National Immunization National Immunization Program ReportProgram Report

NVACWashington, DC February 3-4, 2004

Stephen L. Cochi, M.D., M.P.H.Acting Director, National Immunization Program

Centers for Disease Control and Prevention

Dr. Walter A. OrensteinDr. Walter A. OrensteinNational Immunization ProgramNational Immunization Program

Switzerland 2004

India 1974

Comparison of 20Comparison of 20thth Century Annual Century Annual Morbidity and Current Morbidity, Morbidity and Current Morbidity,

Vaccine-Preventable DiseasesVaccine-Preventable Diseases20th Century

Annual Morbidity†2003*

(Provisional)

PercentDecrease

Diphtheria

Measles

Mumps

Pertussis

Polio (paralytic)

Rubella

Congenital Rubella Syndrome

Tetanus

H. influenzae, type b and unknown (<5 yrs)

175,885

503,282

152,209

147,271

16,316

47,745

823

1,314

20,000‡

1

42

197

8,483

0

7

0

14

213

99.99%

99.99%

99.87%

94.29%

100%

99.99%

100%

98.93%

98.94%

Disease

† Source: CDC. MMWR April 2, 1999. 48: 242-264

* Source: CDC. MMWR January 9, 2004. 52:1277-1300‡ Data are estimated.

Numbers in yellow indicate at or near record lows in 2003

Estimated Vaccination Coverage with Individual Estimated Vaccination Coverage with Individual Vaccines Among Children 19-35 Months of Age, Vaccines Among Children 19-35 Months of Age,

National Immunization Survey,National Immunization Survey,Q3 2002-Q2 2003Q3 2002-Q2 2003

VaccineVaccine Coverage (percent)Coverage (percent)3+ DTP 96

4+ DTP 83.2

3+ Polio 91

1+ MMR 92.6

3+ Hib 93.7

3+ Hep B 91.9

1+ Var 82.5

3+ PCV 59.1

4:3:1 80.7

4:3:1:3 79.8

4:3:1:3:3 77.9

4:3:1:3:3:1 69.7(Numbers in yellow indicate record highs.)

Children in the Q3/2002-Q2/2003 National Immunization Survey were born between August 1999 and November 2001.

Duration of CDC-Reported Duration of CDC-Reported Childhood Vaccine ShortagesChildhood Vaccine Shortages

GAO Report, September 2002: Childhood Vaccines: Ensuring an Adequate Supply Poses Continuing Challenges, p. 8.

President’s Budget RequestPresident’s Budget Request, , FY 2005 FY 2005 Discretionary ImmunizationDiscretionary Immunization

FY 2003Enacted

FY 2004 Enacted

FY 2005*President’s

BudgetDifference2004/2005

Section 317 Grants:Vaccine PurchaseOperations

222 M199 M

220 M198 M

111 M 198 M

-109 M

Program Operations:Prevention Activities**Global Immunization

82 M 148 M

74 M*** 151 M

74 M151 M

TOTAL 651 M 643 M**** 534 M - 109 M

* The proposed decrease to 317 vaccine purchase is offset by an increase to VFC. This offset in the President’s budget request anticipates Congressional action on proposed changes to VFC authorizing language.** Prevention Activities includes $14 M from section 241 of the Public Health Service Act for the National Immunization Survey.*** NVPO**** Funding reflects the $7.3 M transfer of the National Vaccine Program Office (NVPO) from CDC to the Office of Public Health and Science within HHS.

Vaccine Management Business Vaccine Management Business Improvement ProjectImprovement Project

Action taken in response to NVAC recommendation to develop immunization information systems

Comprehensive review of existing vaccine management systems, internal and external VFC business process, benchmarking of industry standards and recommendations on best practices

Goal is to develop and implement an automated, seamless VFC vaccine management system

We are very excited by the prospects for improvement of our system that this project offers.

Pediatric Vaccine StockpilePediatric Vaccine StockpileFebruary 2004February 2004

0

2

4

6

8

10

12

E-I

PV

Hep B

MM

R

Vari

cella

Hib

DTaP

Hep A

PCV

Millions

of D

ose

s

Target quantityDoses purchasedDoses delivered

National Infant National Infant Immunization Week (NIIW)Immunization Week (NIIW)

April 25 – May 1, 2004April 25 – May 1, 2004

New York, New York

Fairfax, Virginia

Dallas, Texas

Border Events

San Diego, California / Tijuana, Mexico

El Paso, Texas (Pending)

Vaccination Week in the Vaccination Week in the Americas - 1Americas - 1

April 24-30, 2004It will involve all 38 countries in the

Western Hemisphere, including U.S., Mexico, and Canada. (Last year, 19 South and Central American countries participated, and it was held in June). This is a first.

Vaccination Week in the Vaccination Week in the Americas - 2Americas - 2

It is primarily a PAHO and UNICEF endeavor although:- It coincides with the U.S. National Infant

Immunization Week;

- CDC/NIP is involved in and providing funding for an evaluation in three countries – Guatemala, Ecuador, and Paraguay. Goal is increased childhood vaccinations.

Vaccination Week in the Vaccination Week in the Americas - 3Americas - 3

All of the posters and visual materials have common visual elements – such as a common theme – “Vaccination is an Act of Love” (or Un Gesto de Amor).

Goals are:1. To promote and foster routine childhood vaccination and 2. To actually vaccinate children and women of

child-bearing age in hard to reach locations (e.g., very rural areas, indigenous people).

Vaccination Week in the Vaccination Week in the Americas - 4Americas - 4

In the U.S. and Canada, the primary goal is to promote increased visibility and awareness for childhood immunizations – and there won’t be specific national efforts to find and vaccinate under-immunized children, though it is likely some health departments may hold vaccination clinics or extend hours at clinics.

Vaccination Week in the Vaccination Week in the Americas - 5Americas - 5

Border events are being jointly planned with Mexico, and will take place in El Paso, Texas, and San Diego border areas, and involve the nearby Mexico communities.

There is discussion of doing this worldwide, perhaps as early as 2005.

5050thth Anniversary of the Start Anniversary of the Start of Polio Clinical Trialsof Polio Clinical Trials

NIP’s GoalsNIP’s GoalsGlobal Targets (GPRA) Tracked by OMBGlobal Targets (GPRA) Tracked by OMB

By 2005- Eradicate Polio

Reduce by 50% the annual global measles-related mortality compared with 1999 estimates (baseline 875,000 deaths)

By 2005-

Eliminate ongoing indigenous measles transmission in all 47 countries/territories of

the Americas

Also: Regional elimination of rubella/CRS by 2010.

Wild Poliovirus* 28 Jan 2003 to 27 Jan 2004

Data in WHO HQ as of 27 Jan 2004

*Excludes viruses detected from environmental surveillance and vaccine derived polio viruses.

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2004. All rights reserved

Case or outbreak following importation

Endemic countries

Wild virus type 1 Wild virus type 3

Wild virus type 1 and 3

Under investigation

Global ProgressMeasles Mortality Reduction by 50% by 2005 Measles Mortality Reduction by 50% by 2005

(compared to 1999: 875,000 deaths)(compared to 1999: 875,000 deaths)

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1999 2000 2001 2002 2003 2004 2005

Estimated Measles Mortality by Year

2002 estimate=614,000 deaths (WHO, WER Jan 16, 2004)