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

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

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

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

5. 20th Century Average Annual Morbidity 2002 † 2010 Target Diphtheria Measles Mumps Pertussis Polio (paralytic) Rubella Congenital Rubella Syndrome Tetanus H. influenzae, type b and unknown (<5 yrs) 175,885 503,282 152,209 147,271 16,316 47,745 823 1,314 20,000 ‡ 1 37 238 8,296 0 14 3 22 167 0 2,000 0 Source: CDC. MMWR 1999. 48: 242-264. † Data are preliminary. ‡ Data are estimated. Disease Comparison of 20 th Century Average Annual Morbidity and 2002 Morbidity, Vaccine-Preventable Diseases Numbers in red indicate record lows in 2002

6. DTP(3+) † MMR(1+) Polio (3+) Hib (3+) Hep B (3+) Varicella (1+) † 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 2002), CDC, NIP and NCHS; No data from 1986-1990 due to cancellation of USIS because of budget reductions 2010 Target 14-22. Vaccine-specific coverage rates among pre-school aged children Percent

7. DTP MMR Polio Hib Hep B Varicella Source: National Immunization Survey (NIS), CDC, NIP and NCHS. 2010 Target 14-22. Achieve and maintain effective vaccination coverage levels for universally recommended vaccines Percent of children 19-35 months PCV

8. White Black Measles vaccination coverage among preschool-aged children, by race Other Note: Children in the USIS and NHIS were 24-35 months of age. Children in the NIS were 19-35 months of age. Source: 1970-1983 United States Immunological Survey (USIS), CDC, Division of Immunization, 1992-1993 National Health Interview Survey (NHIS), CDC, NCHS; 1994-2001 National Immunization Survey (NIS), CDC, EPO. Percent 1983 1970 1976 1992 1994 2001

9. White, Not Hispanic Black, Not Hispanic Hispanic** American Indian / Alaskan Native* Asian* I 95% Confidence interval. § Data are statistically unreliable. *Includes persons of Hispanic and non-Hispanic origin ** Can be of any race Source: National Immunization Survey (NIS), CDC, NIP and NCHS. Percent 2010 Target Native Hawaiian/ Other Pacific Islander* Multiple Race* Obj. 14-22 § § § 14-22. Universally recommended vaccination coverage among children 19-35 months, by race and ethnicity, 2002

10. White, Not Hispanic Black, Not Hispanic Hispanic** American Indian / Alaskan Native* Asian* † DTP (3) is not a Healthy People 2010 objective. ‡ Developmental objective. Target has not been determined. * Includes persons of Hispanic and non-Hispanic origin ** Can be of any race I 95% Confidence interval. Source: National Immunization Survey (NIS), CDC, NIP and NCHS. 14-22. Universally recommended vaccination coverage among children 19-35 months, by race and ethnicity, 2002 DTP (4+) DTP (3+) Percent 4:3:1:3:3 Series 2010 Target PCV(3+) ‡ Percent Native Hawaiian/ Other Pacific Islander* Multiple Race* § § § § §§

11. 2010 target ‡ 14-23. Vaccination coverage of children in daycare, kindergarten, and first grade, 2002 † † Developmental Healthy People 2010 objective. ‡ Proposed Healthy People 2010 target. ^ Kindergarten and first grade percentage based on data from 40 states and the District of Columbia. All states require 3 doses of HepB, however the District of Columbia requires 2 doses. ^ ^ Kindergarten and first grade percentage based on data from 24 states and the District of Columbia. Source: National Immunization Survey (NIS), CDC, NIP and NCHS; School Entry Immunization Assessment Report, CDC, NIP. Kindergarten and first grade Daycare Percent Hepatitis B^ Varicella^^

12. HepB (3+)MMR (1+)DTaP (4) 14-27. Universally recommended vaccination coverage among children 13-15 years, 2001 Source: National Health Interview Survey (NHIS), CDC, NCHS. 55% 74% 76% 93% 34 92% 55% 76% 34% Shot-record data only Shot record and recall data 2010 Target

