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CDC Announces Vaccine Coverage Rates for Children Aged 19-35 Months

September 4, 2008

OPERATOR: Welcome, and thank you for standing by. At this time, all parties have been placed on a listen-only mode until the question-and-answer session. To ask a question during today′s conference, please press star (*), followed by one (“1”) on your touchtone phone. Today′s conference is being recorded; if you have any objections, you may disconnect at this time.

I′d now like to turn the call over to Mr. Curtis Allen. Sir, you may begin.

CURTIS ALLEN: Yes, I′m Curtis Allen with the media relations division at CDC. Thank you for joining us today. Our topic today is coverage rates among children aged 19 to 35 months by Dr. Julie Gerberding, who, as you know, is director of the Centers for Disease Control and Prevention. We also have Dr. Anne Schuchat; that′s A-n-n-e S-c-h-u-c-h-a-t. Dr. Schuchat is the director for the National Center for Immunization and Respiratory Diseases.

A couple of other points before we get started is that on the – at www.cdc.gov/vaccines we have graphs that you can look at and use in your reports. With that, I will turn it over to Dr. Julie Gerberding, who will make a few remarks, and then she will have to return to her meeting. And then I will turn it over to Dr. Schuchat, who will make – go into depth about the study and respond to questions.

Thank you. Dr. Gerberding?

DR. JULIE GERBERDING: Thank you, and thanks for joining us today for this important briefing. You know, each fall when it′s back-to-school time or maybe back-to-daycare time, CDC releases its annual report card. This really gives us a sense of our overall success in protecting our toddlers from vaccine-preventable diseases. Our healthcare providers, and especially our parents and caretakers of these young children have done a great job in 2007, and I′m pleased to say that our immunization report card is very good. Our 2007 National Immunization Survey indicates that we′re above – we′re at our goal of 90% coverage for all but one of the vaccines in the recommended series, and for the series of recommended vaccines we remain steady at 77%, which is very close to our target of 80%.

So let me just clarify what that means: For individual vaccines, we have a goal of 90% coverage; and for a child to have received each one of the vaccines that they′re supposed to achieve, our national goal is 80%. Vaccines save lives and prevent suffering, as you know. This program over time has prevented about 14 million cases of vaccine-preventable diseases and 33,000 premature deaths over the cohort of babies included in the catchment. So in other words, for children born in the vaccine age group, a huge number of deaths and cases of disease are prevented through this national program

The problem with this is that it tends to allow some people to relax their vigilance about getting their kids vaccinated, and I know many parents are worried and concerned about vaccines and vaccine safety. But we hope that people will look at these data as encouraging from the standpoint of protecting our overall population of toddlers and children, but also know that if they have any concerns about immunization to please check with a healthcare professional because we want to make sure their questions and concerns are addressed.

A sobering aspect of our failure to adequately protect children really has emerged recently with the measles outbreak that we reported on a couple of weeks ago. Many of the children who were affected by this were not vaccinated adequately against measles because their parents chose not to do so, and some of them were children who were just too young to be fully immunized through the vaccine program. So these diseases that our children in America are so highly protected from through our immunization program still can be imported from many other places in the world. We are basically one traveler away from creating a threat to unvaccinated kids. So while we′re so pleased with our record high vaccination rates, we have to remain vigilant and we can′t let down our guard until the whole world is protected as we are.

We really recognize that ultimately our program is dependent on trust, trust of moms and dads, trust of caretakers, and trust of the clinicians, pediatricians, family practice professionals who take care of our children. If people have concerns, I do indeed encourage them to contact their healthcare providers for information and advice. I also appreciate the individual healthcare providers who take the time every day to discuss the benefits and risks for vaccine with parents. It′s really their commitment and trusting relationship that builds the sustained success of this immunization program.

So I′m going to ask Dr. Schuchat to provide you some of the specifics on a vaccine-by-vaccine basis and of course follow up some of the details that are in the MMWR. So, Curtis, you want to switch it over to Anne?

CURTIS ALLEN: Okay, thank you, Dr. Gerberding. Anne?

