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

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

3. 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

5. 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 : K-4th , 7th-10th
SY : K-5th , 8th-11th
SY and thereafter: K-12th
Childcare facilities: age-appropriate
Note: 2 doses required if child is 13 years or older at time of first dose

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

7. 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

8. 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

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

10. Varicella Incidence in Texas 1990 – 2007*
Incidence rates:
1998: 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

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

12. 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.

13. 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

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

15. 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

16. 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