Anne Schuchat, MDDirector, National Center for Immunization and Respiratory
DiseasesAssistant Surgeon General, US Public Health Services
Centers for Disease Control and Prevention
CDC Update on Achieving Healthy People 2020 Objectives for Immunization and Vaccine-
Preventable Diseases
National Center for Immunization and Respiratory Diseases
NVAC Meeting, September 10, 2014Washington, DC
Outline Update on immunization & vaccine-
preventable disease objective progress Selected barriers Product issues Consumer and patient issues Provider and system issues
Summary and discussion
MMWR 63(16);352-355, April 25, 2014
Increasing Vaccine-Specific Coverage Rates Among Preschool-Aged Children: 1967 - 2013
Children 19-35 Months Who Received No Vaccinations, 2008-2013, U.S.
0.6 0.60.7
0.8 0.80.7
0
1
2
2008 2009 2010 2011 2012 2013
% z
ero
vacc
inat
ions
Survey Year
HP2020 Goal: <1%
MMWR 63(34); 741-748, August 29, 2014
HP2020 objective IID-9 (tracking measure)
Estimated Vaccinat ion Coverage, Children 19-35 Months,
New Healthy People 2020 Object ives
* HP2020 target for birth dose of HepBis measured by birth cohort. Data shown are estimates from the 2005-2010 birth cohorts.** 2 or 3 doses, depending on the type of rotavirus vaccine receivedSource: CDC, NIS
National Center for Immunization & Respiratory DiseasesHistorical Comparisons of Vaccine-Preventable Disease Morbidity in the U.S.
Comparison of 20th Century Annual Morbidity and Current Morbidity: Vaccine-Preventable Diseases
Disease20th Century
Annual Morbidity†2013
Reported Cases † †Percent
Decrease
Smallpox 29,005 0 100%Diphtheria 21,053 0 100%Measles 530,217 187 > 99%Mumps 162,344 584 > 99%Pertussis 200,752 28,639 86%Polio (paralytic) 16,316 1 > 99%Rubella 47,745 9 > 99%Congenital Rubella Syndrome 152 1 99%Tetanus 580 26 96%Haemophilus influenzae 20,000 31* > 99%† JAMA. 2007;298(18):2155-2163† † CDC. MMWR August 15, 2014:63(32);702-715. (MMWR 2013 final data) * Haemophilus influenzae type b (Hib) < 5 years of age. An additional 10 cases of Hib are estimated tohave occurred among the 185 reports of Hi (< 5 years of age) with unknown serotype.
8/28/14
National Center for Immunization & Respiratory DiseasesHistorical Comparisons of Vaccine-Preventable Disease Morbidity in the U.S.
Comparison of Pre-Vaccine Era Estimated Annual Morbidity with Current Estimate: Vaccine-
Preventable Diseases
DiseasePre-Vaccine Era Annual
Estimate†2013 Estimate* Percent
Decrease
Hepatitis A 117,333 2,890 98%Hepatitis B (acute) 66,232 18,800 72%Pneumococcus (invasive)
all ages 63,067 33,500 47%< 5 years of age 16,069 1,900 88%
Rotavirus (hospitalizations, < 3 years of age)
Varicella
62,500 *
4,085,120
12,500
167,490
80%
96%
† JAMA. 2007;298(18):2155-2163* CDC (NNDSS, ABCs/EIP Network, NVSN)
8/28/14
0.0
5.0
10.0
15.0
20.0
25.0
2008 2009 2010 2011 2012 2013
Case
s per
100
,000
pop
ulat
ion
Year
<5 Overall
<5 Antibiotic-resistant<5 Overall
<5 Antibiotic-resistant
HP2020 Target: 12
PCV13 introductionHP2020 Target: 6
Incidence of Invasive Pneumococcal Disease (IPD) in Children <5 years old
Source: CDC (Active Bacterial Core Surveillance, EIP Network)
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
2008 2009 2010 2011 2012 2013
Case
s per
100
,000
pop
ulat
ion
Year
65+ Overall
65+ Antibioitc-resistant
HP2020 Target: 31
HP2020 Target: 9
PCV13 introduction
Incidence of Invasive Pneumococcal Disease (IPD) in Adults > 65 years old
Source: CDC (Active Bacterial Core Surveillance, EIP Network)
http://www.cdc.gov/vaccines/acip/meetings/slides-2014-08.html
0
50,000
100,000
150,000
200,000
250,000
300,000
Num
ber o
f cas
es
Year
DTP
0
10,000
20,000
30,000
40,000
50,000
60,000
1990 1995 2000 2005 2010 2013
Tdap
DTaP
Reported NNDSS Pertussis Cases: 1922-2013
SOURCE: CDC, National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System and 1922-1949, passive reports to the Public Health Service
Trends in Pertussis by Age Group
0
2000
4000
6000
8000
10000
12000
14000
16000
2012 2013* 2012 2013*
HP2020 Target: 2000
<1 year 11-18 years
HP2020 Target: 2500
*MMWR 62(52); ND-719-ND-732 (provisional, week 522013 NNDSS data) 9-5-14
DTaP Effectiveness (California, 20101) and Tdap Effectiveness (Washington, 20122)
by Time Since Last Dose*
0102030405060708090
100
0-1 1-2 2-3 3-4 (2-4 forTdap)
4-5 >5
Vacc
ine
Effe
ctiv
enes
s (VE
)*
Years Since Vaccinat ion
DTaP VE Tdap VE
1JAMA. 2012;308:2126-2132. *Accounting for clustering by county and provider2CDC, unpublished data.
