# Presentation: 658677

## Healthy People 2010 Focus Area 14:Immunization & Infectious Diseases Progress ReviewJuly 20, 2007

## Vaccines are currently available to protect against 16 diseases 
Morbidity for vaccine-preventable diseases has been reduced
99+ percent reduction since the introduction of vaccines
7 vaccines (DTaP, Td, Hib, polio, MMR, hepatitis B, and varicella)
prevent 14+ million cases of disease
prevent 33,500+ deaths over the lifetime of children born each year
prevent the need to take time off from work, seek care for, and tend to the needs of sick patients
annual savings exceed $40 billion 

- Morbidity for vaccine-preventable diseases has been reduced
- 99+ percent reduction since the introduction of vaccines
- 7 vaccines (DTaP, Td, Hib, polio, MMR, hepatitis B, and varicella)
- prevent 14+ million cases of disease
- prevent 33,500+ deaths over the lifetime of children born each year
- prevent the need to take time off from work, seek care for, and tend to the needs of sick patients
- annual savings exceed $40 billion

**Immunization**

## Pneumonia/ influenza is the 8th leading cause of death in the U.S. 
18% of all physician visits each year are for infectious diseases
Antimicrobial agents are the 5th most frequently prescribed class of drugs
Treatment and lost productivity associated with infectious agents exceeds $120 billion each year 

- 18% of all physician visits each year are for infectious diseases
- Antimicrobial agents are the 5th most frequently prescribed class of drugs
- Treatment and lost productivity associated with infectious agents exceeds $120 billion each year

**Infectious Diseases**

## Highlighted Objectives

- 14-8.         Lyme disease

- Immunization objectives

- 14-22 a-h. Universally recommended vaccinations

**Highlighted Objectives**

- Infectious disease objectives

- Tuberculosis (TB) objectives

- 14-11.       New cases of TB

- Antibiotics objectives

- 14-18.       Antibiotics prescribed for ear infections
- 14-19.       Antibiotics prescribed for common cold

- Hepatitis objectives

- 14-3 a-g.   Hepatitis B in adults

- Improving

- Getting worse

- Little or no change*

- Baseline only

- Target met

- Note: *Percent of targeted change achieved is between -10% and 10%.

## Impact of Pre-1990 Vaccines

| Disease | Pre-Vaccine Licensure
Annual Morbidity |  |  |      2005 |  |  |
| --- | --- | --- | --- | --- | --- | --- |
| Measles |  | 503,282 |            66      |  | > 99% |  |
| Diphtheria |  | 175,885 |               0 |  | 100% |  |
| Mumps |  | 152,209 |           314 |  | > 99% |  |
| Pertussis |  | 147,271 |       25,616 |  | 83% |  |
| Smallpox |  | 48,164 |               0 |  | 100% |  |
| Rubella |  | 47,745 |             11 |  | > 99% |  |
| Haemophilus influenzae |  | 20,000 |        226 |  | 99% |  |
| Polio (paralytic) |  | 16,316 |           1 |  | > 99% |  |
| Tetanus |  | 1,314 | 27 |  | 98% |  |
| Congenital Rubella Syndrome |  | 823 | 1 |  | > 99% |  |

**Impact of Pre-1990 Vaccines**

*****

******

**Percent**
**Decrease**

- Note: * Type b and unknown (< 5 years of age). ** Imported vaccine-associated paralytic polio (VAPP). Numbers in blue indicate at or near record lows in 2005.
- Source: Pre-Vaccine Licensure data - CDC. MMWR. April 2, 1999 / 48: 242-264;  2005 data - CDC.  MMWR. August 18, 2006 / 55(32): 880-893.

## Impact of Recent Vaccines

**Impact of Recent Vaccines**

| Disease | Pre-Vaccine Era Estimated Annual Morbidity  | 
2005 Estimated
Morbidity  | Percent Decrease |
| --- | --- | --- | --- |
| Hepatitis A | 117,333 | 19,183 | 84% |
| Hepatitis B (acute) | 66,232 | 15,352 | 77% |
| Pneumococcus (invasive) |  |  |  |
|       All ages | 63,067 | 40,325 | 36% |
|       <5 years | 16,069 | 4,400 | 73% |
| Varicella | 4,085,120 | 817,024 | 80% |

- Source:  CDC, unpublished data, Nov 2006.

## Vaccine-Specific Coverage:

**MMR(1+)**

**Hib (3+)**

**Hep B ****(3+)**

**Polio (3+)**

**Varicella (1+)**

**PCV 7 ****(3+)**

**2005**

**Vaccine-Specific Coverage:**
**Preschool-Aged Children**

- Note:  † DTP(3+) is not a Healthy People 2010 objective.  DTP(4) is used to assess Healthy People 2010 objective 14-22a.   Children in the USIS and NHIS were 24-35 months of age.  Children in the NIS were 19-35 months of age. No data from 1986-1990 due to cancellation of USIS because of budget reductions.
- Source: USIS (1967-1985), NHIS (1991-1993) CDC, NCHS, and NIS (1994-2005), CDC, NCIRD and NCHS;

