1. Tony Aragon, MS Epidemiologist Immunization Branch May 20, 2010 Vaccine Coverage

2. Objective Explain the differences between the different vaccination coverage levels for children, adolescents, and adults Review National and State Surveys  Data collected  What is measured  Ages  Area  When

3. SurveyData collectedAgesAreaWhen NIS Children (CDC) Dates of vaccinations, race/ethnicity, other, demographics 19-35 months Texas, Dallas County, El Paso County, City of Houston, and Bexar County Annually (Summer) NIS Teens (CDC) Dates of vaccinations race/ethnicity, other, demographics 13-17 yrsUnited StatesAnnually TCRISS (DSHS) Dates of vaccinations, total enrollment of school, exemption data Kindergarten studentsCounty levelOngoing Texas School Immunization Validation Survey (DSHS) Dates of vaccinations, total enrollment of school, exemption data Statewide sample of kindergarten and 7th Grade students State of Texas Annually (Fall) Child Care Assessment (DSHS) Dates of vaccinations, total enrollment of Child care facility, exemption data 19-59 months Licensed childcare facilities Annually (Fall) BRFSS (CDC) Vaccination rates, race ethnicity, other demographics Adults 18 and overUS and StatewideAnnually Texas Annual School Report Vaccination rates, exemption data Kindergarten and 7thGrade students County Level and State Level Annually (Fall) Current Immunization Data Sources

4. Vaccine Coverage…....Outline Surveys National Immunization Survey (NIS) Texas County Retrospective Immunization School Survey (TCRISS) Texas School Immunization Validation Survey Texas Childcare Immunization Assessment The Annual Survey of Immunization Status The Behavioral Risk Factor Surveillance System (BRFSS)

5. Vaccine Coverage for Children 2008 National Immunization Survey (NIS) Texas County Retrospective Immunization School Survey (TCRISS) 2008-09 Annual Report of Immunization Status 2007 Texas School Immunization Validation Survey 2007 Texas Childcare Immunization Assessment

6. Vaccine Coverage for Children National Immunization Survey (NIS) Provides vaccination coverage levels of children aged 19 – 35 months Provides immunization coverage by state, select local areas as well as the nation Bexar Co. City of Houston Dallas Co. El Paso Co. Provides a national standard for vaccine coverage 2008 – 4:3:1:3:3:1 vaccines series 2009 - 4:3:1:3:3:1:4, pneumococcal conjugate vaccine will be added.

7. 4:3:1:3:3:1* Estimated Vaccination Coverage Levels in Children 19-35 Months, US and Texas, NIS 2002-2008 4:3:1:3:3:1* Estimated Vaccination Coverage Levels in Children 19-35 Months, US and Texas, NIS 2002-2008 *4:3:1:3:3:1 – *4:3:1:3:3:1 – 4+ doses DTP, 3+ doses Polio, 1+ dose MMR, 3+ doses of Hib, 3+ doses Hep B, and 1+ doses of varicella

8. Estimated Vaccination Coverage Levels in Children 19-35 Months by State and Local Area, NIS 2008* Estimated Vaccination Coverage Levels in Children 19-35 Months by State and Local Area, NIS 2008* *Based on 2008 US NIS Report (Q1/2008-Q4/2008)

9. Vaccine Coverage for Children Texas County Retrospective Immunization School Survey (TCRISS) Provides county level estimates of vaccination coverage School-based study that measures vaccination coverage levels of kg retrospectively at 24 months Measures Hep A vaccine, prospectively Fulfills a need for county specific vaccination coverage level estimates

11. Vaccine Coverage for Children 2008-09 Annual Report of Immunization Status Texas requires a report of immunization status annually from public schools and accredited private schools Texas Administrative Code,Title 25 Health Services, §§97.61-97.72 The Annual Report of Immunization Status is a self report survey Used to measure immunization coverage among students entering kindergarten and middle school (7 th grade)

12. Percent of Texas Kindergarten Students Completely Vaccinated by Vaccine Antigen, 2008-09 Annual Report of Immunization Status

13. Vaccine Coverage for Children 2007 Texas School Immunization Validation Survey Conducted annually to validate the results of the Annual Report of Immunization Status 70 public schools with kindergarteners and seventy schools with 7th graders are randomly selected statewide Statewide vaccination coverage levels are available for Kindergarten and 7th grade students attending public school in Texas

14. Estimated Coverage Levels of Students in Texas Public School for Kindergarten Students, 2007 Texas School Immunization Validation Survey Vaccine Requirement Percent of Students Vaccinated Kindergarten Diphtheria, Tetanus, Pertussis Vaccine (DTP, DTaP, DT)94.3 Polio Vaccine (OPV or IPV)94.8 Measles, Mumps, Rubella (MMR) vaccine – 1 st dose99.8 MMR (or measles) vaccine – 2 nd dose98.2 Varicella Vaccine98.1 Hepatitis B vaccine98.0

15. Vaccine Coverage for Children 2007 Texas Childcare Immunization Assessment Conducted biennially to assess vaccination coverage levels of children attending a childcare facility Used to monitor compliance vaccine requirements at licensed child care centers (LCCC) and registered child care homes (RCCH) in Texas Approximately 2400 children from approximately 120 child-care facilities per HSR are selected and examined for immunizations and their dates of administration Statewide and regional vaccination coverage levels are estimated for children ages 19 – 59 months of age attending childcare facilities in Texas

