V. Immunization

FY 2000 Performance Plan - Revised Final FY 1999 Performance Plan

Appropriate administration of safe and effective vaccines remains the most cost-effective method of preventing disease, disability, and death and reducing economic costs resulting from vaccine-preventable diseases. For every dollar spent on measles-mumps-rubella (MMR) vaccination, $13 is saved.

Beginning in 1962 when it proposed the first national effort to improve the immunization status of children, CDC has counted immunization among its most vital programs, recognizing it as a core public health activity and perhaps the best example of effective primary prevention. CDC's National Immunization Program (NIP) focuses on several major programmatic areas to achieve its goals, including childhood immunization, adult immunization, and global polio eradication. Although NIP has assistance from many partners, state and local health agencies play a primary role in helping NIP carry out its mission in the United States. State and local health agencies use CDC grant funds for a wide range of activities including hiring staff, conducting surveillance, assessing immunization levels, developing immunization registries, conducting education and outreach, and establishing partnerships with community groups and private sector organizations.

Disease eradication and elimination programs are a shared effort. NIP collaborates with the World Health Organization, Rotary International, the United States Agency for International Development, the Task Force for Child Survival and Development, UNICEF, other centers within CDC, and international agencies, to enhance polio eradication efforts by providing scientific assistance and financial support for vaccine purchase and other key activities. This collaboration is unique among public health initiatives for the unprecedented level of partnerships. Extraordinary progress towards eradicating polio worldwide by the year 2000 continues to occur, suggesting that the current global strategies are effective and that achievement of the global objective is feasible. Examples of activities include:

• Expanding the network of CDC staff, epidemiologists, technical and scientific officers, and virologists assigned to WHO country and regional offices.
• Managing cooperative agreements with UNICEF through which approximately 326 million doses of oral polio vaccine for mass immunization campaigns were provided to 70 polio-endemic countries.
• Expanding the global virology laboratory network in cooperation with CDC's National Center for Infectious Diseases.
• Implementing a special program to prepare a cadre of trained public health professionals from throughout CDC to complete short-term assignments with WHO.

There are two primary sources to measure attainment of performance goals. The National Notifiable Diseases Surveillance System (NNDSS) is the data source for tracking cases of vaccine-preventable disease. Provisional data from this system are routinely published in the Morbidity and Mortality Weekly Report (MMWR). Final data are published in the Annual Summary of Notifiable Diseases.

CDC collects vaccination coverage data at the national, state, and local levels through the National Immunization Survey (NIS). With these data, the impact of national, state, and local policies and programs can be evaluated and monitored, and the results will provide the primary means of monitoring progress toward the goals of the performance plan. These surveys measure antigen-specific and series complete coverage by selected age categories, with detailed analyses for race/ethnicity and by poverty groups also being presented. Such surveys are necessary to monitor the improvement of immunization coverage levels in the target populations of 78 state and local areas.

Although coverage for preschool immunization is high in almost all states, pockets of need, or areas within each state and major city where substantial numbers of under-immunized children reside, continue to exist. These areas are of great concern because, particulary in large urban areas with traditionally under-served populations, there is a potential for outbreaks of vaccine-preventable diseases.

Infrastructure funds are essential to sustain the systems that have resulted in the highest immunization levels ever recorded at or near record low levels of disease incidence. These funds are used to implement proven strategies to raise immunization coverage, to conduct vaccine-preventable disease surveillance, to implement disease outbreak control measures, to assure adequate access to and appropriate administration of vaccines, to perform outreach activities, to develop immunization registry systems, to educate providers and parents about the need for timely immunization, and to assess immunization coverage levels and pockets of under-immunized children, among many other activities. Infrastructure investments must be maintained to ensure that proven systems and high immunization levels are not jeopardized.

Performance Goals and Measures

Performance Goal: Reduce the number of cases of vaccine-preventable diseases.

