Surveillance Materials & Resources

Vaccine–Preventable Disease Morbidity in the United States

A comparison of the morbidity and mortality before and after widespread implementation of national vaccine recommendations for 13 vaccine-preventable diseases for which recommendations were in place prior to 2005.


Roush SW, Murphy TV, Vaccine-Preventable Disease Table Working Group a. Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States.external icon JAMA. 2007; 298(19): 2155-2163. Doi:10.1001/jama.298.18.2155.

Presentation Slides

These slides are updated annually to provide vaccine-preventable disease surveillance data for

VPD morbidity slide1
Comparison of 20th Century Annual Morbidity and Current Morbidity (slide one pdf icon[1 page]) updated 2/14/2020
VPD morbidity slide 2
Comparison of Pre-Vaccine Era Estimated Annual Morbidity with Current Estimate (slide two pdf icon[1 page]) updated 2/14/2020


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For educational materials, see Surveillance Trainings & Videos.

Surveillance of NCIRD Diseases and Conditions in the National Notifiable Diseases Surveillance System (NNDSS)

In cooperation with state health departments, the National Center for Immunization and Respiratory Diseases (NCIRD) coordinates national surveillance for 19 diseases and conditions in NNDSS, including vaccine-preventable diseases (VPDs) and other respiratory diseases and conditions. CDC is notified by state health departments of cases of diseases and conditions under national surveillance, as designated by the Council of State and Territorial Epidemiologists (CSTEexternal icon); these data are published by the Center for Surveillance, Epidemiology, and Laboratory Sciences (CSELS) in the Morbidity and Mortality Weekly Report (MMWR) and/or CDC WONDER. In general, NCIRD encourages state health departments to submit provisional data through NNDSS before completing case investigations; however, cases are included for publication as described in the NNDSS event code list (case status print criteria) approved by CSTE.

CDC publishes NNDSS data weekly in the MMWR and/or CDC WONDER, and yearly in the Annual Summary of Notifiable Diseases. NNDSS data, together with data collected through supplemental surveillance systems, are analyzed by NCIRD staff and are disseminated through surveillance reports, journal manuscripts, MMWR Surveillance Summaries, and other publications.

NCIRD subject matter experts help coordinate surveillance of 19 nationally notifiable conditions, specifically:

Notifiable Conditions and Case Definitions
Congenital rubella syndrome Case definition
Diphtheria Case definition
Haemophilus influenzae (invasive disease) Case definition
Influenza-associated pediatric mortality Case definition
Legionellosis Case definition
Measles Case definition
Mumps Case definition
Neisseria meningitidis (meningococcal disease) Case definition
Novel influenza A infections Case definition
Pertussis Case definition
Poliomyelitis (paralytic) Case definition
Poliovirus infections (non-paralytic) Case definition
Psittacosis Case definition
Rubella Case definition
SARS-coronavirus Case definition
Streptococcus pneumoniae (invasive pneumococcal disease) Case definition
Streptococcal toxic shock syndrome Case definition
Tetanus Case definition
Varicella Case definition
To access CSTE position statements for these conditions, refer to the CSTE Position Statement Archiveexternal icon and enter the position statement number listed on the condition’s case definition page (above), title, author, or keyword into the search box. 

Manual for the Surveillance of Vaccine-Preventable Diseases

The Manual for the Surveillance of Vaccine-Preventable Diseases provides current guidelines for those directly involved in surveillance of VPDs, especially personnel at the local and state/territorial health departments. For each of the VPDs, the manual includes a chapter describing the importance of rapid case identification; the importance of surveillance; disease reduction goals; case definitions (including clinical description and case classifications); epidemiologically important data to be collected during case investigation; activities for enhancing surveillance; activities for case investigation; and activities for outbreak control. Other chapters include information on surveillance indicators; surveillance data analyses; enhancing surveillance; laboratory support for surveillance; and reporting adverse events following vaccination. In addition, the manual includes a section reserved for insertion of state-specific guidance for VPD surveillance, as well as extensive appendices.

Surveillance Indicators

The purpose of vaccine-preventable disease surveillance indicators in the United States is to ensure adequate performance of the essential components of surveillance and case investigation, and to identify components of each that need improvement. Surveillance indicators for selected vaccine-preventable diseases were proposed by CDC and approved by CSTE in 1994. Since then, the indicators have continued to evolve to maximize their usefulness. The CDC currently monitors indicators for measles, mumps, rubella, Haemophilus influenzae, pertussis, meningococcal disease, invasive pneumococcal disease and varicella on a regular basis.

APHL/CDC Vaccine-Preventable Disease Reference Centers

The VPD Reference Centers are four public health laboratories that work closely with the Association of Public Health Laborites (APHL) and CDC to provide quality testing to other public health laboratories and departments free of charge. The VPD Reference Centers are located in California, Minnesota, New York and Wisconsin, and provide testing for measles, mumps, rubella, varicella-zoster, B. pertussis, S. pneumoniae, N. meningiditis, and H. influenzae. For additional information about the testing available at the VPD Reference Centers see APHL’s vaccine-preventable diseases programexternal icon.

Coordination and Enhancement of Vaccine-Preventable Disease Surveillance

To enhance VPD surveillance and coordination, a new project was initiated in the 2015 Fiscal Year through the Epidemiology and Laboratory Capacity for Infectious Disease (ELC) Cooperative Agreement (CoAg). The project, “Surveillance Coordination for NNDSS Vaccine-Preventable Diseases and Enhanced Surveillance for Meningococcal Disease, Varicella, and Acute Flaccid Myelitis (ELC R1 CoAg),” focuses on surveillance coordination and strengthening vaccine-preventable disease outbreak and case-based surveillance, building on the foundation of established surveillance systems to provide broader and more representative data.

The ELC R1 CoAg has four required activities:

  1. Coordination of NNDSS surveillance for selected vaccine-preventable diseases, including the identification of a VPD Surveillance Coordinator.
  2. Enhancement of surveillance for meningococcal disease.
  3. Enhancement of surveillance for varicella.
  4. Establishment/enhancement of surveillance for acute flaccid myelitis.

Optional activities address varicella, pertussis, Haemophilus influenzae, invasive pneumococcal disease, measles, mumps and other vaccine-preventable diseases.

Questions about the ELC R1 CoAg or requests for project documents should be directed to

NNDSS Modernization Initiative

The NNDSS Modernization Initiative (NMI) has been established to improve CDC surveillance efforts and to support the goals of the CDC Surveillance Strategy. NMI has three components: 1) development of new HL7 Message Mapping Guides (MMGs), 2) development of the CDC Message Validation, Processing, and Provisioning System (MVPS), and 3) provision of technical assistance (TA) to jurisdictions.

As part of the CDC Surveillance Strategy and NMI, NCIRD has developed a process to support harmonization of variables across the 19 conditions for which NCIRD provides subject matter expertise. NCIRD considers a harmonization process to include identification of overlapping and similar concepts across conditions, so that concepts are either standardized or a decision is made to retain the concept in a unique format. Each decision is documented.

OMB-PRA approval has been received for the data included in NNDSS. For details, see Federal Register OMB Package 0920-0728external icon.

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Page last reviewed: February 26, 2020