# Presentation: 658666

## August 20, 2003

**Focus Area 14:****Immunization and Infectious Diseases Progress Review**

## Healthy People 2010 Immunization and Infectious Disease Objectives

_**Immunization objectives**_
**14-1****	****Cases of vaccine-preventable diseases.**
**14-22****	****Vaccination coverage levels for universally recommended vaccines among young children.**
**14-23****	****Vaccination coverage levels for children in licensed day care facilities and children in kindergarten through first grade.**
**14-24****	****Proportion of young children who receive all vaccines that have been recommended for universal administration for at least 5 years.**
**14-25****	****Proportion of providers who have measured the vaccination coverage level among children in their practice population within the past 2 years.**
**14-26****	****Proportion of children who participate in fully operational population-based registries.**
**14-27****	****Routine vaccination coverage levels of adolescents.**
**14-29****	****Proportion vaccinated against influenza and pneumococcal disease**
**14-30****	****Vaccine-associated adverse events**
**14-31****	****Persons under surveillance for vaccine safety **

## Healthy People 2010 Immunization and Infectious Disease Objectives

_**Infectious Disease objectives**_
**14-2****	****Chronic Hepatitis B virus infections in infants and young children**
**14-3****	****Hepatitis B infections**
**14-4****	****Bacterial meningitis in young children**
**14-5 ****	****Invasive pneumococcal infections**
**14-6****	****Hepatitis A**
**14-7****	****Meningococcal disease**
**14-8****	****Lyme disease**
**14-9****	****Hepatitis C**
**14-10****	****Chronic Hepatitis C infection identified by state and local health departments**
**14-15****	****International travelers who receive preventive services**
**14-16****	****Invasive early onset group B strep disease**
**14-17****	****Hospitalizations caused by peptic ulcer disease**
**14-18****	****Course of antibiotics for ear infections for young children**
**14-19****	****Courses of antibiotics prescribed for sole diagnosis of common cold**
**14-20****	****Hospital-acquired infections in intensive care unit patients**
**14-21****	****Anti-microbial use among intensive care unit patients**
**14-28****	****Hepatitis B vaccine coverage among high-risk groups**

## Healthy People 2010 Immunization and Infectious Disease Objectives

_**Tuberculosis objectives**_
**14-11****	****Rates of Tuberculosis.**
**14-12****	****Proportion of tuberculosis patients completing curative therapy.**
**14-13****	****Proportion of contacts and other high-risk persons with latent tuberculosis infection completing curative therapy.**
**14-14****	****Average time for a laboratory to confirm and report tuberculosis cases.**

## Comparison of 20th Century Average Annual Morbidity and 2002 Morbidity, Vaccine-Preventable Diseases

**Average Annual Morbidity**

**2002****†**

**2010 **
**Target**

**Diphtheria****	****	**
**Measles****	**
**Mumps**
**Pertussis**
**Polio (paralytic)**
**Rubella**
**Congenital Rubella Syndrome**
**Tetanus****	**
***H. influenzae*****,**
**   ****type b and unknown (<5 yrs)**

**175,885**
**503,282**
**152,209**
**147,271**
**16,316**
**47,745**
**823**
**1,314**
**20,000**‡

**1 **
**37**
**238**
**8,296**
**0**
**14**
**3**
**22**
**167**

**0**
**0**
**0**
**2,000**
**0**
**0**
**0**
**0**
**0**

- Source:  CDC.  MMWR 1999. 48: 242-264.
**†** Data are preliminary. ‡ Data are estimated.**	****	****	****	**

**Disease**

**Comparison of 20****th**** Century Average Annual Morbidity and 2002 Morbidity, Vaccine-Preventable Diseases**

**Numbers in red indicate record lows in 2002**

**Notes:**
For 2002 record lows for: smallpox, measles, mumps, polio, rubella and tetanus
According to the Hib section, the Hib issue is not straight forward and it would not be possible right now to say that the “Hib and ‘unknown serotypes’ combined in kids under age 5 years”  were at an all-time low in 2002. It will not be determined until sometime this summer.
Record lows for 2000 – polio 0, measles 86, mumps 338, tetanus 26 
Record lows for 2001 – polio 0 , mumps 352, rubella 26, (still unknowns for Hib for 2001)

*Slide taken from Walt Orenstein presentation at the 37th Annual National Immunization Conference, Chicago, IL, March 17-20, 2003*