DR. ANNE SCHUCHAT: Hello. And thank you, Dr. Gerberding. Just two weeks ago we talked with you about some concerning news about measles cases and outbreaks that we′ve seen here in the United States this year. Today I′m glad to be able to deliver some good news about immunization coverage, but I also want to clarify the relationship between the survey results we′re releasing today and the measles situation because I think it can be confusing.

Let me just remind you that for every year′s worth of babies that are born in this country, our vaccine program is preventing 14 million infections and preventing 33,000 premature lives lost. We′re also saving about $44 billion in direct and indirect costs. So our vaccine program does save lives and prevents severe infection, and we monitor closely our immunization in young children, toddler age group, to make sure we′re making progress in sustaining the high immunization rates we′ve seen in the past.

So what is the news today? Today we′re releasing the 2007 National Immunization Survey results, and it′s coming out in our MMWR. What we report is results on a survey of over 17,000 children whose vaccination records are confirmed in their doctor′s office. So this is a large survey, and it covers children who were born between January 2004 and July 2006 and their vaccinations up through that age of 19 to 35 months.

As you heard from Dr. Gerberding, the 2007 survey shows sustained record levels of immunization coverage in children 19 to 35 months of age. We have 77.4% of U.S. children receiving the full series of vaccines; that′s compared to 76.9% last year. So we′re sustaining high rates. Our target is 80% for that series coverage.

If we break down the series, it involves six different vaccines: the Diphtheria/Tetanus/Pertussis vaccine, the Polio vaccine, the MMR, the Haemophilus Influenzae B vaccine, Hepatitis-B vaccine, and Chickenpox vaccine. So of those six vaccines, for five of the six we′re above 90% coverage. So we′ve achieved 90% coverage or exceeded it for Polio, MMR, HIB, Hepatitis-B, and Chickenpox. That′s really good news. The only vaccine that isn′t over the 90% point yet is the Diphtheria/Tetanus/Pertussis (or Whooping Cough) vaccine, and that′s at 84.5% for the full four-dose coverage; it′s higher than that for the three-dose coverage.

I want to mention two particular things about vaccines where we′ve seen some changes in this past year or reached some milestones. The Chickenpox vaccine reached 90% this year for the first time ever, so it′s reached our goal for the Healthy People 2010 Process, and that′s really good news. We also reported recently about major progress in preventing Chickenpox disease and hospitalizations, and this high coverage is making that possible.

The other vaccine which had a lot of progress this year is the Pneumococcal Conjugate vaccine. That vaccine prevents several types of meningitis, pneumonia, bloodstream infections, and ear infections…very common conditions in young children. We′ve seen important progress in the Pneumococcal Conjugate vaccine particularly in light of supply problems that we had in the first few years that vaccine was available. Three doses of Pneumococcal Conjugate vaccine have gone from 86.9% last year to 90.0% in 2007. Coverage with four or more doses has risen from 68.4% to 75.3% now. So this is great progress, and we′re pleased to see that continuing.

We also are glad to be able to report that the vaccine coverage levels are similar across all racial and ethnic groups for the vaccine series. There were some specific findings that we wanted to mention. We saw important increases in vaccination coverage among American Indian and Alaskan Native children in particular vaccines, and I′m happy to answer questions about that if you have any. But this was very good news for that important population.

We also continue to have vaccine coverage gaps in poor children compared with others. But the good news this year is that the gap between those children living in poverty and other children is narrowing. So we are making progress, but we′re not finished with all the work we have to do there. So while this general report card is good and we have a lot of good news today, we still have a lot more work to do. And in particular I want to mention the wide variation we have from state to state. This is not new. We′ve seen this in many years, but it′s important to stress that the numbers I′ve been talking about are national averages, not state-by-state figures, and the MMWR will include each state′s report card.

We have variation in the series coverage going from a high of 91.3% in the state of Maryland to the lowest estimate of 63.1% in the state of Nevada.

We also sample only a small number of local areas, cities, or counties, and there′s wide variation in those estimates as well. Philadelphia comes in as our top local area with a coverage of 82.2%.

