Varicella Surveillance in Texas Rita Espinoza, MPH Lucille Palenapa Brandy Tidwell Infectious Disease Surveillance and Epidemiology Branch March 17, 2008

Objectives To describe: Surveillance activities in Texas Epidemiology of varicella in Texas Benefits of implementing case-based surveillance

Overview Public Health Structure in Texas Vaccine Requirements Central office Regional offices Local health departments Vaccine Requirements Timeline Variables collected with named reporting Data 11 public health regions (8 administrative) 65 local health departments

Varicella Vaccine Requirements for Schools and Childcare Facilities Effective August 2000, 1 dose required for: 12 year olds born on or after 9/2/88 5 year olds born on/after 9/2/94 1 year olds born on/after 9/2/99 Effective August 2004, 1 dose required for: SY 2004-2005: K-4th , 7th-10th SY 2005-2006: K-5th , 8th-11th SY 2006-2007 and thereafter: K-12th Childcare facilities: age-appropriate Note: 2 doses required if child is 13 years or older at time of first dose

Surveillance Timeline Aggregate by Age Group Vaccine Req. 1999 2000 NBS Late 2004 NETSS 1972 2001 Case Counts Named Reporting

Implementation of Case-based Reporting Amend the Texas Administrative Code Send notification to physicians, schools, and childcare facilities along with reporting form Published articles in newsletters to increase awareness Post notices and new forms on websites

Variables Collected for Named Reporting DOB Address (street, city, zip, county) Onset date Vaccination history (Y/N) Vaccination dates Recently added number of doses Race/Ethnicity Gender

Reported Cases of Varicella in Texas 1972-2007* Varicella Vaccine Licensed in 1995 * Provisional data as of March 4, 2008

Varicella Incidence in Texas 1990 – 2007* 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 * Provisional data as of March 4, 2008

Varicella Cases and Vaccination Coverage Levels† Reported in Texas 1992-2006 †Among children 19-35 months of age, National Immunization Survey (NIS)

Varicella cases by age group - Texas 2002-2007* *Provisional data as of March 4, 2008 Note: By 2006 school year, students K-12 are required to be vaccinated against varicella.

Proportion of Varicella Cases Vaccinated 2002-2006 * 41% of cases <20 years of age did not have vaccination status ^ 32% of cases <20 years of age did not have vaccination status ** 21% of cases <20 years of age did not have vaccination status

Counties Reporting Varicella * Provisional data as of March 4, 2008

Percentage of Cases by Reporting Facilities – 2007* Reporting Facility Percentage (%) Childcare Facility 3 School 61 Physician Office 14 Laboratory 2 Hospital 4 Other 16 * Provisional data as of March 4, 2008

Summary Number of sites reporting and number of cases has increased Implementation of new reporting requirements Implementation of NBS Schools are the best reporters and are important in implementing case-based reporting for varicella Named reporting has allowed for trend analysis and modification of school vaccination requirements