Healthy People 2010 Focus Area 14 Presented by: Abigail Shefer, MD, FACP CAPT, USPHS Associate Director for Science Immunization Services Division National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention

Healthy People 2010 Focus Areas Top 5 Focus Areas by # of Objectives* Injury/Violence Prevention, 39 objectives 16 sub-objectives Immunization/Infectious Disease, 31 objectives 18 Immunization objectives 55 sub-objectives 13 Infectious Disease objectives 5 sub-objectives Environmental Health, 30 objectives 66 sub-objectives Substance Abuse, 25 objectives 32 sub-objectives Tobacco Use, 21 objectives 38 sub-objectives *Numbers do not take into account mid-course deletions **Half of Focus Areas range from 12-18 objectives. Immunization and Infectious Disease together have the 2nd highest number of objectives. Separated, Immunization has 18 objectives, but a large number of sub-objectives.

Immunization Target Overview Reduction in # of cases Target Individual vaccine-preventable diseases 95% Target Maintain vaccination coverage levels for children in licensed day care facilities and children in kindergarten through first grade. 93% Target Vaccination coverage of occupationally exposed workers with HepB # of cases: drops in total number of cases or cases per 100,000 % Target refer to percentage of total population

Immunization Target Overview Achieve/maintain coverage of universally recommended vaccines for 19-35 month olds Routine vaccination coverage levels for adolescents HepB vaccination coverage in long term hemodialysis patients Pneumococcal and seasonal flu vaccination coverage in both non-institutionalized adults 65+ and institutionalized adults 80% Target 19-35 months and 13-15 yrs who receive all recommended vaccines

Immunization Target Overview Proportion of children who participate in fully operational population-based immunization registries 60% Target HepB vaccination coverage for MSM Pneumococcal and seasonal flu vaccination coverage in non-institutionalized high-risk adults 18-64 yrs Seasonal Flu vaccine coverage for healthcare workers 18-64 yrs 55% Target providers assessment of vaccination coverage in their practice within last 2 years

Healthy People 2010 Immunization Sub-objectives by Year Target Met 1-b Baseline 1999 2000 2001 2002 2003 2004 2005 2006 1-h*** 22-b*** 22-d*** 22-e*** 23-a*** 23-b*** 23-c*** 27-b*** 27-c*** 30-a*** 30-b*** 1-b 30-a 7 23-a 30-b 5-a* 6** 22-c 23-f*** 23-g*** 23-h*** 23-i*** 23-l*** 1-a 5-b* 23-j 24-a 3-d 23-l Objectives were set to be consistent with HP2000 targets. At data baseline year, the following goals were met: 1998: Polio cases Achieve/maintain universally recommended vaccines 19-35 mo: Hib, MMR, polio, Maintain vaccination coverage levels for children in licensed day care facilities: Day care: DTaP, MMR, polio Routine vaccination coverage among adolescents: MMR, Td (based on NCHS data, not NIS) Adverse events from vaccination: associated paralytic polio, febrile seizures 2002/2003: Maintain vaccination coverage levels for children in kindergarten: Kindergarten: DTap, MMR, polio, HepB, Hib, Pneumococcal conjugate vaccine (5a in 2001 and 5b in 2004) and targeted Hepatitis A (6) goals were met within 1-2 years of ACIP recommendation of the vaccine. *Reduce invasive pneumococcal infections; pneumococcal conjugate vaccine recommended by ACIP in 2000. **Reduce Hepatitis A; ACIP recommendation made in 1999 ***Baseline year

Healthy People 2010 Immunization Objectives Met 1: Reduce or eliminate indigenous cases of vaccine preventable diseases Met: Congenital Rubella Syndrome, Diphtheria, Polio, Unmet: Hib, Hepatitis B, Measles, Mumps, Pertussis, Rubella, Tetanus, Varicella 3: Reduce Hepatitis B Met: Adults, High-risk group injection drug users Unmet: 19-24 yrs, 25-39 yrs, 40 yrs+, High risk groups Heterosexually active, MSM, occupationally exposed workers 14-1, 14-3, 14-5, 14-6 and 14-7 are all met through reduction in total number of cases. 1-Polio met at baseline/1998, Congenital rubella syndrome met 2004, Diphtheria met in 1999. 3-Hepatitis B among high risk group injection drug users met in 2005.

Healthy People 2010 Immunization Objectives Met 5: Reduce invasive pneumococcal infections Met: New invasive infection in children, adults 65+ Unmet: Penicillin-resistant infection in children, adults 65+ 6: Reduce Hepatitis A 7: Reduce meningococcal disease. 14-1, 14-3, 14-5, 14-6 and 14-7 are all met through reduction in total number of cases 5-for Pneumococcal infections, invasive infection in children met in 2001, invasive infection in adults 65+ met in 2004 (PCV4 recommended by ACIP in 2000) 6-hepatitis A met in 2001 (targeted hep A immunization recommended by ACIP in 1999.) 7-Meningococcal disease, met in 2000.

Healthy People 2010 Immunization Objectives Met 22: Achieve and maintain effective vaccination coverage levels for universally recommended vaccines among young children aged 19-35 months Met/Maintained: Hib, Hep B, MMR, Polio Unmet: DTaP, Varicella, pneumococcal conjugate, influenza 23: Maintain vaccination coverage levels for children in licensed day care facilities and children in kindergarten Met: Day care for DTaP, MMR, Polio: Kindergarten for DTap, MMR, Polio, Hep B Unmet: Day care for Hep B, Varicella, pneumococcal conjugate, Hib 14-22 met at 90% coverage level 14-23 met at 95% coverage level 22-hib met at baseline/1998, HepB met in 2002, MMR met at baseline/1998, polio met at baseline/1998. 23-day care: DTaP met at baseline/1998, MMR met at baseline/1998, polio met at baseline/1998. kindergarten: DTaP met at at baseline/2002, MMR met at baseline/2002, poplio met at baseline/2002,, HepB met at baseline/2002

Healthy People 2010 Immunization Objectives Met 24: Increase the proportion of young children who receive all vaccines that have been recommended for universal administration for at least 5 years Met: 19-35 mo with all vaccines Unmet: 13-15 yr with all vaccines 27: Increase routine vaccination coverage levels of adolescents Met: MMR, Td Unmet: Hep B, Varicella 30: Reduce vaccine-associated adverse events. 14-24 met at 80% coverage level 14-27 met at 90% coverage level 24-19-35 months met in 2004. 27--was based on flawed NCHS data, showing it was met in baseline/1998. NIS 2006 data shows that Td and MMR are below target

Number of Vaccines in the ACIP Routine Childhood and Adolescent Immunization Schedule HP2010 Launch ACIP 2008 Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) HepB Varicella Pneumococcal Influenza (6 mo-18 yrs) Meningococcal HepA Rotavirus HPV Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) HepB Varicella This slide demonstrates that since HP 2010 was originally released, there has been an increase in the number of routine recommended vaccines for the child and adolescent immunization schedule by ACIP. 10 16

Number of Vaccines in the ACIP Routine Adult Immunization Schedule HP2010 Launch ACIP 2008 Measles Rubella Mumps Diphtheria Tetanus Pertussis Varicella Pneumococcal Influenza HPV Zoster Measles Rubella Mumps Diphtheria Tetanus Varicella Pneumococcal Influenza This slide demonstrates that since HP 2010 was originally released, there has been an increase in the number of routine recommended vaccines for the adult immunizations schedule by ACIP. 8 11

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