In general, the survey confirms that most parents in the United States are vaccinating their children. Less than 1% of the toddlers in this survey had received no vaccines at all by the age of 19 to 35 months. So nearly all parents are vaccinating their young children according to our survey results.

So with all this good news, it may be hard to understand why we′ve been having these measles outbreaks and cases that we′ve talked with you about over the past couple months. So I want to explain a little bit about that because it′s really important that we not take this good news to mean that we′re finished with all the work we have to do. We can′t let down our guard when it comes to protecting children against vaccine-preventable diseases. You know, we′re reporting on state information and national information and certain local area information, but we don′t have survey data for every single community in the United States. And if unimmunized children cluster in a small community, we may not pick that up in the survey based on the way that we do it. That kind of cluster or small area of low immunization might not be visible in our national and state rates. But that clustering is plenty; it′s enough to lead to measles transmission. Measles is extremely contagious, and when it′s introduced, even into a small community, you can see spread to almost everybody who′s unimmunized.

As we′ve said before, measles is so common in other parts of the world with more than 240,000 deaths due to measles last year around the world and about 20 million measles cases around the world. So we believe importations from the rest of the world are very common, and it′s our high immunization rates that keep us from having more measles than we′re seeing. Another reason that our survey may not have picked up the most detailed immunization information, besides the state and national trend situation, is that we′re reporting data for the 2007 survey, which talks about immunizations that occur for children born between January 2004 and July 2006. So if there have been major changes in parents vaccinating their babies in the past nine months, we wouldn′t have picked that up in our survey, and it′s next year where we would be able to see something like that. I′m not saying that we expect that, but we wouldn′t have found it yet if something very, very different was going on this year from last year.

It′s so important for parents to get their questions answered when they have questions about vaccines, and we really encourage parents to talk to their healthcare providers about vaccines and about the risks and benefits so that they can be comfortable about the decisions they′re making. Achieving and maintaining high vaccination coverage is going to be important to further reduce the burden of vaccine preventable diseases and to prevent a major resurgence of measles or similar diseases that have already been eliminated in the United States. So continued partnerships from our national, state, local, private, and public entities are needed to keep these high levels that we′re reporting and ensure that the vaccination programs in the states remain strong.

The good news we′re reporting today would not have been possible without substantial efforts of parents, healthcare providers, and public health programs. Their selective efforts translate to healthier children, and that′s really the bottom line. So I′d like to answer questions that you might have right now.

CURTIS ALLEN: Okay, Wendy. Let′s open it up for questions for Dr. Schuchat.

OPERATOR: Thank you. At this time, to ask a question please press star (*), followed by one (“1”) on your touchtone phone. You will be prompted to record your name. To withdraw your request, please press star (*) followed by two (“2”). Once again, please press star (*), one (“1”) to ask a question.

One moment, please, for the first question.

Our first question is from Michael Smith of Med Page Today. You may ask your question, please.

MICHAEL SMITH: Yeah, hi. I′m having a little bit of problem with the arithmetic I think. You′re talking about 77% national coverage, if I read MMWR correctly, with the 4-3-1-3-3-1 series, 77.4%. And then it goes on to say national coverage was greater than 90% for each of the vaccines included except for more than four doses – or four doses of DTAP. And

I can′t reconcile those numbers. Can you explain that a little bit?

DR. ANNE SCHUCHAT: Yes, absolutely. If you look just at one vaccine, you can be at 90%, but a child needs to be – have received each one of those vaccines in the series to get to the series coverage. So 90% of children have gotten the Chickenpox vaccine, and 92% of children have gotten the Measles, Mumps, Rubella vaccine; but it may not be the same children that missed the vaccine. So that′s why the combination/the series is always lower than the individual one.

CURTIS ALLEN: It′s not an average.

MICHAEL SMITH: Okay. Thank you.

CURTIS ALLEN: Our next question, please?

OPERATOR: Thank you. Will Dunham from Reuters, you may ask your question, please.

WILL DUNHAM: Hi. This is Will Dunham with Reuters in Washington. You all calling on parents to trust vaccine safety I′m assuming, how much do you hope that the study that came out yesterday on autism and vaccination will help that?

