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Press Briefing Transcripts

CDC Announces Teen Vaccination Coverage Rates

October 9, 2008, 12:00 p.m. ET

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 on your touch-tone phone. Today′s call is being recorded. If you have any objections you may disconnect at this time.

I′d now like to introduce Ms. Arleen Porcell-Pharr, thank you, ma′am, you may begin.

ARLEEN PORCELL-PHARR: Yes, good afternoon and welcome to today′s telebriefing on the results of CDC′s second annual national immunization survey 14. My name is Arleen Porcell-Pharr. I′m a public affairs specialist and I′ll be your moderator this afternoon.

Our speaker will be Dr. Lance Rodewald, that′s spelled L-A-N-C-E-R-O-D-E-W-A-L-D. Dr. Rodewald is the director of the Division of Immunization Services in our National Center for Immunization and Respiratory Diseases here at CDC. Dr. Rodewald will give some brief remarks, and then we will open the line for questions-and-answers. Please note, that a transcript of this briefing will be posted in our online newsroom a couple hours after the briefing. You can also call our media office for 404-639-3286 for any questions.

At this time, I will turn the briefing to Dr. Rodewald.

DR. LANCE RODEWALD: OK, thank you, Arleen. Today, we report the results of the 2007 National Immunization Survey for Teens 13 through 17 years of age. In 2005, and 2006, CDC′s advisory committee on immunization practices recommended three new vaccines to protect pre teens and teens from infectious diseases that were not previously preventable in this age group, pertussis or whooping cough, invasive meningococcal disease, and for girls, human papillomavirus or HPV that causes cervical cancer.

Although whooping cough has been preventable among infants and young children, we′ve seen increases in the disease among teens and young adults. The TDAP vaccine is the first vaccine to protect this age group from pertussis which will, in turn, reduce transmission of pertussis to newborns who are too young to vaccine. Invasive meningococcal disease and HPV infections have not been preventable through routine vaccination prior to the 2005, and 2006 recommendations for these two vaccines.

All three of these vaccines have the potential to prevent a substantial burden of disease. Meningococcal disease is the leading cause of bacterial meningitis. Pertussis has been well-controlled among young children is now on the rise among adolescents and adults, with well-over 20,000 cases among teens in the U.S. each year. Cervical cancer causes about 4,000 deaths a year, most of which are caused by the HPV strains prevented by the vaccine. And there are almost three million abnormal pap smears among women in the U.S. many of which are caused by HPV.

Unlike anything new in medicine, the implementation of these new vaccines is a challenge for doctors, nurses and parents, and this raises the question of how well the nation is doing in protection of preteens and teens, with these new lifesaving vaccines. The NIF team survey serves as the nation′s report card on the implementation of the vaccines.

The survey was conducted during the last quarter of 2007, and provides national level measures of vaccination coverage rates. As Arlene said, this is the second year of the NIS-teen survey for national coverage, and the survey results are for about 3,000 teens who vaccinations were verified by their doctor′s offices after permission was granted by the parents for that verification. The teen NIS is different from the NIS that measures coverage among young children, and is also different from the NIS that measures influence coverage. This one is just for teenagers.

We interviewed parents of teens 13 through 17 years old because we wanted to collect information for all vaccines received during their pre teen and teen years. The three vaccines are targeted towards 11 and 12-year-olds so we needed to collect information after the child completed their 12th year by turning 13 years old.

There′s a lot of good new in the survey results, but the results also show that we have a long way to go to reach our national objectives. Compared to the 2006 team NIS coverage for the TD, TDAP vaccines increased from 60 percent to 72 percent or 12 percentage points. We also saw a strong shift from the older TD vaccines, to the newer TDAP vaccine which includes pertussis protection.

Coverage with meningococcal conjugant vaccine was 32 percent, which was up from 12 percent in 2008, a 20 percentage point increase. For a new vaccine in it′s second year of recommendation, 32 percent is very good because it usually takes six to nine years to achieve the desired 90 percent coverage.

Coverage for initiation of HPV vaccination among girls was 25 percent and again, this is very good for a first year of measurement for a new vaccine.

Vaccination levels for catch-up levels was also quite good. Over 85 percent of teens have been vaccinated against hepatitis B, measles, mumps, and rubella. Coverage with one dose of varicella vaccine was protected against chicken pox, was also high at 76 percent. However, the new recommendation is for two doses, and coverage for the second dose is only 19 percent among those who didn′t have chicken pox.

