# 14 {#section .Chapter-# .unnumbered}

# Immunization and Infectious Diseases

#### Diseases Preventable Through Universal Vaccination

14-1 Vaccine-preventable diseases

14-1a Congenital rubella syndrome

14-1b Diphtheria

14-1c *Haemophilus influenzae* type b

14-1d Hepatitis B

14-1e Measles

14-1f Mumps

14-1g Pertussis

14-1h Polio (wild-type virus)

14-1i Rubella

14-1j Tetanus

14-1k Varicella (chicken pox)

14-2 Hepatitis B in infants and young children

14-3 Hepatitis B in adults and high-risk groups

14-3a 19 to 24 years

14-3b 25 to 39 years

14-3c 40 years and older

14-3d Injection drug users

14-3e Heterosexually active persons

14-3f Men who have sex with men

14-3g Occupationally exposed workers

14-4 Bacterial meningitis in young children

14-5 Invasive pneumococcal infections

New invasive pneumococcal infections:

14-5a Children under age 5 years

14-5b Adults aged 65 years and older

Invasive penicillin-resistant pneumococcal infections:

14-5c Children under age 5 years

14-5d Adults aged 65 years and older

#### Diseases Preventable Through Targeted Vaccination

14-6 Hepatitis A

14-7 Meningococcal disease

14-8 Lyme disease

#### Infectious Diseases and Emerging Antimicrobial Resistance

14-9 Hepatitis C

14-10 Identification of persons with chronic hepatitis C

14-11 Tuberculosis

14-12 Curative therapy for tuberculosis

14-13 Treatment for high-risk persons with latent tuberculosis infection

14-14 Timely laboratory confirmation of tuberculosis cases

14-15 Prevention services for international travelers

14-16 Invasive early onset group B streptococcal disease

14-17 Peptic ulcer hospitalizations

14-18 Antibiotics prescribed for ear infections

14-19 Antibiotics prescribed for common cold

14-20 Hospital-acquired infections

Adults:

14-20a Catheter-associated urinary tract infection

14-20b Central line-associated bloodstream infection

14-20c Ventilator-associated pneumonia

Infants less than or equal to 1000g:

14-20d Central line-associated bloodstream infection

14-20e Ventilator-associated pneumonia

14-21 Antimicrobial use in intensive care units

#### Vaccination Coverage and Strategies

14-22 Universally recommended vaccination of children aged 19 to 35
months

14-22a 4 doses diphtheria-tetanus-pertussis (DTaP) vaccine

14-22b 3 doses *Haemophilus influenzae* type b (Hib) vaccine

14-22c 3 doses hepatitis B vaccine (hep B)

14-22d 1 dose measles-mumps-rubella (MMR) vaccine

14-22e 3 doses polio vaccine

14-22f 1 dose varicella vaccine

14-23 Vaccination coverage for children in day care, kindergarten, and
first grade

Day care:

14-23a Diphtheria-tetanus-acellular pertussis (DTaP) vaccine

14-23b Measles/mumps/rubella vaccines

14-23c Polio vaccine

14-23d Hepatitis B vaccine

14-23e Varicella vaccine

K through 1st grade:

14-23f Diphtheria-tetanus-pertussis (DTaP) vaccine

14-23g Measles/mumps/rubella vaccines

14-23h Polio vaccine

14-23i Hepatitis B vaccine

14-23j Varicella vaccine

14-24 Fully immunized young children and adolescents

14-24a Children aged 19 to 35 months

14-24b Adolescents aged 13 to 15 years

14-25 Providers who measure childhood vaccination coverage levels

14-25a Public health providers

14-25b Private providers

14-26 Children participating in population-based immunization registries

14-27 Vaccination coverage among adolescents

14-27a Hepatitis B

14-27b Measles-mumps-rubella

14-27c Tetanus-diphtheria booster

14-27d Varicella

14-28 Hepatitis B vaccination among high-risk groups

14-28a Long-term hemodialysis patients

14-28b Men who have sex with men

14-28c Occupationally exposed workers

14-29 Influenza and pneumococcal vaccination of high-risk adults

Noninstitutionalized adults 65 years and over

14-29a Influenza vaccine

14-29b Pneumococcal vaccine

Noninstitutionalized high-risk adults 18 to 64 years

14-29c Influenza vaccine

14-29d Pneumococcal vaccine

Institutionalized adults

14-29e Influenza vaccine

14-29f Pneumococcal vaccine

#### Vaccine Safety

14-30 Adverse events from vaccinations

14-30a Vaccine-associated paralytic polio

14-30b Febrile seizures following pertussis vaccines

14-31 Active surveillance for vaccine safety

### Diseases Preventable Through Universal Vaccination 

14-1. Reduce or eliminate indigenous cases of vaccine-preventable
diseases.

14-1a. Congenital rubella syndrome (children under age 1 year).

+---------------------+------------------------------------------------+
| **National Data     | National Congenital Syndrome Registry, CDC,    |
| Source**            | NCID.                                          |
+---------------------+------------------------------------------------+
| **State Data        | National Congenital Syndrome Registry, CDC,    |
| Source**            | NCID.                                          |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.1 (Immunization and Infectious Diseases).   |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Number.                                        |
+---------------------+------------------------------------------------+
| **Baseline**        | 7 (1998).                                      |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of confirmed and probable cases of      |
|                     | congenital rubella syndrome among children     |
|                     | under age 1 year.                              |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| ###### Questi       | CDC Congenital Rubella Syndrome Case Report,   |
| ons Used To Obtain  | Form 71.17, Rev. 03/97.                        |
| the National Data { |                                                |
| #questions-used-to- |                                                |
| obtain-the-national |                                                |
| -data .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A case definition for confirmed and probable   |
|                     | cases of congenital rubella syndrome is        |
|                     | available from CDC.**^1^**                     |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-1b. Diphtheria      
  (persons under age 35  
  years).                

  **National Data        National Notifiable Disease Surveillance System
  Source**               (NNDSS), CDC, EPO.

  **State Data Source**  National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  Adapted from 20.1 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Number.

  **Baseline**           1 (1998).

  **Numerator**          Number of confirmed cases of diphtheria among
                         persons under age 35 years.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Diphtheria Worksheet.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition for confirmed cases of
                         diphtheria is available from CDC.**^1^**

                         This objective is a modification of Healthy
                         People 2000 objective 20.1, which tracked the
                         number of confirmed cases of diphtheria among
                         persons aged 25 years and under. This measure
                         tracks the number of confirmed cases of
                         diphtheria among persons under age 35 years.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-1c. *Haemophilus    
  influenzae* type b     
  (children under age 5  
  years).                

  **National Data        National Notifiable Disease Surveillance System
  Sources**              (NNDSS), CDC, EPO; Active Bacterial Core
                         Surveillance (ABCs), Emerging Infection
                         Programs, CDC, NCID.

  **State Data Source**  National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  Adapted from 20.1 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Number.

  **Baseline**           163 (1998).

  **Numerator**          Estimated number of all reported confirmed and
                         probable cases of *Haemophilus influenzae*
                         invasive disease (see Comments).

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC National Bacterial Meningitis and Bacteremia
  Obtain the National    Case Report, CDC 52.15N, Rev. 02/93.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           This measure includes confirmed cases of H.
                         influenzae type b disease and cases in which the
                         isolate of H. influenzae is of unknown serotype
                         (based on the eight States with specific regions
                         under surveillance).

                         A case definition for confirmed and probable
                         cases of *Haemophilus influenzae* type b is
                         available from CDC.**^1^**

                         This objective is a modification of Healthy
                         People 2000 objective 20.1, which tracked the
                         number of cases of vaccine-preventable diseases.
                         *Haemophilus influenzae* type b was previously
                         not included as a vaccine-preventable disease.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 14-1d. Hepatitis B  |                                                |
| (persons aged 2 to  |                                                |
| 18 years).          |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **State Data        | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.1 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Number.                                        |
+---------------------+------------------------------------------------+
| **Baseline**        | 945 (1997).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of laboratory-confirmed new symptomatic |
|                     | hepatitis B cases among persons aged 2 to 18   |
|                     | years.                                         |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| ###### Question     | CDC Viral Hepatitis Case Record for Reporting  |
| s Used To Obtain th | of Patients With Symptomatic Acute Viral       |
| e National Data {#q | Hepatitis, Form 53.1, Rev. 06/93.              |
| uestions-used-to-ob |                                                |
| tain-the-national-d |                                                |
| ata-1 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A case definition for laboratory-confirmed new |
|                     | symptomatic cases of hepatitis B is available  |
|                     | from CDC.**^1^**                               |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.1, which tracked the  |
|                     | number of cases of vaccine-preventable         |
|                     | diseases. Hepatitis B previously was not       |
|                     | included as a vaccine-preventable disease.     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NNDSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-1e. Measles         
  (persons of all ages). 

  **National Data        National Notifiable Disease Surveillance System
  Source**               (NNDSS), CDC, EPO.

  **State Data Source**  National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  20.1 (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Number.

  **Baseline**           74 (1998).

  **Numerator**          Number of confirmed indigenous measles cases.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Measles Surveillance Worksheet, Rev. 05/98.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition for confirmed indigenous cases
                         of measles is available from CDC.**^1^**

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 14-1f. Mumps        |                                                |
| (persons of all     |                                                |
| ages).              |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **State Data        | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.1 (Immunization and Infectious Diseases).   |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Number.                                        |
+---------------------+------------------------------------------------+
| **Baseline**        | 666 (1998).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of confirmed and probably indigenous    |
|                     | cases of mumps.                                |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| ###### Question     | CDC Mumps Surveillance Worksheet.              |
| s Used To Obtain th |                                                |
| e National Data {#q |                                                |
| uestions-used-to-ob |                                                |
| tain-the-national-d |                                                |
| ata-2 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A case definition for confirmed and probable   |
|                     | indigenous cases of mumps is available from    |
|                     | CDC.**^1^**                                    |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NNDSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-1g. Pertussis       
  (children under age 7  
  years).                

  **National Data        National Notifiable Disease Surveillance System
  Source**               (NNDSS), CDC, EPO.

  **State Data Source**  National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  Adapted from 20.1 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Number.

  **Baseline**           3,417 (1998).

  **Numerator**          Number of confirmed and probable cases of
                         pertussis (including cases identified in
                         outbreak settings) among children under age 7
                         years.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Pertussis Report, Form 71.14A, Rev. 06/86.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition for confirmed and probable
                         cases of pertussis (including cases identified
                         in outbreak settings) is available from
                         CDC.**^1^**

                         This objective is a modification of Healthy
                         People 2000 objective 20.1, which tracked the
                         number of confirmed and probable cases of
                         pertussis among persons of all ages. This
                         measure tracks the number of confirmed and
                         probable cases among children under age 7 years.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-1h. Polio           
  (wild-type virus)      
  (persons of all ages). 

  **National Data        National Notifiable Disease Surveillance System
  Source**               (NNDSS), CDC, EPO.

  **State Data Source**  National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  20.1 (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Number.

  **Baseline**           0 (1998).

  **Numerator**          Number of indigenously acquired cases of polio
                         (wild-type virus, excludes imported or
                         vaccine-associated cases).

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Suspected Polio Case Worksheet.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition for indigenously acquired
                         cases of polio (wild-type virus, excluding
                         imported or vaccine-associated cases) is
                         available from CDC.**^1^**

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 14-1i. Rubella      |                                                |
| (persons of all     |                                                |
| ages).              |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **State Data        | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.1 (Immunization and Infectious Diseases).   |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Number.                                        |
+---------------------+------------------------------------------------+
| **Baseline**        | 364 (1998).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of confirmed indigenous cases of        |
|                     | rubella.                                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| ###### Question     | CDC Rubella Surveillance Worksheet.            |
| s Used To Obtain th |                                                |
| e National Data {#q |                                                |
| uestions-used-to-ob |                                                |
| tain-the-national-d |                                                |
| ata-3 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A case definition for confirmed indigenous     |
|                     | cases of rubella is available from CDC.**^1^** |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NNDSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 14-1j. Tetanus      |                                                |
| (persons under age  |                                                |
| 35 years).          |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **State Data        | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.1 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Number.                                        |
+---------------------+------------------------------------------------+
| **Baseline**        | 14 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of confirmed cases of tetanus among     |
|                     | persons under age 35 years.                    |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| ###### Question     | CDC Tetanus Surveillance Case Report, Form     |
| s Used To Obtain th | 71.16, Rev. 06/86.                             |
| e National Data {#q |                                                |
| uestions-used-to-ob |                                                |
| tain-the-national-d |                                                |
| ata-4 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A case definition for confirmed cases of       |
|                     | tetanus is available from CDC.**^1^**          |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.1, which tracked the  |
|                     | number of confirmed cases of tetanus among     |
|                     | persons aged 25 years and under. This measure  |
|                     | tracks the number of confirmed cases of        |
|                     | tetanus among persons under age 35 years.      |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NNDSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
|                     |                                                |
+---------------------+------------------------------------------------+
| 14-1k. Varicella    |                                                |
| (chicken pox)       |                                                |
| (persons under age  |                                                |
| 18 years).          |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.1 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Number (4-year average).                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 4 million (1990--94).                          |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons (all ages) who are reported  |
|                     | to have had chicken pox (varicella) in the     |
|                     | past year.                                     |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1999 National Health Interview Survey |
| Obtain the National | (see Comments):                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Has ([Sample child]{.underline}) ever had  |
|                     |     chicken pox?                               |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   Has ([Sample child]{.underline}) had       |
|                     |     chicken pox during the past 12 months?     |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A case of chicken pox is identified as any     |
|                     | person who reported missing either more than   |
|                     | half of 1 day of school or work due to an      |
|                     | illness or injury or staying in bed more than  |
|                     | half of a day due to an illness or injury and  |
|                     | who also reported that the condition that      |
|                     | caused the day(s) of missed school/work or     |
|                     | day(s) of staying in bed was varicella or      |
|                     | chicken pox. These data are adjusted from a    |
|                     | 2-week incidence to a 12-month incidence by    |
|                     | multiplying the estimates by a factor of 26.   |
+---------------------+------------------------------------------------+
|                     | The baseline data for persons of all ages are  |
|                     | a proxy measure for this objective and were    |
|                     | calculated using the 1990--94 NHIS. NHIS was   |
|                     | redesigned in 1997 to measure prevalence, and  |
|                     | starting in 1999 NHIS included questions on    |
|                     | incidence and asks if children aged under 18   |
|                     | years have ever had chicken pox, and if they   |
|                     | had a case of the chicken pox/varicella in the |
|                     | past 12 months. This annual estimate will be   |
|                     | the measure used to track this objective over  |
|                     | the course of the decade.                      |
+---------------------+------------------------------------------------+
|                     | The responses to questions on medical          |
|                     | conditions are self-reports and are not        |
|                     | validated. However, varicella is a distinct    |
|                     | rash illness that is diagnosed easily by the   |
|                     | lay public.                                    |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.1, which tracked the  |
|                     | number of cases of vaccine-preventable         |
|                     | diseases. Varicella (chicken pox) previously   |
|                     | was not included as a vaccine-preventable      |
|                     | disease.                                       |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-2. Reduce chronic   
  hepatitis B virus      
  infections in infants  
  and young children     
  (perinatal             
  infections).           

  **National Data        Perinatal Hepatitis B Prevention Program, CDC,
  Sources**              NCID; National Vital Statistics System (NVSS),
                         CDC, NCHS.

  **State Data Sources** State Perinatal Hepatitis B Prevention Programs;
                         State Vital Statistics Systems.

  **Healthy People 2000  20.3f (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Number.

  **Baseline**           1,682 (1995).

  **Numerator**          Number of estimated chronic hepatitis B virus
                         (HBV) infections occurring among infants and
                         children aged 2 years and younger of
                         HBV-infected mothers (see Comments).

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Viral Hepatitis Case Record for Reporting of
  Obtain the National    Patients With Symptomatic Acute Viral Hepatitis,
  Data**                 Form 53.1, Rev. 06/93.