13. 14-27a. 3 or more doses of Hepatitis B vaccination among adolescents 13-15 years Source: National Health Interview Survey (NHIS), CDC, NCHS. 2010 Target Shot record data only Shot record and recall data Percent

14. 14-27b. 1 or more doses of MMR vaccination among adolescents 13-15 years Source: National Health Interview Survey (NHIS), CDC, NCHS. 2010 Target Shot record data only Shot record and recall data Percent

15. 14-27c. 1 or more doses of Td vaccination among adolescents 13-15 years Source: National Health Interview Survey (NHIS), CDC, NCHS. 2010 Target Shot record data only Shot record and recall data Percent

16. 80-89% 70-79% 60-69% † 4+DTP, 3+Polio, 1MCV, 3+Hib, 3+HepB 79 76 82 75 80 77 72 76 78 75 68 63 69 67 65 76 73 81 VT 81 75 73 79 70 69 75 80 82 79 72 77 79 69 77 73 78 80 71 67 65 68 NJ CT MA NH RI DC DE MD 84 77 85 82 76 79 86 70 National Coverage = 75% Source: National Immunization Survey (NIS), CDC, NIP and NCHS. 14-24a. Vaccination coverage with the 4:3:1:3:3 † series, among children 19-35 months, 2002

17. Note: Percent receiving vaccine is estimated per Influenza season, using the January-June interviews only. Source: National Health Interview Survey (NHIS), CDC, NCHS. 2010 target 14-29a. Influenza vaccination coverage during the past 12 months, among adults 65 years and older Percent 1988 1990199219941996 199820002002

18. 2010 target * Can be of any race. Source: National Health Interview Survey (NHIS), CDC, NCHS. White, Not Hispanic Hispanic * Black, Not Hispanic 14-29a. Influenza vaccination coverage during the last 12 months of adults 65 years and older, by race/ethnicity Percent 19891991 1993 1995 1999 19972001

19. † Data are preliminary. * Includes persons of Hispanic and non-Hispanic origin. ** Can be any race. Source: National Health Interview Survey (NHIS), CDC, NCHS. White African American Hispanic** 2010 Target Asian* Total 14-29b. Pneumococcal vaccination coverage ever received among adults 65 years and older, by race/ethnicity Percent †

20. † High risk persons include respondents with one or more of the following conditions: heart disease, diabetes, asthma, chronic bronchitis, kidney disease, and cancer (excluding skin cancer). Source: National Health Interview Survey (NHIS), CDC, NCHS. 2010 Target 14-29c. Influenza vaccination in past 12 months among adults with high risk conditions †, ages 18-64 Percent 50-64 years of age 18-49 years of age

21. † High risk persons include respondents with one or more of the following conditions: heart disease, diabetes, asthma, chronic bronchitis, kidney disease, and cancer (excluding skin cancer). * Includes persons of Hispanic and non-Hispanic origin. ** Can be of any race. I 95% Confidence interval. Source: National Health Interview Survey (NHIS), CDC, NCHS. 2010 Target 14-29c. Influenza vaccine coverage among adults with high risk conditions †, ages 18-64, by race/ethnicity 19982001 TOTAL White, Not Hispanic Black, Not Hispanic Hispanic ** Asian * American Indian or Alaska Native * Percent

22. † High risk persons include respondents with one or more of the following conditions: heart disease, diabetes, asthma, chronic bronchitis, kidney disease, and cancer (excluding skin cancer). Source: National Health Interview Survey (NHIS), CDC, NCHS. 2010 Target 14-29d. Pneumococcal vaccination ever received, among adults with high risk conditions †, ages 18-64 years 50-64 years old 18-49 years old Percent

23. ** Can be of any race. † High risk persons include respondents with one or more of the following conditions: heart disease, diabetes, asthma, chronic bronchitis, kidney disease, and cancer (excluding skin cancer). Source: National Health Interview Survey (NHIS), CDC, NCHS. HP 2010 Target 14-29d. Pneumococcal vaccine ever received among adults with high risk conditions †, 18- 64 years, by race/ethnicity Percent 19982001 TOTALWhite, Not Hispanic Black, Not Hispanic Hispanic**

24. 14-6. Reduce Hepatitis A Hepatitis A 2010 Target Cases per 100,000 Source: National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.

