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CDC Press Briefing on the National Immunization Coverage Rates Report

Thursday, September 14, 2006 1:00 p.m. ET

OPERATOR: Good afternoon, and thank you all for holding. At this time your lines have been placed on listen-only until the question and answer session of today′s conference. Please be advised today′s call is being recorded. If you have any objections, please disconnect at this time. I would now like to turn the conference over Mr. Curtis Allen. Please go ahead sir.

MR. ALLEN: Yes, this is Curtis Allen. I am with the Division of Media Relations at CDC. Welcome to our telebriefing on the National Immunization Survey. We have two speakers today. The first is Dr. Anne Schuchat . That is A-N-N-E, Schuchat, S-C-H-U-C-H-A-T, S-C-H-U-C-H-A-T. She is the Director of the National Center for Immunization and Respiratory Diseases.

We also have a Dr. Jim Singleton, Singleton is S-I-N-G-L-E-T-O-N. He is the Chief of the Assessment Branch at NCIRD, or the National Center for Immunization and Respiratory Diseases.

I will turn it over to Dr. Schuchat who will have a brief statement and then we will open it up for questions. Thank you – Dr. Schuchat.

DR. SCHUCHAT: Great. Good afternoon. I am delighted to talk with you today about our annual result from the National Immunization Survey.

Tom Skinner: Thanks Dr. Katz. Melissa, I believe we’re ready for questions please.

As you know, immunizations are one of the most effective tools we have to protect health. And each year we update where we are with the immunization coverage in young children, results obtained through our National Immunization Survey, which is a sample, a telephone interview sample of over 17,000 children. It targets the age group of 19-35 months. And this year we are reporting about results for a six-vaccine series.

So, we have taken a snapshot of the immunization coverage in young children in the U.S. and the results are that we have a very good big picture. And we have a lot of nice details in the picture.

The big picture looks good. We have immunization coverage rates that are at or near record highs. And we have closed or are very close to closing the gap in coverage between racial and ethnic minority groups and others. So that is very good news, something we have been working on for many years.

The big picture is that we are tracking six vaccines, which include diphtheria, tetanus and pertussis or whopping cough containing vaccine. The polio vaccine, the measles containing vaccine, which in the U.S. we use the measles, mumps and rubella vaccine, the HIB vaccine, the hepatitis B vaccine and the chickenpox vaccine.

And the 2005 data that we are reporting today are the first time we have used this six-vaccine series as our indicator of the national picture. The national total looks at - looking at these six vaccines is that we are at 76.1 percent of children in this age group having received all of those vaccines of the six-vaccine series. What is very exciting is that we are closing the gap between blacks and others in this six-vaccine series.

We have a range from - in the coverage of the six-vaccine series in whites was 76.0 percent, in blacks it was 76.3 percent, in Hispanics 75.6 percent, Asians 77.1 percent and children of multiple race had a six-vaccine coverage of 79.5 percent. There was no statistically significant difference between any of those groups and that is why we say that we are closing the racial gaps that have existed in immunization coverage.

That is very exciting news because in the past these gaps have been major. Between 2002 and 2004, blacks averaged six-vaccine series coverage that was 5.4 percent lower than whites. So we have really increased their coverage and eliminated that gap.

The other very good news in this year′s survey relates to the pneumococcal conjugate vaccine. This is a vaccine that was first licensed in 2000 and it was in the news for a number of reasons. It was considered to be fairly expensive and we have had many shortages of the vaccine since it was first introduced.

On the other hand, it has greatly reduced the incidence of the severe infections that the bacteria pneumococcus can cause. We have been worried about coverage in this vaccine though because of the shortage and because of the expense.

But the good news this year is that there has been a significant increase in coverage with the pneumococcal conjugate vaccine. We have increased by 9.5 percentage points coverage for three doses and we have increased by 10.5 - I am sorry- 10.3 percentage points coverage for four doses.

The pneumococcal conjugate vaccine is still a relatively new vaccine. And as I said there have been shortages in the past several years with this vaccine. But if we take the longer view, we have in just a three-year period gone from over 40 percent to over 80 percent of children receiving the three doses of the pneumococcal conjugate vaccine.

We are not done yet. We would like to get this and all new vaccines up to over 90 percent coverage. But we are really getting closer to that target.

The other news is not so new, more like old news that keeps repeating itself. And that is that we continue to have variation between states. Although the national picture does look good, there is a substantial range between states with the highest immunization coverage and states with the lowest.