Performance Measures:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
Vaccine Preventable Diseases (Indigenous Cases Only) Paralytic polio 0 (1997). Rubella 161 (1997). Measles 138 (1997). Haemophilus influenzae 165 (1997). Diphtheria 5 (1997). Congenital rubella syndrome 4 (1997). Tetanus 43 (1997) .	The number of cases of paralytic polio, rubella, measles, Haemophilus influenzae invasive disease in children under 5 years, diphtheria, congenital rubella syndrome, and tetanus will remain at or be reduced to 0.	The number of cases of paralytic polio, rubella, measles, Haemophilus influenzae invasive disease in children under 5 years, diphtheria, congenital rubella syndrome, and tetanus will remain at or be reduced to 0.
Mumps 612 (1997).	The number of cases of mumps will be reduced from 612 (1997) to 500.	The number of cases of mumps will be reduced from 612 (1997) to 500.
Pertussis 5,519 (1997)	The number of cases of pertussis will be reduced from 5,519 (1997) to 2,000.	The number of cases of pertussis will be reduced from 5,519 (1997) to 2,000.

Performance Goal: Ensure that 2-year-olds are appropriately vaccinated.

Performance Measures:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
90% vaccination coverage for each vaccine (1997). 4 doses of Diphtheria-Tetanus-Pertussis containing vaccine (81%); 3 doses of Haemophilus influenzae type b vaccine (93%); 1 dose of Measles-Mumps-Rubella vaccine (91%); 3 doses of Hepatitis B vaccine (84%); 3 doses of Polio vaccine (91%).	Achieve or sustain immunization coverage of at least 90% among children 2 years of age for each vaccine: 4 doses of Diphtheria-Tetanus-Pertussis containing vaccine 3 doses of Haemophilus influenzae type b vaccine 1 dose of Measles-Mumps-Rubella vaccine 3 doses of Hepatitis B vaccine 3 doses of Polio vaccine	At minimum, achieve or sustain the following immunization coverage of at least 90% among children 2 years of age for each vaccine: 4 doses of Diphtheria-Tetanus-Pertussis containing vaccine 3 doses of Haemophilus influenzae type b vaccine 1 dose of Measles-Mumps-Rubella vaccine 3 doses of Hepatitis B vaccine 3 doses of Polio vaccine

Performance Goal: Increase pneumococcal pneumonia and influenza vaccination among persons 65 years.

Performance Measure:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
Influenza: 58% (1995).	The rate of vaccination among non-institutionalized high-risk populations will be increased to 60% for influenza and	The rate of vaccination among persons 65 years will be increased to 60% for influenza and
Pneumonia: 32% (1995).	to 54% for pneumococcal pneumonia.	to 60% for pneumococcal pneumonia.

Verification/Validation of Performance Measures: These data will be validated as stated above in the program description with the addition of the National Health Interview Survey for pneumonia and influenza.

Links to DHHS Strategic Plan

These performance measures relate to DHHS Goal 5: Improve public health systems. CDC collaborates with Health Resources and Services Administration, the Health Care Financing Administration, the Food and Drug Administration, the National Institutes of Health, and others in achieving these objectives.

Performance Goal: Collaborate with domestic and international partners to help achieve WHO's goal of global polio eradication by December 31, 2000.

Performance Measures:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
382 million (1998)	Increase the number of doses of oral polio vaccine purchased to assist in conducting mass immunization campaigns in Asia, Africa, and Europe to 445 million.	Increase the number of doses of oral polio vaccine purchased to assist in conducting mass immunization campaigns in Asia, Africa, and Europe to 526 million.
60 (1998)	Expand the network of CDC and CDC-funded staff, epidemiologists, virologists, technical and scientific officers on long-term assignments in WHO country and regional offices to 67 persons.	Expand the network of CDC and CDC-funded staff, epidemiologists, virologists, technical and scientific officers on long-term assignments in WHO country and regional offices to 82 persons.
0 (1998)	Expand a special program to prepare a cadre of 50 trained public health professionals throughout CDC to complete short-term assignments with WHO.	Expand a special program to prepare a cadre of 60 trained public health professionals throughout CDC to complete short-term assignments with WHO.
Total Program Funding	$449,477	$526,167

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