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Vaccination Coverage among Adults

Vaccination Coverage among Adults. NVAC Session on Adult Immunization October 22, 2007 James A. Singleton, MS Chief, Assessment Branch Immunization Services Division NCIRD/CDC. The findings and conclusions in this presentation are those of the presenter and do not necessarily

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Vaccination Coverage among Adults

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  1. Vaccination Coverage among Adults NVAC Session on Adult Immunization October 22, 2007 James A. Singleton, MS Chief, Assessment Branch Immunization Services Division NCIRD/CDC The findings and conclusions in this presentation are those of the presenter and do not necessarily represent those of the Centers for Disease Control and Prevention

  2. Purpose of Presentation • Review data sources for assessment of adult vaccination coverage • Present available estimates and trends in coverage • Vaccines in the ACIP Adult Immunization Schedule 10/2006-9/2007 • Zoster vaccine • Discuss limitations, gaps and plans for adult vaccine coverage assessment

  3. Six Roles of Immunization ProgramsInstitute of Medicine, 2000, “Calling the Shots” Assure Vaccine Purchase AssureServiceDelivery Control and PreventInfectiousDisease What gets measured, gets done Surveillanceof Vaccine Coverageand Safety Sustain and ImproveCoverage Rates Immunization FinancePolicies and Practices

  4. Data Sources for Population-based Estimates of Vaccine Coverage among Adults

  5. National Health Interview Survey (NHIS) • Annual In-home survey of U.S. noninstitutionalized population • Detailed health survey of a sample adult • Vaccination questions • ≤ 2007: Influenza, PPV, HepB • ≥ 2008: add HPV, Zoster, Td/Tdap, HepA • Provides national coverage estimates • Monitors Healthy People 2010 objectives

  6. National Immunization Survey-Adult • Periodic national telephone survey • Conducted 2003, 2004, 2007 • Collects more timely & detailed information • 2007 survey • Conducted May-August • National samples by age and race/ethnicity • 18-49 (n=1,807), 50-64 (n=2,073), ≥65 years (n=3,087) • Influenza, PPV, HepB, HepA,Td/Tdap,HPV, Zoster • Reasons for non-receipt of vaccination • Results at Feb. 2008 Prevention Conference

  7. Behavioral Risk Factor Surveillance System (BRFSS) • State-based, random-digit-dialed telephone survey of U.S., civilian, noninstitutionalized adults • Influenza, PPV, HepB on core survey • Optional modules states can use • HPV, influenza high-risk conditions, HCW status added 2008 • Td/Tdap, zoster vaccine for 2009

  8. Adult Vaccination Surveys(self-report)

  9. Immunization Surveys in U.S.-Affiliated Jurisdictions • Areas receive immunization grant funds • Telephone surveys not feasible • Face-to-face household surveys • review shot cards & medical records to verify immunization status • Children 12-35 months, 6 years • Adults ≥50 years (influenza, PPV, Td) • Repeat each area every other year • 2005: C. Northern Marinara Islands (CNMI) • 2006: Federated States of Micronesia, Puerto Rico • 2007: Palau, Guam Marshall Islands, CNMI, American Samoa, Virgin Islands (2007 or 2008)

  10. National Nursing Home Survey • Healthy People 2010 objective 14.29 e • Measured by National Nursing Home Survey (NNHS), 1995, 1997, 1999, 2004 • 66% vaccinated, 1999 (90% target) • Influenza vaccination included on 2004 National Nursing Assistant Survey • Supplement to 2004 NNHS

  11. Nursing Home ResidentsCMS Minimum Data Set (MDS) • Resident assessments required at entry and periodically • Required elements include influenza, pneumococcal vaccination • Quality measures available online • Nursing Home Compare • NCIRD developing vaccine coverage estimates to assist state and local immunization programs • Facility-level, state-level

  12. Other Data Sources • Medicare population • Medicare Current Beneficiary Survey • Medicare claims data • Health and Retirement Survey • Health-care systems data • VSD, Medstat • PRAMS (pregnant women), selected states • Published studies in specific populations • Numerator data • Vaccine purchase/distribution data • National Ambulatory Medical Care Surveys • Serologic evidence of immunity (NHANES)

  13. Estimates of Vaccine Coverage among Adults

  14. Tetanus vaccination in the past 10 yearsby age group, NHIS 1999

  15. HPV Coverage • Preliminary results from 2007 NIS-Adult • National data from 2008 NHIS available June 2009 • Data in selected states from 2008 BRFSS available March 2009

  16. Figure 1. Rubella seropositivity by age group at time of survey, National Health and Nutrition Examination Survey (NHANES) III (1998–1994) and 1999–2004. The line with diamonds represents NHANES 1988–1994. The line with the squares represents NHANES 1999–2004. Stars indicate significant changes in rubella IgG seropositivity between survey periods (P _ .05). The dashed and dotted line indicates the modeled threshold of rubella immunity necessary for prevention of viral transmission. Source: Hyde TB, Kruszon-Moran D, McQuillan GM, Cossen C, Forghani B, and Reef SE. Rubella Immunity Levels in the United States Population: Has the Threshold of Viral Elimination Been Reached? Clinical Infectious Diseases 2006; 43:S146–50

  17. Varicella Immunity • NHANES 1988-1994 (Kilgore et al. J Med Virol 2003) • 86.0% ages 6-11 years • 99.6% ages 40-49 years • Military recruits, 1997-2000 (Ryan et al. J Med Virol 2003) • 93% seropositive

  18. Self-Reported Influenza Vaccination in the Past 12 Months, Selected Priority U.S. Populations, 1989-2006, National Health Interview Survey Vaccine shortage: 2004-05 season

  19. Self-Reported Influenza Vaccination in the Past 12 Months, Selected Priority U.S. Populations by Race/ethnicity, 2006, National Health Interview Survey

  20. CDC. Prevention and Control of Influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR 2006;56(RR-6)

  21. Monthly Distribution of Seasonal Influenza Vaccination Uptake, 2004-05 National Health Interview Survey (NHIS) 2005

  22. Self-Reported Pneumococcal Vaccination (ever), Selected Priority U.S. Populations, 1989- 2006, National Health Interview Survey

  23. Self-Reported Pneumococcal Vaccination (ever), Selected Priority U.S. Populations by Race/ethnicity, 2006, National Health Interview Survey

  24. Influenza and Pneumococcal Vaccination Among Nursing Home Residents, 1997-2004 National Nursing Home Survey 90% Target: Healthy People 2010 Objectives 14.29 e, f

  25. Hepatitis A Vaccine Coverage • Preliminary results from 2007 NIS-Adult • National data from 2008 NHIS available June 2009

  26. Self-reported Hepatitis B Vaccination Among Adults at Increased Risk for HBV Infection, 2004 National Health Interview Survey Vaccine Coverage, % MMWR 2006; 55(18);509-511

  27. Zoster Vaccine Coverage • Preliminary results from 2007 NIS-Adult • National data from 2008 NHIS available June 2009

  28. Summary

  29. Influenza Vaccination Coverage Levels • Substantially below Healthy People 2010 objectives • Stable or slightly increasing coverage • Lower coverage in shortage season • Large racial/ethnic disparity for ages ≥65 • Substantial variation by state for ages ≥65

  30. Pneumococcal Vaccination Coverage Levels • Substantially below Healthy People 2010 objectives • Gradually increasing coverage • Large racial/ethnic disparities • ages ≥65 for blacks, Hispanics • High risk ages 50-64 for Hispanics • Substantial variation by state for ages ≥65

  31. Coverage Levels for Other Vaccines • Tetanus: • <70%, decreases with age • Hepatitis B: • Substantially below Healthy People 2010 objectives • Closer for occupationally exposed workers • No data for MMR, varicella, meningococcal vaccines • Data coming for HPV, HepA, Zoster

  32. Data AvailabilityAdult Vaccination Coverage

  33. Limitations

  34. Validity studies of self-reported adult FLU & PPV vaccination status

  35. RFA to study the validity of self-reported adult vaccination status • Posted date: February 2008 • Study vaccinations by age groups • TIV; LAIV; PPV; Td; Tdap; & HepA per 18-49, 50-64 & 65+ • HepB per 18-49 & 50-64 • Zoster per 50-64 & 65+ • HPV per 18-26 & 27-49 • Other subgroups • gender, risk, race/ethnicity and off-label • Minimum sample size in each studied group: 400 • Electronic records required • Study subjects: those with complete and accurate vaccination records for a true gold standard • Will measure net bias (over-reporting minus under reporting) • $500,000/yr for two years

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