DR. ANNE SCHUCHAT: You know, it′s so important for parents to have good information and make wise decisions for the health of their children. I mean, the health of their children is the bottom line for most parents, and they′re trying to make good decisions. But we′re living in a world with a lot of information that can be competing and confusing. Yesterday′s report about the MMR vaccine and lack of association with autism was more good news in that situation. There have been lots of questions and a large number of studies at this point, but I think it′s very important for parents to raise their concerns with their doctor or nurse and feel comfortable about the decisions they′re making. It′s so important for parents to feel like they have good information because they′re ultimately responsible for their children.

WILL DUNHAM: And you are hoping that they are trusting of the safety of the vaccinations, correct?

DR. ANNE SCHUCHAT: You know, I think it′s really important that we have a good vaccine safety system in the United States that we carefully study vaccines before they′re licensed and that we evaluate their safety after they go into larger-scale use. And I think it′s important for parents to know – to understand what that system is and feel comfortable with it. I do think that parents are the ultimate decision-maker; and I believe if they get all the information, they will make wise choices.

CURTIS ALLEN: Next question, please.

OPERATOR: Thank you. Brian Hartman for ABC, you may ask your question, please.

BRIAN HARTMAN: Hi. Do you have any idea why Nevada is so low or why San Bernardino is so low?

DR. ANNE SCHUCHAT: You know, the circumstances in individual states and communities are very complex. I actually was fortunate enough to travel to Nevada last year to work with some of the health departments about their challenges, and I think every community is different, even within Nevada. The north and south of Nevada are different. So if you encourage the local media to follow up with their state health department… In general, we know there are some factors that can really increase immunization rates. Having a good immunization information system or registry can help track children and bring them in through recalls and reminder systems. Having strong partnerships between the public and private sectors/coalitions to help get the word out to the places where parents are can be important.

There are a lot of tools that doctors′ offices can use. There are important issues around financing that can be helpful. And I do think the circumstances are quite different in different communities. So for the particular challenges in Nevada or San Bernardino, you probably need to talk with the health authorities in those communities. But in general, it′s not just doing a good job and getting it done, it′s keeping the work going because it turns out that your statistics are only as good as the next babies that are born. And every day 12,000 babies are born in the United States totally susceptible to vaccine-preventable diseases. And our doctors, our parents, our public health programs needs to keep up with those new babies that are born.

CURTIS ALLEN: Next question, please.

OPERATOR: Thank you. Rob Waters from Bloomberg News, you may ask your question, please.

ROB WATERS: Hi. I don′t cover vaccines that often, so excuse my ignorance a little bit. Can you explain to me, do the 4-3-1-3-3-1 and 4-3-1-3-3-1-4 series include all of the other – you know, all the other individual vaccines? In other words, are they – and what does that represent? What do those numbers represent?

DR. ANNE SCHUCHAT: Right. We follow the series coverage, but we wait until a vaccine has been in use for several years before we start reporting on the series. So, for instance, Rotavirus vaccine was only licensed in 2006, and we′re not tracking that yet in this coverage, but we will a few years from now. So the 4-3-1-3-3-1 series is the current metric. It′s the current series that we′re tracking because it′s not just a year after the vaccine came out; you know, these are vaccines that have been used since 2007 or – I′m sorry, since 2000 or before. And so they′re all being included. But in a few years we′ll add the Rotavirus to the series and report on that.

The 4-3-1-3-3-1-4 also includes that Pneumococcal Conjugate vaccine, and that one as of next year we′ll start to include that – I′m sorry…yeah, as of 2009 we′ll start to include that as our formal way that we measure our progress against national targets called Healthy People 2010 objective. So the MMWR reports on all these different connotations, but it′s really the 4-3-1-3-3-1 that states are trying to aim for at this point.

CURTIS ALLEN: The 4-3-1-3-3-1, what that means is that a child has had four doses of DTAP, one dose of MMR, one dose of Varicella, four doses –

DR. ANNE SCHUCHAT: Yeah. It′s basically doses of the DTAP, the Polio, Measles – the MMR vaccine, HIB, Hepatitis-B, and Chickenpox. And that′s the 4-3-1-3-3-1. We know it′s cumbersome and clumsy, and maybe for Healthy People 2020 we′ll come up with something catchier.