So all-in-all the doctors, nurses, and parents are doing a very good job of protecting teens with the new vaccine. The strong start with the recently recommended vaccines is a good sign that we′ll see widespread acceptance of these vaccines and much broader coverage in future years. However, it′s clear that we have a long ways to go before reaching the 90 percent targets to achieve among teens the same high coverage levels that young children benefit from, many more teens will need to be vaccinated each year.

One of advantage of vaccinating 11 and 12 year-olds is that most of these preteens have doctor visits that can be used to vaccinate. It′s really important for parents to bring their 11 and 12-year-old for a checkup that includes growth and developmental assessments, vaccinations and other preventive services and counseling. And of course, it′s important that doctors and nurses take advantage of every opportunity to assess vaccination status of preteens and teens and to offer vaccinations to those who should be vaccinated. So the bottom line for the report card is that we′ve got a great start for teens, but we need to keep this positive momentum going in order to provide the protection from infectious diseases, that all teens should have. So I′ll give it back to you, Arlene (ph).

ARLEEN PORCELL-PHARR: Very good. Yes, we are going to open the line for question-and-answer.

OPERATOR: Thank you. At this time, to ask a question, please press star one followed by one on your touch-tone phone. You will be prompted to record your name. To withdraw your request, please press star followed by two. Once again, to ask a question, please press star one at this time. One moment for the first question, please.

Our first question is from Will Dunham from Reuters. You may ask your question, please.

WILL DUNHAM: Hello, this is Will Dunham with Reuters in Washington. Just a couple of things on HPV. Can you tell you me how many girls this would translate to, this percentage would translate to in absolute numbers? And can you say what are you hoping for in terms of rates of HPV vaccination?

DR. LANCE RODEWALD: Yes, eventually we would hope to protect all teenage girls. Our national coverage objectives for most of our vaccines are 90 percent, and although we don′t have a healthy people 2010 objective for this vaccine because it′s too knew, I would imagine that our recommendation for coverage was going to be 90 percent for that vaccine as well.

The birth cohort for each year is about four million children and half of them, of course, would be girls. And so for each of these birth cohorts, age 13 through 17, we′re looking at two million girls, and so that would translate into 10 million girls that was in the denominator of this survey.

WILL DUNHAM: So what′s the number.

DR. LANCE RODEWALD: And so the absolutely number of – so 25 percent of 10 million would be two-and-a-half million would be shown to have been vaccinated with this vaccine. I′m doing that one, that math in the top of my head, and I think it′s correct.

WILL DUNHAM: OK, so I can say that about two-and-a-half million girls got the HPV …

DR. LANCE RODEWALD: Yes, that′s correct. However, that under estimates how many were really vaccinated. Actually, 15 million doses of the vaccine have been distributed thus far, and the vaccine is recommended all the way up to age 26. Our survey only covers the years 13 through 17. And so there are many more young women who are vaccinated that are not included in the survey. What we′re trying to do with the survey is to see how well we′re doing vaccinating at as young an age as possible.

ARLENE PORCELL-PHARR: All right, next question, please.

OPERATOR: Thank you. Our next question is from Daniel DeNoon from Web MD, you may ask your question.

DANIEL DENOON: Thank you very much. Is there any sense of whether HPV vaccine is being covered by insurance? And whether the cost of the vaccine is a significant obstacle to vaccination?

DR. LANCE RODEWALD: That′s a very good question. What we′ve been hearing from the company is that coverage among the insurance plans is quite high, very high, with over 90 percent about a year ago, I believe. Also, we have an insurance module as part of the national immunization survey. And most of the children who have health insurance do have vaccine coverage in that health insurance. And for those who don′t have health insurance, or for those who have health insurance that may not include vaccination coverage, we do have programs that help make cost not a barrier.

For example, our vaccines for children program really purchases vaccines for young children and teens up to their 19th birthday, and is one way for financially vulnerable children and adolescents to get the vaccines that they really need. So this country makes a big effort to make cost not a factor for obtaining these vaccines.

ARLENE PORCELL-PHARR: Right. Next question, please.

OPERATOR: Thank you. Shannon Pettypiece from Bloomberg News, you may ask your question.

