Coverage Rates in Texas Coverage Surveys National Immunization

Coverage Rates in Texas

Coverage Surveys • National Immunization Survey • Child • Teen • Flu • Behavioral Risk Factor Surveillance Summary • Annual School Survey 11/28/2017 Texas Immunization Conference 2

2016 NIS-Child National Immunization Survey • Children 19 -35 months • Annual survey conducted by CDC • Vaccine histories are provider-verified 11/28/2017 Texas Immunization Conference 3

Vaccination Coverage Estimates for 19 -35 Month Old Children in Texas and U. S. , 20152016 U. S. National Average 2016 Texas 2015 ≥ 4 doses of DTa. P 83. 4% 81. 3% 82. 1% ≥ 3 doses of Polio 91. 9% 90. 1% 92. 5% ≥ 1 dose of MMR 91. 1% 89. 8% 92. 5% Hib (doses vary) 81. 8% 80. 0% 80. 4% ≥ 3 doses of Hep. B 90. 5% 88. 3% 90. 7% Hep. B birth dose 71. 7% 75. 2% 76. 4% ≥ 1 dose of Var 90. 6% 90. 4% 92. 3% ≥ 4 doses of PCV 81. 8% 82. 4% 83. 3% ≥ 2 doses of Hep. A 60. 6% 60. 5% 64. 6% Rotavirus (doses vary) 74. 1% 72. 7% 75. 7% 4: 3: 1: 3: 3: 1: 4 series 70. 7% 69. 5% 71. 2% Vaccine 11/28/2017 Texas Immunization Conference 4

Immunization Coverage Estimates with 95% Confidence Intervals in 19 -35 Month Old Children, U. S. and Texas, 2016 100 90 Percent Coverage 80 70 60 50 40 30 20 10 H 11/28/2017 Texas Immunization Conference 3: 1: iru 1: 3: ta v 3: Texas 4 s A ep H PC V r Va Ro US 4: ep B bi rt h H do se B ep ib H M R M lio Po D Ta P 0 5

Vaccination Coverage Estimate for DTa. P, Polio, Hib, PCV, and Rotavirus in Texas Children 19 to 35 Months-Old, 2009 -2016 Title (hide) 100, 0 90, 0 Percent vaccinated 80, 0 70, 0 60, 0 50, 0 40, 0 30, 0 20, 0 10, 0 2009 2010 DTa. P 11/28/2017 2011 Polio 2012 2013 Year Hib PCV Texas Immunization Conference 2014 2015 2016 Rotavirus 6

Vaccination Coverage Estimates for MMR, Var, Hep. B Birth Dose, and Hep. A in Texas Children 19 -35 Months, 2009 -2016 100, 0 90, 0 Percent vaccinated 80, 0 70, 0 60, 0 50, 0 40, 0 30, 0 20, 0 10, 0 2009 2010 MMR 11/28/2017 2011 Hep. B 2012 Year 2013 Hep. B birth dose Texas Immunization Conference 2014 Var 2015 2016 Hep. A 7

Coverage Estimate of the 4: 3: 1: 3: 3: 1: 4 Combined Vaccine Series in Texas, 2016 100, 0 90, 0 Percent vaccinated 80, 0 72, 7 70, 0 72, 5 64, 8 71, 2 69, 5 2016 64, 0 58, 6 60, 0 50, 0 40, 7 40, 0 30, 0 20, 0 10, 0 2009 2010 2011 2012 Year 2013 2014 4: 3: 1: 3: 3: 1: 4 11/28/2017 Texas Immunization Conference 8

4: 3: 1: 3: 3: 1: 4 Vaccine Series Coverage with 95% Confidence Intervals among Children 19 through 35 Months Old, U. S. , Texas, Select Jurisdictions, 2016 100 Percent Coverage 90 80 70, 7 70 73, 1 69, 4 69, 5 72, 8 71, 2 68, 3 60 50 40 30 20 10 0 US 11/28/2017 s y nt xa Te r xa e B u Co of y t Ci n nt to H s ou s lla Da u Co Texas Immunization Conference y y nt o s Pa l E u Co ate t f. S o st Re 9

