1. Kristine Sheedy, PhD Associate Director for Communication Science National Center for Immunization and Respiratory Diseases The Importance of Effective Vaccine Communication VICNetwork 2011 Virtual Immunization Symposium May 25, 2011 Office of the Director National Center for Immunization & Respiratory Diseases

2. Comparison of 20 th Century Annual Morbidity and Current Morbidity: Vaccine-Preventable Diseases Disease 20th Century Annual Morbidity † 2009 Reported Cases † † Percent Decrease Smallpox 29,0050100% Diphtheria 21,0530100% Measles 530,21761> 99% Mumps 162,344982 99% Pertussis 200,75213,50693% Polio (paralytic) 16,3160100% Rubella 47,7454> 99% Congenital Rubella Syndrome 152199% Tetanus 5801498% Haemophilus influenzae 20,000243*99% † Source: JAMA. 2007;298(18):2155-2163 † † Source: CDC. MMWR January 8, 2010;58(51,52);1458-1468. (provisional, 2009 week 52 NNDSS data) * 25 type b and 218 unknown (< 5 years of age)

3. Vaccines Routinely Recommended for Children and Adolescents 198519952006 Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) Hepatitis B Varicella Pneumococcal disease Influenza Meningococcal disease Hepatitis A Rotavirus HPV Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) HepB Varicella Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio 7 10 16

4. Increasing Vaccine-Specific Coverage Rates Among Preschool-Aged Children Source: USIS (1967-1985), NHIS (1991-1993) CDC, NCHS, and NIS (1994-2009), CDC, NIP and NCHS; No data from 1986-1990 due to cancellation of USIS because of budget reductions. DTP / DTaP(3+) † MMR(1+) Hib (3+) 2010 Target Hep B (3+) Polio (3+) Varicella (1+) PCV 7 (4+) Rotavirus (3+) 0.6% of toddlers had received no vaccines at all

5. Estimated Return on Investment of Childhood Vaccines, United States, 2011 For each birth cohort vaccinated against 13 diseases in accordance with the childhood schedule for DTaP, Hib, IPV, MMR, hep B, Varicella, Hepatitis A, Pneumo-7, and Rotavirus vaccines: – 42,000 lives are saved – 20M cases of disease are prevented – 13.6 billion dollars in direct costs are saved – 68.9 billion dollars in direct plus indirect (societal) costs are saved – For each dollar invested in these vaccinations, $10.20 is saved Preliminary results of updated analysis from Zhou et al, Arch of Ped and Adolesc Med 2005

6. Confidence in Vaccine Safety Percent of parents of at least one child 6 years of age or younger who reported that they were confident or very confident in the safety of routine childhood vaccines Year Percent Source: PN HealthStyles and ConsumerStyles Surveys

7. The Good News Protect children from 16 VPDs Record low rates for most VPDs Record high toddler immunization rates Less than 1% zero dose children Several newer vaccines in routine use Narrowing racial and economic disparities Generally a high level of confidence in vaccine safety

8. Low disease awareness = increased focus on vaccine risks Low tolerance for vaccine risks Full and complicated immunization schedule Less Disease and More Vaccines = More Attention to Vaccine Risks

10. Highly Concerned Parents seem to Cluster Geographically Although < 1% of all children have received no vaccines, these children cluster geographically and increase the risk of transmitting vaccine- preventable diseases to others in their communities Zero-dose children tend to have higher SES and are frequently source cases in VPD outbreaks Smith, P, Chu, S, Barker L. Children who have received no vaccines: Who are they and where do they live? Pediatrics,2004; 114;187-195.

11. Measles 2008  Highest number of reported cases/year since 1996  No increase in imported cases  Increase in spread within the U.S.  7 “outbreaks”  Parent vaccine refusal common

12. Measles Importations United States, 2011 98 measles cases reported to date in 2011 Importations into > 20 states from 12-15 countries – > 10 from France 8 outbreaks (3-21 cases)

13. Slide: Courtesy of Kathleen Winter, Source: California Department of Public Health

14. Multiple Factors Can Lead to Vaccine- Preventable Disease Increases  Failure to vaccinate (e.g., due to access, supply, acceptance)  Accumulation of unvaccinated susceptible persons permits infectious agent to spread (e.g., measles outbreaks in 2008)  Waning immunity following childhood vaccination  Pertussis rise in CA 2010  Less than optimal vaccine effectiveness and high force of infection  Mumps (Midwest universities 2006, NE religious schools 2010)  Change in circulating strains  Pneumococcal infectious caused by nonvaccine types

15. Which concerns, if any, do you have about childhood vaccines? Preliminary results from PN HealthStyles and ConsumerStyles Surveys Many Parents Have Questions and Concerns

16. What are the three most important sources of information that have helped you make decisions about your youngest child’s vaccinations?  Child’s healthcare provider, such as a doctor or nurse (85%)  Family (46%)  American Academy of Pediatrics (28%)  CDC (26%)  Internet (24%) Preliminary results: Health Styles 2010, parents of children <6

17. 2009 Focus Groups: Vaccine Schedule and Timing  Mothers were generally knowledgeable about the timing of vaccines  Many reacted negatively to receiving multiple injections during one visit  Most were vaccinating according to the recommended schedule, but several across race/education/location segments reported (generally short-term) spreading vaccinations  Variety of reasons for spreading: concerns about children’s ability to “handle” multiple vaccines; concerns about ability to pinpoint source of adverse events; some concerns about pain

18. 2009 Focus Groups: VPD Knowledge and Beliefs  After reading brief descriptions of the 14 VPDs, many mothers said they were surprised to find out how many could be fatal, including some they previously did not consider serious  Many mothers shared personal stories that impacted their view of particular VPDs  Some knew a baby who had whooping cough (heightened their perception of severity)  Most talked about their own experience with flu or chickenpox (lessened their perception of severity)

19. www.cdc.gov/vaccines/conversations

20. Websites  Provider Resources for Vaccine Conversations with Parents  www.cdc.gov/vaccines/conversations www.cdc.gov/vaccines/conversations  Give Feedback on Provider Resources  www.cdc.gov/vaccines/tellus www.cdc.gov/vaccines/tellus  Health Care Professional Home Page  www.cdc.gov/vaccines/hcp www.cdc.gov/vaccines/hcp  “Get the Picture” Childhood Video  www.youtube.com/user/CDCStreamingHealth www.youtube.com/user/CDCStreamingHealth

21. Thank you ksheedy@cdc.gov