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Press Briefing Transcript

Media telebriefing on National Immunization Survey results

Tuesday, September 16, 2010 – 11:00am ET

Operator: Welcome and thank you for standing by. During the question and answer session, you may press 1 to ask a question. I will turn it over to Mr. Tom Skinner.

Tom Skinner: Thank you, Shirley, and thank you all for joining us. Hopefully, you all have a copy of today's Morbidity and Mortality Weekly Report which contains an article about national, state and local area vaccination coverage among children age 19 to 35 months of age in the United States for the year 2009. With me today is Dr. Anne Schuchat. That's A-N-N-E, S-C-H-U-C-H-A-T. She is the director of the National Center for Immunization and Respiratory Diseases. She is going to provide a brief opening statement regarding the data in the MMWR and then we will open the lines up to your questions. So, Dr. Schuchat.

Anne Schuchat: Thank you, Tom. Good afternoon, everyone. Today, we have reassuring news on the national childhood immunization front. I want people to know that vaccination rates in infants and toddlers remain high. We have increases in some of the newer vaccines or newer vaccine recommendations. But, we did see a drop in one vaccine that was in shorter supply during the period that this survey was conducted. We're reporting on the 2009 National Immunization Survey. The survey shows that immunization of children 19 to 35 months of age against vaccine preventable diseases is high. Fewer than 1 percent of young children did not get any vaccines at all. So fewer than 1 percent of parents of these young children were opting out of the vaccination system all together. The survey is carried out by telephone and this survey reports on results for 17,313 children who were born between January, 2006 and July, 2008 and about the vaccinations they had received by the time they were 19 to 35 months of age. We saw continuing high vaccine coverage against polio virus, against measles, mumps and rubella, against the hepatitis b virus, against chickenpox or varicella virus. Each of those vaccines had coverage that was near or above our target of 90 percent for children in this age group.

We saw increases in vaccination against hepatitis A and in receipt of a birth dose of hepatitis B. Those were two of the newer recommendations that we were tracking with this report. Coverage of those two vaccines increased. We saw an increase in hepatitis A coverage of 6 percent points and an increase in the birth dose of hepatitis B vaccine of 5 percent points comparing the 2008 and 2009 National Immunization Survey results. The survey detected a substantial drop in coverage of the haemophilus influenza b or Hib vaccine that we know was in short vaccine. During this period, we actually recommended suspension of a booster dose of vaccine because of the short supply. Our system detected that 83.6 percent of toddlers had received three doses of the Hib vaccine in the 2009 survey. That was down 6 percentage points from 2008 and reflects the national shortage that we were under. Fortunately, when we analyze the data about completion of the primary series of Hib vaccine, which could be two or three doses, depending on the type of vaccine, we found that 92 percent of children had received the appropriate primary series, consistent with the idea that providers were following the recommendation for dropping the booster dose during the shortage. The very good news about Hib vaccine is that the shortage is over and the vaccine is now readily available. That shortage was just between December 2007 and September 2009, but it was a bad enough shortage that it showed up in our national coverage estimate.

We got good news on the rotavirus vaccine front. Rotavirus vaccine was first licensed in the U.S. in 2006, with a second vaccine being licensed in 2008. Today's report is reporting for the first time on rotavirus vaccine coverage with our national data. It shows similar good uptake early in the course of a vaccine introduction. 44 percent of toddlers in this survey had received the rotavirus vaccine during their infancy. And when we look at just the youngest of toddlers in this survey, in terms of children born between January and June of 2008, 60 percent of those children had received the rotavirus vaccine series. So that's very good uptake of this vaccine. Of course, we are already seeing very important drop in disease caused by the rotavirus. We did see variation across the states in vaccine coverage. States with the highest and lowest coverage varied by particular vaccine. We saw several states had significant increases in completing four doses of the pneumococcal conjugate vaccine. We see state-to-state variation each year and that's an important thing to follow and an important area for state programs and providers to work on. We also saw some disparities in immunization by race or ethnicity and between poor and more affluent children. We have seen those over the years, fortunately the disparities are less than they used to be based on the successful Vaccines For Children programs, which provides them at no cost to uninsured and other vulnerable children. The VFC program has been quite effective in reducing, but not eliminating the gaps among children in vaccine coverage.

