Overview of National Surveillance for VaccinePreventable Diseases
Sandra W. Roush, MT, MPH September 30, 2014
Comparison Annual of 20th Century Morbidity and Current Morbidity: Vaccine-Preventable Diseases 20th Century Annual Morbidity†
Disease
2013 Reported Cases † †
Percent Decrease
Smallpox
29,005
0
100%
Diphtheria
21,053
0
100%
Measles
530,217
187
> 99%
Mumps
162,344
584
> 99%
Pertussis
200,752
28,639
86%
Polio (paralytic)
16,316
1
> 99%
Rubella
47,745
9
> 99%
Congenital Rubella Syndrome
152
1
99%
Tetanus
580
26
96%
20,000
31*
> 99%
Haemophilus influenzae †
JAMA. 2007;298(18):2155-2163 CDC. MMWR August 15, 2014:63(32);702-715. (MMWR 2013 final data) * Haemophilus influenzae type b (Hib) < 5 years of age. An additional 10 cases of Hib are estimated to have occurred among the 185 reports of Hi (< 5 years of age) with unknown serotype. ††
National Center for Immunization & Respiratory Diseases 8/28/14
Historical Comparisons of Vaccine-Preventable Disease Morbidity in the U.S.
Comparison of Pre-Vaccine Era Estimated Annual Morbidity with Current Estimate: Vaccine-Preventable Diseases Pre-Vaccine Era Annual Estimate
Disease Hepatitis A Hepatitis B (acute)
2013 Estimate (unless otherwise specified)
Percent Decrease
117,333 † 66,232 †
2,890 * 18,800 *
98% 72%
63,067 †
33,500 #
47%
16,069 † 62,500 † †
1,900 ## 12,500 ###
88% 80%
4,085,120 †
167,490 ####
96%
Pneumococcus (invasive) all ages < 5 years of age Rotavirus (hospitalizations, < 3 years of age) Varicella †
JAMA. 2007;298(18):2155-2163 CDC. MMWR. February 6, 2009 / 58(RR02);1-25 * CDC. Viral Hepatitis Surveillance - United States, 2011 # CDC, Active Bacterial Core Surveillance Provisional Report; S. pneumoniae 2013 ## CDC. Unpublished, Active Bacterial Core Surveillance ### New Vaccine Surveillance Network 2013 data (unpublished); U.S. rotavirus disease now has biennial pattern #### CDC. Varicella Program 2013 data (unpublished) ††
National Center for Immunization & Respiratory Diseases 8/28/14
Historical Comparisons of Vaccine-Preventable Disease Morbidity in the U.S.
Objectives for Vaccine-Preventable Disease Surveillance • • • • • • • • •
Estimate burden of disease, severity, complications Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures, monitor use of vaccine Monitor changes in infectious agents Detect changes in health practices Facilitate public health planning
Surveillance Continuum: Factors Affecting Surveillance Planning S. pneumoniae
Disease incidence
measles/rubella
pertussis
Specificity of clinical presentation
H. influenzae
pertussis
Availability and ease of lab testing
measles
Additional control strategies (e.g., outbreak control) pertussis
Goal (control vs. elimination)
rubella
Stage of vaccination or other prevention program
Questions about Surveillance Data • What do the data mean?
• Does ZERO mean ZERO? • Can we describe the strengths and challenges of the surveillance system? • Are there vaccine failures?
• Are the reported cases really cases?
Critical Elements in National Surveillance for Vaccine-Preventable Diseases • Demographic data • Clinical history • Vaccination history
• Laboratory testing, confirmation, and molecular epidemiology • Importation status
Surveillance Indicators • Developed in 1988 by PAHO for polio eradication effort – – – –
surveillance infrastructure timeliness of reporting adequacy of case investigation appropriateness of laboratory testing and diagnostic effort
• Concept for U.S. VPD surveillance indicators approved by CSTE in 1994 – initially applied to measles – currently for measles, rubella, mumps, pertussis, H. influenzae type b; adding meningococcal disease and varicella
National Surveillance Indicator Report: Pertussis Total cases*
% with complete vaccine hx
# cases < 7 yr old
2008
13,278
8
2009
16,858
2010
Pertussis
% <7 with complete vaccine history Manufacturer name required
Manufacturer name not required
4,109
17
30
6
6,025
17
29
27,550
7
10,181
15
30
2011
18,719
7
6,443
14
32
2012
48,277
8
13,259
16
43
* NBS (AL, AR, DC, ID, KY, MD, ME, MT, NE, NM, NV, RI, SC, TN, TX, VA, VT, WV, WY) states' data may not accurately reflect state-based data or surveillance effort.
BBBBB
National Surveillance Indicator Report: Haemophilus influenzae H. influenzae
Total Cases < 5 yr old*
% < 5 with serotyping
2008
437
2009
*
% < 5 with complete vaccine history Manufacturer name required
Manufacturer name not required
63
22
32
449
63
23
37
2010
446
50
17
28
2011
385
41
15
26
2012
445
53
16
28
NBS (AL, AR, DC, ID, KY, MD, ME, MT, NE, NM, NV, RI, SC, TN, TX, VA, VT, WV, WY) states' data may not accurately reflect state-based data or surveillance effort.
Nationally Notifiable Diseases Surveillance System (NNDSS) States* Data Map for National Center for Immunization and Respiratory Diseases (NCIRD) (9/2014) “NEDSS Compatible” Systems (33 states) NETSS Extract Epi Data
NEDSS Base System (NBS) (19 states)
Varicella HL7 message
HL7 NBS Message
Epi data
Core Data
Core Data
National Electronic Telecommunications System for Surveillance (NETSS)
Nationally Notifiable Diseases Surveillance System (NNDSS) at CDC
NBS and HL7 mapping to NETSS
Nationally Notifiable Diseases Surveillance System (NNDSS) at CDC: MMWR data available to NCIRD *Includes states, DC, and NYC
CDC Data warehouses and/or platforms: Data NOT available to NCIRD Programs
CDC Surveillance Strategy • Launched February 24, 2014 • http://www.cdc.gov/ophss/docs/CDCSurveillance-Strategy-Final.pdf • Four cross-cutting agency initiatives • • • •
NNDSS Modernization Initiative (NMI) BioSense enhancement Accelerate electronic lab reporting National Vital Statistics System enhancement
NNDSS Modernization Initiative (NMI) • Message mapping guides – HL7 standard messages • CDC Platform (CDCP) to support the electronic exchange of surveillance data • Technical assistance • http://wwwn.cdc.gov/nndss/script/NNDSS_Moder nization_Initative.aspx • Initial phase of NMI includes generic guide v.2, STD, hepatitis, congenital syphilis, pertussis, and mumps
Case reports were transmitted by telephone or telegraph to the Poliomyelitis Surveillance Unit, where the data were collated, analyzed, and disseminated via poliomyelitis surveillance reports. The first report was mailed out on May 1, 1955 - only 3 days after the surveillance activity was initiated. Data were collected, analyzed, and disseminated rapidly to allow policy makers to base their decisions on the best information available. Morbidity data were not collected for publication in archival tables but rather to characterize an important public health problem and to facilitate effective public health action.
Describing national polio surveillance after the licensure of inactivated poliomyelitis vaccine (IPV) in 1955. CDC. Manual for the Surveillance of Vaccine-Preventable Diseases. Chapter 23. Dec 2011
THANK YOU ! Sandra W. Roush, MT, MPH Surveillance Officer National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention phone: 404-639-8741
[email protected]
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention
