Issue Number
192
September 22,
2000
CONTENTS OF THIS ISSUE
CDC PUBLISHES SURVEILLANCE SUMMARY ON VACCINATION
COVERAGE AMONG CHILDREN AND ADULTS--UNITED STATES
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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:
- National, State, and Urban Area Vaccination Coverage
Levels Among Children Aged 19-35 Months--United States, 1998
- Vaccination Coverage Among Children Enrolled in Head
Start Programs or Day Care Facilities or Entering School
- Influenza, Pneumococcal, and Tetanus Toxoid Vaccination
of Adults--United States, 1993-1997
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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:
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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.
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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
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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:
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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.
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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.
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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/
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