**2010 Target: 90**

**Obj. 14-22b-g**

**Percent**

**0**

**20**

**40**

**60**

**80**

**100**

**1967**

**1970**

**1973**

**1976**

**1979**

**1982**

**1985**

**1988**

**1991**

**1994**

**1997**

**2000**

**2003**

## 4:3:1:3:3:1 Vaccination Coverage:

-   0

- 60

- 70

- 80

- 90

- 2002

- 2003

- 2004

- 2005

**4:3:1:3:3:1 Vaccination Coverage:**
**Children 19-35 Months**

- Note: 4+ doses of DTP, 3+ doses of poliovirus vaccine, 1+ doses of any MMR, 3+ doses of Hib, 3+ doses of HepB, and 1+ doses of varicella. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.
- Source: National, State and Urban Area Vaccination Coverage Among Children Aged 19-35 Months, United States, 2005.
-  MMWR Morb Mortal Wkly Rep 2006;55:36;988-993

**White**

**Black**

**Hispanic**

**Percent**

**Obj. 14-24a (mod.)**

## 4:3:1:3:3:1* Series Coverage:

**4:3:1:3:3:1* Series Coverage:**
**Children 19-35 Months, 2005**

- Note:  *4+DTP, 3+Polio, 1+MMR, 3+Hib, 3+HepB, 1+ varicalla.
- Source: National Immunization Survey (NIS), CDC, NCIRD and NCHS.

- 80-89%

- 70-79%

****** **69%

****** **90%

**National Coverage = 76%**

**Obj. 14-24a (mod.)**

## Invasive Pneumococcal Infections

- 0

- 20

- 40

- 60

- 80

- 100

- 1997

- 1998

- 1999

- 2000

- 2001

- 2002

- 2003

- 2004

- 2005

**Decrease desired**

**Invasive Pneumococcal Infections**

**New cases**
**per 100,000 population**

**Obj. 14-5**

**Children (<5 years)**

**Older adults (**_**>**_**65 years) **

**Older adults  2010 Target: 42**

**Children 2010 Target: 46**

- Source: Active Bacterial Core Surveillance (ABCs), CDC, NCIRD, Emerging Infections Program Network.

## Invasive Pneumococcal Infections, 2005

**New cases**
**per 100,000 population**

**Children (<5 years)**

**Black**

**Older adults (**_**>**_**65 years) **

**White **

**Invasive Pneumococcal Infections, 2005**

**Obj. 14-5**

- Source: Active Bacterial Core Surveillance (ABCs), CDC, NCIRD, Emerging Infections Program Network.

## Lyme Disease: Endemic* States

**per 100,000 population**

**Lyme ****Disease: Endemic* States**

- Note: *10 reference states where the disease is endemic (Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin). Each data point represents a 5-year average (i.e. ‘1996’ data are from 1992-1996).
- Source: National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

**Obj. 14-8**

- 0

- 10

- 20

- 30

- 40

- 50

- 1996

- 1999

- 2000

- 2001

- 2002

- 2003

- 2004

- 2005

## Hepatitis B

**0**

**5**

**10**

**15**

**20**

**25**

**1997**

**1998**

**1999**

**2000**

**2001**

**2002**

**2003**

**2004**

**2005**

**40+ years**

**Hepatitis B**

- Source: National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

**Obj. 14-3**

**25-39 years**

**19-24 years**

**New cases**
**per 100,000 population**

## Hepatitis B, 2005

**American Indian**

**New cases**
**per 100,000 population**

**19-24 years**

**25-39 years**

**40+ years**

**Hispanic**

**White**

**Black**

**Hepatitis B, 2005**

- Note: American Indian includes Alaska Native. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the  single race categories shown are for persons who reported only one racial group.
- Source: National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

**Obj. 14-3**

## Tuberculosis

**0**

**10**

**20**

**30**

**40**

**50**

**1993**

**1995**

**1997**

**1999**

**2001**

**2003**

**2005**

- *All races are non-Hispanic. In 2003, Asian/Pacific Islander category includes persons who reported race as Asian only and/or Native Hawaiian or Other Pacific Islander only.**Updated as of March 29, 2006.

**Tuberculosis**

- Note: American Indian includes Alaska Native. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race.
- Source: National TB Surveillance System, CDC, NCHHSTP.

**Obj. 14-11**

**American Indian**

**White**

**Hispanic**

**Black**

**Asian**

**New cases**
**per 100,000 population**

## Antibiotics Prescribed for Ear Infections:

**Children Under 5 Years**

**1996-97**

**2004-05**

**Courses **
**per 100 population**

- Source: National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

**Obj. 14-18**

## Antibiotics Prescribed for Common Cold

**Antibiotics Prescribed for Common Cold**

**1996-97**

**2004-05**

- Note: *Data are unreliable.
- Source: National Ambulatory Medical Care Survey (NAMCS), CDC, NCHS; National Hospital Ambulatory Medical Care Survey (NHAMCS), CDC, NCHS.

**Obj. 14-19**

*****

**Courses **
**per 100 population**

## Target met or exceeded
Improving
Little or no change*
Getting worse
No trend data
Dropped at midcourse
Retained as developmental

- Target met or exceeded
- Improving
- Little or no change*
- Getting worse
- No trend data
- Dropped at midcourse
- Retained as developmental

- 31
- 34
- 4
- 7
- 6
- 1
- 3

- Note: *Percent of targeted change achieved is between -10% and 10%.

## Substantial progress – most objectives met or moving toward 2010 targets

Racial disparities persist, although there is evidence of improvement

Challenges – Lyme disease, Pertussis 

- Racial disparities persist, although there is evidence of improvement
- Challenges – Lyme disease, Pertussis

**Summary**

## http://www.cdc.gov/nchs/hphome.htm

**are available on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**