In the 2005 survey that we are reporting today, the state with the highest immunization coverage was Massachusetts and their six-vaccine coverage was 90.7 percent. The state with the lowest immunization coverage for that six-vaccine series was Vermont right next door, and their coverage was 62.9 percent.

So we are very excited about closing that gap and disparity between the racial and ethnic groups in the United States. But we would also like to close the gaps among states and raise the coverage in all states to achieve our Healthy People 2010 objective.

We are not at our Healthy People 2010 target yet for the six-vaccine series. We are hoping to get to at least 80 percent of the full immunization series. But we are on the right track and excited about the narrowed racial disparity and the jump in the pneumococcal conjugate vaccine. So I think now I would like to answer questions that you may have.

MR. ALLEN: First question, please.

OPERATOR: Thank you. At this time, if you would like to ask a question please press star followed by one on your touch-tone phone. You will be announced by name prior to asking your questions. Once again, please press star one to ask a question. Our first question comes from Peggy Pecks with MedPage Today.

MS. PECK: Yes. I am wondering about this, the disparity between or among states. And can you address this a little bit more specifically what - why these big differences particularly when you have states that are in the same region?

DR. SCHUCHAT: Right, I think there are a lot of factors that go into immunization programs. One thing to remember is that immunization is the largest public/private partnership that we have in public health. It involves public health programs and lots of private practioners who care for children in this case in terms of the pediatric immunization coverage. And it involves the community - community attitudes about vaccines and about disease, sometimes community laws.

So there are a lot of factors that differ state-to-state, whether there are strong immunization programs on a public sector side, whether there is a commitment from the pediatricians, whether there are community attitudes that support vaccines for children.

So I think there are also differences in financing, there are federal programs that reach every state. But states invest different amounts of their own resources into immunizations. I think for a particular state it is going to be important to talk with their authorities. But we have a diverse country and every state has its own particular situation.

MR. ALLEN: Next question please.

OPERATOR: Thank you. Our next question comes from Mike Stobbe with the Associated Press.

MR. STOBBE: Hi, Drs. Thank you or doing this. First question is just clarifying, this is the first time on record that you have not seen a statistical, a statically significant difference between the vaccination rates of the different racial groups. Is that correct?

DR. SCHUCHAT: It is the first time in the past 10 years that we have seen no difference. One thing to recognize is that, which I should have said in my opening remarks, is that our immunization schedule is getting more and more complicated. So this year is the first time we are tracking the six-vaccine coverage.

Last year we reported on the five-vaccine coverage. And this year we added chickenpox to the list. But when we go back as far as 10 years with that full series coverage, this is the first time we haven′t seen statistically significant racial gaps. So it is very exciting news.

MR. STOBBE: Was there a time before 10 years ago that there was no statically significant gap?

DR. SCHUCHAT: I think long ago, when the immunization schedule was very simple, there weren′t. But as we added more and more products, it has gotten, these gaps have been important. So I think when we only had about three vaccines we were using, there weren′t necessarily gaps.

The other thing is that, we now have a very good system to track these things. Since 1994, we have had the National Immunization Survey, that telephone random digit dialing survey, which I mentioned was over 17,000 children. And in that survey we do track things like racial and ethnic information and economic information more recently. So with consistent methods, we have had a gap and now we don′t.

MR. STOBBE: That′s, I am sorry, one more. Either now or after this conference is over, could you follow up on the specific data points in that figure on page 992 of the MMWR, the percentage for each racial group that is in that figure?

DR. SCHUCHAT: Yes. And let me for everybody on the call give you one of the statistics. If you look at the figure, what is really striking is that the six-vaccine series really increased in blacks between 2002 and 2005. In 2002, the six-vaccine series in blacks, the coverage of that six-vaccine series was 61.7 percent. In 2005, the six-vaccine series coverage in blacks was 76.3 percent.

So that was a pretty impressive increase. For comparison, in whites in 2002, the six vaccine series coverage was 66.2 percent and by 2005, it was 76.0 percent.

So I think it is important for you and your readers to realize that we didn′t close this gap because we lowered immunization in the highest performer. We closed it by raising immunization in the minority populations that had lower coverage at the beginning. Does that help?

MR. STOBBE: It does. I am going to ask you either now or later for what the ′03 and ′04 were and also for the Hispanic group

DR. SCHUCHAT: OK. I can just give you those. For, again this is all for the six-vaccine series. The 2003 black coverage was 68.4 percent. The 2004 black coverage was 70.9 percent.

MR. STOBBE: OK.

