Update on the Nation’s Immunization National Immunization Conference Kansas City, Missouri—March 5, 2007 Update on the Nation’s Immunization Anne Schuchat, MD Rear Admiral, US Public Health Service Director, National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta, GA

Today 11,000 babies will be born in US 17 diseases are now vaccine-preventable 3 new vaccines in last year alone Rotavirus Human Papilloma Virus Shingles

In Dreams Begin Responsibilities Delmore Schwartz

Eliminating Racial Disparity in Immunization Coverage 4:3:1:3:3:1 Vaccination Coverage 19-35 Month Olds, United States National Immunization Survey, MMWR Sept 14, 2006

Increasing Vaccine-Specific Coverage Rates Among Preschool-Aged Children 2010 Target DTP(3+)† Hep B (3+) PCV 7 (3+) MMR(1+) Polio (3+) Hib (3+) Varicella (1+) 2005 † 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 2003), CDC, NIP and NCHS; No data from 1986-1990 due to cancellation of USIS because of budget reductions.

VMBIP Goes Live!

Monitoring Vaccine Safety October 14, 2005 April 7, 2006 October 20, 2006

Parotitis initially may be unilateral, with swelling of the other gland 2-3 days later. The swelling usually peaks and resolves within about 7-10 days. Although this looks alarming, long term sequelae of mumps parotitis are rare. However, serious complications of mumps can occur without evidence of parotitis. OUTBREAK !

Mumps Cases by Week of Onset, United States, Jan 1– Sept 9, 2006 (n=5594) National Notifiable Diseases Surveillance System (data provisional)

Human H5N1 Avian Influenza Cases and Deaths since 2003 Source: World Health Organization Cumulative: as of 2/27/2007

Influenza Vaccine Production and Distribution, US, 1980-2005 Year Doses Produced (millions) Doses Distributed (millions) 1980 15.7 12.4 1985 23.1 20.1 1990 32.3 28.3 1995 71.5 54.9 1999 77.2 76.8 2000 77.9 70.4 2001 87.7 77.7 2002 95.0 83.0 2003 86.9 83.1 2004 61.0 56.5 2005 86.0 81.2 Produced Distributed 1980 15.7 12.4 79% 1985 23.1 20.1 87% 1990 32.3 28.3 88% 1995 71.5 54.9 77% 1999 77.2 76.8 99% 2000 77.9 70.4 90% 2001 87.7 77.7 89% 2002 95.0 83.0 87% 2003 86.9 83.1 96% 2004 61.0 56.5 93% 86.0 81.2 94% sanofi: 50 m Chiron: 40 m GSK: 7-9 m MedImmune: 3 m 100-102 m IDB: 15-20 m

Influenza Vaccine Production and Distribution, US, 1980-2005 Year Doses Produced (millions) Doses Distributed (millions) 1980 15.7 12.4 1985 23.1 20.1 1990 32.3 28.3 1995 71.5 54.9 1999 77.2 76.8 2000 77.9 70.4 2001 87.7 77.7 2002 95.0 83.0 2003 86.9 83.1 2004 61.0 56.5 2005 86.0 81.2 2006/7 Vaccine Season: 102 million doses Largest Number Ever Distributed Produced Distributed 1980 15.7 12.4 79% 1985 23.1 20.1 87% 1990 32.3 28.3 88% 1995 71.5 54.9 77% 1999 77.2 76.8 99% 2000 77.9 70.4 90% 2001 87.7 77.7 89% 2002 95.0 83.0 87% 2003 86.9 83.1 96% 2004 61.0 56.5 93% 86.0 81.2 94% sanofi: 50 m Chiron: 40 m GSK: 7-9 m MedImmune: 3 m 100-102 m IDB: 15-20 m

Cumulative Monthly Distribution of Influenza Vaccine, 2000 – 2006/7 (01/12/2007) 102.5 83 81.2 Doses (Millions) This graph, produced by Greg Wallace at CDC, shows the timing of influenza vaccine distribution by month for 2000, 2002, 2004, and 2005. The white dotted oval will help you to focus on the month of October, a time when vaccination activities are solidly underway and when delays in vaccine arrival begin to become increasingly problematic. The light blue line represents 2000, a season in which there was a delay that resulted in only about 30% of doses being delivered by the end of October. In contrast, the orange line represents 2002, a season in which nearly 100% of doses were distributed by the end of October. The most recent season, shown in yellow, falls somewhat between 2000 and 2002 in terms of vaccine availability during October.

National Influenza Vaccination Week November 27 – December 3, 2006

Do you know where your children are? ITS 10 O’CLOCK Do you know where your children are?

Increased Participation in Immunization Information Systems Percent

4:3:1:3:3 Coverage by Insurance Status 19-24 mo old children, NIS 2001-2002 PJ Smith et al, Pediatrics, 2006; 117:1972-1978.

Estimated Vaccination Coverage with 3+ PCV Estimated Vaccination Coverage with 3+ PCV*, by Coverage Level and State National Coverage = 83% 84 85 81 87 82 73 90 89 83 79 70 80 86 78 66 88 75 77 76 54 VT 89 NJ CT MA NH RI DC DE MD 87 95 94 91 82 83 77 85  90% 80-89% 70-79%  69% * 3+ doses Pneumoccocal Conjugate vaccine Source: National Immunization Survey 2005

Federal Contract Prices for Vaccines Recommended Universally for Children and Adolescent Girls 1985, 1995, 2006 $1182 $155 $45 Federal contract price shown for 1985 and 1995 are averages that account for price changes within that year.

State HPV Vaccine Legislation, 2007

For Girls Only… HPV vaccine is first routine vaccine in US recommended only in girls or women Targets HPV types linked to 70% of cervical cancer

Kyaw M et al, New Engl J Med 2006;354:14. Decreased Invasive Pneumococcal Disease Caused by Both Penicillin Nonsusceptible and Susceptible Strains, Children <2 years, 1996-2004 Pen S Vaccine Introduced Pen NS Kyaw M et al, New Engl J Med 2006;354:14.

Decreased Incidence of IPD Caused by Penicillin Nonsusceptible Pneumococci in Persons 2 yrs or older, 1996 to 2004 Kyaw M, et al. New Engl J Med 2006;354:14.

Poliovirus Spread, 2003-2006 25 countries, 71 events Number of importations from India viral origin: 13 (18%) Number of importations from Nigeria viral origin: 58 (82%) Wild virus type 1 Wild virus type 3 Wild virus type 1 & 3 Endemic countries Case or outbreak following importation (last 6 months) Case or outbreak following importation (6 - 12 months) Data in HQ as of January2007

Sleepless in Seattle

mmunization I I nformation I nspiration

Thank you! THEN NOW Smallpox 48,164 Diphtheria 175,885 Measles 503,282 Diphtheria 175,885 Measles 503,282 66 Mumps 152,209 314 Pertussis 147,271 25,616 Polio (paralytic) 16,316 1 Rubella 47,745 11 Congenital Rubella Syndrome 823 Tetanus 1,314 27 Hepatitis A 117,333 19,183 Hepatitis B (acute) 66,232 15,352 H. influenzae 20,000 226 Pneumococcus (inv.) All ages 63,067 40,325 < 5 y/o 16,069 4,400 Varicella 4,085,120 817,024 Thank you!