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The Importance of Effective Vaccine Communication Kristine Sheedy, PhD Associate Director for Communication Science National Center for Immunization and Respiratory Diseases VICNetwork 2011 Virtual Immunization Symposium May 25, 2011 National Center for Immunization & Respiratory Diseases Office of the Director Comparison of 20th Century Annual Morbidity and Current Morbidity: Vaccine-Preventable Diseases Disease 20th Century Annual Morbidity† 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% 20,000 243* 99% Haemophilus influenzae †Source: 2009 Reported Cases † † JAMA. 2007;298(18):2155-2163 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) † † Source: Percent Decrease Vaccines Routinely Recommended for Children and Adolescents 7 1985 1995 2006 Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) HepB Varicella Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) Hepatitis B Varicella Pneumococcal disease Influenza Meningococcal disease Hepatitis A Rotavirus HPV 10 16 Increasing Vaccine-Specific Coverage Rates Among Preschool-Aged Children 2010 Target DTP / DTaP(3+)† MMR(1+) Hep B (3+) PCV 7 (4+) Polio (3+) Rotavirus (3+) Hib (3+) Varicella (1+) 0.6% of toddlers had received no vaccines at all 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. Estimated Return on Investment of Childhood Vaccines, United States, 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 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 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 Less Disease and More Vaccines = More Attention to Vaccine Risks • Low disease awareness = increased focus on vaccine risks • Low tolerance for vaccine risks • Full and complicated immunization schedule 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 vaccinepreventable 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 Importations United 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 VaccinePreventable 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 Many Parents Have Questions and Concerns Which concerns, if any, do you have about childhood vaccines? 2010 Weighted % It is painful for children to receive so many shots during one doctor’s visit. 38 My child getting too many vaccines in one doctor’s visit. 36 Children get too many vaccines in the first two years of life. 34 Vaccines causing fevers in my child. 32 Vaccines may cause learning disabilities (such as autism). 30 Preliminary results from PN HealthStyles and ConsumerStyles Surveys 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 you [email protected]