  **Expected             Annual.
  Periodicity**          

  **Comments**           Using data collected by the Perinatal Hepatitis
                         B Prevention Program and NVSS, this measure is
                         based on the following estimation
                         procedure:**^1,\ 2,\ 3,\ 4,\ 5^**

                         \(1\) Multiply the total births per year to
                         HBsAg-positive women by the proportion of
                         pregnant women screened for HBsAg and then by
                         the proportion of infants born to identified
                         HBsAg-positive women who receive the vaccine
                         (this estimates the number of infants who were
                         born to identified HBsAg-positive women and
                         received at least one dose of vaccine).

                         \(2\) Multiply the total number of infants who
                         were born to HBsAg-positive women and received
                         at least one dose of vaccine by the proportion
                         of vaccinated infants who will remain
                         susceptible, and add to the number of infants
                         born to HBsAg-positive women who are not
                         vaccinated (this estimates the number of infants
                         born to HBsAg-positive women who remain
                         susceptible).

                         \(3\) Finally, multiply number of infants born
                         to HBsAg-positive women remaining susceptible by
                         the proportion of susceptible infants who will
                         become infected and then by the proportion of
                         infected infants who will remain chronically
                         infected with HBV.

                         The estimated number of births to HBV-infected
                         mothers is derived by applying race- and
                         ethnicity-specific estimates of the prevalence
                         of hepatitis B surface antigen to NVSS annual
                         natality data.

                         See Part C for a description of NVSS (natality)
                         and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

14-3. Reduce hepatitis B.

###### Adults {#adults .HeadingTHPsub}

+---------------------+------------------------------------------------+
| 14-3a. 19 to 24     |                                                |
| years.              |                                                |
+---------------------+------------------------------------------------+
| ######              | National Notifiable Disease Surveillance       |
| National Data Sourc | System (NNDSS), CDC, EPO.                      |
| e {#national-data-s |                                                |
| ource .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **State Data        | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.3 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 100,000 population.                   |
+---------------------+------------------------------------------------+
| **Baseline**        | 24.0 (1997).                                   |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of estimated cases of hepatitis B among |
|                     | persons aged 19 to 24 years.                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons aged 19 to 24 years.         |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | CDC Viral Hepatitis Case Record for Reporting  |
| Obtain the National | of Patients With Symptomatic Acute Viral       |
| Data**              | Hepatitis, Form 53.1, Rev. 06/93.              |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | To determine the estimated number of hepatitis |
|                     | B cases by year of age, 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 divided by    |
|                     | the age-specific proportions of infections     |
|                     | which are symptomatic.**^6,\ 7^**              |
+---------------------+------------------------------------------------+
|                     | To determine the estimated hepatitis B rate    |
|                     | for a specific age group, the estimated number |
|                     | of cases for each year of age included in the  |
|                     | group are added together and divided by the    |
|                     | total population in that age group.            |
+---------------------+------------------------------------------------+
|                     | This measure is a modification of its          |
|                     | comparable Healthy People 2000 objective 20.3, |
|                     | which tracked all ages. This measure tracks    |
|                     | specific age groups.                           |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NNDSS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| **14-3b. 25 to 39   |                                                |
| years.**            |                                                |
+---------------------+------------------------------------------------+
| ###### Na           | National Notifiable Disease Surveillance       |
| tional Data Source  | System (NNDSS), CDC, EPO.                      |
| {#national-data-sou |                                                |
| rce-1 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **State Data        | National Notifiable Disease Surveillance       |
| Source**            | System (NNDSS), CDC, EPO.                      |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.3 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 100,000 population.                   |
+---------------------+------------------------------------------------+
| **Baseline**        | 20.2 (1997).                                   |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of estimated cases of hepatitis B among |
|                     | persons aged 25 to 39 years.                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons aged 25 to 39 years.         |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | CDC Viral Hepatitis Case Record for Reporting  |
| Obtain the National | of Patients With Symptomatic Acute Viral       |
| Data**              | Hepatitis, Form 53.1, Rev. 06/93.              |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-3 for  |
|                     | more information.                              |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-3c. 40 years and    
  older.                 

  **National Data        National Notifiable Disease Surveillance System
  Source**               (NNDSS), CDC, EPO.

  **State Data Source**  National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  Adapted from 20.3 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Rate per 100,000 population.

  **Baseline**           15.0 (1997).

  **Numerator**          Number of estimated cases of hepatitis B among
                         persons aged 40 years and older.

  **Denominator**        Number of persons aged 40 years and older.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Viral Hepatitis Case Record for Reporting of
  Obtain the National    Patients With Symptomatic Acute Viral Hepatitis,
  Data**                 Form 53.1, Rev. 06/93.

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 14-3 for
                         more information.
  ---------------------- ------------------------------------------------

###### High-risk groups {#high-risk-groups .HeadingTHPsub}

  ---------------------- ------------------------------------------------
  14-3d. Injection drug  
  users.                 

  **National Data        National Notifiable Disease Surveillance System
  Sources**              (NNDSS), CDC, EPO; Sentinel Counties Study of
                         Viral Hepatitis, CDC, NCID.

  **State Data Sources** National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO; Viral Hepatitis Surveillance
                         Program.

  **Healthy People 2000  20.3a (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Number.

  **Baseline**           7,232 (1997).

  **Numerator**          Number of estimated hepatitis B cases multiplied
                         by the proportion of hepatitis B cases reported
                         to the Sentinel Counties Study of Viral
                         Hepatitis that were attributable to injection
                         drug use.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Viral Hepatitis Case Record for Reporting of
  Obtain the National    Patients With Symptomatic Acute Viral Hepatitis,
  Data**                 Form 53.1, Rev. 06/93.

  **Expected             Annual.
  Periodicity**          

  **Comments**           To determine the estimated number of hepatitis B
                         cases occurring in injection drug users
                         nationwide, the estimated total number of
                         hepatitis B cases in all age groups (for
                         complete description of the calculation method,
                         see objective 14-3a Comments) is multiplied by
                         the proportion of cases reported to Sentinel
                         Counties Study of Viral Hepatitis that occurred
                         in injection drug users.

                         To obtain State-specific measures for this
                         objective, local Viral Hepatitis Surveillance
                         Program data are used to determine the estimated
                         number of cases occurring in the State and the
                         proportion attributable to injection drug use.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-3e. Heterosexually  
  active persons.        

  **National Data        National Notifiable Disease Surveillance System
  Sources**              (NNDSS), CDC, EPO; Sentinel Counties Study of
                         Viral Hepatitis, CDC, NCID.

  **State Data Sources** National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO; Viral Hepatitis Surveillance
                         Program.

  **Healthy People 2000  20.3b (Immunization and Infectious Diseases)
  Objective**            (also part of 19.7).

  **Measure**            Number.

  **Baseline**           15,225 (1997).

  **Numerator**          Number of estimated hepatitis B cases multiplied
                         by the proportion of new symptomatic hepatitis B
                         cases reported to the Sentinel Counties Study of
                         Viral Hepatitis that occurred among
                         heterosexually active persons.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Viral Hepatitis Case Record for Reporting of
  Obtain the National    Patients With Symptomatic Acute Viral Hepatitis,
  Data**                 Form 53.1, Rev. 06/93.

  **Expected             Annual.
  Periodicity**          

  **Comments**           To determine the estimated number of hepatitis B
                         cases occurring in heterosexually active persons
                         nationwide, the estimated total number of
                         hepatitis B cases in all age groups (for
                         complete description of the calculation method,
                         see objective 14-3a Comments) is multiplied by
                         the proportion of cases reported to Sentinel
                         Counties Study of Viral Hepatitis that occurred
                         in heterosexually active persons.

                         To obtain State-specific measures for this
                         objective, local Viral Hepatitis Surveillance
                         Program data are used to determine the estimated
                         number of cases occurring in the State and the
                         proportion attributable to heterosexual
                         activity.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-3f. Men who have    
  sex with men.          

  **National Data        National Notifiable Disease Surveillance System
  Sources**              (NNDSS), CDC, EPO; Sentinel Counties Study of
                         Viral Hepatitis, CDC, NCID.

  **State Data Sources** National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO; Viral Hepatitis Surveillance
                         Program.

  **Healthy People 2000  20.3c (Immunization and Infectious Diseases)
  Objective**            (also part of 19.7).

  **Measure**            Number.

  **Baseline**           7,232 (1997).

  **Numerator**          Number of estimated hepatitis B cases multiplied
                         by the proportion of hepatitis B cases reported
                         to the Sentinel Counties Study of Viral
                         Hepatitis that were attributable to male
                         homosexual behavior.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Viral Hepatitis Case Record for Reporting of
  Obtain the National    Patients With Symptomatic Acute Viral Hepatitis,
  Data**                 Form 53.1, Rev. 06/93.

  **Expected             Annual.
  Periodicity**          

  **Comments**           To determine the estimated number of hepatitis B
                         cases occurring in homosexual males nationwide,
                         the estimated total number of hepatitis B cases
                         in all age groups (for complete description of
                         the calculation method, see objective 14-3a
                         Comments) is multiplied by the proportion of
                         cases reported to Sentinel Counties Study of
                         Viral Hepatitis that occurred in homosexual
                         males.

                         To obtain State-specific measures for this
                         objective, local Viral Hepatitis Surveillance
                         Program data are used to determine the estimated
                         number of cases occurring in the State and the
                         proportion attributable to male homosexual
                         activity.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-3g. Occupationally  
  exposed workers.       

  **National Data        National Notifiable Disease Surveillance System
  Sources**              (NNDSS), CDC, EPO; Sentinel Counties Study of
                         Viral Hepatitis, CDC, NCID.

  **State Data Sources** National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO; Viral Hepatitis Surveillance
                         Program.

  **Healthy People 2000  20.3e (Immunization and Infectious Diseases)
  Objective**            (also 10.5).

  **Measure**            Number.

  **Baseline**           249 (1997).

  **Numerator**          Number of estimated hepatitis B cases multiplied
                         by the proportion of hepatitis B cases reported
                         to the Sentinel Counties Study of Viral
                         Hepatitis that were attributed to occupational
                         exposure.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Viral Hepatitis Case Record for Reporting of
  Obtain the National    Patients With Symptomatic Acute Viral Hepatitis,
  Data**                 Form 53.1, Rev. 06/93.

  **Expected             Annual.
  Periodicity**          

  **Comments**           To determine the estimated number of hepatitis B
                         cases occurring in occupationally exposed
                         workers nationwide, the estimated total number
                         of hepatitis B cases in all age groups (for a
                         complete description of the calculation method,
                         see objective 14-3a Comments) is multiplied by
                         the proportion of cases reported to Sentinel
                         Counties Study of Viral Hepatitis that occurred
                         in occupationally exposed workers.

                         To obtain State-specific measures for this
                         objective, local Viral Hepatitis Surveillance
                         Program data are used to determine the estimated
                         number of cases occurring in the State and the
                         proportion attributable to occupational
                         exposure.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-4. Reduce bacterial 
  meningitis in young    
  children.              

  **National Data        Active Bacterial Core Surveillance (ABCs),
  Source**               Emerging Infection Programs, CDC, NCID.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 20.7 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Rate per 100,000 population

  **Baseline**           13.0 (1998) (selected regions in eight
                         States---see Comments).

  **Numerator**          Number of laboratory culture confirmed cases
                         with bacterial meningitis in children aged 1 to
                         23 months.

  **Denominator**        Number of children aged 1 to 23 months.

  **Population           Resident population in the eight States with
  Targeted**             specific regions under surveillance (see
                         Comments).

  **Questions Used To    CDC Active Surveillance Bacterial Meningitis and
  Obtain the National    Bacteremia Case Report, Form 52.15A, Rev. 12/97.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A laboratory culture-confirmed case of bacterial
                         meningitis is defined as either the isolation of
                         *Haemophilus influenzae*, Neisseria
                         meningitidis, group B Streptococcus, groups A
                         Streptococcus, or Streptococcus pneumoniae from
                         cerebral spinal fluid or a positive culture of
                         *Haemophilus influenzae*, Neisseria
                         meningitidis, group B Streptococcus, groups A
                         Streptococcus, or Streptococcus pneumoniae from
                         a different normally sterile site (blood,
                         pleural fluid, etc.) and a clinical diagnosis of
                         meningitis.**^1^**

                         ABCs is an active and laboratory-based case
                         surveillance system. Data are collected from
                         acute care hospitals and reference laboratories
                         for laboratory-confirmed cases as well as from
                         case report forms.

                         Data are based on surveillance of selected
                         regions in eight States: California,
                         Connecticut, Georgia, Maryland, Minnesota, New
                         York, Oregon, and Tennessee.

                         This measure is a modification of Healthy People
                         2000 objective 20.7, which tracked bacterial
                         meningitis for all ages using the Bacterial
                         Meningitis Surveillance System, CDC, NCID. This
                         measure tracks bacterial meningitis for children
                         aged 1 to 23 months using ABCs.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

14-5. Reduce invasive pneumococcal infections.

###### New invasive pneumococcal infections {#new-invasive-pneumococcal-infections .HeadingTHPsub}

  ---------------------- ------------------------------------------------
  14-5a. Children under  
  age 5 years.           

  **National Data        Active Bacterial Core Surveillance (ABCs),
  Source**               Emerging Infection Programs, CDC, NCID.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 20.10 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Rate per 100,000 population

  **Baseline**           76 (1997) (selected regions in eight
                         States---see Comments).

  **Numerator**          Number of children under age 5 years with a
                         laboratory-confirmed invasive pneumococcal
                         infection (see Comments) in the past 12 months.

  **Denominator**        Number of children under age 5 years.

  **Population           Resident population in the eight States with
  Targeted**             specific regions under surveillance (see
                         Comments).

  **Questions Used To    CDC Active Surveillance Bacterial Meningitis and
  Obtain the National    Bacteremia Case Report, Form 52.15A, Rev. 12/97.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           An invasive pneumococcal infection is defined as
                         a laboratory-confirmed isolation of
                         Streptococcus pneumoniae from a normally sterile
                         site (blood, cerebral spinal fluid,
                         etc.).**^1^**

                         ABCs is an active and laboratory-based case
                         surveillance system. Data are collected from
                         acute care hospitals and reference laboratories
                         for laboratory-confirmed cases as well as from
                         case report forms.

                         Data are based on surveillance of selected
                         regions in eight States: California,
                         Connecticut, Georgia, Maryland, Minnesota, New
                         York, Oregon, and Tennessee. Data for Alaska
                         Natives are measured by the Arctic
                         Investigations Program, CDC, NCID.

                         This measure is a modification of Healthy People
                         2000 objective 20.10, which tracked restricted
                         activity days among children under age 5 years
                         using the National Health Interview Survey
                         (NHIS), CDC, NCHS. This objective tracks the
                         incidence of pneumococcal infections among
                         children under age 5 years using ABCs.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-5b. Adults aged 65  
  years and older.       

  **National Data        Active Bacterial Core Surveillance (ABCs),
  Source**               Emerging Infection Programs, CDC, NCID.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 20.10 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Rate per 100,000 population

  **Baseline**           62 (1997) (selected regions in eight
                         States---see Comments).

  **Numerator**          Number of adults aged 65 years and older with a
                         laboratory-confirmed invasive pneumococcal
                         infection (see Comments) in the past 12 months.

  **Denominator**        Number of adults aged 65 years and older.

  **Population           Resident population in the eight States with
  Targeted**             specific regions under surveillance (see
                         Comments).

  **Questions Used To    CDC Active Surveillance Bacterial Meningitis and
  Obtain the National    Bacteremia Case Report, Form 52.15A, Rev. 12/97.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           An invasive pneumococcal infection is defined as
                         a laboratory-confirmed isolation of
                         Streptococcus pneumoniae from a normally sterile
                         site (blood, cerebral spinal fluid,
                         etc.).**^1^**

                         ABCs is an active and laboratory-based case
                         surveillance system. Data are collected from
                         acute care hospitals and reference laboratories
                         for laboratory-confirmed cases as well as from
                         case report forms.

                         Data are based on surveillance of selected
                         regions in eight States: California,
                         Connecticut, Georgia, Maryland, Minnesota, New
                         York, Oregon, and Tennessee. Data for Alaska
                         Natives are measured by the Arctic
                         Investigations Program, CDC, NCID.

                         This measure is a modification of Healthy People
                         2000 objective 20.10, which tracked restricted
                         activity days among adults aged 65 years and
                         older years using the National Health Interview
                         Survey (NHIS), CDC, NCHS. This objective tracks
                         the incidence of pneumococcal infections among
                         adults aged 65 years and older using ABCs.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

###### Invasive penicillin-resistant pneumococcal infections {#invasive-penicillin-resistant-pneumococcal-infections .HeadingTHPsub}

  ---------------------- ------------------------------------------------
  14-5c. Children under  
  age 5 years.           

