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August, 2004
 

  National Immunization Awareness Month August 2004. Are you up to date? Vaccinate!
 
 
AUGUST IS NATIONAL IMMUNIZATION AWARENESS MONTH
Each year, National Immunization Awareness Month (NIAM) increases awareness about immunization across the lifespan as parents and children prepare for the return to school, and the medical community begins preparations for the upcoming flu season. Immunization has been cited as one of the top ten public health achievements of the 20th century. Yet the burden of vaccine-preventable diseases in adults in the U.S. is staggering – approximately 46,000 to 48,000 adults die each year from vaccine-preventable diseases.
Each year approximately 114,000 people in the United States are hospitalized because of influenza; an average of 36,000 people die annually due to influenza and its complications– most are people 65 years of age and over. Annually there are approximately 60,000 cases of invasive pneumococcal disease in the United States and one-third (20,000) of these cases occur in people 65 and older. Influenza vaccine coverage rates were up from 33 percent in 1989 to 64 percent in 1998, and pneumococcal vaccine coverage rates were up from 15 percent to 46 percent. Despite these increases, adult vaccination coverage rates for certain racial and ethnic groups remain substantially below the general population. On the national level, vaccination coverage among U.S. preschool children is at or near record high levels. This successful achievement of the past decade has largely reduced the marked racial and ethnic disparities in vaccination coverage rates among children that existed during the late 1980s and early 1990s. While disparities have been greatly reduced for the individual vaccines received by children, there is an indication that racial and ethnic disparities in series complete childhood vaccination coverage have been increasing in the last few years.
EXAMPLES OF IMPORTANT DISPARITIES
Blacks or African Americans
In 2003, non-Hispanic black persons were 21% less likely than non-Hispanic white persons to have received a flu shot during the past 12 months and 23% less likely to have ever received a pneumococcal vaccination. For adults aged 65 years and over, the percent of persons receiving a flu shot during the past 12 months was 68.6% for non-Hispanic white persons and 47.7% for non-Hispanic black persons. The percent of adults aged 65 years and over who had ever received a pneumococcal vaccination was 59.6% for non-Hispanic white persons, and 36.9% for non-Hispanic black persons.
In 2001, 85% of African American children ages 19-35 months had received hepatitis B vaccine, compared with 89% of the total population.  In that same year, 4.33 per 100,000 African Americans were reported with acute hepatitis B virus, compared with 1.31 per 100,000 white non-Hispanic Americans.
Although disparities in childhood immunization coverage have been greatly reduced for most vaccines that children routinely receive, disparities in the full immunization series (4:3:1:3:3 completion)* have not been eliminated.  From 1996-2001, the immunization coverage gap between non-Hispanic white children and non-Hispanic black children widened by an average of 1.1% (+_0.7%; p=0.01) each year.  The growing disparity is due to failure of series completion rates among non-Hispanic blacks to increase substantially during the period 1996 to 2002 (66.8% to 67.7%), while series completion rates among non-Hispanic whites increased (68.9% to 77.7%) during this same period.
Hispanics or Latinos
In 2003, Hispanic/Latino persons were less likely than non-Hispanic white persons to have received a flu shot during the past 12 months or to have ever received a pneumococcal vaccination.  For adults aged 65 years and over, the percent of persons receiving a flu shot during the past 12 months was 45.4% for Hispanic/Latino persons and 68.6% for non-Hispanic white persons. The percent of adults aged 65 years and over who had ever received a pneumococcal vaccination was 31.0% for Hispanic/Latino persons and 59.6% for non-Hispanic white persons.