Coverage Estimates with 95% Confidence Intervals for MMR, Hep. B Birth Dose, Var, Hep. A, and the 4: 3: 1: 3: 3: 1: 4 Vaccine Series, U. S. , City of Houston, and Texas, 2016 100 95, 6 94, 5 89, 3 90 77, 2 80 70 Percent Coverage 73, 1 68, 1 60 50 40 30 20 10 0 MMR Hep. B birth dose U. S. 11/28/2017 Texas Var Hep. A 4: 3: 1: 3: 3: 1: 4 City of Houston Texas Immunization Conference 13

Coverage Estimates with 95% Confidence Intervals for MMR, Hep. B Birth Dose, Var, Hep. A, and the 4: 3: 1: 3: 3: 1: 4 Vaccine Series, U. S. , Dallas County, and Texas, 2016 100 85, 7 91, 2 92, 5 89, 1 90 80 71, 2 Percent Coverage 70 64, 1 60 50 40 30 20 10 0 MMR Hep. B birth dose U. S. 11/28/2017 Texas Var Hep. A 4: 3: 1: 3: 3: 1: 4 Dallas County Texas Immunization Conference 15

Coverage Estimates with 95% Confidence Intervals MMR, Hep. B Birth Dose, Var, Hep. A, and the 4: 3: 1: 3: 3: 1: 4 Vaccine Series, U. S. , El Paso County, and Texas, 2016 94, 8 100 96, 7 96, 0 90 80 74, 8 72, 8 66, 8 Percent Coverage 70 60 50 40 30 20 10 0 MMR Hep. B birth dose U. S. 11/28/2017 Texas Var Hep. A 4: 3: 1: 3: 3: 1: 4 El Paso County Texas Immunization Conference 17

2016 NIS-Teen National Immunization Survey • Children 13 -17 years • Vaccines recommended for that age group • Childhood vaccine catch-up • Annual survey conducted by CDC • Vaccine histories are provider-verified 11/28/2017 Texas Immunization Conference 18

Vaccination Coverage Estimates for 13 -17 Year Old Children in Texas and U. S. , 2015 -2016 U. S. National Average 2016 Texas 2015 ≥ 1 dose of Tdap 88. 0% 85. 1% ≥ 1 dose Men. ACWY 82. 2% 85. 5% 89. 6% ≥ 1 dose HPV 60. 4% 49. 3% 50. 6% HPV Up-To-Date (UTD) 43. 4% 32. 9% - ≥ 1 HPV, females 65. 1% 54. 5% 60. 1% HPV UTD, females 49. 5% 39. 7% - ≥ 1 dose HPV, males 56. 0% 44. 3% 41. 4% HPV UTD, males 37. 5% 26. 5% - ≥ 2 doses MMR 90. 9% 83. 5% 84. 7% ≥ 2 dose VAR 85. 6% 80. 4% 81. 6% Vaccine 11/28/2017 Texas Immunization Conference 19

Immunization Coverage Estimates with 95% Confidence Intervals in 13 -17 Year Old Children, U. S. and Texas, 2016 100% 90% 80% Coverage Estimate 70% 60% 50% 40% 30% 20% 10% 0% ≥ 1 Tdap ≥ 1 Men. ACWY ≥ 2 MMR United States 11/28/2017 ≥ 2 VAR ≥ 1 HPV UTD Texas Immunization Conference 20

Vaccination Coverage Estimates with 95% Confidence Intervals for Tdap and Men. ACWY among Children 1317 Years Old, U. S. , Texas, Select Jurisdictions, 2016 100% 90% 80% Coverage Estimate 70% 60% 50% 40% 30% 20% 10% 0% ≥ 1 Tdap United States 11/28/2017 Texas Bexar County ≥ 1 Men. ACWY City of Houston Texas Immunization Conference Dallas County El Paso County 21