Improving Vaccination during Pregnancy is Key
Amirthalingam, Lancet, July 16, 2014 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960686-3/fulltext
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Estimated Herpes Zoster (Shingles)Vaccination Coverage, Adults aged > 60 years
0
10
20
30
40
2008 2009 2010 2011 2012
% Z
oste
r Cov
erag
e
Year
HP2020 at least 30%
National Health Interview Survey
Major Supply Constraints in Past 5 Years
Hib vaccine shortage:Dec. 2007-July 2009
Zoster vaccine shortage:2009-Dec. 2011
Pentacel combinat ion vaccine shortage:Apr. 2012- May/June 2014
Reported Measles Incidence United States, 1992-2014*
0.00.10.20.30.40.50.60.70.80.91.0
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
Cases/100,000
Year
*YTD
1 case/million
Measles elimination declared
*As of September 2, 2014
National Vaccination Coverage Levels Adolescents 13-17 Years,
NIS-Teen, 2006-2013
0
20
40
60
80
100
2006 2007 2008 2009 2010 2011 2012 2013
Perc
ent
Year
Tdap
MenACWY
>1 HPV (girls)
>3 HPV (girls)>3 HPV (boys
> 3 H P V ( b o y s )
MMWR. 2014;63;625-33
22
Vaccination Coverage, Adolescents 13-15 years, 2006-2013
NIS-Teen
≥1 Tdap
≥1 MCV
≥3 HPVfemales only
0
10
20
30
40
50
60
70
80
90
100
2006 2007 2008** 2009 2010 2011 2012 2013
Perc
ent ≥1 HPV*
females only
Varicella
HP 2020 Target*
* Target is 90% for 2 doses of varicella; > 1 HPV is not an HP 2020 objective. ** Baseline for HP 2020.
Actual and potent ially achievable vaccinat ion coverage of >1 HPV vaccine by age 13 years among adolescent girls if missed
opportunit ies* were eliminated, NIS-Teen 2007-2013 combined
12
28 32 34 3642
47
20
57
7480
85 88 91
0
20
40
60
80
100
1994 1995 1996 1997 1998 1999 2000
% v
acci
nate
d
Year of Birth
Actual Coverage
Potential Coverage
*Missed opportunity defined as having a healthcare encounter where at least one vaccine was administered but HPV was notMMWR. 2014; 63:620-4
Healthy People 2020 Objective 17.1Increase percentage of public health providers who have had vaccination coverage levels among children in their practice
population measured in the past year
0%
10%
20%
30%
40%
50%
60%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Healthy People 2020 Target
70%
25
Healthy People 2020 Objective 17.2Increase percentage of private providers who have had
vaccination coverage levels among children in their practice population measured in the past year
0%
10%
20%
30%
40%
50%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Healthy People 2020 Target
60%
26
60%
65%
70%
75%
80%
85%
90%
95%
100%
2006 2007 2008 2009 2010 2011 2012 2013
IID-18 Increase the percentage of children under the age of 6 years of age whose immunization records are in a
fully operational, population-based immunization information system (IIS)
27
Immunization Information System Executive Board First meeting held Nov 19, 2013
Newly chartered inter-governmental board Federal, state, and local governmental members Provides input to CDC to help update IIS strategic plan Helps NCIRD sustain nat ional leadership role in future
direct ion of IIS Assists us with development and alignment of strategic
init iat ives to support goals Strengthens links with key governmental stakeholders
and enablers (Office of the Nat ional Coordinator, CMS,Indian Health Service, cancer registries, etc.)
CDC’s IIS Strategic Plan Focus Areas
National leadership Vision, strategy, policy, standards, accountability, shared services
Service Delivery Provider/patient access & clinical decision support at point of care
Capacity & Infrastructure Immunization programs, informatics, surveillance, coverage
Interoperability/data management Data exchange across information ecosystem, including data
quality & semantic interoperability considerations
Sustainability Long-term funding, resources to maintain immunization
information management and informatics at a national level
Changes in HP2020 Objectives
• Influenza objectives have been consolidated and datasources updated– http://www.healthypeople.gov/2020/topicsobjectives2020/ob
jectiveslist.aspx?topicid=23
• HPV objective for boys has been approved– Eventually, aim for HPV objective for all teens (girls and boys)
30
Summary for 2013/14 HP2020
• Most VPDs low or decreasing– Sustained or improved immunization coverage– Measles in 2014 and pertussis cycles
• Current barriers and challenges– Reducing pertussis deaths through Tdap in
pregnancy– Intermittent supply shortages– Public and provider barriers
• Measles among selected groups (e.g. Amish)• HPV vaccination issues (missed opportunities)
31