National Immunization Program Report NVAC Washington, DC  February 3-4, 2004 Stephen L. Cochi, M.D., M.P.H. Acting Director, National Immunization Program Centers for Disease Control and Prevention

Dr. Walter A. Orenstein National Immunization Program Switzerland 2004India 1974

Comparison of 20 th Century Annual Morbidity and Current Morbidity, Vaccine-Preventable Diseases 20th Century Annual Morbidity † 2003* ( Provisional) Percent Decrease Diphtheria Measles Mumps Pertussis Polio (paralytic) Rubella Congenital Rubella Syndrome Tetanus H. influenzae, type b and unknown (<5 yrs) 175, , , ,271 16,316 47, ,314 20,000 ‡ , % 99.87% 94.29% 100% 99.99% 100% 98.93% 98.94% Disease † Source: CDC. MMWR April 2, : * Source: CDC. MMWR January 9, : ‡ Data are estimated. Numbers in yellow indicate at or near record lows in 2003

Estimated Vaccination Coverage with Individual Vaccines Among Children Months of Age, National Immunization Survey, Q Q Vaccine Coverage (percent) 3+ DTP96 4+ DTP Polio91 1+ MMR Hib Hep B Var PCV59.1 4:3: :3:1: :3:1:3: :3:1:3:3:169.7 (Numbers in yellow indicate record highs.) Children in the Q3/2002-Q2/2003 National Immunization Survey were born between August 1999 and November 2001.

Duration of CDC-Reported Childhood Vaccine Shortages GAO Report, September 2002: Childhood Vaccines: Ensuring an Adequate Supply Poses Continuing Challenges, p. 8.

President’s Budget Request, FY 2005 Discretionary Immunization FY 2003 Enacted FY 2004 Enacted FY 2005* President’s Budget Difference 2004/2005 Section 317 Grants: Vaccine Purchase Operations 222 M 199 M 220 M 198 M 111 M 198 M -109 M Program Operations: Prevention Activities** Global Immunization 82 M 148 M 74 M*** 151 M 74 M 151 M TOTAL 651 M 643 M****534 M- 109 M * The proposed decrease to 317 vaccine purchase is offset by an increase to VFC. This offset in the President’s budget request anticipates Congressional action on proposed changes to VFC authorizing language. ** Prevention Activities includes $14 M from section 241 of the Public Health Service Act for the National Immunization Survey. *** NVPO **** Funding reflects the $7.3 M transfer of the National Vaccine Program Office (NVPO) from CDC to the Office of Public Health and Science within HHS.

Vaccine Management Business Improvement Project Vaccine Management Business Improvement Project  Action taken in response to NVAC recommendation to develop immunization information systems  Comprehensive review of existing vaccine management systems, internal and external VFC business process, benchmarking of industry standards and recommendations on best practices  Goal is to develop and implement an automated, seamless VFC vaccine management system  We are very excited by the prospects for improvement of our system that this project offers.

Pediatric Vaccine Stockpile February 2004

National Infant Immunization Week (NIIW) April 25 – May 1, 2004  New York, New York  Fairfax, Virginia  Dallas, Texas Border Events  San Diego, California / Tijuana, Mexico  El Paso, Texas (Pending)

Vaccination Week in the Americas - 1  April 24-30, 2004  It will involve all 38 countries in the Western Hemisphere, including U.S., Mexico, and Canada. (Last year, 19 South and Central American countries participated, and it was held in June). This is a first.

Vaccination Week in the Americas - 2  It is primarily a PAHO and UNICEF endeavor although: -It coincides with the U.S. National Infant Immunization Week; -CDC/NIP is involved in and providing funding for an evaluation in three countries – Guatemala, Ecuador, and Paraguay. Goal is increased childhood vaccinations.

Vaccination Week in the Americas - 3  All of the posters and visual materials have common visual elements – such as a common theme – “Vaccination is an Act of Love” (or Un Gesto de Amor).  Goals are: 1. To promote and foster routine childhood vaccination and 2. To actually vaccinate children and women of child-bearing age in hard to reach locations (e.g., very rural areas, indigenous people).

Vaccination Week in the Americas - 4  In the U.S. and Canada, the primary goal is to promote increased visibility and awareness for childhood immunizations – and there won’t be specific national efforts to find and vaccinate under- immunized children, though it is likely some health departments may hold vaccination clinics or extend hours at clinics.

Vaccination Week in the Americas - 5  Border events are being jointly planned with Mexico, and will take place in El Paso, Texas, and San Diego border areas, and involve the nearby Mexico communities.  There is discussion of doing this worldwide, perhaps as early as 2005.

50 th Anniversary of the Start of Polio Clinical Trials

NIP’s Goals Global Targets (GPRA) Tracked by OMB By Eradicate Polio Reduce by 50% the annual global measles- related mortality compared with 1999 estimates (baseline 875,000 deaths) By Eliminate ongoing indigenous measles transmission in all 47 countries/territories of the Americas Also: Regional elimination of rubella/CRS by 2010.

Wild Poliovirus* 28 Jan 2003 to 27 Jan 2004 Data in WHO HQ as of 27 Jan 2004 *Excludes viruses detected from environmental surveillance and vaccine derived polio viruses. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.  WHO All rights reserved Case or outbreak following importation Endemic countries Wild virus type 1 Wild virus type 3 Wild virus type 1 and 3 Under investigation

Measles Mortality Reduction by 50% by 2005 (compared to 1999: 875,000 deaths) Global Progress Measles Mortality Reduction by 50% by 2005 (compared to 1999: 875,000 deaths) Estimated Measles Mortality by Year 2002 estimate=614,000 deaths (WHO, WER Jan 16, 2004)