Issue Number 192            September 22, 2000

CONTENTS OF THIS ISSUE

CDC PUBLISHES SURVEILLANCE SUMMARY ON VACCINATION COVERAGE AMONG CHILDREN AND ADULTS--UNITED STATES

----------------------------------------------------------

The Centers for Disease Control and Prevention (CDC) published a surveillance summary titled "Surveillance for Vaccination Coverage Among Children and Adults--United States" in the September 22, 2000, issue of the MMWR. The summary includes three reports:

1. National, State, and Urban Area Vaccination Coverage Levels Among Children Aged 19-35 Months--United States, 1998
2. Vaccination Coverage Among Children Enrolled in Head Start Programs or Day Care Facilities or Entering School
3. Influenza, Pneumococcal, and Tetanus Toxoid Vaccination of Adults--United States, 1993-1997

Back to Top

REPORT 1: NATIONAL, STATE, AND URBAN AREA VACCINATION COVERAGE LEVELS AMONG CHILDREN AGED 19-35 MONTHS--UNITED STATES, 1998

Do you know how well your state is doing in immunizing children during the first two years of life? This survey reports a wealth of data on U.S. immunization rates among children aged 19-35 months. The statistics are broken down in tables to give state-by-state and regional information by vaccine, year, race/ethnicity, and poverty level.

The abstract of this surveillance report is reprinted here in full:

***********************************

Problem/Condition: High vaccination levels in the population are necessary to decrease disease transmission and prevent disease; therefore, an important component of the U.S. vaccination program is the assessment of vaccination coverage. Current goals are for at least 90 percent coverage with recommended vaccines during the first 2 years of life.

Reporting Period: January-December 1998.

Description of Systems: The National Immunization Survey (NIS) is an ongoing, random-digit-dialed telephone survey that gathers vaccination coverage data for children aged 19-35 months in all 50 states and 28 urban areas. Vaccination coverage rates derived from NIS data are adjusted statistically for households with multiple telephone lines, household nonresponse, the proportion of households without telephones, and vaccination provider nonresponse. The results were also adjusted to match the known total population of children in each survey area.

Results: On the basis of NIS data, national coverage was at least 90 percent for three doses of poliovirus vaccine (Polio), three doses of Haemophilus influenzae type b vaccine (Hib), and one dose of measles-containing vaccine (MCV). Coverage was the highest ever reported for four doses of any diphtheria and tetanus toxoids and pertussis vaccine (DTP) (i.e., diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and tetanus toxoids [DT], or diphtheria and tetanus toxoids and acellular pertussis vaccine [DTaP])(83.9 percent), three doses of hepatitis B vaccine (Hep B, 87.0 percent), and one dose of varicella vaccine (43.2 percent). The number of states achieving the 90 percent or greater goal was 47 for three doses of Hib, 40 for three doses of Polio, 40 for one dose of MCV, nine for three doses of Hep B, and seven for four doses of DTP. Proportionally fewer urban areas achieved the 90 percent goal: 23 of 28 for three doses of Hib, 13 for three doses of Polio, 16 for one dose of MCV, five for three doses of Hep B, and one for four doses of DTP. No state or urban area has yet achieved the 90 percent goal for varicella.

Interpretation: Findings from the 1998 NIS indicate that national vaccination coverage levels for routinely recommended childhood vaccines are at the highest levels ever reported. However, substantial variation in coverage remains at the state and urban area levels.

Public Health Actions: The public health community and vaccination providers in areas with low coverage should intensify their efforts to implement recommended strategies for increasing vaccination coverage to ensure that children are equally well protected throughout the United States.

***********************************

To view the complete text of this surveillance summary report online in text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4909a1.htm

Back to Top

REPORT 2: VACCINATION COVERAGE AMONG CHILDREN ENROLLED IN HEAD START PROGRAMS OR DAY CARE FACILITIES OR ENTERING SCHOOL

Many states have vaccination requirements for children entering schools and licensed day care facilities. This is the first report of state-specific surveys that show how well states are meeting their vaccination goals. Check here to see information on vaccination rates broken down by state and vaccine for Head Start programs, licensed day care facilities, and kindergarten/first grade.