In 2001, 90% of Hispanic/Latino children ages 19-35 months had received hepatitis B vaccine, compared with 89% of the total population.  In that same year, 1.84 per 100,000 Hispanic/Latinos were reported with acute hepatitis B virus, compared with 1.31 per 100,000 white non-Hispanic Americans. From 1996-2001, for the full vaccination series the immunization coverage gap between non-Hispanic white children and Hispanic/Latino children widened by an average 0.5% (+_1.0%; p=0.14). For Hispanic/Latino children, as for African American children, disparities have been closed or greatly reduced for most vaccines.
Asian Americans or Pacific Islanders
Immunization with hepatitis B vaccine is the most effective means of preventing hepatitis B virus infection and its consequences. However, while the rate of acute Hepatitis B (HBV) among AAPIs has been decreasing, the reported rate in 2001 was more than twice as high among AAPIs (2.95 per 100,000 population) as among white Americans (1.31 per 100,000 population). In 2001, 90% of AAPI children ages 19-35 months had received hepatitis B vaccine, compared with 89% of the total population.
American Indians or Alaska Natives
Viral hepatitis has historically been common in AI/AN communities. However, the number of viral hepatitis infections in these communities has been reduced. In 2001, 86% of AI/AN children ages 19-35 months had received the hepatitis B vaccine, compared with 89% of the total population.  In that same year, 1.86 per 100,000 AI/AN were reported with acute HBV, compared with 1.31 per 100,000 white non-Hispanic Americans.
In FY 2002, 82,231 AI/ANs 65 years and older were eligible for influenza and pneumococcal vaccination.  Of those, 25,700 or 31 % received an influenza vaccination and 13,866, or 17% received a pneumoccocal vaccination in Indian Health Service (IHS) healthcare facilities. This compares to 63.1% of Americans overall who received an influenza vaccination in 2001, and 54% of all Americans who had ever received a pneumoccocal vaccination in 2001.
EVIDENCE BASED STRATEGIES
Studies have consistently shown that focusing efforts to improve coverage on health care providers, as well as health care systems, is the most effective means of raising vaccine coverage in adults. For example, all health care providers should assess routinely the vaccination status of their patients. Likewise, health plans should develop mechanisms for assessing the vaccination status of their participants. Also, nursing home facilities and hospitals should ensure that policies exist to promote vaccination.
 Efforts need to be intensified, particularly to increase vaccination coverage for children living in poverty. Substantial numbers of undervaccinated children remain in some areas, particularly the large urban areas with traditionally underserved populations, creating great concern because of the potential for outbreaks of disease. Reasons for racial disparities in coverage rates for the full vaccination series among pre-school aged children are incompletely understood. Further studies are planned to develop an understanding of the underlying causes of these disparities so that effective strategies to reduce the disparities can be developed.
A comprehensive strategy to prevent hepatitis B virus infection, acute hepatitis B, and the sequelae of hepatitis B virus infection in the United States must eliminate transmission that occurs during infancy and childhood, as well as during adolescence and adulthood. A comprehensive prevention strategy includes a) prenatal testing of pregnant women for HBsAg to identify newborns who require immunoprophylaxis for the prevention of perinatal infection and to identify household contacts who should be vaccinated, b) routine vaccination of children born to HBsAg-negative mothers, c) vaccination of certain adolescents, and d) vaccination of adults at high risk of infection.  Integrating hepatitis B vaccine into childhood vaccination schedules in populations with high rates of childhood infection (e.g., Alaskan Natives and Pacific Islanders) has been shown to interrupt hepaitis B virus transmission.
 