## 14-22. Vaccine-specific coverage rates among pre-school aged children

**DTP(3+)****†**

**MMR(1+)**

**Polio (3+)**

**Hib (3+)**

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

**Varicella (1+)**

**†**** **DTP(3+) is not a Healthy People 2010** **objective.  DTP(4) is used to assess Healthy People 2010 objectives.
- Note:  Children in the USIS and NHIS were 24-35 months of age.  Children in the NIS were 19-35 months of age.
- Source: USIS (1967-1985), NHIS (1991-1993) CDC, NCHS, and NIS (1994-December 2002), CDC, NIP and NCHS; No data from 1986-1990 due to cancellation of USIS because of budget reductions

**2010 Target**

**14-22. Vaccine-specific coverage rates among pre-school aged children**

**Percent**

**Notes:**
*Slide taken from Sudip Parik’s presentation, December 2002, presented by Walt Orenstein*  Data checked by DMD, Lawrence Barker, May 28, 2003.

## 14-22. Achieve and maintain effective vaccination coverage levels for universally recommended vaccines

**DTP**

**MMR**

**Polio**

**Hib**

**Hep**** ****B**

**Varicella**

**  **Source: National Immunization Survey (NIS), CDC, NIP and NCHS.

**2010 Target**

**14-22. Achieve and maintain effective vaccination coverage levels for universally recommended vaccines**

**Percent of children 19-35 months**

**PCV**

**Notes:**
*Slide taken from Sudip Parik’s presentation, December 2002, presented by Walt Orenstein*  Data checked by DMD, Lawrence Barker, May 28, 2003.

## Measles vaccination coverage among preschool-aged children, by race

**White**

**Black**

**Measles vaccination coverage among ****preschool-aged children, by race**

**Other**

- Note:  Children in the USIS and NHIS were 24-35 months of age.  Children in the NIS were 19-35 months of age.
- Source:  1970-1983 United States Immunological Survey (USIS), CDC, Division of Immunization, 1992-1993 National Health Interview Survey (NHIS), CDC, NCHS; 1994-2001 National Immunization Survey (NIS), CDC, EPO.

**Percent**

**1983**

**1970**

**1976**

**1992**

**1994**

**2001**

**Notes:**
*From NFID Presentation in San Francisco, Walt Orenstein, 2001*

## 14-22.  Universally recommended vaccination coverage among children 19-35 months, by race and ethnicity, 2002

**White, Not Hispanic**

**Black, Not Hispanic**

**Hispanic** **

**American Indian / Alaskan Native* **

**Asian***

- I 95% Confidence interval. §  Data are statistically unreliable.
- *Includes persons of Hispanic and non-Hispanic origin  ** Can be of any race
- Source:  National Immunization Survey (NIS), CDC, NIP and NCHS.

**Percent**

**Percent**

**Percent**

**Percent**

**2010 Target**

**Native Hawaiian/ Other Pacific Islander* **

**Multiple Race* **

**Obj. 14-22**

**§**

**§**

**§**

**14-22.  Universally recommended vaccination coverage among children 19-35 months, by race and ethnicity, 2002**

**Notes:**
*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.*
Data was updated by Lawrence Barker, DMD, May 28, 2003.

## 14-22.  Universally recommended vaccination coverage among children 19-35 months, by race and ethnicity, 2002

**White, ****Not Hispanic**

**Black, **
**Not Hispanic**

**Hispanic** **

**American Indian / Alaskan Native* **

**Asian* **

**†**** **DTP (3) is not a Healthy People 2010 objective. **‡**** **Developmental objective.  Target has not been determined.
- * Includes persons of Hispanic and non-Hispanic origin  ** Can be of any race  I 95% Confidence interval.
- Source:  National Immunization Survey (NIS), CDC, NIP and NCHS.

**14-22.  Universally recommended vaccination coverage among children 19-35 months, by race and ethnicity, 2002**

**DTP (4+) **

**DTP (3+)**

**Percent**

**Percent**

**Percent**

**4:3:1:3:3 Series**

**2010 Target**

**PCV(3+)****‡**

**Percent**

**Native Hawaiian/ Other Pacific Islander* **

**Multiple Race* **

**§**

**§**

**§**

**§**

**§**

**§**

**Notes:**
*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.*
Data was updated by Lawrence Barker, DMD, May 28, 2003.