SHANNON PETTYPIECE: Hi. I was wondering if you had any data or sense of what the rates are like in the older women. So those who are 18 or 19 through 26. I know that wasn′t listed on the survey, but if you had any other data, or sense of – it might even be just higher or lower.

And also, I was wondering if this 25 percent, is that better than you had expected? Is that good? Is there any sort of context you could put that 25 percent number into?

DR. LANCE RODEWALD: Yes, thank you for those questions. Unfortunately, we don′t have information outside of the teen age group for this survey and so we don′t know what the coverage is among young adult women.

And then your other question had to do with?

SHANNON PETTYPIECE: Yes, whether the 25 percent …

DR. LANCE RODEWALD: The 25 percent is something – is a number that we′re happy with or, not happy with essentially. And, I think that for a new vaccine, 25 percent is really very good. This is the first time that the vaccine coverage was every reported, even though we measured coverage for teenagers the year before, it was so knew that we weren′t able to report coverage last year. And it generally takes about seven or eight years before you can go from a new vaccine all the way to having 90 percent coverage rate which would be the eventual target.

And so, in general, we′re quite pleased with the results of 25 percent. But it points out that we′ve got a long ways to go. We need to see that increase each and every year, if we′re going to make the 90 percent goal in a few years.

ARLEEN PORCELL-PHARR: Very good, next question, please.

OPERATOR: Mike Stobbe from Associated Press, you may ask your question.

MIKE STOBBE: Hi. Thanks for taking the question. Just a detail question, of the roughly 3,000 teens in the survey, how many of those were girls? Is it half?

DR. LANCE RODEWALD: Yes, just about half were girls in the survey, that′s correct, right.


ARLEEN PORCELL-PHARR: All right, next question, please.

OPERATOR: John Reichard from Congressional Quarterly, you may ask your question.

JOHN REICHARD: Yes, thanks. I just wanted to quickly clarify one thing and then ask another question.

So were you saying that it was 2.5 million girls in the 13 to 17 age group that got the HPV vaccine, that was the clarification?

And then secondly you know some groups are expressing concern about the HPV vaccine for fear that it would encourage sexual activity, and I′m wondering what concerns you have about getting from 25 to 90 percent.

DR. LANCE RODEWALD: OK. So yes, in the survey denominator there would be about 10 million girls. And 25 percent of them would have initiated the vaccine. So that would translate to about two-and-a-half million girls in the NIS-teen. However, there were vaccinations going on beyond that age-group, as I pointed out a little bit earlier.

With regard to whether …

JOHN REICHARD: So it is 2.5 million 13 to 17 girls?

DR. LANCE RODEWALD: That′s correct. And then the question about whether the HPV vaccine may encourage sexual behavior, I think this was something that was looked at during the recommendation time by the advisory committee and there was no evidence looking at other recommendations that were would be any encouragement of sexual activity caused by vaccination. So the question has been looked at and decided that that was not the case.

And, I think, the challenges of going from where we are now at 25 percent, all the way up to 90 percent or beyond has to do with getting widespread acceptance and understanding and use of the vaccine. It′s now much more available than it was when it first came out as a fairly easy to find vaccine. The question earlier about insurance coverage was an important one because we want to make sure that there′s not financial barriers to receive the vaccine. And so as with any other vaccine it takes time to really move from starting at zero and going all the way up to 90 percent. It takes a number of years to do that in the U.S.

ARLEEN PORCELL-PHARR: All right, next question, please.

OPERATOR: Thank you. Matt Cover,, you may ask your question.

MATT COVER: Thank you. I guess a two-part question. First, why does CDC recommend that 11 to 12 year-old girls get vaccinated for HPV which is defined as a sexually transmitted illness? And the second part, is there any evidence that suggests that there are large numbers of girls in this age group who are sexually active?

DR. LANCE RODEWALD: OK. The second question, I don′t know the answer to. I think that I don′t know the answer to the prevalence of sexual activity in this age group, but the first part of the question, why was the recommendation for age 11 and 12, the answer is that you always want to vaccinate before the period where there could be disease. And so it′s very important to vaccinate before the onset of sexual activity and 11 and 12-year-old of course, is before the onset of sexual activity. And so this provides protection in anticipation of exposure that would happen later in life.

ARLEEN PORCELL-PHARR: Next question, please.

OPERATOR: Molly McCray from KPIX you may ask your question.