Today's report is generally very reassuring despite concerns we have seen in the past about whether parents are continuing to have their children vaccinated and despite some resurgences in vaccine-prevented diseases in particular areas. Today's national report provides good news. Most parents are continuing to make sure their children are receiving the recommended vaccines and keeping them protected against life-threatening, vaccine-preventable diseases. With that, I would be open to take questions.

Tom Skinner: Great. Shirley, we will take the first question. As we start the question and answer period, I want to remind the media on the call that the MMWR is embargoed until noon. While we started our media briefing at 11:00, the material is embargoed until noon. We will open up to Q and A.

Operator: We will now begin the question and answer session. If you would like to ask a question, please request star one and record your name clearly. To withdraw your question, please hit star 2. One moment for our first question. Our first question comes from Mike Stobbe with Associated Press. You may ask your question.

Mike Stobbe: Hi, doctor. Thanks for taking the call. I am curious about pertussis and about measles, two diseases we have seen increases in. I'm looking at table one. Three doses of dtp, Tdap. There is a decline from 2008 to 2009. Was that significant and why did that occur, do you think? I am also a few lines down wondering about MMR and the decrease from 2008. Was that significant and why do you think that occurred?

Anne Schuchat: Yea, thanks Mike. I think the pertussis and measles outbreaks we have seen are very important to mention. I don't think that the infant or toddler dtp series is the reason for those outbreaks of pertussis. We see the principle challenge there is ongoing pertussis transmission in teens and adults and the very youngest of children, babies under two months of age are the most vulnerable to serious complications of pertussis. We think that challenges are increasing vaccination of teens and adults. It continues to be important for babies and toddlers to get their dtap doses in. The measles was a significant drop but not a large drop. Between 2008 and 2009, MMR coverage fell from 92.1 percent down to 90.0 percent. That might be a warning sign of larger drops to come or a small change because our survey was so very large was statistically significant. On the other hand, nationally, the measles coverage rates can be high. 90 percent is our target to achieve for the first dose of MMR. You can still have communities with very large pockets of susceptible children. What we saw in 2008 was communities where certain schools had a large number of children who were unvaccinated when the virus was imported from other countries where measles still are very common. The virus could find a vulnerable population to spread in. Babies under one year of age don't yet receive measles vaccines and they are, again, very vulnerable.

These two examples show that we can't let our guard down. Vaccine-preventable diseases are everywhere around the world. We are lucky here in the U.S. that most of these are at record low levels. For some, like pertussis, we have an opportunity to really strengthen our protection by vaccinating adults, especially those around young babies, vaccinating teens and older and younger brothers and sisters of the babies and health care workers as well. With measles, we can never let down our guard in any community where there is a large number of susceptibles. You can see a measles outbreak. While we have been able to maintain our status as having eliminated the indigenous spread of measles, unfortunately, we saw a country like the United Kingdom, which had eliminated measles, unable to break the chains of transmission and now continuing to be facing a large outbreak. So I think this shows that every year, parents need to remain vigilant. We need providers to keep doing the great jobs of educating parents about vaccines, answering their questions and making sure they are able to protect their kids. Next question, please?

Operator: Thank you again. If you have a question, press star one. Our next question comes from Bill Hendrick with the WebMD.

Bill Hendrick: I am having a little trouble with my reading glasses and also with Table 2.

Anne Schuchat: Okay.

Bill Hendrick: The 95.4 for Alabama means what?