  **National Data        Active Bacterial Core Surveillance (ABCs),
  Source**               Emerging Infection Programs, CDC, NCID.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 20.10 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Rate per 100,000 population.

  **Baseline**           16 (1997) (selected regions in eight
                         States---see Comments).

  **Numerator**          Number of children under age 5 years with a
                         laboratory-confirmed invasive
                         penicillin-resistant pneumococcal infection (see
                         Comments) in the past 12 months.

  **Denominator**        Number of children under age 5 years.

  **Population           Resident population in the eight States with
  Targeted**             specific regions under surveillance (see
                         Comments).

  **Questions Used To    CDC Active Surveillance Bacterial Meningitis and
  Obtain the National    Bacteremia Case Report, Form 52.15A, Rev. 12/97.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A laboratory-confirmed invasive
                         penicillin-resistant pneumococcal infection is
                         defined as the isolation of Streptococcus
                         pneumoniae from a normally sterile site (blood,
                         cerebral spinal fluid, etc.) with a penicillin
                         minimum inhibitory concentration of greater than
                         2 μg/ml.

                         ABCs is an active and laboratory-based case
                         surveillance system. Data are collected from
                         acute care hospitals and reference laboratories
                         for laboratory-confirmed cases as well as from
                         case report forms.

                         Data are based on surveillance of selected
                         regions in eight States: California,
                         Connecticut, Georgia, Maryland, Minnesota, New
                         York, Oregon, and Tennessee. Data for Alaska
                         Natives are measured by the Arctic
                         Investigations Program, CDC, NCID.

                         This measure is a modification of Healthy People
                         2000 objective 20.10, which tracked restricted
                         activity days among children under age 5 years
                         using the National Health Interview Survey
                         (NHIS), CDC, NCHS. This objective tracks the
                         incidence of penicillin-resistant pneumococcal
                         infections among children under age 5 years
                         using ABCs.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-5d. Adults aged 65  
  years and older.       

  **National Data        Active Bacterial Core Surveillance (ABCs),
  Source**               Emerging Infection Programs, CDC, NCID.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 20.10 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Rate per 100,000 population.

  **Baseline**           9 (1997) (selected regions of eight States---see
                         Comments).

  **Numerator**          Number of adults aged 65 years and older with a
                         laboratory-confirmed invasive
                         penicillin-resistant pneumococcal infection (see
                         Comments) in the past 12 months.

  **Denominator**        Number of adults aged 65 years and older.

  **Population           Resident population in the eight States with
  Targeted**             specific regions under surveillance (see
                         Comments).

  **Questions Used To    CDC Active Surveillance Bacterial Meningitis and
  Obtain the National    Bacteremia Case Report, Form 52.15A, Rev. 12/97.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A laboratory-confirmed invasive
                         penicillin-resistant pneumococcal infection is
                         defined as the isolation of Streptococcus
                         pneumoniae from a normally sterile site (blood,
                         cerebral spinal fluid, etc.) with a penicillin
                         minimum inhibitory concentration of greater than
                         2 μg/ml.

                         ABCs is an active and laboratory-based case
                         surveillance system. Data are collected from
                         acute care hospitals and reference laboratories
                         for laboratory-confirmed cases as well as from
                         case report forms.

                         Data are based on surveillance of selected
                         regions in eight States: California,
                         Connecticut, Georgia, Maryland, Minnesota, New
                         York, Oregon, and Tennessee. Data for Alaska
                         Natives are measured by the Arctic
                         Investigations Program, CDC, NCID.

                         This measure is a modification of Healthy People
                         2000 objective 20.10, which tracked restricted
                         activity days among adults aged 65 years and
                         older using the National Health Interview Survey
                         (NHIS), CDC, NCHS. This objective tracks the
                         incidence of penicillin-resistant pneumococcal
                         infections among adults aged 65 years and older
                         using ABCs.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

### Diseases Preventable Through Targeted Vaccination

  ---------------------- ------------------------------------------------
  14-6. Reduce hepatitis 
  A.                     

  **National Data        National Notifiable Disease Surveillance System
  Source**               (NNDSS), CDC, EPO.

  **State Data Source**  National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  20.3 (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           11.3 (1997).

  **Numerator**          Number of new symptomatic hepatitis A cases
                         reported in the past 12 months.

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Viral Hepatitis Case Record for Reporting of
  Obtain the National    Patients With Symptomatic Acute Viral Hepatitis,
  Data**                 Form 53.1, Rev. 06/93.

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition for new symptomatic cases of
                         hepatitis A is available from CDC.**^1^**

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-7. Reduce           
  meningococcal disease. 

  **National Data        Active Bacterial Core Surveillance (ABCs),
  Sources**              Emerging Infections Program Network, CDC, NCID;
                         National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **State Data Sources** Active Bacterial Core Surveillance (ABCs),
                         Emerging Infections Program Network, CDC, NCID;
                         National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  Adapted from 20.7 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Rate per 100,000 population.

  **Baseline**           1.3 (1997) (selected regions in eight
                         States---see Comments).

  **Numerator**          Number of new laboratory-confirmed meningococcal
                         disease cases reported in past 12 months.

  **Denominator**        Number of persons.

  **Population           Resident population (selected regions in eight
  Targeted**             States---see Comments).

  **Questions Used To    CDC National Bacterial Meningitis and Bacteremia
  Obtain the National    Case Report, Form 52.15N, Rev. 02/93.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition for laboratory-confirmed cases
                         of meningococcal disease is available from
                         CDC.**^1^**

                         ABCs is an active and laboratory-based case
                         surveillance system. Data are collected from
                         acute care hospitals and reference laboratories
                         for laboratory-confirmed cases as well as from
                         case report forms.

                         Data are based on surveillance of selected
                         regions in eight States: California,
                         Connecticut, Georgia, Maryland, Minnesota, New
                         York, Oregon, and Tennessee.

                         This measure is a modification of Healthy People
                         2000 objective 20.10, which tracked bacterial
                         meningitis cases using the Bacterial Meningitis
                         Surveillance System, CDC, NCID. This measure
                         tracks meningococcal disease (meningitis and/or
                         meningococcemia) using both NNDSS and ABCs.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-8. Reduce Lyme      
  disease.               

  **National Data        National Notifiable Disease Surveillance System
  Source**               (NNDSS), CDC, EPO.

  **State Data Source**  National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 population (5-year average).

  **Baseline**           17.4 (1992--96) (selected States in endemic
                         regions---see Comments).

  **Numerator**          Number of reported cases of Lyme disease.

  **Denominator**        Number of persons.

  **Population           Resident population (selected States in endemic
  Targeted**             regions---see Comments).

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition is available from CDC.**^1^**

                         Baseline endemic regions include Connecticut,
                         Delaware, Maryland, Massachusetts, Minnesota,
                         New Jersey, New York, Pennsylvania, and Rhode
                         Island.

                         Data were unavailable by gender for Pennsylvania
                         in 1992--93. Therefore, Pennsylvania was
                         excluded from baseline estimates by gender.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

### Infectious Diseases and Emerging Antimicrobial Resistance

+---------------------+------------------------------------------------+
| 14-9. Reduce        |                                                |
| hepatitis C.        |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Sentinel Counties Study of Viral Hepatitis,    |
| Source**            | CDC, NCID.                                     |
+---------------------+------------------------------------------------+
| **State Data        | Viral Hepatitis Surveillance Program, CDC,     |
| Source**            | NCID.                                          |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.3 (Immunization and Infectious Diseases).   |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 100,000 population.                   |
+---------------------+------------------------------------------------+
| **Baseline**        | 2.4 (1996).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of new symptomatic hepatitis C cases.   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons.                             |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| ###### Question     | CDC Viral Hepatitis Case Record for Reporting  |
| s Used To Obtain th | of Patients With Symptomatic Acute Viral       |
| e National Data {#q | Hepatitis, Form 53.1, Rev. 06/93.              |
| uestions-used-to-ob |                                                |
| tain-the-national-d |                                                |
| ata-5 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A case definition for new symptomatic cases of |
|                     | hepatitis C is available from CDC.**^1^**      |
+---------------------+------------------------------------------------+
|                     | To estimate the incidence of new symptomatic   |
|                     | hepatitis C, the incidence rate of reported    |
|                     | non-A, non-B hepatitis per 100,000 population  |
|                     | in the sentinel counties is multiplied by an   |
|                     | underreporting adjustment factor of 2.4 and    |
|                     | then by the a factor of 0.9, the proportion of |
|                     | non-A, non-B hepatitis that is attributable to |
|                     | hepatitis C virus (HCV) infection, weighted to |
|                     | the U.S. population. The estimates from        |
|                     | sentinel counties are then weighted to the     |
|                     | U.S. resident population.                      |
+---------------------+------------------------------------------------+
|                     | Because reporting of new symptomatic hepatitis |
|                     | C to national surveillance systems has been    |
|                     | unreliable to date, the national incidence of  |
|                     | hepatitis C is based on cases reported through |
|                     | the Sentinel Counties Study of Viral           |
|                     | Hepatitis.                                     |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-10. (Developmental) 
  Increase the           
  proportion of persons  
  with chronic hepatitis 
  C infection identified 
  by State and local     
  health departments.    

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed national data source is the National
                         Health and Nutrition Examination Survey, CDC,
                         NCHS. A proposed State data source are the State
                         and local health departments.

                         Establishment of registries for HCV-infected
                         persons will be needed to determine the
                         cumulative number of HCV-infected persons
                         reported to State and local health departments.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

-   

14-11. Reduce tuberculosis.

  ---------------------- ------------------------------------------------
  **National Data        National TB Surveillance System, CDC, NCHSTP.
  Source**               

  **State Data Source**  State TB Surveillance Systems.

  **Healthy People 2000  20.4 (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           6.8 (1998).

  **Numerator**          Number of confirmed new cases of tuberculosis
                         reported to CDC by local health departments in
                         all 50 States and the District of Columbia.

  **Denominator**        Number of persons.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Report of Verified Case of Tuberculosis,
  Obtain the National    Form 72.9A, Rev. 05/93, and Forms 72.9B-C, Rev.
  Data**                 12/92.

  **Expected             Annual.
  Periodicity**          

  **Comments**           A confirmed case definition for tuberculosis is
                         available from CDC.**^1^**

                         Data for this measure are also included in
                         Reported Tuberculosis in the United States,
                         1998.**^8^**

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-12. Increase the    
  proportion of all      
  tuberculosis patients  
  who complete curative  
  therapy within 12      
  months.                

  **National Data        National TB Surveillance System, CDC, NCHSTP.
  Source**               

  **State Data Source**  State TB Surveillance Systems.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           74 (1996).

  **Numerator**          Number of persons with confirmed new cases of
                         tuberculosis who were alive at diagnosis, with
                         an initial drug regimen of one or more drugs
                         prescribed, who did not die during therapy, and
                         who completed curative therapy within 12 months
                         of diagnosis.

  **Denominator**        Number of persons with confirmed new cases of
                         tuberculosis who were alive at diagnosis, with
                         an initial drug regimen of one or more drugs
                         prescribed, and who did not die during therapy.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Report of Verified Case of Tuberculosis,
  Obtain the National    Form 72.9A, Rev. 05/93, and Forms 72.9B-C, Rev.
  Data**                 12/92.

  **Expected             Annual.
  Periodicity**          

  **Comments**           A confirmed case definition for tuberculosis is
                         available from CDC.**^1^**

                         Data for this measure are also included in
                         Reported Tuberculosis in the United States,
                         1998.**^8^**

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 14-13. Increase the |                                                |
| proportion of       |                                                |
| contacts and other  |                                                |
| high-risk persons   |                                                |
| with latent         |                                                |
| tuberculosis        |                                                |
| infection who       |                                                |
| complete a course   |                                                |
| of treatment.       |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Aggregate Reports for TB Reports Evaluation,   |
| Source**            | CDC, NCHSTP.                                   |
+---------------------+------------------------------------------------+
| **State Data        | State TB Surveillance Systems.                 |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.18 (Immunization and           |
| 2000 Objective**    | Infectious Diseases).                          |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 62 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of contacts, tuberculin converters, and |
|                     | others placed on treatment for latent TB       |
|                     | infection who complete the recommended         |
|                     | therapy.                                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of contacts, tuberculin converters, and |
|                     | other persons placed on treatment for latent   |
|                     | TB infection.                                  |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| ###### Question     | CDC Report of Verified Case of Tuberculosis,   |
| s Used To Obtain th | Form 72.9A, Rev. 05/93, and Forms 72.9B-C,     |
| e National Data {#q | Rev. 12/92; CDC Tuberculosis Program           |
| uestions-used-to-ob | Management Report, Completion of Preventive    |
| tain-the-national-d | Therapy, Form 72.21 (formerly 5.63), Rev.      |
| ata-6 .Heading6THP} | 01/97.                                         |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A confirmed case definition for tuberculosis   |
|                     | is available from CDC.**^1^**                  |
+---------------------+------------------------------------------------+
|                     | High-risk persons are defined by the CDC       |
|                     | Tuberculosis Program Management Report form.   |
|                     | "Contacts" are all persons who have recently   |
|                     | shared the same air space with a person who    |
|                     | has pulmonary tuberculosis. "Recent tuberculin |
|                     | converters" are those who have had a           |
|                     | tuberculin skin test conversion within the     |
|                     | past 2 years exclusive of those persons        |
|                     | eligible for the contact category. "Others     |
|                     | placed on treatment for latent TB infection"   |
|                     | include all other persons started on therapy   |
|                     | for latent tuberculosis infection during the   |
|                     | time period.                                   |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 14-14. Reduce the   |                                                |
| average time for a  |                                                |
| laboratory to       |                                                |
| confirm and report  |                                                |
| tuberculosis cases. |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Survey of State Public Health Laboratories,    |
| Source**            | CDC, NCHSTP.                                   |
+---------------------+------------------------------------------------+
| **State Data        | Survey of State Public Health Laboratories,    |
| Source**            | CDC, NCHSTP.                                   |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Mean number of days per State health           |
|                     | laboratory.                                    |
+---------------------+------------------------------------------------+
| **Baseline**        | 21 (1996).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Sum of the mean number of days (from receipt   |
|                     | of an initial diagnostic specimen from a       |
|                     | suspected case to confirming it as coming from |
|                     | a case of tuberculosis among the most rapidly  |
|                     | confirmed 75 percent of laboratory-confirmed   |
|                     | tuberculosis cases), as reported by all        |
|                     | participating State health laboratories.       |
+---------------------+------------------------------------------------+
| **Denominator**     | Sum of the number of all the cases of          |
|                     | tuberculosis confirmed by each State health    |
|                     | laboratory, as reported by all participating   |
|                     | State health laboratories, multiplied by a     |
|                     | factor of 0.75.                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1996 National Survey of State Public  |
| Obtain the National | Health Laboratories:                           |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   For the most rapidly confirmed 75% of the  |
|                     |     laboratory-confirmed tuberculosis cases,   |
|                     |     what was the mean number of days or hours  |
|                     |     from receipt of an initial diagnostic      |
|                     |     specimen from a suspected case to          |
|                     |     confirming it as coming from a case of     |
|                     |     tuberculosis                               |
|                     |                                                |
|                     |     \_\_\_\_\_ mean number of days (hours) to  |
|                     |     confirm 75% of tuberculosis cases          |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   How many cases of tuberculosis were        |
|                     |     confirmed by your laboratory?              |
|                     |                                                |
|                     |     \_\_\_\_ number of laboratory-confirmed    |
|                     |     tuberculosis cases                         |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The mean number of days was calculated by each |
|                     | State health laboratory by summing the mean    |
|                     | number of days it takes to confirm 75 percent  |
|                     | of the most rapidly confirmed cases out of all |
|                     | its laboratory-confirmed cases of tuberculosis |
|                     | and was then divided by the total number of    |
|                     | confirmed cases that constituted the 75        |
|                     | percent most rapidly confirmed cases. This     |
|                     | mean was then summed with all participating    |
|                     | State health laboratories and divided by the   |
|                     | number of laboratories.**^9,\ 10^**            |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-15. (Developmental) 
  Increase the           
  proportion of          
  international          
  travelers who receive  
  recommended prevention 
  services when          
  traveling in areas of  
  risk for select        
  infectious diseases:   
  hepatitis A, malaria,  
  and typhoid.           