MOLLY MCCRAY: Yes, thank you. I′m wondering, out of the girls who receive the HPV vaccine, did they receive all of the doses that are recommended? And also, is the CDC actively looking at how long immunity from these vaccines will last?

DR. LANCE RODEWALD: Yes, good questions. About a quarter of the girls who received the HPV vaccine received all three doses. But the survey was also probably done for most of the children between dose one and two or dose two and three. And so our anticipation is that those who initiated the series, the 25 percent who initiated the series will go on to complete the series.

But at the time of the survey, they may have had only their first or second dose waiting to get the second or third dose after the survey results. And then the question about the duration of immunity is also a very good question. The early clinical trials were down showing protection for, at least, six years after vaccination. If anticipated, that will probably be much longer and there′s ongoing studies to measure the duration of protection. This does get back to the other question about why 11 and 12-year-olds and another part of that answer is that for HPV vaccines, it′s known that 11 and 12-year-olds have a very strong and robust immune response, and that also helps add protection that will last through the risky period.

ARLEEN PORCELL-PHARR: Very good, next question, please.

OPERATOR: Jennifer Corbett of Dow Jones, you may ask your question please.

JENNIFER CORBETT: Yes, I just wanted to ask abut the varicella recommendation, the second dose, if you could just refresh my memory, when was that added? Was that 2006?

DR. LANCE RODEWALD: Ye, that′s right. It was 2006 when it was recommended. And the reason for its recommendation was that there were a number of outbreaks in the school settings and a second dose is really needed to help reduce outbreaks of varicella in that school setting. So in 2006, the ACIP recommended that everybody that didn′t have history of disease, of chicken pox, should get both doses of – two doses of that vaccine.

JENNIFER CORBETT: OK. So last year was really just the full year then that recommendation had been made.

DR. LANCE RODEWALD: That′s correct. That′s right. And so it′s a new recommendation which, I think, helps to explain that the coverage for the second dose of varicella among those that have not had chicken box was only around 19 percent. ACIP is our advisory committee on immunization practices.


ARLEEN PORCELL-PHARR: Next question, please.

OPERATOR: Sara Willey from WCVB-TV you may ask your question.

SARA WILLEY: Yes, I was wondering when it comes to Gardasil and the reported side effects, do you have any current number right now, other than what′s been reported in the past?

DR. LANCE RODEWALD: There′s ongoing – we after a vaccine is licensed there′s a very strong ongoing post marketing surveillance system for vaccine safety and adverse events. And thus far, there have been some adverse events that are seen primarily fainting after a vaccine. There a number of cases of adverse events, 94 percent of which are not considered serious, these include headache, nausea and pain at the injection site and fainting.

The Food and Drug Administration when they saw the fainting side effect started – made a change in the package insert, so that there should be a 15-minute watch period after vaccination just so that the teen who was just vaccinated doesn′t faint. The serious adverse events that were seen through the monitoring system were thought not to be related to the vaccine itself.

There′s been no change in recommendation looking at all of the post marketing vaccine safety assessments.

JENNIFER CORBETT: When were those new changes – when did they go into effect, when it comes into that 15-minute watch period.

DR. LANCE RODEWALD: I think was just in the last couple of months.


ARLEEN PORCELL-PHARR: Next question, please.

OPERATOR: Thank you. As a reminder, for any further questions, please press star one on your touch-tone phone. Our next question is from Alyson Wyckoff of AAP News, you may ask your question.

ALYSON WYCKOFF: Yes, thank you. Do you have any special messages for general pediatricians based on these results? Such as where more parent education might be needed for any one or all of these vaccines?

DR. LANCE RODEWALD: I think that′s a really good question. I think for the general pediatrician, the message is that this is a great start. This is another – these three vaccines are another reason to have that 11 and 12-year-old visit that can provide not only vaccinations but also counseling and prevention and growth and developmental assessments. And so I think that the basic message is to keep up the good work, to offer vaccines at every visit, and to talk to parents about the importance of protecting their pre teens and teens from these vaccine preventable diseases.


ARLEEN PORCELL-PHARR: Next question, please.

OPERATOR: At this time, I′m showing no further questions.

ARLEEN PORCELL-PHARR: Very good. If there are no further questions, this concludes this telebriefing. Thank you very much for attending and have a wonderful afternoon.

OPERATOR: Thank you. This concludes today′s conference. Thank you for participating. You may disconnect at this time.




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