Anne Schuchat: Right. The 95.4 for Alabama means that 95.4 percent of children 19 to 35 months of age for Alabama have received at least one dose of the measles, mumps, rubella or MMR vaccine. So table 2. In the first row, you see the U.S. figures for MMR, pneumococcal conjugate vaccine, hepatitis B birth dose, hepatitis A series and rotavirus vaccine and then you have the individual state. We think it is important for people to be cautious about comparing each individual state because the confidence intervals are fairly wide. For Alabama, that plus or minus 2.9 percentage points means the survey is only accurate within that amount. For some of the smaller states, there are pretty large confidence intervals around that. You know, the uncertainty around the estimate. For each state, there is useful data here but there is an awful lot of data for your reporter. We're sorry about that.

Bill Hendrick: That's no problem. By my count, there were in that particular column there were 28 states plus D.C. that had, for this particular one in column one, of 90 percent or higher. Three states and I understand what you said about the variation but Arkansas and Alaska and Colorado were much lower than the U.S. Virgin Islands was incredibly lower. I think you have already explained it by saying, don't put too much stock in these variations.

Anne Schuchat: I think the key point with MMR is that we need very high coverage levels because measles is such an infectious virus. We have a two-dose recommendation for MMR, for children to get the first dose around 12 months of age and a second dose before school entry. We have had to have very high rates of measles second-dose coverage in order to sustain the elimination of measles' spread in the U.S. So that when imported cases come in, they don't find places to spread. It takes continued effort to sustain those high rates. We have had resurgences a couple times in the U.S. The worst was 1989 to 1991 with about 55,000 hospitalizations from measles. We know that if we don't maintain these very high rates, we will be back in that severe time. That's why we track these numbers every year and we see them back to each state so that they can be on top of this. Even when the state numbers are reassuring though, there can be local communities with large numbers of vulnerable children. This is the responsibility for every community, for every parent, for every doctor really to take seriously.

Bill Hendrick: Can I follow this up? One really quick question, which is this. I know scientists don't like to give opinions or to speculate. I'm wondering if the big scare of the last few years, claiming to show a connection between autism and childhood vaccination, may be keeping some parents from, 90 percent is pretty good but keeping some parents from having their kids vaccinated.

Anne Schuchat: We know parents have a lot of questions and it is important for us to provide good information so they can make wise choices for their families. There have been questions about measles and autism. At this point, a number of studies have been done and that question has been resolved. There is no link between measles vaccine, MMR vaccine, and autism. In fact, the original article that proposed that link was retracted by the scientists involved. So, at this point, we know is a residual concern for some people. I think it is vital we get good information to parents so they can protect their children. CDC has a website, www.cdc.gov/vaccines that has excellent information, including information for parents and providers to help them answer the questions they have about the safety and the efficacy of vaccines. So could we go to the next question, please, operator?

Operator: Yes, thank you. Press star one to ask a question. Our next question comes from Nina Thorson with KQED Radio.

Nina Thorson: Hi, doctor. I'm in San Francisco wondering if you have anything specific to say about pertussis in California or northern California given the epidemic situation that we have here right now.

Anne Schuchat: Yes. The situation in California is serious and we are working together with the California health department to really promote uptake of the pertussis vaccine for teens and adults, that's called Tdap or Tdap. We know that the California health department has made vaccine available to hospitals where women deliver babies to try to make sure moms and dads get a Tdap vaccine and help protect their babies. Other people who are around young babies and adults need to get the Tdap vaccine. It is relatively new. It was licensed in 2005 so it is newly available. Many adults didn't know you were supposed to get it. It actually replaces the old tetanus, diphtheria booster that you get every ten years. You can get this instead of one of those every ten years. The coverage in California for four doses of Tdap, the pertussis containing baby shot, the coverage for four doses was 83.4 percent. That's not in the MMWR article but it is information that California will have. We don't think it is the coverage level in the babies and toddlers that is leading to that pertussis challenge in California. We know pertussis is a hard to control disease. It comes in cycles. Every five to ten years, we have big challenges with it. We are doing studies together with California to really understand all the details of what's going on there and the best way to control the problem. I do want people to know you should be able to get Tdap from your doctor or pharmacist or at the birthing hospitals where babies are being delivered. Do ask your doctor about that. We strongly recommend teens 11 years and up and adults to get one of those shots. Next question, please?