The abstract of this surveillance report is reprinted here in full:

***********************************

Problem/Condition: Undervaccinated children enrolled in day care centers and schools are vulnerable to outbreaks of vaccine-preventable diseases. A Healthy People 2000 objective is to increase to at least 95 percent vaccination coverage among children attending licensed day care facilities and kindergarten through postsecondary school (objective 20.11).

Reporting Period Covered: September 1997-June 1998.

Description of System: CDC's National Immunization Program administers grants to support 64 vaccination programs. These programs are in all 50 states, eight territories or jurisdictions (American Samoa, Republic of Marshall Islands, Federated States of Micronesia, Guam, Commonwealth of Northern Mariana Islands, Puerto Rico, Republic of Palau, and the U.S. Virgin Islands), five cities (Chicago, Houston, San Antonio, New York City, and Philadelphia), and the District of Columbia. Grant guidelines require annual school vaccination surveys and biennial surveys of Head Start programs and licensed day care facilities. This system constitutes the only source of nationally representative vaccination coverage estimates for these populations.

Results: 
Head Start Programs: Of the 64 reporting areas, 33 (51.6 percent) submitted coverage levels for children enrolled in Head Start programs. Of these, all 33 programs reported coverage levels for diphtheria and tetanus toxoids and pertussis vaccine (DTP), diphtheria and tetanus toxoids (DT), or tetanus toxoids (Td), poliovirus vaccine, and measles vaccine; and 32 reported coverage levels for mumps and rubella vaccines. Four programs reported coverage levels for the combined measles, mumps, and rubella vaccine (MMR). The mean vaccination coverage levels for the 1997-98 school year among the reporting vaccination programs were 97.8 percent for poliovirus vaccine (range: 80.0 percent-100.0 percent), 97.0 percent for DTP/DT/Td (range: 87.7 percent-100.0 percent), 93.3 percent for measles vaccine (range: 91.4 percent-100.0 percent), and 93.2 percent for mumps and rubella vaccines (range: 91.4 percent-100.0 percent).

Licensed Day Care Facilities: Of the 63 reporting areas with licensed day care facilities, 38 (60.3 percent) submitted coverage levels for enrolled children. Of these, all 38 programs reported coverage levels for poliovirus vaccine and DTP/DT/Td, 37 reported coverage levels for measles vaccine, and 36 reported coverage levels for mumps and rubella vaccines. Four programs reported coverage levels for the combined MMR. The mean vaccination coverage levels among the reporting areas were 95.8 percent for poliovirus vaccine (range: 85.1 percent-99.8 percent), 95.7 percent for DTP/DT/Td (range: 77.6 percent-99.9 percent), 89.1 percent for measles vaccine (range: 78.0 percent-99.9 percent), and 89.1 percent for mumps and rubella vaccines (range: 78.0 percent-99.9 percent).

Kindergarten/First Grade: Of the 64 reporting areas, 43 (67.2 percent) submitted coverage levels for children enrolled in kindergarten and first grade. Of these 43 programs, 42 reported coverage levels for poliovirus vaccine and DTP/DT/Td, and 43 reported coverage levels for measles, mumps, and rubella vaccines. Four of the 43 programs reported coverage levels for the combined MMR. The mean vaccination coverage levels among the reporting areas were 96.7 percent for poliovirus vaccine (range: 82.8 percent-99.9 percent), 96.7 percent for DTP/DT/Td (range: 82.8 percent-99.8 percent), 96.0 percent for measles vaccine (range: 82.8 percent-99.9 percent), and 96.5 percent for mumps and rubella vaccines (range: 82.8 percent-99.9 percent).

Interpretation: High levels of vaccination coverage among children entering school most likely result from the successful implementation of state-specific school vaccination laws, which have applied to children entering school in all states and the District of Columbia since at least 1990. All states, territories, and the District of Columbia have additional laws that require vaccination of children in licensed day care facilities. However, because a high proportion of states and territories did not submit vaccination coverage reports to CDC, these estimated means may not reflect levels for all children in the United States.