25. Hepatitis A Incidence 1999 ACIP recommendations 1996 ACIP recommendations 1995 vaccine licensure † Data are preliminary. Source: National Notifiable Disease Surveillance System (NNDSS), CDC, EPO. Cases per 100,000 19801985199019952000 2002 † 2010 Target

26. 14-6. Reduce Hepatitis A, by race and ethnicity 2010 Target Cases per 100,000 * Not Hispanic ** Can be of any race AI/AN = American Indian Alaska Native A/PI= Asian or Pacific Islander Source: National Notifiable Disease Surveillance System (NNDSS), CDC, EPO. Hispanic** AI/ AN A/PI Black* White*

27. Hepatitis A Incidence, by age Incidence per 100,000 † Data are preliminary. Source: National Notifiable Disease Surveillance System (NNDSS), CDC, EPO. 19 years and older Less than 19 years old 1990 19921994 1996 1998 20002002 †

28. Hepatitis B Incidence † The number of hepatitis B cases reported to NNDSS by year of age is multiplied by age-specific ratios of infections to reported cases and by the age-specific proportions of infections which are symptomatic. Source: National Notifiable Diseases Surveillance System (NNDSS), CDC, EPO. Estimated † cases per 100,000 19-39 years 40 years and older Less than19 years Obj. 14-3 19902002 20001998199619941992

29. 14-3. Hepatitis B Incidence, by race and ethnicity, 2001 American Indian/ Alaska Native* I 95% Confidence interval. *Includes persons of Hispanic and non-Hispanic origin **Can be of any race. Source: National Notifiable Diseases Surveillance System (NNDSS), CDC, EPO. Per 100,000 2010 target 19-24 years 25-39 years 40 years and older Asian or Pacific Islander* Hispanic** White, Not Hispanic Black, Not Hispanic

30. 14-11. Cases of Tuberculosis 198219861990199419982002 † † Data are preliminary Number of Cases Source: National TB Surveillance System, CDC, NCHSTP.

31. 2010 target 14-11. Rates of Tuberculosis, by race and ethnicity * Includes persons of Hispanic and non-Hispanic origin ** Can be of any race Note: Data are age adjusted to the 2000 standard population. Data in parentheses represent the percent change in the rate between 1998 and 2001. Source: National TB Surveillance System, CDC, NCHSTP. 20011998 American Indian or Alaska Native* Asian or Pacific Islander* Black, Not Hispanic White, Not Hispanic Hispanic** TOTAL Per 100,000 population -15% -11% -12% -13% -20% -26%

32. Percent 2010 target 14-12. Proportion of Tuberculosis Patients Completing Curative Therapy * Includes persons of Hispanic and non-Hispanic origin **Can be of any race Source: National TB Surveillance System, CDC, NCHSTP. 19991996 American Indian or Alaska Native* Asian or Pacific Islander* Black, Not Hispanic White, Not Hispanic Hispanic** TOTAL

33. Percent Percent of Tuberculosis labs using recommended procedures Source: Tuberculosis Elimination and Laboratory Upgrade Cooperative Agreements. Unpublished CDC data. Rapid Drugs Liquid Media Fluorochrome Rapid I. D.

34. Percent Percent of Tuberculosis labs meeting turn-around time goal Note: Data for laboratories using Liquid Media procedures was not available. Source: Tuberculosis Elimination and Laboratory Upgrade Cooperative Agreements. Unpublished CDC data. Fluorochrome Rapid I. D. Rapid Drugs

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