## 14-23. Vaccination coverage of children in daycare, kindergarten, and first grade, 2002†

**2010 target ****‡**

**14-23. Vaccination coverage of children in daycare, kindergarten, and first grade, 2002****†**

**† **Developmental Healthy People 2010 objective. **‡**** **Proposed Healthy People 2010 target.
- ^ Kindergarten and first grade percentage based on data from 40 states and the District of Columbia.  All states require 3 doses of HepB, however the District of Columbia requires 2 doses.  ^ ^  Kindergarten and first grade percentage based on data from 24 states and the District of Columbia.
- Source:  National Immunization Survey (NIS), CDC, NIP and NCHS; School Entry Immunization Assessment Report, CDC, NIP.

**Kindergarten and first grade**

**Daycare**

**Percent**

**Hepatitis B****^**

**Varicella****^^**

**Notes:**
Patient evaluation of good provider-patient communication increases as patient’s age increases.

## 14-27.  Universally recommended vaccination coverage among children 13-15 years, 2001

**HepB (3+)**

**MMR (1+)**

**DTaP (4)**

**14-27.  Universally recommended vaccination coverage among children 13-15 years, 2001**

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

**55%**

**74%**

**76%**

**93%**

**34**

**92%**

**55%**

**76%**

**34%**

**Shot-record data only**

**Shot record and recall data**

**2010 Target**

**Notes:**
*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.*
Data was updated by Lawrence Barker, DMD, May 28, 2003.

## 14-27a.  3 or more doses of Hepatitis B vaccination among adolescents 13-15 years

**14-27a.  3 or more doses of Hepatitis B vaccination among adolescents 13-15 years**

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

**2010 Target**

**Shot record data only**

**Shot record and recall data**

**Percent**

**Notes:**
*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.*
Data was updated by Lawrence Barker, DMD, May 28, 2003.

## 14-27b.  1 or more doses of MMR vaccination among adolescents 13-15 years

**14-27b.  1 or more doses of MMR vaccination among adolescents 13-15 years**

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

**2010 Target**

**Shot record data only**

**Shot record and recall data**

**Percent**

**Notes:**
*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.*
Data was updated by Lawrence Barker, DMD, May 28, 2003.

## 14-27c.  1 or more doses of Td vaccination among adolescents 13-15 years

**14-27c.  1 or more doses of Td vaccination among adolescents 13-15 years**

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

**2010 Target**

**Shot record data only**

**Shot record and recall data**

**Percent**

**Notes:**
*Slide taken from NIP Program Review presentation, Walt Orenstein, 2002.*
Data was updated by Lawrence Barker, DMD, May 28, 2003.

## 14-24a. Vaccination coverage with the 4:3:1:3:3† series, among children 19-35 months, 2002

**80-89%**

**70-79%**

**60-69%**

- † 4+DTP, 3+Polio, 1MCV, 3+Hib, 3+HepB

**79**

**76**

**82**

**75**

**80**

**77**

**72**

**76**

**78**

**78**

**75**

**68**

**63**

**69**

**67**

**65**

**76**

**76**

**73**

**81**

**VT 81**

**75**

**73**

**79**

**70**

**69**

**75**

**80**

**82**

**79**

**72**

**77**

**79**

**69**

**77**

**73**

**78**

**78**

**80**

**71**

**67**

**65**

**68**

- National Coverage = 75%

- Source: National Immunization Survey (NIS), CDC, NIP and NCHS.

**14-24a. Vaccination coverage with the 4:3:1:3:3****†**** series, among children 19-35 months, 2002**

**Notes:**
The 2010 goal for the combined series is 80%.
3+DTP – 93.9
4+DTP – 81.5
3+Polio – 89.8
1+MMR – 91.0
3+Hib – 92.9
3+HepB – 88.3
1+Var – 78.6

*Slide taken from Walt Orenstein presentation at the 37th Annual National Immunization Conference, Chicago, IL, March 17-20, 2003*

## 14-29a.  Influenza vaccination coverage during the past 12 months, among adults 65 years and older

- Note: Percent receiving vaccine is estimated per Influenza season, using the January-June interviews only.
- Source:  National Health Interview Survey (NHIS), CDC, NCHS.

**2010 target**

**14-29a.  Influenza vaccination coverage during the past 12 months, among adults 65 years and older**

**Percent**

**1988**

**1990**

**1992**

**1994**

**1996**

**1998**

**2000**

**2002**

**Notes:**
I’m first going to talk about coverage rates in the elderly, over 65 years of age. Why do we want to focus on this group?  Influenza accounts for ~40,000 deaths each years, with ~90% occurring in those over 65 years of age. 