DR. SCHUCHAT: The 2003 white coverage was 73.9 percent.

MR. STOBBE: OK.

DR. SCHUCHAT: The 2004 white coverage was 77.2 percent.

MR. STOBBE: OK and the...

DR. SCHUCHAT: I will just read the four numbers. 2002, 66.0 percent.

MR. STOBBE: OK.

DR. SCHUCHAT: 2003, 71.3 percent.

MR. STOBBE: OK.

DR. SCHUCHAT: 2004, 75.9 percent.

MR. STOBBE: OK.

DR. SCHUCHAT: 2005, 75.6 percent.

MR. STOBBE: Thank you very much.

DR. SCHUCHAT: Sure, that is all your time.

MR. ALLEN: Next question please.

OPERATOR: Thank you. At this time we have no further question. Again, as a reminder, please press star one if you would like to ask a question. Our next question comes from Alicia Ault with Pediatric News.

MS. AULT: Yes thank you. I am just trying to understand. This is the first year you added the six- vaccine series as part of the survey and it was five vaccines before. So how are you getting these percentage coverage figures for the six vaccines in the previous years?

DR. SCHUCHAT: Right, let me clarify. We track all of the vaccines in our survey but we use...You know, there are a lot of numbers. And so we pick targets that we follow for our goals. And the targets are based on the maturity of the program. If we introduce the vaccine one year, we don′t start that vaccine, we don′t include that vaccine in our overall snapshot the next year. We still collect the data but we don′t use that as how we are tracking things.

So in the actual MMWR article that is being published later this week, we actually report the information for the three-vaccine series, the four-vaccine series, the five-vaccine series and the six-vaccine series.

And we also include information on the pneumococcal conjugate vaccine, which is actually the seventh in the vaccine series. We are not including that in the overall national statistic but we are tracking that individually.

So it is kind of trying to have a simple way to report coverage when there are many, you know, hundreds of ways we could report it.

MS. AULT: All right. So just as a follow up, how valid is it then to compare these coverage years, say from 2002 to 2005 when you are talking about the six-vaccine series?

DR. SCHUCHAT: Right. So the six - the varicella vaccine was first introduced in 1995. And so we are looking at - varicella is the sixth one, the one that we are comparing information over the past five years. But we can also compare information for the five-vaccine series. We try to compare apples-to-apples.

And so this year we felt varicella has been around long enough, it is time to start talking about that in the overall national picture. It is time for the state programs and the pediatricians to really make sure they have gotten their children fully up to date with the varicella coverage. So that is where - why we started to add it this year.

MS. AULT: OK. Thank you.

DR. SCHUCHAT: Sure.

MR. ALLEN: Any other questions?

OPERATOR: Thank you. Our next question comes from Todd Zwillich with WebMD, Public Radio.

MR. ZWILLICH: Hi. Oh, wait a minute. WebMD does not have public radio. They are two different things, just for everybody′s edification.

The vagaries of self report not withstanding, you are confident that 17,000 randomly dialed people reliably recall the immunization coverage of their kids. I mean, if you ask is your kid covered, somebody is going to obviously want to say yes. I mean, you are confident that people reply accurately?

DR. SCHUCHAT: Yes. Thank you so much for that question because I neglected to clarify. One of the really fantastic elements of the National Immunization Survey is that we do not rely on parents saying my child is up to date. As you say, it is very easy to overestimate how many shots our kids have gotten or whether we have gotten all of the preventive visits in.

The National Immunization Survey is a massive undertaking and in addition to calling all of these people and asking them about vaccine histories, we get permission to contact providers and verify the immunization records. So the information that you are hearing is based on validated immunization results, basically receipt of immunization documented in the physician′s office.

There are a lot of statistical methods to address for the, you know, the people that you can′t find. But we don′t assume a person is immunized just because their parent says they are.

MR. ZWILLICH: And how much young kids have been added to the trivalent recommendations, so how long before you might start adding those to your national immunization survey to see if those are - to see if they are taking those up?

DR. SCHUCHAT: Yes. You are asking about the influenza coverage...

MR. ZWILLICH: Yes.

DR. SCHUCHAT: ...and actually we will be starting to collect the influenza vaccine coverage as well as Hepatitis A vaccine coverage. And one of the exciting things that we are starting in the fourth quarter of 2006 in terms of our data collection, is we are adding adolescent interviews into the survey.