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         This objective is a modification of Healthy
                         People 2000 objective 20.6, which tracked the
                         number of cases of typhoid fever, hepatitis A,
                         and malaria using, respectively, the Typhoid
                         Surveillance System, CDC NCID; Sentinel Counties
                         of Acute Viral Hepatitis, CDC, NCID and NNDSS,
                         CDC, EPO; and Malaria Surveillance System, CDC,
                         NCID.

                         The proposed measure will track the proportion
                         of travelers receiving the recommended
                         prevention services. A proposed data source is
                         the *Abstract of International Travel to and
                         from the United States*, Department of Commerce.
                         The number of international travelers from the
                         United States has increased an average of 3
                         percent a year for the past decade. Recognition
                         of such increases will be factored into the
                         analysis for denominator data.

                         Travelers to risk areas will be defined as those
                         travelers to moderate and high prevalence areas
                         of hepatitis A as identified in the most recent
                         edition of CDC's Health Information for
                         International Travel. Travelers who received
                         either hepatitis A vaccine or immune globulin
                         according to current Advisory Committee on
                         Immunization Practices (ACIP) recommendations
                         will be considered protected.

                         An appropriate prescription of antimalarial
                         prophylaxis medications constitutes recommended
                         preventive services for this disease. Risk areas
                         will be identified by referencing the malaria
                         section in the most recent edition of Health
                         Information for International Travel.

                         Travelers to risk countries will be considered
                         those persons who visit countries with
                         intermediate to high endemicity for typhoid
                         fever infection. Three vaccines currently are
                         available in the United States for prevention of
                         typhoid fever, and all these are considered
                         adequate protection. If new vaccines are
                         approved and identified by CDC as efficacious,
                         they also could be included.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-16. Reduce invasive 
  early onset group B    
  streptococcal disease. 

  **National Data        Active Bacterial Core Surveillance (ABCs),
  Sources**              Emerging Infections Program Network, CDC, NCID;
                         National Vital Statistics System, CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000 live births.

  **Baseline**           1.0 (1996) (selected regions in eight States).

  **Numerator**          Number of newborns aged 0 to 6 days with a newly
                         reported laboratory-confirmed case of
                         early-onset group B streptococcal disease in the
                         past 12 months.

  **Denominator**        Number of live births.

  **Population           Resident population (selected regions in eight
  Targeted**             States) (see Comments).

  **Questions Used To    CDC Active Surveillance Bacterial Meningitis and
  Obtain the National    Bacteremia Case Report, Form 52.15A, Rev. 12/97.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A laboratory-confirmed case of group B
                         Streptococcus is defined as either the isolation
                         of group B Streptococcus from cerebrospinal
                         fluid or a positive culture of group B
                         Streptococcus from a different normally sterile
                         site (blood, pleural fluid, etc.) in a newborn
                         aged 0 to 6 days in the surveillance area.

                         ABCs is an active and laboratory-based case
                         surveillance system. Data are collected from
                         acute care hospitals and reference laboratories
                         for laboratory-confirmed cases as well as from
                         case report forms.

                         Data are based on surveillance of selected
                         regions in eight States: California,
                         Connecticut, Georgia, Maryland, Minnesota, New
                         York, Oregon, and Tennessee.

                         More information on laboratory-based
                         surveillance for meningococcal disease
                         (including group B streptococcal disease) is
                         provided by CDC.**^11^**

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

+---------------------+------------------------------------------------+
| 14-17. Reduce       |                                                |
| hospitalizations    |                                                |
| caused by peptic    |                                                |
| ulcer disease in    |                                                |
| the United States.  |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Hospital Discharge Survey (NHDS),     |
| Source**            | CDC, NCHS.                                     |
+---------------------+------------------------------------------------+
| **State Data        | State hospital discharge data systems.         |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 17.21 (Diabetes and Chronic       |
| 2000 Objective**    | Disabling Conditions).                         |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 100,000 population.                   |
+---------------------+------------------------------------------------+
| **Baseline**        | 71 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of hospitalizations with uncomplicated  |
|                     | ulcers or ulcers complicated by bleeding or    |
|                     | perforation as the principal diagnosis         |
|                     | (ICD-9-CM codes 531-534).                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons.                             |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| ###### Question     | Not applicable.                                |
| s Used To Obtain th |                                                |
| e National Data {#q |                                                |
| uestions-used-to-ob |                                                |
| tain-the-national-d |                                                |
| ata-7 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Principal diagnosis is the diagnosis chiefly   |
|                     | responsible for admission of the person to the |
|                     | hospital.                                      |
+---------------------+------------------------------------------------+
|                     | This measure is a modification from its        |
|                     | comparable Healthy People 2000 objective       |
|                     | 17.21, which tracked the proportion of persons |
|                     | in the U.S. civilian, noninstitutionalized     |
|                     | population who reported having an ulcer in the |
|                     | past 12 months, using self-reported            |
|                     | conditions, from the National Health Interview |
|                     | Survey (NHIS), CDC, NCHS. This measure tracks  |
|                     | the number of hospitalizations with            |
|                     | uncomplicated ulcers or ulcers complicated by  |
|                     | bleeding or perforation as the first-listed    |
|                     | diagnosis (ICD-9-CM codes 531-534) in the U.S. |
|                     | civilian population using NHDS.                |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| 14-18. Reduce the   |                                                |
| number of courses   |                                                |
| of antibiotics for  |                                                |
| ear infections for  |                                                |
| young children.     |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Ambulatory Medical Care Survey        |
| Sources**           | (NAMCS), CDC, NCHS; National Hospital          |
|                     | Ambulatory Medical Care Survey (NHAMCS), CDC,  |
|                     | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.9 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 100 children (2-year average).        |
+---------------------+------------------------------------------------+
| **Baseline**        | 108 (1996--97).                                |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of antibiotic courses ordered,          |
|                     | supplied, administered, or continued at a      |
|                     | specific visit for children under age 5 years  |
|                     | diagnosed with an ear infection (ICD-9-CM      |
|                     | codes 381.0, 381.4, 382.0, 382.4, or 382.9).   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of children under age 5 years.          |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1996--97 National Ambulatory Medical  |
| Obtain the National | Care Survey/National Hospital Ambulatory       |
| Data**              | Medical Care Survey:                           |
+---------------------+------------------------------------------------+
|                     | -   Physician's diagnosis for this visit. As   |
|                     |     specifically as possible, list diagnoses   |
|                     |     related to this visit including chronic    |
|                     |     conditions (e.g. depression, obesity,      |
|                     |     asthma, etc.).                             |
|                     |                                                |
|                     |     1\. Primary diagnosis:                     |
|                     |                                                |
|                     |    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                     |     2. Other:                                  |
|                     |     \_\_\_\_\_\_\                              |
|                     | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                     |     3. Other:                                  |
|                     |     \_\_\_\_\_\_                               |
|                     | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+---------------------+------------------------------------------------+
|                     | -   Medications/injections. List names of up   |
|                     |     to 6 medications that were ordered,        |
|                     |     supplied, administered, or continued       |
|                     |     during this visit. Include L and OTC       |
|                     |     medications, immunizations, allergy shots, |
|                     |     and anesthetics.                           |
|                     |                                                |
|                     |     □ None                                     |
|                     |                                                |
|                     |     Check the box next to drug name if it is   |
|                     |     from the patient's insurance formulary     |
|                     |     list.                                      |
|                     |                                                |
|                     |     Check here if NO drugs are from a          |
|                     |     formulary list                             |
|                     |                                                |
|                     |     □ 1.                                       |
|                     |     \_\_\_\_\_\_\                              |
|                     | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                     |     □ 2.                                       |
|                     |     \_\_\_\_\_\_\                              |
|                     | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                     |     □ 3.                                       |
|                     |     \_\_\_\_\_\_\                              |
|                     | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                     |     □ 4.                                       |
|                     |     \_\_\_\_\_\_\                              |
|                     | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                     |     □ 5.                                       |
|                     |     \_\_\_\_\_\_\                              |
|                     | _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
|                     |     □ 6.                                       |
|                     |     \_\_\_\_\_\_                               |
|                     | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The number of courses of antibiotics for ear   |
|                     | infections among young children (and for the   |
|                     | sole diagnosis of the common cold among all    |
|                     | ages) are the sum of cases reported by NAMCS   |
|                     | and NHAMCS that are listed as any diagnosis    |
|                     | (including the primary diagnosis).             |
+---------------------+------------------------------------------------+
|                     | NAMCS and NHAMCS are being redesigned in 2000, |
|                     | and modifications to survey questions on       |
|                     | medications may affect the trend of this       |
|                     | measure.                                       |
+---------------------+------------------------------------------------+
|                     | This objective differs from Healthy People     |
|                     | 2000 objective 20.9, which tracked restricted  |
|                     | activity days due to ear infections among      |
|                     | children aged 4 years and under using the      |
|                     | National Health Interview Survey (NHIS), CDC,  |
|                     | NCHS.                                          |
+---------------------+------------------------------------------------+
|                     | See Part C for descriptions of NAMCS and       |
|                     | NHAMCS and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-19. Reduce the      
  number of courses of   
  antibiotics prescribed 
  for the sole diagnosis 
  of the common cold.    

  **National Data        National Ambulatory Medical Care Survey (NAMCS),
  Sources**              CDC, NCHS; National Hospital Ambulatory Medical
                         Care Survey (NHAMCS), CDC, NCHS.

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 population (2-year average).

  **Baseline**           2,535 (1996--97).

  **Numerator**          Number of antibiotic courses ordered, supplied,
                         administered, or continued at a specific visit
                         for persons diagnosed with the common cold
                         (ICD-9-CM codes 460.0, 465, or 472.0).

  **Denominator**        Number of persons.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    provided with objective 14-18.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 14-18 for
                         more information.
  ---------------------- ------------------------------------------------

14-20. Reduce hospital-acquired infections in intensive care unit
patients.

###### Intensive care unit patients {#intensive-care-unit-patients .HeadingTHPsub}

14-20a. Catheter-associated urinary tract infection.

+---------------------+------------------------------------------------+
| **National Data     | National Nosocomial Infections Surveillance    |
| Source**            | (NNIS) System, CDC, NCID.                      |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.5 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 1,000 days' use.                      |
+---------------------+------------------------------------------------+
| **Baseline**        | 5.9 (1998).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of hospital-acquired indwelling urinary |
|                     | catheter-associated urinary tract infections   |
|                     | among intensive care unit patients.            |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of indwelling urinary catheter-days     |
|                     | among intensive care unit patients.            |
+---------------------+------------------------------------------------+
| **Population        | Acute care general hospital patient            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | Numerator: CDC National Nosocomial Infections  |
| Obtain the National | Surveillance System Infection Worksheet, Form  |
| Data**              | 57.58D, Rev. 01/98.                            |
|                     |                                                |
|                     | Denominator: CDC National Nosocomial           |
|                     | Infections Surveillance System Adult and       |
|                     | Pediatric Intensive Care Unit (ICU) Monthly    |
|                     | Report Form, Form 57.58B, Rev. 01/98.          |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The 1998 point estimate represents an          |
|                     | aggregate of data from all types of ICUs       |
|                     | during January 1992 through March 1999.        |
+---------------------+------------------------------------------------+
|                     | Data may not be representative of all U.S.     |
|                     | hospitals. For each year of data collection,   |
|                     | not all participating hospitals are            |
|                     | represented.                                   |
+---------------------+------------------------------------------------+
|                     | Detailed surveillance protocols used in NNIS   |
|                     | System, including all data field definitions,  |
|                     | can be found in the *NNIS Manual*, May 1999    |
|                     | (available by request to NNIS hospitals, State |
|                     | health departments, and international          |
|                     | ministries of health).**^12^** Definitions of  |
|                     | infections and key data fields and a           |
|                     | description of the protocols are               |
|                     | available.**^13,\ 14^**                        |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.5, which tracked the  |
|                     | urinary tract infection rates per 1,000 device |
|                     | days among patients by specific type of        |
|                     | intensive care unit categories (surgical ICUs, |
|                     | medical ICUs, and pediatric ICUs). This        |
|                     | measure tracks catheter-associated urinary     |
|                     | tract infection rates per 1,000 days' use      |
|                     | among patients in all ICUs.                    |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

14-20b. Central line-associated bloodstream infection.

+---------------------+------------------------------------------------+
| **National Data     | National Nosocomial Infections Surveillance    |
| Source**            | (NNIS) System, CDC, NCID.                      |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.5 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 1,000 days' use.                      |
+---------------------+------------------------------------------------+
| **Baseline**        | 5.3 (1998).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of hospital-acquired central            |
|                     | line-associated bloodstream infections among   |
|                     | intensive care unit patients.                  |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of central line-days among intensive    |
|                     | care unit patients.                            |
+---------------------+------------------------------------------------+
| **Population        | Acute care general hospital patient            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | Numerator: CDC National Nosocomial Infections  |
| Obtain the National | Surveillance System Infection Worksheet, Form  |
| Data**              | 57.58D, Rev. 01/98.                            |
|                     |                                                |
|                     | Denominator: CDC National Nosocomial           |
|                     | Infections Surveillance System Adult and       |
|                     | Pediatric Intensive Care Unit (ICU) Monthly    |
|                     | Report Form, Form 57.58B, Rev. 01/98, and CDC  |
|                     | National Nosocomial Infections Surveillance    |
|                     | Infection Worksheet, Forms 57.58 B and D, Rev. |
|                     | 01/98.                                         |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The 1998 point estimate represents an          |
|                     | aggregate of data from all types of ICUs from  |
|                     | January 1992 through March 1999.               |
+---------------------+------------------------------------------------+
|                     | Data may not be representative of all U.S.     |
|                     | hospitals. For each year of data collection,   |
|                     | not all participating hospitals are            |
|                     | represented.                                   |
+---------------------+------------------------------------------------+
|                     | Detailed surveillance protocols used in NNIS   |
|                     | System, including all data field definitions,  |
|                     | can be found in the *NNIS Manual*, May 1999    |
|                     | (available by request to *NNIS hospitals*,     |
|                     | State health departments, and international    |
|                     | ministries of health).**^12^** Definitions of  |
|                     | infections and key data fields and a           |
|                     | description of the protocols are               |
|                     | available.**^13,\ 14^**                        |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.5, which tracked      |
|                     | bloodstream infection rates per 1,000 device   |
|                     | days among patients by specific type of        |
|                     | intensive care unit categories (surgical ICUs, |
|                     | medical ICUs, and pediatric ICUs). This        |
|                     | measure tracks central line-associated         |
|                     | bloodstream infection rates per 1,000 days'    |
|                     | use among patients in all ICUs.                |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

-   

14-20c. Ventilator-associated pneumonia.

+---------------------+------------------------------------------------+
| **National Data     | National Nosocomial Infections Surveillance    |
| Source**            | (NNIS) System, CDC, NCID.                      |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.5 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 1,000 days' use.                      |
+---------------------+------------------------------------------------+
| **Baseline**        | 11.1 (1998).                                   |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of hospital-acquired                    |
|                     | ventilator-associated pneumonia infections     |
|                     | among intensive care unit patients.            |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of ventilator-days among intensive care |
|                     | unit patients.                                 |
+---------------------+------------------------------------------------+
| **Population        | Acute care general hospital patient            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | Numerator: CDC National Nosocomial Infections  |
| Obtain the National | Surveillance System Infection Worksheet, Form  |
| Data**              | 57.58D, Rev. 01/98.                            |
|                     |                                                |
|                     | Denominator: CDC National Nosocomial           |
|                     | Infections Surveillance System Adult and       |
|                     | Pediatric Intensive Care Unit (ICU) Monthly    |
|                     | Report Form, Form 57.58B, Rev. 01/98.          |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The 1998 point estimate represents an          |
|                     | aggregate of data from all types of ICUs from  |
|                     | January 1992 through March 1999.               |
+---------------------+------------------------------------------------+
|                     | Data may not be representative of all U.S.     |
|                     | hospitals. For each year of data collection,   |
|                     | not all participating hospitals are            |
|                     | represented.                                   |
+---------------------+------------------------------------------------+
|                     | Detailed surveillance protocols used in NNIS   |
|                     | System, including all data field definitions,  |
|                     | can be found in the *NNIS Manual*, May 1999    |
|                     | (available by request to NNIS hospitals, State |
|                     | health departments, and international          |
|                     | ministries of health).**^12^** Definitions of  |
|                     | infections and key data fields and a           |
|                     | description of the protocols are               |
|                     | available.**^13,\ 14^**                        |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.5, which tracked      |
|                     | pneumonia infection rates per 1,000 device     |
|                     | days among patients by specific type of        |
|                     | intensive care unit categories (surgical ICUs, |
|                     | medical ICUs, and pediatric ICUs). This        |
|                     | measure tracks ventilator-associated pneumonia |
|                     | infection rates per 1,000 days' use among all  |
|                     | ICUs.                                          |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

###### Infants weighing 1,000 grams or less at birth in intensive care {#infants-weighing-1000-grams-or-less-at-birth-in-intensive-care .HeadingTHPsub}

14-20d. Central line-associated bloodstream infection.