This chart shows the upward trend in self-reported influenza vaccination in the past year from 1989 through 2001 for >65 yr olds in the U.S.   Data from both the NHIS (1989-2000) and BRFSS (1993-1999) are shown. 

Influenza vaccination coverage among persons aged 65 years or older has increased at a slower rate in recent years and may be approaching a plateau.  Between 1997 and 2000, coverage increased 1 percentage point per year, while coverage nearly doubled from 30% in 1989 to 58% in 1995.   The dip in coverage after 2000 was most likely due to the vaccine delay. 

Because of the 12 month recall period, coverage estimates by survey year primarily reflects vaccinations received for the prior season. 

## 14-29a.  Influenza vaccination coverage during the last 12 months of  adults 65 years and older, by race/ethnicity

**2010 target**

- * Can be of any race.
- Source:  National Health Interview Survey (NHIS), CDC, NCHS.

**White, Not Hispanic**

**Hispanic ***

**Black, Not Hispanic**

**14-29a.  Influenza vaccination coverage during the last 12 months of  adults 65 years and older, by race/ethnicity**

**Percent**

**1989**

**1991**

**1993**

**1995**

**1999**

**1997**

**2001**

**Notes:**
Here we see differences by race/ethnicity for influenza vaccine for those >65 yrs. Non-hispanic whites have the highest rates while hispanics have lower rates and blacks have the lowest.

## 14-29b.  Pneumococcal vaccination coverage ever received among adults 65 years and older, by race/ethnicity

- †** **Data are preliminary.
- * Includes persons of Hispanic and non-Hispanic origin.  ** Can be any race.
- Source:  National Health Interview Survey (NHIS)*, *CDC, NCHS.

**White**

**African American**

**Hispanic****

**2010 Target**

**Asian***

**Total**

**14-29b.  Pneumococcal vaccination coverage ever received among adults 65 years and older, by race/ethnicity**

**Percent**

**†**

**Notes:**
Here we see bigger differences in coverage rates by race/ethnicity than we saw for flu.  Rates seem to be beginning to level off, at least in the white population.

## 14-29c.  Influenza vaccination in past 12 months among adults with high risk conditions†, ages 18-64

- † High risk persons include respondents with one or more of the following conditions: heart disease, diabetes, asthma, chronic bronchitis, kidney disease, and cancer (excluding skin cancer).
- Source:  National Health Interview Survey (NHIS), CDC, NCHS.

**2010 Target**

**14-29c.  Influenza vaccination in past 12 months among adults with high risk conditions****†****, ages 18-64**

**Percent**

**50-64 years of age**

**18-49 years of age**

**Notes:**
This chart shows the  trend in self-reported influenza vaccination from 1996 – 2000 for those 18-64 years. Higher  coverage is among persons aged 50-64 (purple lines) compared to those aged 18-49 years (orange lines) but still below HP2010.  

## 14-29c. Influenza vaccine coverageamong adults with high risk conditions†, ages 18-64, by race/ethnicity

- † High risk persons include respondents with one or more of the following conditions: heart disease, diabetes, asthma, chronic bronchitis, kidney disease, and cancer (excluding skin cancer).
- * Includes persons of Hispanic and non-Hispanic origin. ** Can be of any race. I 95% Confidence interval.
- Source:  National Health Interview Survey (NHIS), CDC, NCHS.

**2010 Target**

**14-29c. Influenza vaccine coverage****among adults with high risk conditions****†****, ages 18-64, by race/ethnicity**

**1998**

**2001**

**TOTAL**

**White, Not Hispanic**

**Black, Not Hispanic**** **

**Hispanic ********

**Asian*******

**American Indian or Alaska Native*******

**Percent**

**Notes:**
Here we see influenza vaccination coverage for those 18-64 yrs by race/ethnicity. You can see that whites have higher coverage compared to other races, but the differences are much less in this group (18-64 yrs) compared to the 65+ group. 

## 14-29d.  Pneumococcal vaccination ever received, among adults with high risk conditions†, ages 18-64 years

- † High risk persons include respondents with one or more of the following conditions: heart disease, diabetes, asthma, chronic bronchitis, kidney disease, and cancer (excluding skin cancer).
- Source:  National Health Interview Survey (NHIS)*, *CDC, NCHS.

**2010 Target**

**14-29d.  Pneumococcal vaccination ever received, among adults with high risk conditions****†****, ages 18-64 years**

**50-64 years old**

**18-49 years old**

**Percent**

**Notes:**
This chart shows the  trend in self-reported pneumococcal vaccination from 1996 – 2000 for those 18-64 years. Higher  coverage is among persons aged 50-64 (purple lines) compared to those aged 18-49 years (orange lines) but still below HP2010 of 60%.  

