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National Center for Immunization & Respiratory Diseases WHY WE’RE HERE Melinda Wharton, MD, MPH Director, Immunization Services Division AIM Leadership Conference February 8, 2017
National Center for Immunization & Respiratory Diseases
WHY WE’RE HERE
Melinda Wharton, MD, MPH
Director, Immunization Services Division
AIM Leadership Conference
February 8, 2017
Vaccines save lives.
507,300 diphtheria deaths20,300 pertussis deaths57,300 measles deaths
59,700 hepatitis B deaths55,000 pneumococcal deaths
13,700 Haemophilus influenzae type b deaths14,800 polio deaths
Nationally, vaccination of young childrencontinues to be the norm.
Vaccine-specific Coverage* among Children 19-35 Months, National Immunization Survey, United States, 1994-2014
* The Healthy People 2020 target for coverage is 90% for all vaccines with the exception of rotavirus (80%) and HepA (85%).† DTP (3+) is not a Healthy People 2020 objective. DTaP (4+) is used to assess Healthy People 2020 objectives.§ Reflects 3+ doses through 2008, and Full Series (3 or 4 doses depending on type of vaccine received) 2009 and later.
0
10
20
30
40
50
60
70
80
90
100
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
Pe
rce
nt
Vac
cin
ate
d
Year
MMR (1+)
DTP/Dtap (3+ )†
Polio (3+)
Hib (3+)§
HepB (3+)
Varicella (1+)
PCV (4+)
Rotavirus*
HepA (2+)*
Rotavir3
1+
3+
2+ HepA
4+ PCV
http://www.culturalcognition.net/browse-papers/vaccine-risk-perceptions-and-ad-hoc-risk-communication-an-em.html
But there’s still room for improvement.
Results - Vaccination Coverage by Poverty Status,§ NIS 2014
Vaccine and Doses Below Poverty Level Percentage Point Difference
3+ DTaP 2.8
4+ DTaP† 8.3
3+ Polio† 2.5
1+ MMR† 3.3
Hib-Primary Series 4.1
Hib-Full Series† 9.2
3+ HepB†
HepB-birth dose
1+ Varicella†
3+ PCV 3.1
4+ PCV† 10.0
2+ HepA 5.2
Rotavirus 14.1
4:3:1:3*:3:1:4 series 9.7
§ Comparison group is “at or above poverty level” † included in series
Not all outbreaks of vaccine-preventable disease are caused by lack of vaccination.
We cannot prevent outbreaks of pertussiswith our current pertussis vaccine.
Reported NNDSS pertussis cases: 1922-2015*
0
50,000
100,000
150,000
200,000
250,000
300,000
Nu
mb
er
of
case
s
Year*2015 data are provisional
SOURCE: CDC, National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System and 1922-1949, passive reports to the Public Health Service
0
10,000
20,000
30,000
40,000
50,000
60,000
1990 1995 2000 2005 2010 2015*
DTP
DTaPTdap
Shifting the Timing of Mother’s Tdap Dose:Postpartum to Pregnancy
Provides earlier protection to mother
Transfers high levels of transplacental maternal antibodies to infants
Likely provides direct immunity to infant
Pregnancy Postpartum
We now know how to improve HPV vaccine coverage.
Estimated HPV Vaccination Coverage among Adolescents Aged 13-17 Years, NIS-Teen, United States, 2006-2015
0
10
20
30
40
50
60
70
80
90
100
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Pe
rce
nt
Vac
cin
ate
d
Survey Year
Tdap
MCV4
1 HPV girls
3 HPV girls
1 HPV boys
86.4
81.3
62.8
49.8
41.9
28.1
56.1
Source: Reagan-Steiner, et al. MMWR; August 26, 2016 / 65(33);850–858
SYSTEMS STRATEGIES TO IMPROVE HPV VACCINE COVERAGE
Establish standing orders for HPV vaccination beginning at age 11-12 years in your practice
Conduct reminder/recall beginning at 11-12 years of age
Assess HPV vaccine coverage at every visit and prompt clinical staff to give HPV vaccine at that visit
Schedule return visit for next dose before the patient leaves the office
Document each dose in the child’s medical record and the state’s immunization information system
TACTICS FOR SUCCESSFUL HPV VACCINE DELIVERY,DENVER HEALTH
Routine use of a robust immunization registry for multiple functions, including recording vaccine history and recommended needed vaccines at every visit
Medical assistants check vaccine registry for recommended vaccines at every visit
Standing order for routine immunizations
Vaccines are given early in the visit when possible
Education for providers to present Tdap, MCV, and HPV as a standard “bundle” of adolescent immunizations
Provider-level “report cards” with adolescent vaccination coverage rates
Vaccination drives at school-based health centersFarmer et al, Pediatrics 2016
Immunization Rates for Adolescents Denver Health, 2004-2014
Farmer et al, Pediatrics 2016
We need a modern information systems for immunization.
It’s too big a job (and too important) for any of us alone;
all of us need to work on it, together.
State Health Department
Local HealthDepartments
State Health Department
Local HealthDepartments
State AAPChapter
State AFPChapter
School Nurses
Public Health Nurses
Medicaid
Primary Care Association
IntegratedHealthcare
Systems
MedicaidManaged Care Organizations
Other Payers
Federally Qualified Health
Centers
ImmunizationCoalitions
State Health Department
Local HealthDepartments
State AAPChapter
State AFPChapter
School Nurses
Public Health Nurses
Medicaid
Primary Care Association
IntegratedHealthcare
Systems
MedicaidManaged Care Organizations
Other Payers
Federally Qualified Health
Centers
ImmunizationCoalitions
American CancerSociety
Cancer CoalitionsAcademic
Cancer Centers
State Comprehensive Cancer Control
Program
State Health Department
Local HealthDepartments
State AAPChapter
State AFPChapter
School Nurses
Public Health Nurses
Medicaid
Primary Care Association
IntegratedHealthcare
Systems
MedicaidManaged Care Organizations
Other Payers
Federally Qualified Health
Centers
ImmunizationCoalitions
American CancerSociety
Cancer CoalitionsAcademic
Cancer Centers
State Comprehensive Cancer Control
Program
Medicare
Pharmacies
Employee Health
Programs
For more information, contact CDC1-800-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.
Thank you
www.cdc.gov/vaccines
