Tony Aragon, MSEpidemiologist

Immunization BranchMay 20, 2010

Vaccine Coverage

Vaccine Coverage 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

Survey Data collected Ages Area When

NIS Children(CDC)

Dates of vaccinations, race/ethnicity, other,

demographics19-35 months

Texas, Dallas County, El Paso County, City of Houston, and Bexar County

Annually (Summer)

NIS Teens(CDC)

Dates of vaccinations race/ethnicity, other,

demographics13-17 yrs United States Annually

TCRISS(DSHS)

Dates of vaccinations, total enrollment of school,

exemption dataKindergarten students County level Ongoing

Texas School Immunization Validation Survey

(DSHS)

Dates of vaccinations, total enrollment of school,

exemption data

Statewide sample of kindergarten and 7th

Grade studentsState of Texas

Annually(Fall)

Child Care Assessment(DSHS)

Dates of vaccinations, total enrollment of Child care facility, exemption data

19-59 monthsLicensed childcare

facilitiesAnnually

(Fall)

BRFSS(CDC)

Vaccination rates, race ethnicity, other demographics

Adults 18 and over US and Statewide Annually

Texas Annual School ReportVaccination rates, exemption

dataKindergarten and 7thGrade

studentsCounty Level and State

LevelAnnually

(Fall)

Current Immunization Data Sources

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)

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

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.

4:3:1:3:3:1* Estimated Vaccination Coverage Levels in 4:3:1:3:3:1* Estimated Vaccination Coverage Levels in Children 19-35 Months, US and Texas, NIS 2002-2008Children 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

Estimated Vaccination Coverage Levels in ChildrenEstimated Vaccination Coverage Levels in Children19-35 Months by State and Local Area, NIS 2008* 19-35 Months by State and Local Area, NIS 2008*

*Based on 2008 US NIS Report (Q1/2008-Q4/2008)

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

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 (7th grade)

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

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

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 – 1st dose 99.8

MMR (or measles) vaccine – 2nd dose 98.2

Varicella Vaccine 98.1

Hepatitis B vaccine 98.0

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

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

82.5 81.9

93.7

78.983 83.8 83.3 85

82.3

0

20

40

60

80

100

1 2/3 4/5N 6/5S 7 8 9/10 11 State

HSR

% V

acc

ina

ted

91.1 92.297.5

8689.8 89.6 90.1

9390.1

0

20

40

60

80

100

1 2/3 4/5N 6/5S 7 8 9/10 11 StateHSR

% V

acc

ina

ted

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

Vaccination Coverage for Adolescents

2008 NIS-Teen Survey 2007 Texas School Immunization Validation

2008-09 Annual Report of Immunization Status

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

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

88.9

81.675.7

72.3

32.4

25.1

0

20

40

60

80

100

2+ MMR 3+ HepB 1+ VAR 1+Td/Tdap

1+ MCV4 1+ HPV

Vaccines

% V

ac

cin

ate

d

Estimated Vaccine Coverage Level in Texas Public School for 7th Grade Students, 2007 Texas School Immunization Validation Survey

Vaccine Requirement*% of 7th 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 – 1st dose 94.4

MMR (or measles) vaccine – 2nd dose 93.4

Varicella Vaccine 96.2

Hepatitis B vaccine 98.2

Percent of 7th Grade Students Completely Vaccinated with Individual Vaccine by Health Service Region, 2008-09 Annual Report of Immunization Status

HSR Tdap Hepatitis B MMR Polio Varicella

1 36.5% 99.6% 99.7% 99.3% 99.7%

2 47.9% 99.5% 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% 99.6%

5 72.6% 99.5% 99.5% 98.7% 93.4%

6 57.8% 99.2% 99.2% 99.1% 99.1%

7 53.8% 99.1% 90.4% 99.2% 99.1%

8 74.1% 99.3% 99.3% 99.4% 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% 99.8%

Vaccination Coverage for Adults

The Behavioral Risk Factor Surveillance System (BRFSS)

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

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

Flu Vaccine Coverage Level, US & TX18 Years and Older, BRFSS 2003-2009

Pneumonia Shot, US & TX65 Years and Older, BRFSS 2002-2009

Other Immunization Data

Conscientious Exemptions Conscientious Objections (COs)

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

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

2008-09 Annual Report of Immunization Status: Kindergarten Conscientious Exemptions

Kindergarten Conscientious Exemptions

Vaccine Category Number (%)

DTP/DTaP 1383 0.43

Hepatitis B 1215 0.38

Measles 1 1241 0.38

Measles 2 1407 0.38

Mumps 1316 0.41

Polio 1368 0.42

Rubella 1315 0.41

Varicella 1237 0.38

2008-09 Annual Report of Immunization Status: 7th Grade Conscientious Exemptions

7th Grade Conscientious Exemptions

Vaccine Category Number (%)

Tdap 431 0.14

Hepatitis B 503 0.16

MMR 516 0.16

Polio 498 0.16

Varicella 528 0.17

Annual Report of Immunization Status: Total Number of Conscientious Exemptions Reported, School Year 2003-2008

SchoolYear

Number of Students Enrolled with a Conscientious Exemption

Percent of Students Enrolled with a Conscientious Exemption

2003-04 2,314 0.08%

2004-05 2,722 0.09%

2005-06 6,991 0.15%

2006-07 9,606 0.21%

2007-08 10,404 0.23%

2008-09 12,633 0.28%

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

Legend

0

1 - 126

127 - 265

266 - 659

660 - 1194

No Data

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 ImmunizationStatus, School Year 2007-08

DSHS, Immunization Branch

Map Created by: DSHS Center for Health Statistics

Questions?

Tony Aragon, MSEpidemiologist

Tony.aragon@dshs.state.tx.us