## 14-29d. Pneumococcal vaccine ever received among adults with high risk conditions†, 18- 64 years, by race/ethnicity

- ** Can be of any race.
- † High risk persons include respondents with one or more of the following conditions: heart disease, diabetes, asthma, chronic bronchitis, kidney disease, and cancer (excluding skin cancer).
- Source: National Health Interview Survey (NHIS),* *CDC, NCHS.

**HP 2010 Target**

**14-29d. Pneumococcal vaccine ever received among adults with high risk conditions****†****, 18- 64 years, by race/ethnicity**

**Percent**

**1998**

**2001**

**TOTAL**

**White, **
**Not Hispanic**

**Black, **
**Not Hispanic**

**Hispanic****

**Notes:**
Here we see pneumococcal vaccination coverage for those 18-64 yrs by race/ethnicity. You can see that whites have higher coverage compared to other races, but the rates are so low overall that it is difficult to see differences in this group. 

## 14-6.  Reduce Hepatitis A 

**Hepatitis A**

**2010 Target**

**Cases per 100,000**

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

## Hepatitis A Incidence

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

**Cases per 100,000**

**1980**

**1985**

**1990**

**1995**

**2000**

**2002****†**** **

**2010 Target**

**Notes:**
As you know, the incidence of hepatitis A has generally be cyclic, with peaks every 10-15 years.  [click] In 1995 hepatitis A vaccine was licensed by FDA and became available in the United States, and [click] in 1996 the Advisory Committee on Immunization Practices (ACIP) published the first national recommendations for its use in hepatitis A prevention.  These recommendations were updated [click] and extended in 1999.  As you can see, hepatitis A incidence has been falling, beginning in 1998 to dip below recorded historic lows, even if we look all the way back to when national hepatitis surveillance first began in the 1960’s.  The 2001 rate [click] of 3.8/100,000 is well below the previously-recorded lowest rate of about 9/100,000.  This overall rate is an indicator of truly transformed hepatitis A epidemiology, some examples of which I’ll show you in a moment.  To put this in context, though, first I’d like to to describe the epidemiologic rationale behind the recommendations, which, as you’ll see, represent a somewhat novel approach to childhood vaccination.

## 14-6.  Reduce Hepatitis A, by race and ethnicity 

**2010 Target**

**Cases per 100,000**

- * Not Hispanic    ** Can be of any race   AI/AN = American Indian Alaska Native  A/PI= Asian or Pacific Islander
- Source: National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.

**Hispanic****

**AI/ AN**

**A/PI**

**Black***

**White***

## Hepatitis A Incidence, by age

**Incidence per 100,000**

- † Data are preliminary.
- Source:  National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.

**19 years and older**

**Less than 19 years old**

**1990**

**1992**

**1994**

**1996**

**1998**

**2000**

**2002****†**

## Hepatitis B Incidence

**† **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 by the age-specific proportions of infections which are symptomatic.** **
- Source: National Notifiable Diseases Surveillance System (NNDSS), CDC, EPO.

**Estimated****†**** cases per 100,000**

**19-39 years**

**40 years and older**

**Less than19 years**

**Obj. 14-3**

**1990**

**2002**

**2000**

**1998**

**1996**

**1994**

**1992**

**Notes:**
If we look at the incidence data by age group, we notice two things – first, that incidence has declined in all age groups, including persons younger than 12, seen on this inset
Click
.....because the incidence is so much lower.
Second, that the decline has been greater among persons under age 20. In fact, there has been only a 65% decline 
Click   .....in incidence among persons older than 20 since 1990, 
Click
compared to the 85% decline among 12-19 year olds, and the 89% decline among children less than 12. 
In 2001, more than 96% of cases were among adults. 
The plateau noted in the overall incidence slide, and here, is because of a slowing of the decline in adult infections. 

Among 12 to 19 year olds, the decline since 1999 has been 37%, and among those less than 12 it has been 45%, compared to only 5% among those 20 and older.
Pink it out
Fonts, line up %

## 14-3.  Hepatitis B Incidence, by race and ethnicity, 2001

**14-3.  Hepatitis B Incidence, by race and ethnicity, 2001**

**American Indian/ **
**Alaska Native* **

- I 95% Confidence interval.
- *Includes persons of Hispanic and non-Hispanic origin  **Can be of any race.
- Source: National Notifiable Diseases Surveillance System (NNDSS), CDC, EPO.

