Kristine Sheedy, PhD Associate Director for Communication Science National Center for Immunization and Respiratory Diseases The Importance of Effective Vaccine Communication VICNetwork 2011 Virtual Immunization Symposium May 25, 2011 Office of the Director National Center for Immunization & Respiratory Diseases
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Kristine Sheedy, PhD Associate Director for Communication Science National Center for Immunization and Respiratory Diseases The Importance of Effective.
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Kristine Sheedy, PhDAssociate Director for Communication
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)