FEDERAL PROGRAMS THAT ADDRESS RACIAL/ETHNIC DISPARITIES IN IMMUNIZATION
CDC’s National Immunization Program (NIP) strives to prevent disease, disability, and death in children and adults through vaccination.  NIP is committed to promoting immunization at every stage of life, providing leadership on vaccines and immunization, strengthening and communicating immunization science, establishing partnerships and fostering collaboration, providing immunization education and information, and improving health in the United States and globally. NIP supports the following programs:
  Racial and Ethnic Adult Disparities Immunization Initiative (READII)
  The Department of Health and Human Services (HHS) has made the elimination of racial and ethnic disparities in influenza and pneumococcal vaccination coverage for people 65 years of age and older a priority. To address these disparities and to assist in reaching the 2010 national health goal of 90% influenza and pneumococcal vaccination rates among persons 65 and over, HHS, in collaboration with the Centers for Disease Control and Prevention (CDC) and other federal partners, launched the Racial and Ethnic Adult Disparities Immunization Initiative (READII) in July 2002. READII is a two-year demonstration project being conducted in five sites (Chicago, IL; Rochester, NY; San Antonio, TX; Milwaukee, WI; and 19 counties in the Mississippi Delta region) to improve influenza and pneumococcal vaccination rates for African-Americans and Hispanics 65 years of age and older. CDC is implementing the READII project with the support of the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, the Administration on Aging, the Agency for Healthcare Research and Quality, and other federal agencies.
  Vaccines for Children (VFC)
  Since 1994, the Vaccines for Children (VFC) program has allowed eligible children to receive vaccinations as part of routine care, supporting the reintegration of vaccination and primary care.  Based on the total doses of routinely recommended pediatric vaccines distributed in the U.S., the VFC program served about 41% of the childhood population in 2002.  The VFC program provides publicly purchased vaccines for use by all participating providers.  These vaccines are given to eligible children without cost to the provider or the parent.  The VFC program provides immunizations for children who are uninsured, Medicaid recipients, Native Americans, or Alaska Natives at their doctors' offices. VFC also provides immunizations for children whose insurance does not cover immunizations at participating federally qualified health centers (FQHCs) and rural health clinics (RHCs).  The program has contributed to high immunization rates and reduced delays in immunizations and, subsequently, the risk of serious illness or death from vaccine-preventable diseases.
  National Minority Organization Immunization Programs
  This project seeks to strengthen the cultural competence of the health care system to better serve Asian Americans in the area of immunizations and to provide support to community-based organizations through subcontracts.  The program has four objectives: provide immunization information on the web, provide training for health care professionals, translate immunization information into at least five Asian languages, and conduct education projects to raise immunization awareness.
  Vacunas para la familia
  This project seeks to increase immunization rates by providing support to large Hispanic communities.  Hispanic communities are targeted in six cities with high Hispanic populations: New York City, Los Angeles, Miami, San Antonio, Phoenix and Oklahoma City.  The program has four objectives: disseminate linguistically appropriate and culturally sensitive materials, post current health information on the National Alliance for Hispanic Health web site, participate in local and national immunization coalitions, and provide health care providers with cultural sensitivity training.
  Indian Health Service (IHS)
  IHS clinics are encouraged to provide influenza vaccine to adults 55 years of age and pneumococcal vaccine to adults 65 years of age during clinic visits and during mass immunization clinics.  Educating patients is a part of the strategy to ensure influenza vaccine is provided.  The proposed FY 2004 IHS budget will support the capacity for sites to continue existing strategies and maintain current immunization coverage levels in the face of population growth.
 

FOR MORE INFORMATION

immunizations CDC’s Office of Minority health (OMH)
    Eliminate Disparities in Adult and Child Immunization Rates
immunizations National Immunization Program (NIP)
  Parents Guide to Childhood Immunization
  Protect the Circle of Life: Immunize Our Nations
  Racial and Ethnic Adult Disparities Immunization Initiative (READII)
  Vaccines for Children (VFC)
immunizations

National Center for Infectious Diseases (NCID)

  HBV: A Silent Killer
  Preventing Emerging Infectious Diseases: A Strategy for the 21st Century
immunizations

Department of Health and Human Services (HHS)

 

National Vaccine Program Office

immunizations

Indian Health Service

immunizations

Healthy People 2010

 

Chapter 14: Immunization and Infectious Diseases

 

*Series completion is defined as up to date for the 4:3:1:3:3 series (4 or more doses of diphtheria and tetanus toxoids and [acellular] pertussis vaccine; 3 or more doses of poliovirus vaccine; 1 or more doses of measles-containing vaccine; 3 or more doses of Haemophilus influenzae type b vaccine; and 3 or more doses of hepatitis B vaccine.


 

 

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