Sandra W. Roush, MT, MPHSurveillance Officer, CDC/NCIRD

August 7, 2012NCHS 2012 National Conference on Health Statistics

Overview of Vaccine Preventable Disease (VPD) Surveillance in the United States

National Center for Immunization and Respiratory DiseasesOverview of Vaccine Preventable Disease (VPD) Surveillance in the US

Presentation Objectives

Discuss:

• Purpose of vaccine-preventable disease (VPD) surveillance

• Types of surveillance data collected• Surveillance systems/methods• Support for VPD surveillance

Purpose of vaccine-preventable disease (VPD) surveillance

Purpose of Vaccine-Preventable Disease Surveillance

• Estimate burden of disease• Evaluate control measures• Determine geographic distribution• Portray the natural history• Detect epidemics/define a problem• Generate hypotheses, stimulate research• Monitor changes in infectious agents• Detect changes in health practices• Facilitate planning

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

Disease20th Century

Annual Morbidity†2011

Reported Cases † †Percent Decrease

Smallpox 29,005 0 100%

Diphtheria 21,053 0 100%

Measles 530,217 212 > 99%

Mumps 162,344 370 > 99%

Pertussis 200,752 15,216 92%

Polio (paralytic) 16,316 0 100%

Rubella 47,745 4 > 99%

Congenital Rubella Syndrome 152 0 100%

Tetanus 580 9 98%

Haemophilus influenzae 20,000 8* > 99%†Source: JAMA. 2007;298(18):2155-2163† † Source: CDC. MMWR January 6, 2012;60(51);1762-1775. (provisional 2011 data) * Haemophilus influenzae type b (Hib) < 5 years of age. An additional 14 cases of Hib are estimated to have occurred among the 237 reports of Hi (< 5 years of age) with unknown serotype.

Comparison of Pre-Vaccine Era Estimated Annual Morbidity with Current Estimate: Vaccine-Preventable

Diseases

Disease Pre-Vaccine Era Annual Estimate

2010 Estimate Percent Decrease

Hepatitis A 117,333 † 7,138 94%Hepatitis B (acute) 66,232 † 9,428 86%Pneumococcus (invasive)

all ages 63,067 † 39,500 # 37%

< 5 years of age 16,069 † 4,400## 73%

Rotavirus (hospitalizations, < 3 years of age)

Varicella

62,500 † †

4,085,120 †

2,500###

281,873

96%

93%

† Source: JAMA. 2007;298(18):2155-2163†† Source: CDC. MMWR. February 6, 2009 / 58(RR02);1-25# Source: CDC. Active Bacterial Core surveillance Provisional Report; S. pneumoniae 2010. http://www.cdc.gov/abcs/reports-findings/survreports/spneu09.htmll## Source: 2010 (provisional) Active Bacterial Core surveillance ### Source: New Vaccine Surveillance Network (unpublished)

Types of VPD surveillance data collected

1922

1930

1940

1950

1960

1970

1980

1990

2000

2010

0

50,000

100,000

150,000

200,000

250,000

300,000

Year

Num

ber o

f cas

esReported Pertussis Cases, 1922–2010

DTP

1990

1995

2000

2005

2010

0

5,000

10,000

15,000

20,000

25,000

30,000

Tdap

DTaP

SOURCE: CDC, National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System and 1922-1949, passive reports to the Public Health Service

Reported Pertussis Cases by Diagnosis± 1990-2010

1990 1995 2000 2005 20100

5000

10000

15000

20000

25000

30000

UnknownSero+(MA)Epi-linkedDFAPCRCulture

Year

Num

ber o

f Cas

es

±Data collection for PCR and Epi-Link began in 1995Source: CDC, National Notifiable Diseases Surveillance System and Supplemental Pertussis Surveillance System, 2010

Measles Cases, United States, 1962-2011

1960

1961

1962

1963

1964

1965

1966

1967

1968

1969

1970

1971

1972

1973

1974

1975

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

100,000

200,000

300,000

400,000

500,000

600,000

Year

Num

ber o

f cas

es

1989 – 2nd Dose Recommended

0

5,000

10,000

15,000

20,000

25,000

30,000

1963Vaccine

Licensed1989-1991

Resurgence

1993Vaccines for

Children Program

2000 Elimination

Declared

Measles, United States, 2001-2011Importations by WHO Region

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

10

20

30

40

50

60

70

80 UnknownWestern Pacific(WPR)South East Asian(SEAR)European(EUR)Eastern Mediterranean(EMR)African(AFR)American(AMR)

Year

Num

ber o

f Cas

es

Critical Elements in National Surveillance for VPDs

• Demographic data• Clinical history• Vaccination history• Laboratory testing, confirmation,

and molecular epidemiology • Role of importation

Surveillance systems/methods

VPD Surveillance Data Sources in the U.S.• State-based national passive surveillance

(National Notifiable Disease Surveillance System - NNDSS)

• Sentinel sites with active surveillance• Administrative data reviews (hospital

discharge data and other resources)• Special studies for specific diseases or

conditions• Laboratory-based studies

NNDSS: Case Reporting and Case Notification in the U.S.

Local Health Department

State Health Department

Laboratoryreporting

Health Care Provider reporting

CDC• 50 states• 64 grantees• > 3,000

counties

notification

States’ Participation in National VPD Surveillance

• List of nationally notifiable diseases from the Council of State and Territorial Epidemiologists (CSTE), with individual state implementation

• Case definitions determined by CSTE, to improve specificity and enhance comparability of cases (suspect, probable, confirmed)

• Laboratory support from Association of Public Health Laboratories (APHL)

National VPD Surveillance Data in the U.S.

• Reporting completeness varies (10%-90%)• Limited federal funding is available specifically

for surveillance • Number of case reports changes related to

disease incidence, but also due to testing technology, state laws, provider awareness

Support for vaccine-preventable disease (VPD) surveillance

Federal Assistance for VPD Surveillance

• Immunization program grant/cooperative agreement and special projects

• Technical assistance– Consultation and epidemiologic response– Standards of practice: Manual for the

Surveillance of Vaccine-Preventable Diseases http://www.cdc.gov/vaccines/pubs/surv-manual/ and Immunization Program Operations Manual

• Laboratory support

Federal Assistance for VPD Surveillance, continued

• Information dissemination – Weekly/annual MMWR surveillance

summaries– Manuscripts and other venues

• Electronic data transmission, including demographic and epidemiologic case information (NETSS, NEDSS)

• Monitoring national surveillance indicators (imported cases, laboratory confirmation, timeliness, completeness, and others)

Thank you!

Contact info:

Sandy Roush, CDC/NCIRD404-639-8741swr1@cdc.gov