**Per 100,000 **

**2010 target**

**19-24 years**

**25-39 years**

**40 years and older**

**Asian or Pacific Islander* **

**Hispanic****

**White, Not Hispanic**

**Black, Not Hispanic**

**Notes:**
Patients with public health insurance rate provider communication highest (esp. for listening carefully and spending enough time); patients with no health insurance rate provider communication lowest (esp. for listening carefully and explaining things clearly).

## 14-11.  Cases of Tuberculosis

**1982**

**1986**

**1990**

**1994**

**1998**

**2002****†**

**†**** **Data are preliminary

**Number of Cases**

- Source:  National TB Surveillance System, CDC, NCHSTP.

## 14-11.  Rates of Tuberculosis, by race and ethnicity

**2010 target**

**14-11.  Rates of Tuberculosis, by race and ethnicity**

*** **Includes persons of Hispanic and non-Hispanic origin  ******Can be of any race
- Note:  Data are age adjusted to the 2000 standard population.  Data in parentheses represent the percent change in the rate between 1998 and 2001.
- Source:  National TB Surveillance System, CDC, NCHSTP.

**2001**

**1998**

**American Indian or Alaska Native***

**Asian or Pacific Islander***

**Black, Not Hispanic**** **

**White, Not Hispanic**

**Hispanic****

**TOTAL**

**Per 100,000 population**

**-15%**

**-11%**

**-12%**

**-13%**

**-20%**

**-26%**

**Notes:**
Patient evaluation of good provider-patient communication increases as patient’s age increases.

## 14-12.  Proportion of Tuberculosis Patients Completing Curative Therapy

**Percent**

**2010 target**

**14-12.  Proportion of Tuberculosis Patients Completing Curative Therapy**

*** **Includes persons of Hispanic and non-Hispanic origin  ******Can be of any race
- Source:  National TB Surveillance System, CDC, NCHSTP.

**1999**

**1996**

**American Indian or Alaska Native***

**Asian or Pacific Islander***

**Black, Not Hispanic**** **

**White, Not Hispanic**

**Hispanic****

**TOTAL**

**Notes:**
Patient evaluation of good provider-patient communication increases as patient’s age increases.

## Percent of Tuberculosis labs using recommended procedures

**Percent**

**Percent of Tuberculosis labs using recommended procedures**

- Source: Tuberculosis Elimination and Laboratory Upgrade Cooperative Agreements. Unpublished CDC data.

**Rapid Drugs**

**Liquid Media**

**Fluorochrome**

**Rapid I. D.**

**Notes:**
Patient evaluation of good provider-patient communication increases as patient’s age increases.

##   Percent of Tuberculosis labs meeting turn-around time goal 

**Percent**

**  ****Percent of Tuberculosis labs meeting turn-around time goal**

- Note:  Data for laboratories using Liquid Media procedures was not available.
- Source: Tuberculosis Elimination and Laboratory Upgrade Cooperative Agreements. Unpublished CDC data.

**Fluorochrome**

**Rapid I. D.**

**Rapid Drugs**

**Notes:**
Patient evaluation of good provider-patient communication increases as patient’s age increases.

## Developmental Objectives

**14-10.   Increase the proportion of persons with chronic Hepatitis C infection identified by State and local health departments.**
**	****(proposed source, National Electronic Telecommunications System for Surveillance)**
**14-15.  Increase the proportion of international travelers who receive recommended preventive services when traveling in areas of risk for: hepatitis A, malaria, and typhoid.**
**	****(proposed source, Travelers’ Health Survey)**
**14-22g.  Achieve and maintain the levels of pneumococcal conjugate vaccination coverage among young children. ****(future source, National Immunization Survey)**

## Developmental Objectives

**14-23d, e.  Maintain vaccination coverage levels for children in licensed day care facilities- Hepatitis B and Varicella.**
**	****(proposed source, National Immunization Survey)**
**14-23i, j.  Maintain vaccination coverage levels for children in kindergarten and first grade- Hepatitis B and Varicella.**
**	****(proposed source, The School Entry Immunization Assessment Report)**
**14-24b.  Increase the proportion of adolescents who receive all vaccines that have been recommended for universal administration for at least 5 years**
**	****(proposed source, National Immunization Survey)**

## Progress Review data and slides can be found on the web at: 

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

- _[http://www.cdc.gov/nchs/hphome.htm](http://www.cdc.gov/nchs/hphome.htm)_