+---------------------+------------------------------------------------+
| **National Data     | National Nosocomial Infections Surveillance    |
| Source**            | (NNIS) System, CDC, NCID.                      |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.5 (Immunization and Infectious |
| 2000 Objective**    | Diseases).                                     |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 1,000 days' use.                      |
+---------------------+------------------------------------------------+
| **Baseline**        | 12.2 (1998).                                   |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of hospital-acquired central            |
|                     | line-associated bloodstream infections among   |
|                     | infants with a birth weight of 1,000 grams or  |
|                     | less.                                          |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of central line-days among infants with |
|                     | a birth weight of 1,000 grams or less.         |
+---------------------+------------------------------------------------+
| **Population        | Acute care general hospital patient            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | Numerator: CDC National Nosocomial Infections  |
| Obtain the National | Surveillance System Infection Worksheet, Form  |
| Data**              | 57.58D, Rev. 01/98.                            |
|                     |                                                |
|                     | Denominator: CDC National Nosocomial           |
|                     | Infections Surveillance System High Risk       |
|                     | Nursery (HRN) Surveillance Monthly Report      |
|                     | Form, Form 57.58H, Rev. 01/98.                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The 1998 point estimate represents an          |
|                     | aggregate of data from high-risk nurseries     |
|                     | (level II-III neonatal intensive care units)   |
|                     | from January 1990 through May 1999.            |
+---------------------+------------------------------------------------+
|                     | Data may not be representative of all U.S.     |
|                     | hospitals. For each year of data collection,   |
|                     | not all participating hospitals are            |
|                     | represented.                                   |
+---------------------+------------------------------------------------+
|                     | Detailed surveillance protocols used in NNIS   |
|                     | System, including all data field definitions,  |
|                     | can be found in the *NNIS Manual*, May 1999    |
|                     | (available by request to NNIS hospitals, State |
|                     | health departments, and international          |
|                     | ministries of health).**^12^** Definitions of  |
|                     | infections and key data fields and a           |
|                     | description of the protocols are               |
|                     | available.**^13,\ 14^**                        |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.5, which tracked      |
|                     | bloodstream infection rates per 1,000 device   |
|                     | days among patients by specific type of        |
|                     | intensive care unit categories (surgical ICUs, |
|                     | medical ICUs, and pediatric ICUs). This        |
|                     | measure tracks central line-associated         |
|                     | bloodstream infection rates per 1,000 days'    |
|                     | use among infants weighing 1,000 grams or less |
|                     | at birth in all level II-III neonatal ICUs.    |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

-   

14-20e. Ventilator-associated pneumonia.

+---------------------+------------------------------------------------+
| **National Data     | National Nosocomial Infections Surveillance    |
| Source**            | (NNIS) System, CDC, NCID.                      |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.5 (Immunization and Infectious |
| 2000 Objective**    | Diseases)                                      |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 1,000 days' use.                      |
+---------------------+------------------------------------------------+
| **Baseline**        | 4.9 (1998).                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of hospital-acquired                    |
|                     | ventilator-associated pneumonia infections     |
|                     | among infants with a birth weight of 1,000     |
|                     | grams or less.                                 |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of ventilator-days among infants with a |
|                     | birth weight of 1,000 grams or less.           |
+---------------------+------------------------------------------------+
| **Population        | Acute care general hospital patient            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | Numerator: CDC National Nosocomial Infections  |
| Obtain the National | Surveillance System Infection Worksheet, Form  |
| Data**              | 57.58D, Rev. 01/98.                            |
|                     |                                                |
|                     | Denominator: CDC National Nosocomial           |
|                     | Infections Surveillance System High Risk       |
|                     | Nursery (HRN) Surveillance Monthly Report      |
|                     | Form, Form 57.58H, Rev. 01/98, and CDC         |
|                     | National Nosocomial Infections Surveillance    |
|                     | System High Risk Nursery (HRN) Surveillance    |
|                     | Monthly Report Form, Form 57.58H, Rev. 01/98.  |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The 1998 point estimate represents an          |
|                     | aggregate of data from high-risk nurseries     |
|                     | (level II-III neonatal intensive care units)   |
|                     | from January 1990 through May 1999.            |
+---------------------+------------------------------------------------+
|                     | Data may not be representative of all U.S.     |
|                     | hospitals. For each year of data collection,   |
|                     | not all participating hospitals are            |
|                     | represented.                                   |
+---------------------+------------------------------------------------+
|                     | Detailed surveillance protocols used in NNIS   |
|                     | System, including all data field definitions,  |
|                     | can be found in the *NNIS Manual*, May 1999    |
|                     | (available by request to NNIS hospitals, State |
|                     | health departments, and international          |
|                     | ministries of health).**^12^** Definitions of  |
|                     | infections and key data fields and a           |
|                     | description of the protocols are               |
|                     | available.**^13,\ 14^**                        |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.5, which tracked      |
|                     | pneumonia infection rates per 1,000 device     |
|                     | days among patients in pediatric ICUs. This    |
|                     | measure tracks ventilator-associated pneumonia |
|                     | infection rates per 1,000 days' use among      |
|                     | infants weighing 1,000 grams or less at birth  |
|                     | in all level II-III neonatal ICUs.             |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-21. Reduce          
  antimicrobial use      
  among intensive care   
  unit patients.         

  **National Data        National Nosocomial Infections Surveillance
  Source**               (NNIS) System, CDC, NCID.

  **State Data Source**  Not identified.

  **Healthy People 2000  Adapted from 20.5 (Immunization and Infectious
  Objective**            Diseases).

  **Measure**            Rate per 1,000 Intensive Care Unit (ICU) days.

  **Baseline**           150 (1995).

  **Numerator**          Number of defined daily doses of FDA-approved
                         antimicrobial agents or grams per day of
                         FDA-approved antimicrobial agents of all
                         patients hospitalized in the intensive care
                         unit.

  **Denominator**        Number of all the days of all the patients that
                         are hospitalized in the ICU (number of
                         patient-days).

  **Population           Acute care general hospital patient population.
  Targeted**             

  **Questions Used To    CDC National Nosocomial Infections Surveillance
  Obtain the National    System Antimicrobial Use and Resistance
  Data**                 Component Monthly Report Form.

  **Expected             Annual.
  Periodicity**          

  **Comments**           The 1995 point estimate represents an aggregate
                         of data for 1994--95.

                         Grams of specific antibiotics used in intensive
                         care units are based on reports by participating
                         NNIS hospitals. Defined daily dose estimates are
                         available for most FDA-approved antimicrobial
                         agents.

                         Data may not be representative of all U.S.
                         hospitals. Not all antimicrobial agents are
                         included in the surveillance system. For each
                         year of data collection, not all participating
                         hospitals are necessarily represented. The
                         appropriateness of antibiotic therapies is not
                         addressed in this measure.

                         Agents dosed by patient weight (i.e.,
                         aminoglycosides, macrolides) are defined by
                         total grams administered daily.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

### Vaccination Coverage and Strategies

14-22. Achieve and maintain effective vaccination coverage levels for
universally recommended vaccines among young children.

4-22a. 4 doses of diphtheria-tetanus-acellular pertussis (DTaP) vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **State Data        | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.11 (Immunization and           |
| 2000 Objective**    | Infectious Diseases).                          |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 84 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 19 to 35 months        |
|                     | receiving at least four or more doses of the   |
|                     | combination of diphtheria, tetanus, and        |
|                     | acellular pertussis antigens.                  |
+---------------------+------------------------------------------------+
| **Denominator**     | Children aged 19 to 35 months.                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Immunization Survey     |
| Obtain the National | Household Survey:                              |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many D-T-P or D-T shots (sometimes     |
|                     |     called a D-P-T shot,                       |
|                     |     diphtheria-tetanus-pertussis shot, baby    |
|                     |     shot, three-in-one shot) has ([Sample      |
|                     |     child]{.underline}) ever received?         |
+---------------------+------------------------------------------------+
|                     | -   Other shots received?                      |
+---------------------+------------------------------------------------+
|                     | From the 1998 National Immunization Survey     |
|                     | Provider Record Check:                         |
+---------------------+------------------------------------------------+
|                     | -   Specify month, day and year that each      |
|                     |     immunization was given, either by the      |
|                     |     office or another provider (OP), as        |
|                     |     documented in the records.                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The National Immunization Survey (NIS) is a    |
|                     | continuing nationwide telephone sample survey  |
|                     | among children aged 19 to 35 months. Estimates |
|                     | of vaccine‑specific coverage are available for |
|                     | the United States, each State, and 28 urban    |
|                     | areas considered to be high risk for           |
|                     | under‑vaccination. NIS uses a two‑phase sample |
|                     | design. First, a random‑digit‑dialing (RDD)    |
|                     | sample of telephone numbers is drawn. In 1995, |
|                     | 69 percent of households with age‑eligible     |
|                     | children completed vaccination interviews,     |
|                     | yielding data for 31,997 children.             |
+---------------------+------------------------------------------------+
|                     | The interviewer also asks for permission to    |
|                     | contact the vaccination provider. In the       |
|                     | second phase, all vaccination providers are    |
|                     | contacted by mail. Vaccination information     |
|                     | from providers\' records was obtained for 52   |
|                     | percent of all children who were eligible for  |
|                     | provider followup in 1995 and 64 percent in    |
|                     | 1996. Providers' responses are combined with   |
|                     | information obtained from households to        |
|                     | provide a more accurate estimate of            |
|                     | vaccination coverage levels. Final estimates   |
|                     | are adjusted for noncoverage of nontelephone   |
|                     | households.                                    |
+---------------------+------------------------------------------------+
|                     | For further information, visit the National    |
|                     | Immunization Survey Web site at                |
|                     | http://www.nisabt.org/.                        |
+---------------------+------------------------------------------------+
|                     | Statistical adjustments are made to minimize   |
|                     | bias due to (1) lower coverage among children  |
|                     | living in households without telephones, (2)   |
|                     | discrepancies between vaccinations reported by |
|                     | household compared with immunization           |
|                     | providers, and (3) differences in race/ethnic  |
|                     | population distribution in sample compared to  |
|                     | race/ethnic population distribution at birth.  |
+---------------------+------------------------------------------------+
|                     | This measure is a modification of its          |
|                     | comparable Healthy People 2000 objective       |
|                     | 20.11, which tracked the number of children    |
|                     | aged 19 to 35 months receiving three or more   |
|                     | doses of the combination of diphtheria,        |
|                     | tetanus, and pertussis antigens (DTP).         |
+---------------------+------------------------------------------------+
|                     | This baseline measure tracks the number of     |
|                     | children aged 19 to 35 months receiving four   |
|                     | or more doses of the combination of            |
|                     | diphtheria, tetanus, and acellular pertussis   |
|                     | antigens (DTaP) as well as those children who  |
|                     | received the combination of diphtheria,        |
|                     | tetanus, and pertussis antigens (DTP).         |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

-   

14-22b. 3 doses Haemophilus influenzae type b (Hib) vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **State Data        | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases).  |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 93 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 19 to 35 months        |
|                     | receiving at least three doses of the          |
|                     | *Haemophilus influenzae* B antigen.            |
+---------------------+------------------------------------------------+
| **Denominator**     | Children aged 19 to 35 months.                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Immunization Survey     |
| Obtain the National | Household Survey:                              |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many H-I-B shots (this is for          |
|                     |     Meningitis and is called Haemophilus       |
|                     |     Influenzae), H-I-B vaccine, or H flu       |
|                     |     vaccine has ([Sample child]{.underline})   |
|                     |     ever received?                             |
+---------------------+------------------------------------------------+
|                     | -   Other shots received?                      |
+---------------------+------------------------------------------------+
|                     | From the 1998 National Immunization Survey     |
|                     | Provider Record Check:                         |
+---------------------+------------------------------------------------+
|                     | -   Specify month, day and year that each      |
|                     |     immunization was given, either by the      |
|                     |     office or another provider (OP), as        |
|                     |     documented in the records.                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-22a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

-   

14-22c. 3 doses hepatitis B (hep B) vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **State Data        | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases)   |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 87 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 19 to 35 months        |
|                     | receiving at least three doses of the          |
|                     | hepatitis B antigen.                           |
+---------------------+------------------------------------------------+
| **Denominator**     | Children aged 19 to 35 months.                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Immunization Survey     |
| Obtain the National | Household Survey:                              |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many Hepatitis B shots has ([Sample    |
|                     |     child]{.underline}) ever received?         |
+---------------------+------------------------------------------------+
|                     | -   Other shots received?                      |
+---------------------+------------------------------------------------+
|                     | From the 1998 National Immunization Survey     |
|                     | Provider Record Check:                         |
+---------------------+------------------------------------------------+
|                     | -   Specify month, day and year that each      |
|                     |     immunization was given, either by the      |
|                     |     office or another provider (OP), as        |
|                     |     documented in the records.                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-22a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

-   

14-22d. 1 dose measles-mumps-rubella (MMR) vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **State Data        | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases).  |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 92 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 19 to 35 months        |
|                     | receiving at least one dose of the combination |
|                     | of measles, mumps, and rubella antigens.       |
+---------------------+------------------------------------------------+
| **Denominator**     | Children aged 19 to 35 months.                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Immunization Survey     |
| Obtain the National | Household Survey:                              |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many measles or M-M-R                  |
|                     |     (Measles-Mumps-Rubella) shots has ([Sample |
|                     |     child]{.underline}) ever received?         |
+---------------------+------------------------------------------------+
|                     | -   Other shots received?                      |
+---------------------+------------------------------------------------+
|                     | From the 1998 National Immunization Survey     |
|                     | Provider Record Check:                         |
+---------------------+------------------------------------------------+
|                     | -   Specify month, day and year that each      |
|                     |     immunization was given, either by the      |
|                     |     office or another provider (OP), as        |
|                     |     documented in the records.                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The MMR estimate for 1998 is based on all      |
|                     | measles-containing vaccines.                   |
+---------------------+------------------------------------------------+
|                     | See Comments provided with objective 14-22a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

-   

14-22e. 3 doses polio vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **State Data        | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases).  |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 91 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 19 to 35 months        |
|                     | receiving at least three doses of the polio    |
|                     | antigen.                                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Children aged 19 to 35 months.                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Immunization Survey     |
| Obtain the National | Household Survey:                              |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many polio vaccine shots (by mouth,    |
|                     |     pink drops, or by a polio shot) has        |
|                     |     ([Sample child]{.underline}) ever          |
|                     |     received?                                  |
+---------------------+------------------------------------------------+
|                     | -   Other shots received?                      |
+---------------------+------------------------------------------------+
|                     | From the 1998 National Immunization Survey     |
|                     | Provider Record Check:                         |
+---------------------+------------------------------------------------+
|                     | -   Specify month, day and year that each      |
|                     |     immunization was given, either by the      |
|                     |     office or another provider (OP), as        |
|                     |     documented in the records.                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-22a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

-   

14-22f. 1 dose varicella vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **State Data        | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 43 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 19 to 35 months        |
|                     | receiving at least one dose of the varicella   |
|                     | antigen.                                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Children aged 19 to 35 months.                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Immunization Survey     |
| Obtain the National | Household Survey:                              |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many chicken pox (or Varicella) shots  |
|                     |     has ([Sample child]{.underline}) ever      |
|                     |     received?                                  |
+---------------------+------------------------------------------------+
|                     | -   Other shots received?                      |
+---------------------+------------------------------------------------+
|                     | From the 1998 National Immunization Survey     |
|                     | Provider Record Check:                         |
+---------------------+------------------------------------------------+
|                     | -   Specify month, day and year that each      |
|                     |     immunization was given, either by the      |
|                     |     office or another provider (OP), as        |
|                     |     documented in the records.                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-22a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

14-23. Maintain vaccination coverage levels for children in licensed day
care facilities and children in kindergarten through the first grade.