As you know, we have got several vaccines now that are routinely recommended for teens. They include the meningococcal conjugate vaccine, the tetanus diphtheria, and acellular pertussis vaccine and most recently the human papilloma virus vaccine. And so those are very important new tools that we have to prevent disease in teens or in older people through prevention in teens.

And we think it is important to start understanding uptake of those vaccines. So in the next couple of years you will start to hear results for adolescent coverage as well. You will also start to get those results about the influenza vaccine uptake from - in next year′s report.

MR. ALLEN: Next month.

DR. SCHUCHAT: Or next month actually - sorry, you′re going to get it even before then.

MR. ZWILLICH: Oh, OK. And just to clarify quickly, the 2010 goal is 80 percent, correct? That is...

DR. SCHUCHAT: The 2010 has two different kinds of goals. We have a goal for the full series and that is to achieve 80 percent. And we have goals for individual vaccines and that is to get to at least 90 percent for an individual vaccine that basically being in a program for at least five years.

MR. ZWILLICH: So which of those two figures most accurately reflects the six that you are reporting on today?

DR. SCHUCHAT: I′m sorry, the 80 percent is the target for the ones that I am reporting today.

MR. ZWILLICH: For the - OK. Yes.

DR. SCHUCHAT: Yes. That, you know the six-vaccine series right now is what we are tracking to try to get to 80 percent.

MR. ZWILLICH: Right. OK.

DR. SCHUCHAT: You may recall that last year we got to 80 percent, but it was with the five-vaccine series. So we have - we achieved that bar and we raised the bar and now we are trying to step over the next bar or jump over the next bar.

MR. ZWILLICH: Thank you.

MR. ALLEN: Next question.

OPERATOR: Thank you. Our next question comes from Mike Stobbe with the Associated Press.

MR. STOBBE: Hi now, can I go one more time?

MR. ALLEN: Sure.

MR. STOBBE: OK. I just want to clarify something about Todd - about what Todd asked. You actually surveyed more than 17 -- the families of 17,500 it was the 17,500 represented 63 percent of those households, right?

DR. SCHUCHAT: 17,0000 is what the respondents are, correct. Yes, it is a much larger survey than that. I was trying to kind of keep it simple.

MR. STOBBE: I′m sorry, I was a little confused. So, how many people - there were 17,000 - how many households responded?

DR. SCHUCHAT: Yes, let me - just hold on one second and we will try to get the right numbers for you so I don′t confuse you further.

MR. STOBBE: Right, I just wanted to make sure that 17,000 is a fraction of a bigger number or whether it was the actual survey.

DR. SCHUCHAT: I mean the - right. I mean, essentially those - the wording from MMWR is the household survey response was 65.1 percent that means you could, you know, get information from the household, provider verification was available on 63.6 percent of those households, which means 17,563 kids.

So you would have to divide that number by .636 and probably - except for there is a lot of weighting in this. You would get about the number of households. I don′t think we have the number of households with us.

MR. SINGLETON: Yes. But we could give you specific numbers for different parts of the response to the survey. That 65 percent includes households that we called, but never found out if they were eligible or couldn′t get through to. It also includes households where we got through the screening identified the age eligible child, but for some reason or other, the family did not participate in the survey.

MR. STOBBE: I′m sorry, but just one more time. It was 17,563, 63 percent of the responding children...

DR. SCHUCHAT: Those - the interview was completed. So we did an interview, and then with 63.6 percent of them we could get to the verified...

MR. STOBBE: Got you.

DR. SCHUCHAT: ...five immunization record.

MR. SINGLETON: Right.

MR. STOBBE: I am sorry, one more. Doctor, you talked a little bit about what the disparity used to be, you said a couple of years ago I think was 5.4 percent lower for blacks than whites. Can you go back even further in history? Did the gap between blacks and whites used to be even greater? How great was it?

DR. SCHUCHAT: You know, it has been at least 10 percent at some point. I think that - so we′re definitely getting better. But I would stress that we have lots of challenges in the future with all of these new vaccines.

So, we are excited to be closing this gap, but we really have to be vigilant for the future with a much more complicated vaccine schedule and more costly products that we don′t start to see new gaps emerge.

MR. STOBBE: OK. Thank you.

MR. ALLEN: Next question.

OPERATOR: We have no further questions at this time.

MR. ALLEN: No further questions? OK. Thank you very much for participating. Again, I am Curtis Allen with the Division of Media Relations. If you have additional questions, you may call the Division of Media Relations at (404) 639-3286. That is (404) 639-3286. And thank you very much.

OPERATOR: Thank you. This does conclude today′s conference call, we thank you for your participation.

END

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