16. Estimated Vaccination Coverage Levels Among Child Care Attendees by Health Service Region and Texas, 4:3:1:3:3:1* Series, 2007 Texas Childcare Immunization Assessment

17. Vaccination Coverage Level Estimates Among Child Care Attendees by HSR and Texas, 4 Doses of DTaP 2007 Texas Childcare Immunization Assessment

18. Vaccination Coverage for Adolescents 2008 NIS-Teen Survey 2007 Texas School Immunization Validation 2008-09 Annual Report of Immunization Status

19. Vaccine Coverage for Adolescents National Immunization Survey (NIS)-Teen Provides an on-going, consistent data set for analyzing vaccination levels among adolescents 13 to 17 years old The NIS-Teen provides national, state, and selected area estimates of vaccination coverage Bexar Co. City of Houston Rest of State Provides a national standard for vaccine coverage among adolescents

20. Estimated Vaccination Coverage Among Adolescents 13-17 Years of Age, 2008 National Immunization Survey-Teen

21. Estimated Vaccine Coverage Level in Texas Public School for 7th Grade Students, 2007 Texas School Immunization Validation Survey Vaccine Requirement* % of 7 th Grade Students Vaccinated Diphtheria, Tetanus, Pertussis Vaccine (DTP, DTaP, Tdap, or Td)97.1 Polio Vaccine (OPV or IPV)92.4 Measles, Mumps, Rubella (MMR) vaccine – 1 st dose94.4 MMR (or measles) vaccine – 2 nd dose93.4 Varicella Vaccine96.2 Hepatitis B vaccine98.2

22. Percent of 7 th Grade Students Completely Vaccinated with Individual Vaccine by Health Service Region, 2008-09 Annual Report of Immunization Status HSRTdapHepatitis BMMRPolioVaricella 1 36.5%99.6%99.7%99.3%99.7% 2 47.9%99.5% 99.6%99.5% 3 72.3%98.9%98.8%99.0%98.9% 4 55.0%99.6%99.5%99.6% 5 72.6%99.5% 98.7%93.4% 6 57.8%99.2% 99.1% 7 53.8%99.1%90.4%99.2%99.1% 8 74.1%99.3% 99.4% 9 55.7%99.6%99.7%99.8%99.7% 10 76.8%99.3%99.6%99.3%99.5% 11 60.2%99.5%99.7%99.8%

23. Vaccination Coverage for Adults The Behavioral Risk Factor Surveillance System (BRFSS)

24. Adult Immunization Data Sources The Behavioral Risk Factor Surveillance System (BRFSS) BRFSS is an ongoing data collection program designed to measure behavioral risk factors in the adult population 18 years of age or older Provides adult immunization rates on Influenza Pneumococcal

25. Flu Vaccine Coverage Level, US & TX BRFSS 2002-2009, 65 Years and Older

26. Flu Vaccine Coverage Level, US & TX 18 Years and Older, BRFSS 2003-2009

27. Pneumonia Shot, US & TX 65 Years and Older, BRFSS 2002-2009

28. Other Immunization Data Conscientious Exemptions Conscientious Objections (COs)

29. Sources for Conscientious Exemption Data Number of affidavit forms requested Number of requests Number of children for whom exemptions are requested Number of affidavit forms per child Zip Code Number of exemptions reported via school surveys & child-care audits

30. Yearly Comparison of the Number of Individuals Requesting Conscientious Exemptions, 2004 - 2009

31. 2008-09 Annual Report of Immunization Status: Kindergarten Conscientious Exemptions Kindergarten Conscientious Exemptions Vaccine CategoryNumber(%) DTP/DTaP13830.43 Hepatitis B12150.38 Measles 112410.38 Measles 214070.38 Mumps13160.41 Polio13680.42 Rubella13150.41 Varicella12370.38

32. 2008-09 Annual Report of Immunization Status: 7 th Grade Conscientious Exemptions 7 th Grade Conscientious Exemptions Vaccine CategoryNumber(%) Tdap4310.14 Hepatitis B5030.16 MMR5160.16 Polio4980.16 Varicella5280.17

33. Annual Report of Immunization Status: Total Number of Conscientious Exemptions Reported, School Year 2003-2008 School Year Number of Students Enrolled with a Conscientious Exemption Percent of Students Enrolled with a Conscientious Exemption 2003-042,3140.08% 2004-052,7220.09% 2005-066,9910.15% 2006-079,6060.21% 2007-0810,4040.23% 2008-0912,6330.28%

34. Annual School Report: Total Number of Conscientious Exemptions Reported, School Year 2003-2008

35. Independent School Districts and Accredited Private Schools Reporting Conscientious Exemptions by County, School Year 2007- 08 Disclaimer: This data is self reported data and may vary from year to year. Data Source: Annual School report of Immunization Status, School Year 2007-08 DSHS, Immunization Branch Map Created by: DSHS Center for Health Statistics

36. Questions? Tony Aragon, MS Epidemiologist Tony.aragon@dshs.state.tx.us