###### Children in day care {#children-in-day-care .HeadingTHPsub}

14-23a. Diphtheria-tetanus-acellular pertussis (DTaP) vaccine.

  ---------------------- ------------------------------------------------
  **National Data        Annual Immunization Assessment Reports, CDC,
  Source**               NIP.

  **State Data Source**  Annual Immunization Assessment Reports, CDC,
                         NIP.

  **Healthy People 2000  20.11 (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Percent (2-year average).

  **Baseline**           96 (1997--98).

  **Numerator**          Number of surveyed enrollees in day care centers
                         who received the combination of diphtheria,
                         tetanus, and either acellular pertussis or
                         pertussis antigens.

  **Denominator**        Number of surveyed enrollees in day care
                         centers.

  **Population           U.S. day care center population.
  Targeted**             

  **Questions Used To    CDC Annual Immunization Assessment Report: Day
  Obtain the National    Care Centers, Head Start Centers, and Schools.
  Data**                 

  **Expected             Biennial.
  Periodicity**          

  **Comments**           Baseline includes enrollees who received the
                         combination of diphtheria, tetanus, and
                         pertussis antigens.

                         States may collect and/or report data on
                         selective antigens depending upon school entry
                         requirements.

                         Overall (national) mean coverage levels are
                         estimated by weighting the vaccine-specific
                         coverage levels reported by States and
                         territories to their respective birth cohorts.

                         Sampling methodology may vary by State.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

-   

14-23b. Measles/mumps/rubella vaccines.

  ---------------------- ------------------------------------------------
  **National Data        Annual Immunization Assessment Reports, CDC,
  Source**               NIP.

  **State Data Source**  Annual Immunization Assessment Reports, CDC,
                         NIP.

  **Healthy People 2000  20.11 (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Percent (2-year average).

  **Baseline**           89 (1997--98).

  **Numerator**          Number of surveyed enrollees in day care centers
                         who received the combination of measles, mumps,
                         and rubella antigens.

  **Denominator**        Number of surveyed enrollees in day care
                         centers.

  **Population           U.S. day care center population.
  Targeted**             

  **Questions Used To    CDC Annual Immunization Assessment Report: Day
  Obtain the National    Care Centers, Head Start Centers, and Schools.
  Data**                 

  **Expected             Biennial.
  Periodicity**          

  **Comments**           See Comments provided with objective 14-23a for
                         more information.
  ---------------------- ------------------------------------------------

-   

14-23c. Polio vaccine.

  ---------------------- ------------------------------------------------
  **National Data        Annual Immunization Assessment Reports, CDC,
  Source**               NIP.

  **State Data Source**  Annual Immunization Assessment Reports, CDC,
                         NIP.

  **Healthy People 2000  20.11 (Immunization and Infectious Diseases)
  Objective**            

  **Measure**            Percent (2-year average).

  **Baseline**           96 (1997--98).

  **Numerator**          Number of surveyed enrollees in day care centers
                         who received the polio antigen.

  **Denominator**        Number of surveyed enrollees in day care
                         centers.

  **Population           U.S. day care center population.
  Targeted**             

  **Questions Used To    CDC Annual Immunization Assessment Report: Day
  Obtain the National    Care Centers, Head Start Centers, and Schools.
  Data**                 

  **Expected             Biennial.
  Periodicity**          

  **Comments**           See Comments provided with objective 14-23a for
                         more information.
  ---------------------- ------------------------------------------------

-   

14-23d. (Developmental) Hepatitis B vaccine.

+---------------------+------------------------------------------------+
| ##                  | An operational definition could not be         |
| #### Comments {#com | specified at the time of publication.          |
| ments .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
|                     | The proposed national and State data sources   |
|                     | are the Annual Immunization Assessment         |
|                     | Reports, CDC, NIP.                             |
+---------------------+------------------------------------------------+
|                     | The proposed numerator is the number of        |
|                     | surveyed enrollees in day care centers who     |
|                     | received the hepatitis B antigen. The proposed |
|                     | denominator is the number of surveyed          |
|                     | enrollees in day care centers.                 |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

-   

14-23e. (Developmental) Varicella vaccine.

  ---------------------- ------------------------------------------------
  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national and State data sources are
                         the Annual Immunization Assessment Reports, CDC,
                         NIP.

                         The proposed numerator is the number of surveyed
                         enrollees in day care centers who received the
                         varicella antigen. The proposed denominator is
                         the number of surveyed enrollees in day care
                         centers.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

###### Children in K through 1st grade {#children-in-k-through-1st-grade .HeadingTHPsub}

14-23f. Diphtheria-tetanus-acellular pertussis (DTaP) vaccine.

  ---------------------- ------------------------------------------------
  **National Data        Annual Immunization Assessment Reports, CDC,
  Source**               NIP.

  **State Data Source**  Annual Immunization Assessment Reports, CDC,
                         NIP.

  **Healthy People 2000  20.11 (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Percent (2-year average).

  **Baseline**           97 (1997--98).

  **Numerator**          Number of surveyed enrollees in kindergarten
                         and/or first grade who received the combination
                         of diphtheria, tetanus, and either acellular
                         pertussis or pertussis antigens.

  **Denominator**        Number of surveyed enrollees in kindergarten
                         and/or first grade.

  **Population           U.S. kindergarten and first grade student
  Targeted**             population.

  **Questions Used To    CDC Annual Immunization Assessment Report: Day
  Obtain the National    Care Centers, Head Start Centers, and Schools.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 14-23a for
                         more information.
  ---------------------- ------------------------------------------------

-   

14-23g. Measles/mumps/rubella vaccines.

  ---------------------- ------------------------------------------------
  **National Data        Annual Immunization Assessment Reports, CDC,
  Source**               NIP.

  **State Data Source**  Annual Immunization Assessment Reports, CDC,
                         NIP.

  **Healthy People 2000  20.11 (Immunization and Infectious Diseases).
  Objective**            

  **Measure**            Percent (2-year average).

  **Baseline**           96 (1997--98).

  **Numerator**          Number of surveyed enrollees in kindergarten
                         and/or first grade who received the combination
                         of measles, mumps, and rubella antigens.

  **Denominator**        Number of surveyed enrollees in kindergarten
                         and/or first grade.

  **Population           U.S. kindergarten and first grade student
  Targeted**             population.

  **Questions Used To    CDC Annual Immunization Assessment Report: Day
  Obtain the National    Care Centers, Head Start Centers, and Schools.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments with objective 14-23a for more
                         information.
  ---------------------- ------------------------------------------------

-   

14-23h. Polio vaccine.

  ---------------------- ------------------------------------------------
  **National Data        Annual Immunization Assessment Reports, CDC,
  Source**               NIP.

  **State Data Source**  Annual Immunization Assessment Reports, CDC,
                         NIP.

  **Healthy People 2000  20.11 (Immunization and Infectious Diseases)
  Objective**            

  **Measure**            Percent (2-year average).

  **Baseline**           97 (1997--98).

  **Numerator**          Number of surveyed enrollees in kindergarten
                         and/or first grade who received the polio
                         antigen.

  **Denominator**        Number of surveyed enrollees in kindergarten
                         and/or first grade.

  **Population           U.S. kindergarten and first grade student
  Targeted**             population.

  **Questions Used To    CDC Annual Immunization Assessment Report: Day
  Obtain the National    Care Centers, Head Start Centers, and Schools.
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 14-23a for
                         more information.
  ---------------------- ------------------------------------------------

-   

14-23i. (Developmental) Hepatitis B vaccine.

  ---------------------- ------------------------------------------------
  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national and State data sources are
                         the Annual Immunization Assessment Reports, CDC,
                         NIP.

                         The proposed numerator is the number of surveyed
                         enrollees in kindergarten and/or first grade who
                         received the hepatitis B antigen. The proposed
                         denominator is the number of surveyed enrollees
                         in kindergarten and/or first grade.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

-   

14-23j. (Developmental) Varicella vaccine.

  ---------------------- ------------------------------------------------
  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         The proposed national and State data sources are
                         the Annual Immunization Assessment Reports, CDC,
                         NIP.

                         The proposed numerator is the number of surveyed
                         enrollees in kindergarten and/or first grade who
                         received the varicella antigen. The proposed
                         denominator is the number of surveyed enrollees
                         in kindergarten and/or first grade.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

14-24. Increase the proportion of young children and adolescents who
receive all vaccines that have been recommended for universal
administration for at least 5 years.

14-24a. Children aged 19 to 35 months who received the recommended
vaccines (4 DTaP, 3 polio, 1 MMR, 3 Hib, 3 hepatitis B).

+---------------------+------------------------------------------------+
| **National Data     | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **State Data        | National Immunization Survey (NIS), CDC, NIP   |
| Source**            | and NCHS.                                      |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.11 (Immunization and           |
| 2000 Objective**    | Infectious Diseases).                          |
+---------------------+------------------------------------------------+
| **Leading Health    | Immunization.                                  |
| Indicator**         |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 73 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 19 to 35 months        |
|                     | receiving at least four doses of               |
|                     | diphtheria-tetanus-acellular pertussis (DTaP), |
|                     | at least three doses of polio, at least one    |
|                     | dose of measles-mumps-rubella (MMR), at least  |
|                     | three doses of *Haemophilus influenzae* B      |
|                     | (Hib), and at least three doses of hepatitis B |
|                     | antigens.                                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Children aged 19 to 35 months.                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Immunization Survey     |
| Obtain the National | Household Survey:                              |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many D-T-P or D-T shots (sometimes     |
|                     |     called a D-P-T shot,                       |
|                     |     diphtheria-tetanus-pertussis shot, baby    |
|                     |     shot, three-in-one shot) has ([Sample      |
|                     |     child]{.underline}) ever received?         |
+---------------------+------------------------------------------------+
|                     | -   How many polio vaccine shots (by mouth,    |
|                     |     pink drops, or by a polio shot) has        |
|                     |     ([Sample child]{.underline}) ever          |
|                     |     received?                                  |
+---------------------+------------------------------------------------+
|                     | -   How many measles or M-M-R                  |
|                     |     (Measles-Mumps-Rubella) shots has ([Sample |
|                     |     child]{.underline}) ever received?         |
+---------------------+------------------------------------------------+
|                     | -   How many H-I-B shots (this is for          |
|                     |     Meningitis and is called Haemophilus       |
|                     |     Influenzae), H-I-B vaccine, or H flu       |
|                     |     vaccine has ([Sample child]{.underline})   |
|                     |     ever received?                             |
+---------------------+------------------------------------------------+
|                     | -   How many Hepatitis B shots has ([Sample    |
|                     |     child]{.underline}) ever received?         |
+---------------------+------------------------------------------------+
|                     | -   Other shots received?                      |
+---------------------+------------------------------------------------+
|                     | From the 1998 National Immunization Survey     |
|                     | Provider Record Check:                         |
+---------------------+------------------------------------------------+
|                     | -   Specify month, day and year that each      |
|                     |     immunization was given, either by the      |
|                     |     office or another provider (OP), as        |
|                     |     documented in the records.                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Any new vaccines that have been universally    |
|                     | recommended for at least 5 years will be added |
|                     | to the series over the course of Healthy       |
|                     | People 2010.                                   |
+---------------------+------------------------------------------------+
|                     | See Comments provided with objective 14-22a    |
|                     | for more information on NIS.                   |
+---------------------+------------------------------------------------+
|                     | This objective differs from the comparable     |
|                     | measure in Healthy People 2000 objective       |
|                     | 20.11, which tracked children aged 19 to 35    |
|                     | months with at least four doses of             |
|                     | diphtheria-tetanus-pertussis (DTAP), at least  |
|                     | three doses of polio, and at least one dose of |
|                     | measles-mumps-rubella (MMR) only. This         |
|                     | objective adds Haemophilus influenzae type B   |
|                     | and hepatitis B.                               |
+---------------------+------------------------------------------------+
|                     | This objective is one of the measures used to  |
|                     | track the Immunization Leading Health          |
|                     | Indicator. See Appendix H for a complete       |
|                     | listing.                                       |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  ---------------------- ------------------------------------------------
  14-24b.                
  (Developmental)        
  Adolescents aged 13 to 
  15 years who received  
  the recommended        
  vaccines.              

  **Comments**           An operational definition could not be provided
                         at the time of publication.

                         The proposed source is the National Health
                         Interview Survey (NHIS), CDC, NCHS.

                         Currently there are no vaccines for adolescents
                         aged 13 to 15 years that have been universally
                         recommended for at least 5 years. As vaccines
                         for adolescents aged 13 to 15 years are
                         identified over the course of Healthy People
                         2010, they will be tracked.

                         See Part C for a description of NHIS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

14-25. Increase the proportion of providers who have measured the
vaccination coverage levels among children in their practice population
within the past 2 years.

14-25a. Public health providers.

+---------------------+------------------------------------------------+
| **National Data     | Immunization Program Annual Reports, CDC, NIP. |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **State Data        | Immunization Program Annual Reports, CDC, NIP. |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 66 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of public provider sites that routinely |
|                     | provided immunizations in the past 2 years to  |
|                     | children under age 6 years and participated in |
|                     | a provider assessment at least once in the     |
|                     | past 2 years.                                  |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of public provider sites that routinely |
|                     | provided immunizations in the past 2 years to  |
|                     | children under age 6 years.                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 Immunization Program Annual      |
| Obtain the National | Report:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Enter the number of public provider sites, |
|                     |     by type, that routinely provide            |
|                     |     immunizations to children aged less than 6 |
|                     |     years:                                     |
|                     |                                                |
|                     |     \_\_\_\_\_\_ Health department clinics\    |
|                     |     \_\_\_\_\_\_ Community/migrant health      |
|                     |     centers\                                   |
|                     |     \_\_\_\_\_\_ Indian Health Service/Tribal  |
|                     |     clinics\                                   |
|                     |     \_\_\_\_\_\_ Other public providers        |
+---------------------+------------------------------------------------+
|                     | -   How many private provider sites in your    |
|                     |     jurisdiction provide immunizations to      |
|                     |     preschool children?                        |
+---------------------+------------------------------------------------+
|                     | -   Status of Assessment and Feedback of       |
|                     |     Provider Immunization Practices:           |
|                     |                                                |
|                     |     \_\_\_\_\_\_ Number of public provider     |
|                     |     sites (by type of public provider) that    |
|                     |     participated in a clinic assessment\       |
|                     |     \_\_\_\_\_\_ Number of private provider    |
|                     |     sites (by type of private provider) that   |
|                     |     participated in a provider assessment      |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A provider site is a service delivery location |
|                     | that maintains permanent records, excluding    |
|                     | temporary locations or mobile immunization     |
|                     | clinics or fairs and the like. Well-child      |
|                     | clinics and immunization-only clinics in the   |
|                     | same location should be counted as separate    |
|                     | sites only if they maintain separate sets of   |
|                     | records.                                       |
+---------------------+------------------------------------------------+
|                     | Public providers include health department     |
|                     | clinics, community/migrant health centers,     |
|                     | Indian Health Service/Tribal health clinics,   |
|                     | or other public providers (for example, any    |
|                     | other public clinic that provides              |
|                     | immunizations, such as a county medical center |
|                     | outpatient clinic).                            |
+---------------------+------------------------------------------------+
|                     | Private providers are individual or group      |
|                     | primary care or pediatric practices and may    |
|                     | include providers for which some or all of     |
|                     | their clients are members of different managed |
|                     | care plans or managed care organizations.      |
+---------------------+------------------------------------------------+
|                     | A public provider assessment is an assessment  |
|                     | that includes a review of a random sample (or  |
|                     | 100 percent) of immunization records of        |
|                     | 2-year-olds. The assessment may have been      |
|                     | conducted by project, clinic, or contractual   |
|                     | personnel.                                     |
+---------------------+------------------------------------------------+
|                     | A private provider assessment is an assessment |
|                     | that includes a review of a random sample (or  |
|                     | 100 percent) of immunization records of        |
|                     | 2-year-olds. The assessment may have been      |
|                     | conducted either by immunization project staff |
|                     | or through a contractual agreement that        |
|                     | provides this service.                         |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

-   

14-25b. Private providers.