***********************************

To view the complete text of this surveillance summary report online in text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4909a2.htm

Back to Top

REPORT 3: INFLUENZA, PNEUMOCOCCAL, AND TETANUS TOXOID VACCINATION OF ADULTS--UNITED STATES, 1993-1997

This report offers adult vaccination rates for influenza, pneumococcal, and tetanus toxoid by sex, race/ethnicity, poverty status, education level, insurance status, and medical condition. State-by-state information is given for influenza and pneumococcal vaccine by year and by race/ethnicity.

The abstract of this surveillance report is reprinted here in full:

***********************************

Problem/Condition: An increasing proportion of adults have received recommended vaccinations against influenza, pneumococcal infection, and tetanus. However, in 1995, fewer than 60 percent of adults were vaccinated as recommended.

Reporting Period Covered: 1993-1997.

Description of System: Data were obtained from the state-based Behavioral Risk Factor Surveillance System (BRFSS) for 1993, 1995, and 1997 and from the National Health Interview Survey (NHIS) for 1995 to describe national, regional, and state-specific patterns of use of influenza and pneumococcal vaccines and tetanus toxoid among noninstitutionalized adults aged 18 years or older.

Results: Among adults aged 65 years or older in 1995, 58 percent reported receiving an influenza vaccination during the previous 12 months, and 34 percent reported ever receiving a pneumococcal vaccination. In this age group, non-Hispanic whites were more likely to report receipt of influenza (61 percent) and pneumococcal vaccines (36 percent) than non-Hispanic blacks (40 percent and 22 percent, respectively) and Hispanics (50 percent and 23 percent, respectively). Among the 50 states and the District of Columbia, the median vaccination level among older adults (i.e., persons aged 65 years or older) increased from 51 percent in 1993 to 66 percent in 1997 for influenza vaccine, and from 28 percent in 1993 to 46 percent in 1997 for pneumococcal vaccine. Adults with chronic medical conditions had low vaccination levels. Those aged 50-64 years were more likely than those aged 18-49 years to report influenza (38 percent versus 20 percent) and pneumococcal vaccination (20 percent versus 12 percent). In 1995, the proportion of adults who reported receiving a tetanus vaccination during the previous 10 years decreased with age, from 65 percent among those aged 18-49 years to 54 percent among those aged 50-64 years and to 40 percent among those aged 65 years or older. In each age group, women were less likely than men to report receiving tetanus toxoid; and among adults aged 65 years or older, Hispanics and Asians/Pacific Islanders were least likely among all racial/ethnic groups to report receiving tetanus toxoid.

Interpretation: By 1995, the Healthy People 2000 objective to increase to at least 60 percent the proportion of persons aged 65 years or older who had received annual influenza vaccination had been achieved among non-Hispanic whites (objective 20.11). However, substantial improvement is needed among non-Hispanic blacks, Hispanics, and adults aged less than 65 years with high-risk medical conditions.

Public Health Actions: Continued surveillance of vaccine coverage among adults will direct attention to undervaccinated populations that may be disproportionately affected by vaccine-preventable diseases. Vaccination coverage data can be used to guide efforts to increase awareness among health-care providers and the public about the benefits of vaccination, establish systems to ensure that every contact with the health-care system is used to update vaccinations, and further support financial mechanisms to increase vaccine delivery.

***********************************
To view the complete text of this surveillance summary report online in text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4909a3.htm

To obtain a camera-ready copy (PDF format) of the entire surveillance summary (72 pages), including all three reports, go to: http://www.cdc.gov/mmwr/PDF/ss/ss4909.pdf


HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR
To obtain a free electronic subscription to the "Morbidity and Mortality Weekly Report" (MMWR), visit CDC's MMWR website listed below. Select "Free MMWR Subscription" from the menu at the left of the screen. Once you have submitted the required information, weekly issues of the MMWR and all new ACIP statements (published as MMWR's "Recommendations and Reports") will automatically arrive in your e-mail box. To go to the MMWR website, visit: http://www.cdc.gov/mmwr/