.6) 67.8 (±0.9) 94.3 (±0.5) 82.1 (±0.8) 89.4 (±0.7) 93.0 (±0.6) 91.4 (±0.6) 88.9 (±0.7) 76.3 (±0.8) 94.9 (±0.6) 81.6 (±0.9) 90.2 (±0.7) 93.1 (±0.6) 91.6 (±0.7) 89.9 (±0.7) 80.6 (±0.9) 96.0 (±0.5) 84.8 (±0.8) 91.6 (±0.7) 93.9 (±0.6) 93.0 (±0.6) 92.4 (±0.6) 84.8 (±0.8) 95.9 (±0.5) 85.5 (±0.8) 91.6 (±0.7) 93.5 (±0.6) 93.0 (±0.6) 92.4 (±0.6) 87.5 (±0.7) ≥3 doses ≥4 doses --- --- 40.8 (±1.1) -- 68.1 (±1.0) 35.8 (±1.0) 73.2 (±1.0) 43.4 (±1.1) Estimated Vaccination Coverage* Among Children 19-35 Months of Age by Race/Ethnicity† – US, National Immunization Survey, 2000-2004 4:3:1:3:3‡ 2000 2001 % (95% CI) 2002 % (95% CI) 2003 % (95% CI) 2004 % (95% CI) Vaccine US National % (95% CI) 72.8 (±0.9) 73.7 (±0.9) 74.8 (±1.0) 79.4 (±0.9) 82.5 (±0.9) White only, non-Hispanic Black only, non-Hispanic 76.1 (±1.1) 75.4 (±1.1) 77.7 (±1.2) 82.5 (±1.1) 85.1 (±1.1) 67.8 (±2.7) 67.2 (±2.8) 67.7 (±3.1) 73.0 (±3.2) 76.0 (±3.0) Hispanic 68.5 (±2.2) 74.1 (±2.0) 72.7 (±2.4) 77.0 (±2.1) 81.2 (±2.0) * Estimate=NA (Not Available) if the unweighted sample size for the numerator was <30 or (CI half width)/Estimate >0.5 or (CI half width)>10 † Self-reported by respondent. Individual racial groups do not include Hispanic children. Children of Hispanic ethnicity may be of any race ‡ 4 or more doses of DTP, 3 or more doses of poliovirus vaccine, 1 or more doses of any MCV, 3 or more doses of Hib, and 3 or more doses of HepB