+---------------------+------------------------------------------------+
| **National Data     | Immunization Program Annual Reports, CDC, NIP. |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **State Data        | Immunization Program Annual Reports, CDC, NIP. |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 6 (1997).                                      |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of private provider sites that          |
|                     | routinely provided immunizations in the past 2 |
|                     | years to children under age 6 years and        |
|                     | participated in a provider assessment at least |
|                     | once in the past 2 years.                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of private provider sites that          |
|                     | routinely provided immunizations in the past 2 |
|                     | years to children under age 6 years.           |
+---------------------+------------------------------------------------+
| **Questions Used To | See Questions Used To Obtain the National Data |
| Obtain the National | provided with objective 14-25a.                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-25a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+
| 14-26. Increase the |                                                |
| proportion of       |                                                |
| children who        |                                                |
| participate in      |                                                |
| fully operational   |                                                |
| population-based    |                                                |
| immunization        |                                                |
| registries.         |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Immunization Program Annual Reports, CDC, NIP. |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **State Data        | State Immunization Program Survey, CDC, NIP;   |
| Sources**           | Community Population-Based Registry Reports.   |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 32 (1999).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children under age 6 years who have  |
|                     | at least one immunization record in the        |
|                     | registry.                                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of children under age 6 years.          |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population.                      |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 State Immunization Program       |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many children less than 6 years old    |
|                     |     (0-5 year olds) are in your catchment      |
|                     |     area?                                      |
+---------------------+------------------------------------------------+
|                     | -   How many children less than 6 years old    |
|                     |     (0-5 year olds) are in your registry and   |
|                     |     have at least one vaccination recorded     |
|                     |     (excluding the first hepatitis B dose at   |
|                     |     birth)?                                    |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Baseline is a proxy measure. By 2005, data     |
|                     | from the registry systems will be used to      |
|                     | track this objective, instead of the current   |
|                     | survey data from immunization program          |
|                     | grantees.                                      |
+---------------------+------------------------------------------------+
|                     | Starting in 2000, questions will be asked      |
|                     | about children under age 6 years who are in    |
|                     | the registry and have two vaccinations         |
|                     | recorded.                                      |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

14-27. Increase routine vaccination coverage levels for adolescents.

14-27a. 3 or more doses of hepatitis B.

+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NHIS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.11 (Immunization and           |
| 2000 Objective**    | Infectious Diseases).                          |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 48 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adolescents aged 13 to 15 years      |
|                     | reported to be vaccinated with three or more   |
|                     | doses of the hepatitis B antigens.             |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adolescents aged 13 to 15 years.     |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Are shot records available for ([Child\'s  |
|                     |     name]{.underline})?                        |
+---------------------+------------------------------------------------+
|                     | -   Are all the immunizations the ([Child's    |
|                     |     name]{.underline}) ever received included  |
|                     |     in this shot record?                       |
+---------------------+------------------------------------------------+
|                     | -   Are there any OTHER immunizations listed   |
|                     |     on the shot record that I have NOT asked   |
|                     |     you about?                                 |
|                     |                                                |
|                     |     \[If yes:\]                                |
|                     |                                                |
|                     |     -   What are the names of OTHER            |
|                     |         immunizations listed on the shot       |
|                     |         record that I have NOT asked you       |
|                     |         about?                                 |
|                     |                                                |
|                     |         Influenza\                             |
|                     |         Pneumococcal\                          |
|                     |         Hepatitis A\                           |
|                     |         Other immunizations                    |
+---------------------+------------------------------------------------+
|                     | -   Has ([Child\'s name]{.underline}) ever     |
|                     |     received an additional Hepatitis B shot?   |
|                     |                                                |
|                     |     \[If yes:\]                                |
|                     |                                                |
|                     |     -   How many additional Hepatitis B shots  |
|                     |         has ([Child\'s name]{.underline}) ever |
|                     |         received?                              |
+---------------------+------------------------------------------------+
|                     | \[If no shot record (or incomplete):\]         |
|                     |                                                |
|                     | -   Has ([Child's name]{.underline}) ever      |
|                     |     received an immunization (that is a shot   |
|                     |     or drops)?                                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.11, which tracked     |
|                     | immunization coverage for selected antigens    |
|                     | (three or more doses of DTP, three or more     |
|                     | doses of polio, one or more doses of           |
|                     | measles-containing, three or more doses of     |
|                     | Haemophilus influenzae type B, and three or    |
|                     | more doses of hepatitis B) among children aged |
|                     | 19 to 35 months. This objective tracks         |
|                     | selected antigens (two or more doses of MMR,   |
|                     | three or more doses of hepatitis B, one or     |
|                     | more doses of varicella if indicated, and one  |
|                     | or more doses of tetanus-diphtheria booster)   |
|                     | among adolescents aged 13 to 15 years.         |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

-   

14-27b. 2 or more doses of measles, mumps, rubella.

+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NHIS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.11 (Immunization and           |
| 2000 Objective**    | Infectious Diseases).                          |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 89 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adolescents aged 13 to 15 years      |
|                     | reported to be vaccinated with two or more     |
|                     | doses of the measles, mumps, and rubella       |
|                     | antigens.                                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adolescents aged 13 to 15 years.     |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Are shot records available for ([Child\'s  |
|                     |     name]{.underline})?                        |
+---------------------+------------------------------------------------+
|                     | -   Are all the immunizations the ([Child's    |
|                     |     name]{.underline}) ever received included  |
|                     |     in this shot record?                       |
+---------------------+------------------------------------------------+
|                     | -   Are there any OTHER immunizations listed   |
|                     |     on the shot record that I have NOT asked   |
|                     |     you about?                                 |
|                     |                                                |
|                     |     \[If yes:\]                                |
|                     |                                                |
|                     |     -   What are the names of OTHER            |
|                     |         immunizations listed on the shot       |
|                     |         record that I have NOT asked you       |
|                     |         about?                                 |
|                     |                                                |
|                     |         Influenza\                             |
|                     |         Pneumococcal\                          |
|                     |         Hepatitis A\                           |
|                     |         Other immunizations                    |
+---------------------+------------------------------------------------+
|                     | -   Has ([Child's name]{.underline}) ever      |
|                     |     received an additional measles or MMR      |
|                     |     (measles, mumps, rubella) shot?            |
|                     |                                                |
|                     |     \[If yes:\]                                |
|                     |                                                |
|                     |     -   How many additional measles or MMR     |
|                     |         (measles, mumps, rubella) shots has    |
|                     |         ([Child\'s name]{.underline}) ever     |
|                     |         received?                              |
+---------------------+------------------------------------------------+
|                     | \[If no shot record (or incomplete):\]         |
|                     |                                                |
|                     | -   Has ([Child's name]{.underline}) ever      |
|                     |     received an immunization (that is a shot   |
|                     |     or drops)?                                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-27a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

-   

14-27c. 1 or more doses of tetanus-diphtheria booster.

+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NHIS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.11 (Immunization and           |
| 2000 Objective**    | Infectious Diseases).                          |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 93 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adolescents aged 13 to 15 years      |
|                     | reported to be vaccinated with two or more     |
|                     | doses of the tetanus and diphtheria antigens.  |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adolescents aged 13 to 15 years.     |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Are shot records available for ([Child\'s  |
|                     |     name]{.underline})?                        |
+---------------------+------------------------------------------------+
|                     | -   Are all the immunizations the ([Child's    |
|                     |     name]{.underline}) ever received included  |
|                     |     in this shot record?                       |
+---------------------+------------------------------------------------+
|                     | -   Are there any OTHER immunizations listed   |
|                     |     on the shot record that I have NOT asked   |
|                     |     you about?                                 |
|                     |                                                |
|                     |     \[If yes:\]                                |
|                     |                                                |
|                     |     -   What are the names of OTHER            |
|                     |         immunizations listed on the shot       |
|                     |         record that I have NOT asked you       |
|                     |         about?                                 |
|                     |                                                |
|                     |         Influenza\                             |
|                     |         Pneumococcal\                          |
|                     |         Hepatitis A\                           |
|                     |         Other immunizations                    |
+---------------------+------------------------------------------------+
|                     | -   Has ([Child\'s name]{.underline}) ever     |
|                     |     received an additional tetanus-diphtheria  |
|                     |     (Td) shot?                                 |
|                     |                                                |
|                     |     \[If yes:\]                                |
|                     |                                                |
|                     |     -   How many additional tetanus-diphtheria |
|                     |         (Td) shots has {[Child\'s              |
|                     |         name]{.underline}} ever received?      |
+---------------------+------------------------------------------------+
|                     | \[If no shot record (or incomplete):\]         |
|                     |                                                |
|                     | -   Has ([Child's name]{.underline}) ever      |
|                     |     received an immunization (that is a shot   |
|                     |     or drops)?                                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-27a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

14-27d. 1 or more doses of varicella.

+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NHIS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 20.11 (Immunization and           |
| 2000 Objective**    | Infectious Diseases).                          |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 45 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adolescents aged 13 to 15 years      |
|                     | reported to be vaccinated with two or more     |
|                     | doses of the varicella antigen, excluding      |
|                     | those who are reported to ever have had        |
|                     | varicella (chicken pox).                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adolescents aged 13 to 15 years      |
|                     | excluding those who are reported to ever have  |
|                     | had varicella (chicken pox).                   |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   Are shot records available for ([Child\'s  |
|                     |     name]{.underline})?                        |
+---------------------+------------------------------------------------+
|                     | -   Are all the immunizations the ([Child's    |
|                     |     name]{.underline}) ever received included  |
|                     |     in this shot record?                       |
+---------------------+------------------------------------------------+
|                     | -   Are there any OTHER immunizations listed   |
|                     |     on the shot record that I have NOT asked   |
|                     |     you about?                                 |
|                     |                                                |
|                     |     \[If yes:\]                                |
|                     |                                                |
|                     |     -   What are the names of OTHER            |
|                     |         immunizations listed on the shot       |
|                     |         record that I have NOT asked you       |
|                     |         about?                                 |
|                     |                                                |
|                     |         Influenza\                             |
|                     |         Pneumococcal\                          |
|                     |         Hepatitis A\                           |
|                     |         Other immunizations                    |
+---------------------+------------------------------------------------+
|                     | -   Has ([Child\'s name]{.underline}) ever     |
|                     |     received an additional chicken pox shot?   |
|                     |                                                |
|                     |     \[If yes:\]                                |
|                     |                                                |
|                     |     -   How many additional chicken pox shots  |
|                     |         has ([Child\'s name]{.underline}) ever |
|                     |         received?                              |
+---------------------+------------------------------------------------+
|                     | \[If no shot record (or incomplete):\]         |
|                     |                                                |
|                     | -   Has ([Child's name]{.underline}) ever      |
|                     |     received an immunization (that is a shot   |
|                     |     or drops)?                                 |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   Has ([Child's name]{.underline}) EVER had  |
|                     |     chicken pox?                               |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-27a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

14-28. Increase hepatitis B vaccine coverage among high-risk groups.

14-28a. Long-term hemodialysis patients.

+---------------------+------------------------------------------------+
| ###### Na           | Annual Survey of Chronic Hemodialysis Centers, |
| tional Data Source  | CDC, NCID and HCFA.                            |
| {#national-data-sou |                                                |
| rce-2 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 35 (1995).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of patients receiving chronic           |
|                     | hemodialysis who have ever received at least   |
|                     | three doses of hepatitis B vaccine.            |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of patients receiving chronic           |
|                     | hemodialysis.                                  |
+---------------------+------------------------------------------------+
| **Population        | U.S. chronic hemodialysis patient population.  |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1995 Annual Survey of Chronic         |
| Obtain the National | Hemodialysis Centers:                          |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many patients were assigned to your    |
|                     |     hemodialysis center as of (date of         |
|                     |     survey)?                                   |
+---------------------+------------------------------------------------+
|                     | -   How many of these patients had ever in     |
|                     |     their lives received at least 3 doses of   |
|                     |     hepatitis B vaccine?                       |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

14-28b. Men who have sex with men.

  ---------------------- ------------------------------------------------
  **Comments**           A complete operational definition was not
                         provided at the time of publication.

                         The national data source is the Young Men's
                         Survey, National Center for HIV, STD, and TB
                         Prevention, CDC, NCHSTP.

                         This objective is comparable to one of the
                         measures in Healthy People 2000 objective 20.11
                         (Immunization and Infectious Diseases).

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

-   

14-28c. Occupationally exposed workers.

+---------------------+------------------------------------------------+
| **National Data     | Periodic Vaccine Coverage Surveys, CDC, NCID   |
| Source**            | (See Comments).                                |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases)   |
| 2000 Objective**    | (also 10.9).                                   |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 71 (1995).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of health care workers reported by      |
|                     | participating facilities to have received at   |
|                     | least three doses of hepatitis B vaccine.      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of health care workers employed at      |
|                     | participating facilities.                      |
+---------------------+------------------------------------------------+
| **Population        | U.S. health care worker population.            |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1995 survey:**^15,\ 16^**             |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   How many full-time and part-time staff who |
|                     |     had direct contact with patients were      |
|                     |     employed at your center?                   |
+---------------------+------------------------------------------------+
|                     | -   How many of these staff had ever received  |
|                     |     at least 3 doses of hepatitis B vaccine?   |
+---------------------+------------------------------------------------+
| **Expected          | Periodic.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| ####                | Methodology on measuring this objective has    |
| ## Comments {#comme | been previously published.**^15,\ 16^**        |
| nts-1 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
|                     | The expected periodicity for measuring this    |
|                     | objective is every 5 years.                    |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

14-29. Increase the proportion of adults who are vaccinated annually
against influenza and ever vaccinated against pneumococcal disease.

###### Noninstitutionalized adults aged 65 years and older {#noninstitutionalized-adults-aged-65-years-and-older .HeadingTHPsub}

14-29a. Influenza vaccine.

