Decline in Varicella Incidence in Texas Julie Townsend, MS; Laura Tabony, MS; and Rita Espinoza, MPH May 11, 2004

Objective Assess the impact of vaccination and school requirements on the incidence of varicella Discuss the stability of reporting in Texas

Background Information Structure of Texas 254 counties State/PHR/LHD Varicella Reporting 1972, case counts 1999, age-group 2001, named reporting Variables collected with named reporting Name, dob, address, onset, vaccination history, race/ethnicity, sex 11 public health regions (8 administrative) 65 local health departments

Varicella Vaccine Requirement, 1999-4/1/04 Children attending child-care facilities: 1 dose by 12 months of age School Children kindergarten enterers children 12 years of age Note: Two doses are required if the child was thirteen years old or older at the time the first dose of varicella vaccine was received.

Varicella Vaccine Requirement, 4/1/04 Children attending child-care facilities: 1 dose by 19 months of age School Children 2004-2005 Kg-4th grade & 7th-10th grade 2005-2006 Kg-5th grade and 7th-11th grade; and thereafter, beginning in school year 2006-2007, for all students in grades kg-12th grade. Note: Two doses are required if the child was thirteen years old or older at the time the first dose of varicella vaccine was received.

Disease Reporting Review of data since 1990 Stable reporting since 1990 6% of birth cohort Improvement needed

Varicella Vaccination Coverage Levels NIS 83% of Texas children aged 19 – 35 months in 2002 vaccinated School Survey 96% of eligible school-aged children in 2002 vaccinated

% of Texas Children Aged 19 – 35 Months Receiving Varicella Vaccine School Data: 2000 – 92%; 2001 – 95%; 2002 – 96%

Reported Cases of Varicella in Texas 1972-2003 Varicella Vaccine Licensed in 1995

Varicella Incidence in Texas 1990 - 2003 Incidence rates: 1998: 103.7 cases/100,000 1999: 37.3 cases/100,000 2000: 33.6 2001: 26.9 2002: 28.1 2003: 25.0

Reported Cases of Varicella 1995 - 2003 Cases: 20,484 in 1998; 7,473 in 1999, 7,003 in 2000, 5,741 in 2001, 6,047 in 2002, 5465 in 2003

Counties Reporting Varicella

Reported Varicella Cases by Age Group, 2001-2003

Summary Texas has named reporting Reporting has remained stable Allows for trend analysis Some increases in sites reporting, yet cases have declined and now remain stable School and child care facilities requirements have assisted in the decrease

Contact Information Julie Townsend, Epidemiologist Julie.Townsend@tdh.state.tx.us Rita Espinoza, Epidemiologist Rita.Espinoza@tdh.state.tx.us