Kristine Sheedy, PhDAssociate Director for Communication

ScienceNational Center for Immunization

and Respiratory Diseases

The Importance of Effective Vaccine Communication

VICNetwork 2011 Virtual Immunization SymposiumMay 25, 2011

Office of the Director

National Center for Immunization & Respiratory Diseases

Comparison of 20th Century Annual Morbidity and Current Morbidity: Vaccine-Preventable Diseases

Disease

20th CenturyAnnual

Morbidity†

2009Reported Cases † †

Percent Decrease

Smallpox 29,005 0 100%

Diphtheria 21,053 0 100%

Measles 530,217 61 > 99%

Mumps 162,344 982 99%

Pertussis 200,752 13,506 93%

Polio (paralytic) 16,316 0 100%

Rubella 47,745 4 > 99%

Congenital Rubella Syndrome

152 1 99%

Tetanus 580 14 98%

Haemophilus influenzae 20,000 243* 99%†Source: JAMA. 2007;298(18):2155-2163† † Source: CDC. MMWR January 8, 2010;58(51,52);1458-1468. (provisional, 2009 week 52 NNDSS data) * 25 type b and 218 unknown (< 5 years of age)

Vaccines Routinely Recommended for Children and Adolescents

1985 1995 2006MeaslesRubellaMumpsDiphtheriaTetanusPertussisPolioHib (infant) Hepatitis BVaricellaPneumococcal diseaseInfluenzaMeningococcal diseaseHepatitis ARotavirusHPV

MeaslesRubellaMumpsDiphtheriaTetanusPertussisPolioHib (infant) HepBVaricella

MeaslesRubellaMumpsDiphtheriaTetanusPertussisPolio

710

16

Increasing Vaccine-Specific Coverage Rates Among Preschool-Aged

Children

Source: USIS (1967-1985), NHIS (1991-1993) CDC, NCHS, and NIS (1994-2009), CDC, NIP and NCHS;

No data from 1986-1990 due to cancellation of USIS because of budget reductions.

DTP / DTaP(3+)†

MMR(1+)

Hib (3+)

2010 Target

Hep B (3+)

Polio (3+)

Varicella (1+)

PCV 7 (4+)

Rotavirus (3+)

0.6% of toddlers had received no vaccines at all

Estimated Return on InvestmentEstimated Return on Investmentof Childhood Vaccines, United of Childhood Vaccines, United

States, 2011States, 2011• For each birth cohort vaccinated against 13

diseases in accordance with the childhood schedule for DTaP, Hib, IPV, MMR, hep B, Varicella, Hepatitis A, Pneumo-7, and Rotavirus vaccines:– 42,000 lives are saved– 20M cases of disease are prevented– 13.6 billion dollars in direct costs are saved– 68.9 billion dollars in direct plus indirect (societal) costs

are saved– For each dollar invested in these vaccinations, $10.20 is

saved

Preliminary results of updated analysis from Zhou et al, Arch of Ped and Adolesc Med 2005

Confidence in Vaccine Safety

Percent of parents of at least one child 6 years of age or younger who reported that they were confident or very confident

in the safety of routine childhood vaccines

Year

Perc

en

t

Source: PN HealthStyles and ConsumerStyles Surveys

The Good News

• Protect children from 16 VPDs• Record low rates for most VPDs• Record high toddler immunization

rates• Less than 1% zero dose children• Several newer vaccines in routine use• Narrowing racial and economic

disparities• Generally a high level of confidence in

vaccine safety

• Low disease awareness = increased focus on vaccine risks

• Low tolerance for vaccine risks• Full and complicated immunization

schedule

Less Disease and More Vaccines = More Attention to

Vaccine Risks

Highly Concerned Parents seem to

Cluster Geographically • Although < 1% of all children have received no

vaccines, these children cluster geographically and increase the risk of transmitting vaccine-preventable diseases to others in their communities

• Zero-dose children tend to have higher SES and are frequently source cases in VPD outbreaks

Smith, P, Chu, S, Barker L. Children who have received no vaccines: Who are they and where do they live? Pediatrics, 2004; 114;187-195.

Measles 2008

Highest number of reported cases/year since 1996

No increase in imported cases

Increase in spread within the U.S. 7 “outbreaks” Parent vaccine

refusal common

Measles ImportationsUnited States, 2011

• 98 measles cases reported to date in 2011

• Importations into > 20 states from 12-15 countries– > 10 from France

• 8 outbreaks (3-21 cases)

Slide: Courtesy of Kathleen Winter, Source: California Department of Public Health

Multiple Factors Can Lead to Vaccine-Preventable Disease Increases

Failure to vaccinate (e.g., due to access, supply, acceptance) Accumulation of unvaccinated susceptible persons permits

infectious agent to spread (e.g., measles outbreaks in 2008)

Waning immunity following childhood vaccination Pertussis rise in CA 2010

Less than optimal vaccine effectiveness and high force of infection Mumps (Midwest universities 2006, NE religious schools 2010)

Change in circulating strains Pneumococcal infectious caused by nonvaccine types

Which concerns, if any, do you have about childhood vaccines?

Preliminary results from PN HealthStyles and ConsumerStyles Surveys

Many Parents Have Questions and Concerns

What are the three most important sources of information that have helped

you make decisions about your youngest child’s vaccinations?

Child’s healthcare provider, such as a doctor or nurse (85%)

Family (46%) American Academy of Pediatrics

(28%) CDC (26%) Internet (24%)

Preliminary results: Health Styles 2010, parents of children <6

2009 Focus Groups: Vaccine Schedule and Timing

Mothers were generally knowledgeable about the timing of vaccines

Many reacted negatively to receiving multiple injections during one visit

Most were vaccinating according to the recommended schedule, but several across race/education/location segments reported (generally short-term) spreading vaccinations Variety of reasons for spreading: concerns about children’s

ability to “handle” multiple vaccines; concerns about ability to pinpoint source of adverse events; some concerns about pain

2009 Focus Groups: VPD Knowledge and Beliefs

After reading brief descriptions of the 14 VPDs, many mothers said they were surprised to find out how many could be fatal, including some they previously did not consider serious

Many mothers shared personal stories that impacted their view of particular VPDs Some knew a baby who had whooping cough

(heightened their perception of severity) Most talked about their own experience with flu or

chickenpox (lessened their perception of severity)

www.cdc.gov/vaccines/conversations

Websites

Provider Resources for Vaccine Conversations with Parents www.cdc.gov/vaccines/conversations

Give Feedback on Provider Resources www.cdc.gov/vaccines/tellus

Health Care Professional Home Page www.cdc.gov/vaccines/hcp

“Get the Picture” Childhood Video www.youtube.com/user/CDCStreamingHealth

Thank youksheedy@cdc.gov