+---------------------+------------------------------------------------+
| ###### Na           | National Health Interview Survey (NHIS), CDC,  |
| tional Data Source  | NCHS.                                          |
| {#national-data-sou |                                                |
| rce-3 .Heading6THP} |                                                |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases),  |
| 2000 Objective**    | age adjusted to the 2000 standard population.  |
+---------------------+------------------------------------------------+
| **Leading Health    | Immunization.                                  |
| Indicator**         |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 64 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 65 years and older who   |
|                     | report receiving an influenza vaccination in   |
|                     | the past 12 months.                            |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 65 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   During the PAST 12 MONTHS, have you had a  |
|                     |     flu shot? A flu shot is usually given in   |
|                     |     the fall and protects against influenza    |
|                     |     for the flu season.                        |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | This objective is one of the measures used to  |
|                     | track the Immunization Leading Health          |
|                     | Indicator. See Appendix H for a complete       |
|                     | listing.                                       |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and BRFSS |
|                     | and Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

-   

14-29b. Pneumococcal vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases),  |
| 2000 Objective**    | age adjusted to the 2000 standard population.  |
+---------------------+------------------------------------------------+
| **Leading Health    | Immunization.                                  |
| Indicator**         |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 46 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of adults aged 65 years and older who   |
|                     | report ever receiving a pneumococcal           |
|                     | vaccination.                                   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of adults aged 65 years and older.      |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Have you EVER had a pneumonia vaccination? |
|                     |     This shot is usually given only once in a  |
|                     |     person\'s lifetime and is different from   |
|                     |     the flu shot.                              |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-29a    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

###### Noninstitutionalized high-risk adults aged 18 to 64 years {#noninstitutionalized-high-risk-adults-aged-18-to-64-years .HeadingTHPsub}

14-29c. Influenza vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Health Interview Survey (NHIS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases),  |
| 2000 Objective**    | age adjusted to the 2000 standard population.  |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 26 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of high-risk persons aged 18 to 64      |
|                     | years who report receiving an influenza        |
|                     | vaccination in the past 12 months.             |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of high-risk persons aged 18 to 64      |
|                     | years.                                         |
+---------------------+------------------------------------------------+
| **Population        | U.S. civilian, noninstitutionalized            |
| Targeted**          | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 National Health Interview        |
| Obtain the National | Survey:                                        |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[NUMERATOR:\]                                 |
|                     |                                                |
|                     | -   During the PAST 12 MONTHS, have you had a  |
|                     |     flu shot? A flu shot is usually given in   |
|                     |     the fall and protects against influenza    |
|                     |     for the flu season.                        |
+---------------------+------------------------------------------------+
|                     | \[DENOMINATOR:\]                               |
|                     |                                                |
|                     | -   Have you EVER been told by a doctor or     |
|                     |     other health professional that you had\... |
|                     |                                                |
|                     |     \... Hypertension, also called high blood  |
|                     |     pressure?\                                 |
|                     |     \... Coronary heart disease?\              |
|                     |     \... Angina, also called angina pectoris?\ |
|                     |     \... A heart attack (also called           |
|                     |     myocardial infarction)?\                   |
|                     |     \... Any kind of heart condition or heart  |
|                     |     disease (other than the ones I just asked  |
|                     |     about)?\                                   |
|                     |     \... A stroke\                             |
|                     |     \... Emphysema?\                           |
|                     |     \... Asthma?                               |
+---------------------+------------------------------------------------+
|                     | -   During the PAST 12 MONTHS, have you had an |
|                     |     episode of asthma or asthma attack?        |
+---------------------+------------------------------------------------+
|                     | -   Have you EVER been told by a doctor or     |
|                     |     other health professional that you had     |
|                     |     \...                                       |
|                     |                                                |
|                     |     \... Cancer or a malignancy of any kind?   |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   What kind of cancer was it?                |
|                     |                                                |
|                     |     \(1\) Bladder\                             |
|                     |     (2) Blood\                                 |
|                     |     (3) Bone\                                  |
|                     |     (4) Brain\                                 |
|                     |     (5) Breast\                                |
|                     |     (6) Cervix\                                |
|                     |     (7) Colon\                                 |
|                     |     (8) Esophagus\                             |
|                     |     (9) Gallbladder\                           |
|                     |     (10) Kidney\                               |
|                     |     (11) Larynx - windpipe\                    |
|                     |     (12) Leukemia\                             |
|                     |     (13) Liver\                                |
|                     |     (14) Lung\                                 |
|                     |     (15) Lymphoma\                             |
|                     |     (16) Melanoma\                             |
|                     |     (17) Mouth/tongue/lip\                     |
|                     |     (18) Ovary\                                |
|                     |     (19) Pancreas\                             |
|                     |     (20) Prostate\                             |
|                     |     (21) Rectum\                               |
|                     |     (22) Skin (non-melanoma)\                  |
|                     |     (23) Skin (DK what kind)\                  |
|                     |     (24) Soft Tissue (muscle or fat)\          |
|                     |     (25) Stomach\                              |
|                     |     (26) Testes\                               |
|                     |     (27) Throat - pharynx\                     |
|                     |     (28) Thyroid\                              |
|                     |     (29) Uterus\                               |
|                     |     (30) Other\                                |
|                     |     (96) More than 3 kinds                     |
+---------------------+------------------------------------------------+
|                     | -   (Other than during pregnancy,) Have you    |
|                     |     EVER been told by a doctor or health       |
|                     |     professional that you have diabetes or     |
|                     |     sugar diabetes?                            |
+---------------------+------------------------------------------------+
|                     | -   During the PAST 12 MONTHS, have you been   |
|                     |     told by a doctor or other health           |
|                     |     professional that you had..                |
|                     |                                                |
|                     |     \... Chronic bronchitis?\                  |
|                     |     \... Weak or failing kidneys? ‑ Do not     |
|                     |     include kidney stones, bladder infections  |
|                     |     or incontinence.\                          |
|                     |     \... Any kind of liver condition?          |
+---------------------+------------------------------------------------+
|                     | -   Are you currently pregnant?                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A high-risk person is defined as a respondent  |
|                     | who answered "yes" to one or more of the       |
|                     | conditions listed in the questions above. The  |
|                     | only condition not included in the definition  |
|                     | of high risk is skin cancer (see conditions 22 |
|                     | and 23 listed in Questions Used To Obtain the  |
|                     | National Data above). High-risk adults are     |
|                     | defined by the Advisory Committee on           |
|                     | Immunization Practices (ACIP).                 |
+---------------------+------------------------------------------------+
|                     | Not all high-risk conditions for complications |
|                     | of influenza and pneumococcal disease can be   |
|                     | ascertained by NHIS (for example,              |
|                     | immunocompromised), and the sample size may be |
|                     | too small for some groups.                     |
+---------------------+------------------------------------------------+
|                     | This objective is a modification of Healthy    |
|                     | People 2000 objective 20.11, which tracked     |
|                     | influenza vaccinations in the past 12 months   |
|                     | among persons aged 65 years and older. This    |
|                     | measure tracks high-risk persons aged 18 to 64 |
|                     | years.                                         |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHIS and       |
|                     | BRFSS, and Appendix A for focus area contact   |
|                     | information.                                   |
+---------------------+------------------------------------------------+

-   

14-29d. Pneumococcal vaccine.

  ---------------------- ------------------------------------------------
  **National Data        National Health Interview Survey (NHIS), CDC,
  Source**               NCHS.

  **State Data Source**  Behavioral Risk Factor Surveillance System
                         (BRFSS), CDC, NCCDPHP.

  **Healthy People 2000  20.11 (Immunization and Infectious Diseases),
  Objective**            age adjusted to the 2000 standard population.

  **Measure**            Percent (age adjusted---see Comments).

  **Baseline**           13 (1998).

  **Numerator**          Number of high-risk persons aged 18 to 64 years
                         who report ever receiving a pneumococcal
                         vaccination.

  **Denominator**        Number of high-risk persons aged 18 to 64 years.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    See Questions Used To Obtain the National Data
  Obtain the National    for objectives 14-29b (numerator only) and
  Data**                 14-29c (denominator only).

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 14-29c for
                         more information.
  ---------------------- ------------------------------------------------

###### Institutionalized adults (persons in long-term care or nursing homes) {#institutionalized-adults-persons-in-long-term-care-or-nursing-homes .HeadingTHPsub}

14-29e. Influenza vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Nursing Home Survey (NNHS), CDC,      |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases),  |
| 2000 Objective**    | age adjusted to the 2000 standard population.  |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 59 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons in long-term care facilities |
|                     | and nursing homes reported to have received an |
|                     | influenza vaccination in the past 12 months.   |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons in long-term care facilities |
|                     | and nursing homes.                             |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population (see Comments).       |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Nursing Home Survey:    |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   During the past 12 months, has             |
|                     |     ([Name]{.underline}) had a flu shot at     |
|                     |     this facility or any other location?       |
+---------------------+------------------------------------------------+
| **Expected          | Biennial.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Data are from the population residing in       |
|                     | long-term care facilities or nursing homes and |
|                     | exclude residents in facilities providing only |
|                     | room and board or serving special health       |
|                     | problems such as mental retardation or         |
|                     | alcoholism.                                    |
+---------------------+------------------------------------------------+
|                     | Vaccination status is ascertained by the staff |
|                     | member completing the survey based on          |
|                     | available records; sampled residents are not   |
|                     | queried. In the 1995 NNHS, the percentage of   |
|                     | sampled residents for whom vaccination status  |
|                     | could not be ascertained was 21 percent for    |
|                     | influenza vaccination and 43 percent for       |
|                     | pneumococcal vaccination.                      |
+---------------------+------------------------------------------------+
|                     | The percent vaccinated calculation will        |
|                     | include persons with unknown vaccination       |
|                     | status in the denominator. Improvements to     |
|                     | administration of the survey will be made in   |
|                     | 1999 to minimize the reporting of unknown      |
|                     | vaccination status.                            |
+---------------------+------------------------------------------------+
|                     | Data are age adjusted to the 2000 standard     |
|                     | population. Age-adjusted percents are weighted |
|                     | sums of age-specific percents. For a           |
|                     | discussion on age adjustment, see Part A,      |
|                     | section 5.                                     |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

14-29f. Pneumococcal vaccine.

+---------------------+------------------------------------------------+
| **National Data     | National Nursing Home Survey (NNHS), CDC,      |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 20.11 (Immunization and Infectious Diseases),  |
| 2000 Objective**    | age adjusted to the 2000 standard population.  |
+---------------------+------------------------------------------------+
| **Measure**         | Percent (age adjusted---see Comments).         |
+---------------------+------------------------------------------------+
| **Baseline**        | 25 (1997).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of persons in long-term care facilities |
|                     | and nursing homes reported to have ever        |
|                     | received a pneumococcal vaccination.           |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of persons in long-term facilities and  |
|                     | nursing homes.                                 |
+---------------------+------------------------------------------------+
| **Population        | U.S. resident population (see Comments).       |
| Targeted**          |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1997 National Nursing Home Survey:    |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Has (Name) ever had a pneumococcal         |
|                     |     vaccine, that is, a pneumonia vaccination? |
+---------------------+------------------------------------------------+
| **Expected          | Biennial.                                      |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | See Comments provided with objective 14-19e    |
|                     | for more information.                          |
+---------------------+------------------------------------------------+

### Vaccine Safety

14-30. Reduce vaccine-associated adverse events.

14-30a. Eliminate vaccine-associated paralytic polio (VAPP).

  ---------------------- ------------------------------------------------
  **National Data        National Notifiable Disease Surveillance System
  Source**               (NNDSS), CDC, EPO.

  **State Data Source**  National Notifiable Disease Surveillance System
                         (NNDSS), CDC, EPO.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Number.

  **Baseline**           5 (1997).

  **Numerator**          Number of confirmed cases of vaccine-associated
                         paralytic poliomyelitis.

  **Denominator**        Not applicable.

  **Population           U.S. resident population.
  Targeted**             

  **Questions Used To    CDC Suspected Polio Case Worksheet, Rev. 08/98.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A case definition for paralytic poliomyelitis is
                         available from CDC.**^1^**

                         A confirmed case of vaccine-associated paralytic
                         poliomyelitis is defined as a person who (1) was
                         vaccinated 4 to 30 days prior to the onset of
                         illness; (2) was exposed to someone vaccinated 4
                         to 75 days after oral polio vaccine (OPV) was
                         fed to a recipient in contact with a patient,
                         and contact occurred within 30 days before the
                         onset of illness; or (3) had no history of
                         receiving OPV or of contact with an OPV
                         recipient, but the virus was isolated and
                         characterized as vaccine-related. In addition,
                         the person has a neurologic deficit 60 days
                         after the onset of initial symptoms, has died,
                         or has unknown followup status.

                         All suspected paralytic poliomyelitis cases are
                         reviewed by an external committee and are
                         classified following confirmation by this
                         committee.

                         See Part C for a description of NNDSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

-   

14-30b. Reduce febrile seizures following pertussis vaccines.

  ---------------------- ------------------------------------------------
  **National Data        Vaccine Adverse Event Reporting System (VAERS),
  Sources**              HRSA, FDA, CDC; Vaccine Safety Datalink (VSD),
                         CDC, NIP.

  **State Data Source**  Not identified.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Number.

  **Baseline**           152 (1998).

  **Numerator**          Number of children with febrile seizures
                         (observed or reported muscular contractions and
                         loss of consciousness lasting from several
                         minutes to more than 15 minutes and not
                         accompanied by focal neurological signs or
                         symptoms, with these seizures or convulsions
                         associated with fever in children aged 0 to 9
                         years) that occur within 48 hours after receipt
                         of a pertussis-containing vaccine.

  **Denominator**        Not applicable.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           In addition to incident cases of febrile
                         seizures caused by pertussis vaccines, CDC
                         monitors the net number of doses of
                         pertussis-containing vaccines distributed by
                         year and by type through the Biologics Survey to
                         verify that reductions are not due to decreases
                         in the number of vaccine doses administered.

                         Estimates may also be available based on
                         extrapolations from the National Immunization
                         Survey.

                         VAERS reports of febrile seizures are coded
                         using Coding Terms for a Thesaurus of Adverse
                         Reaction Terms (COSTART). VAERS is a passive
                         surveillance system.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
  14-31. Increase the    
  number of persons      
  under active           
  surveillance for       
  vaccine safety via     
  large linked           
  databases.             

  **National Data        Vaccine Safety Datalink (VSD), CDC, NIP.
  Source**               

  **State Data Source**  Vaccine Safety Datalink (VSD), CDC, NIP.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Number.

  **Baseline**           6 million persons (1999).

  **Numerator**          Number of persons enrolled in all health plans
                         with large‑linked databases in the past year.

  **Denominator**        Number of persons.

  **Population           U.S. civilian, noninstitutionalized population.
  Targeted**             

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Not specified.
  Periodicity**          

  **Comments**           Data are collected from computer databases of
                         participating health plans. Quality of health
                         plan databases on vaccinations and medical
                         encounters varies.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

## References

1\. Centers for Disease Control and Prevention (CDC). Case definitions
for infectious conditions under public health surveillance. *Morbidity
and Mortality Weekly Report* 46 (RR-10), 1997.

2\. Margolis, H.S.; Alter, M.J.; and Hadler, S.C. Hepatitis B: Evolving
epidemiology and implications for control. *Seminars in Liver Disease*
11(2): 84-92, 1991.

3\. CDC. *Hepatitis Surveillance Report* (56). 1995.

4\. Yusuf, H.R.; Mahoney, F.J.; Shapiro, C.N.; et al. Hospital-based
evaluation of programs to prevent perinatal hepatitis B virus
transmission. *Archives of Pediatrics and Adolescent Medicine*
150:593-597, 1996.

5\. Margolis, H.S.; Coleman, P.J.; Brown, R.E.; et al. Prevention of
hepatitis B virus transmission by immunization: An economic analysis of
current recommendations. *Journal of the American Medical Association*
274:1201-1208, 1995.

6\. Coleman, P.J.; McQuillan, G.M.; Moyer, L.A.; et al. Incidence of
hepatitis B virus infection in the United States, 1976--1994: Estimates
from the National Health and Nutrition Examination Surveys. *Journal of
Infectious Diseases* 178: 954-959, 1998.

7\. McMahon, B.J.; Alward, W.L.; Hall, D.B.; et al. Acute hepatitis B
virus infection: Relation of age to the clinical expression of disease
and subsequent development of the carrier state. *Journal of Infectious
Diseases* 151(4): 599-603, 1985.

8\. CDC. *Reported Tuberculosis in the United States, 1998*. Atlanta,
GA: CDC, 1999.

9\. Denniston, M.M.; Bird, B.R.; and Kelley, K.A. Contrast of survey
results between State and a cohort of non-State mycobacteriology
laboratories: Changes in laboratory practices. *Journal of Clinical
Microbiology* 35(2):422-426, 1997.

10\. Bird, B.R.; Denniston, M.M.; Huebner, R.E.; et al. Changing
practices in mycobacteriology: A follow-up survey of State and
Territorial public health laboratories. *Journal of Clinical
Microbiology* 34(3): 554-559, 1996.

11\. CDC. Laboratory-based surveillance for meningococcal disease in
selected areas, United States, 1989--91. *Morbidity and Mortality Weekly
Report* 42 (SS-2).

12\. CDC. *NNIS Manual*. Atlanta, GA: CDC, 1999.

13\. Gaynes, R.P. and Horan, T.C. Surveillance of nosocomial infections.
In: Mayhall, C.G., ed. *Hospital Epidemiology and Infection Control*.
2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 1999,
1285-1317.

14\. Horan, T.C. and Emori, T.G. Definitions of key terms used in the
NNIS system. *American Journal of Infection Control* 25:112-116, 1997.

15\. Mahoney, F.J.; Stewart, K.; Hu, H.; et al. Progress toward the
elimination of hepatitis B virus transmission among health care workers
in the United States. *Archives of Internal Medicine* 157: 2601-2605,
1997.

16\. Agerton, T.B.; Mahoney, F.J.; Polish, L.B.; et al. Impact of the
bloodborne pathogens standard on vaccination of healthcare workers with
hepatitis B vaccine. *Infection Control and Hospital Epidemiology* 16:
287-291, 1995.