Operator: At this time, I am showing no further questions.

Tom Skinner: We will give it 30 seconds or so. If there are no further questions, we will conclude the briefings. Should reporters have follow-up questions, they can call the main press office here at CDC at 404-639-3286. Shirley, are you still showing no questions?

Operator: Wait, one moment, please. We do have a question from Tom Maugh with Los Angeles Times. You may ask your question.

Tom Maugh: I'm sorry, Dr. Schuchat, could you repeat the name of the vaccine for teens and adults for pertussis?

Anne Schuchat: It is T, as in tetanus, and D, as in diptheria, small a, as in acellular, and capital P, which in pertussis, the technical name for whooping cough. So it is Tdap. The whooping cough booster vaccine is the other way you can ask for it. It should be readily available in California and the Los Angeles area. We know California is seeing record high amounts of pertussis this year. So far, they have actually had nine babies die since January of pertussis, a tragic story, record high for California. We really hope we can start to make a dent in that outbreak there, keeping the families protected. Very important for adults, teens, health care workers, anybody that's going to be around a baby to make sure they have gotten the Tdap vaccine if they are 11 years old or older. Thanks for that follow-up question.

Operator: We have a question from Pam Auerbach with CBS News.

Pam Auerbach: I have two questions, both relating to pertussis. One is, I've seen just in the last two days, localized cases in West Virginia of children that were believed to be, quote, "current in their vaccines" who have come down with whooping cough. Wondering if the CDC is aware and how concerned that makes you? Two, can a pregnant woman get the vaccine and would she then pass the immunity on to her child?

Anne Schuchat: We don't think that the cases that are occurring in this outbreak that we are seeing, is necessarily linked to incomplete vaccination. It can happen you have gotten all the vaccines you are supposed to get and you still get whooping cough. We know that vaccines given in infancy can wane in their protection. By the teen years in particular, we realize that children need a booster dose. That's why the Tdap vaccine was developed and formulated, so that we could try to bump up the protection after the early childhood vaccine started to wear off. There isn't a perfect 100 percent protection of the vaccine and then it could wane.

In terms of whether the vaccination can be given during pregnancy, I have to say that it was subject of much debate when our Advisory Committee for Immunization Practices were considering the recommendations. There were experts who felt the information was perfectly fine for the vaccine to be given during pregnancy and some providers do that. The committee recommended that it be given before pregnancy or right at post partum, after the baby was born. There have been times where the vaccine has been used in pregnancy and we haven't been aware of adverse events. But many parents and physicians are reluctant to give vaccines. That actually gives me an excuse to remind you that flu vaccine is out there and perfectly fine and very strongly recommended to give influenza vaccine during pregnancy. Our current recommendation for the pertussis vaccine is we want all adults to get it. When a mother gives birth, if she hasn't had a whooping cough vaccine yet, she should get it right at delivery. She can get it at the hospital. The father of the child can also get it and the other caretakers for the children can get it. It should provide a cocoon of protection around the newborn. Babies at birth are too young to get the vaccine. They don't get it until they are two months of age. We are trying to protect all those other people that are going to be holding the baby, feeding the baby, and taking care of the baby. That's our strategy for pregnant women. Sometimes people who are vaccinated can have milder diseases but not be perfectly protected. In general, we think the key strategy for pertussis is to get those baby shots and the shots before you enter school and then also to get the teen booster, for adults to get one Tdap vaccine. Are there any other questions?

Operator: I am showing no further questions.

Tom Skinner: Okay. Shirley, thank you and thank you all for joining us. Again, should you have follow-up questions later on, call the main press office here at CDC at 404-639-3286. A transcript of this telebriefing will be available later this afternoon. Thank you for joining us.

Operator: Thank you. This does conclude today's conference. We thank you for your participation. At this time, you may disconnect your lines.

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