ROB WATERS: Okay. Thank you.

CURTIS ALLEN: Next question, please.

OPERATOR: Thank you. Bob Roche from Sigret [phonetic] News, you may ask your question, please.

BOB ROCHE: Thank you. I think you possibly addressed this maybe already, but I was just wondering about why the influenza vaccination wasn′t included in this report, since it′s recommended for small children now.

DR. ANNE SCHUCHAT: Yes, that′s right. There are two reasons: One reason is that it′s newly recommended and we don′t actually start including it in the series until later. We will be reporting on influenza coverage in young children later this fall. The other reason is that we haven′t actually yet established targets for influenza vaccination in young children, and that′s our progress that discussions are ongoing but we haven′t yet sorted out what appropriate health targets might be for that particular vaccine. It′s very different from the other childhood vaccines. There′s a shorter time period during which vaccinations can be given, and a catch-up doesn′t really make sense in terms of the summer months. And exactly what we are aiming to achieve with that in terms of disease control is still under discussion. So that′s not included for those reasons, but we will be reporting influenza vaccination coverage in the next few weeks I believe.

BOB ROCHE: Thank you.

CURTIS ALLEN: Our next question, please.

OPERATOR: Thank you. As a reminder, to ask a question please press star (*), one (“1”) at this time. Gabrielle Spritzer from Chicago Public Radio, you may ask your question, please.

GABRIELLE SPRITZER: Hello. Just one quick clarification and then my question. As far as the – I see, you know, several series broken out on the spreadsheet that you guys included. You′ve been talking about the 4-3-1-3-3-1, and then there′s also the 4-3-1-3-3-1-3 and the one that ends in four. So would you say that the 4-3-1-3-3-1 is the operative benchmark?

DR. ANNE SCHUCHAT: Correct.

GABRIELLE SPRITZER: Okay, thank you. So my question is you talked a little bit about the income disparities, the disparities of immunizations among different income groups. There has been anecdotally some discussion that folks who decline to vaccinate their kids tend to be concentrated in the upper income brackets. I wonder if you′ve found anything along those lines, that affluent people are vaccinating any less?

DR. ANNE SCHUCHAT: Thank you for that question. The survey results that we′re reporting today are the immunization coverage information, but they don′t include analysis by various income levels – I′m sorry. They don′t include attitudes about vaccination. And the point that I wanted to make here was that as of 2008 in the surveys that we′re carrying out right now and going forward, we have a new extra module that′s part of this national immunization survey that′s asking parents about their attitudes and beliefs about vaccines so we can understand more about concerns that parents may have or factors that lead parents to consider delaying or deferring the vaccine. So I think the anecdotal information that you suggested may or may not turn out to be true, and we really hope to learn more about that in a systematic way to follow over time, to understand at the national and state level where we′re going with attitudes and concerns.

We know that for years – actually decades – poor children had a much harder time getting all the vaccines that they needed. And in 1994, a new program, the Vaccines for Children program came out, which really helped overcome the financial barriers that families had to getting their children vaccinated. And we′ve seen a really wonderful narrowing of the poverty gap in the era of the Vaccines for Children program. But it′s not disappeared. And so it′s still in our national data that coverage is lower among poor children than among the affluent or those who are of middle income.

But we do hope in the future to get more information about which parents are concerned about what kinds of things related to vaccines and try to get information to those parents and their providers that will address the concerns that they have.

CURTIS ALLEN: Next question, please. Are there any more questions?

OPERATOR: I′m showing no further questions.

CURTIS ALLEN: Okay. In that case, thank you very much for joining us today. A couple of reminders: If you have additional questions, please call the division of media relations at CDC at 404-639-3286. Also we hope you view our new website at www.cdc.gov/media. There are a lot of resources there. We hope you visit that site. We would also like you to know that the transcript of this briefing will be on that site later this afternoon. Thank you. Thank you very much for joining.

END

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