Vaccination Coverage Estimates with 95% Confidence Intervals for MMR and VAR among Children 13 -17 Years Old, U. S. , Texas, Select Jurisdictions, 2016 100% 90% Coverage Estimate 80% 70% 60% 50% 40% 30% 20% 10% 0% ≥ 2 MMR United States 11/28/2017 Texas Bexar County ≥ 2 VAR City of Houston Texas Immunization Conference Dallas County El Paso County 22

Vaccination Coverage Estimates with 95% Confidence Intervals for ≥ 1 Dose of HPV and Up-to. Date HPV among Children 13 -17 Years Old, U. S. , Texas, Select Jurisdictions, 2016 100% 90% Coverage Estimate 80% 70% 60% 50% 40% 30% 20% 10% 0% ≥ 1 HPV United States 11/28/2017 Texas Bexar County HPV UTD City of Houston Texas Immunization Conference Dallas County El Paso County 23

100% Vaccination Coverage Estimates with 95% Confidence Intervals for ≥ 1 Dose of HPV by Sex among Children 13 -17 Years Old, U. S. , Texas, Select Jurisdictions, 2016 90% 80% Coverage Estimate 70% 60% 50% 40% 30% 20% 10% 0% ≥ 1 HPV, females United States 11/28/2017 Texas Bexar County ≥ 1 HPV, males City of Houston Texas Immunization Conference Dallas County El Paso County 24

Vaccination Coverage Estimates with 95% Confidence Intervals for Up-to-Date HPV Series by Sex among Children 13 -17 Years Old, U. S. , Texas, Select Jurisdictions, 2016 100% 90% 80% Coverage Estimate 70% 60% 50% 40% 30% 20% 10% 0% HPV UTD, females United States 11/28/2017 Texas Bexar County HPV UTD, males City of Houston Texas Immunization Conference Dallas County El Paso County 25

2016 NIS-Flu National Immunization Survey • Children 6 months-17 years • Self-reported data, not providerverified Behavioral Risk Factor Surveillance System • Adults • Self-reported data, not providerverified 11/28/2017 Texas Immunization Conference 26

2016 -2017 Seasonal Influenza Immunization Coverage in the US and Texas by Age Group 100 80 70 72 Percent Vaccinated 65 59 60 60 47 60 60 49 62 50 44 43 38 40 38 33 20 0 ≥ 6 mos − 4 6 mos− yrs 17 yrs 5− 12 yrs 13− 17 yrs ≥ 18 yrs 18− 64 yrs ≥ 65 yrs United States 11/28/2017 Texas Immunization Conference 27

2016 -2017 Seasonal Influenza Immunization Coverage Estimates for the US, Texas, Bexar County, and City of Houston, by Age Group 100 90 Coverage Estimate (Percent) 80 70 70 72 70 73 68 60 60 60 64 62 49 50 70 65 50 53 58 38 40 30 33 60 37 30 20 10 0 6 mos-4 yrs 5 -12 yrs United States 11/28/2017 Texas 13 -17 yrs Age Group 18 -64 yrs Bexar County City of Houston Texas Immunization Conference 65+ yrs 28

2016 BRFSS Behavioral Risk Factor Surveillance System • Adults • Annual telephone survey • Self-reported data, not providerverified 11/28/2017 Texas Immunization Conference 29

Coverage Estimate for “Received Any Tetanus Vaccine since 2005” in Adults by Age Group, 2016 100 90 Percent Vaccinated 80 70 65, 8 60 60, 9 58, 0 52, 0 50 40 30 20 10 0 18 -29 11/28/2017 30 -44 45 -64 Age Group (in years) Texas Immunization Conference 65+ 30

Type of Tetanus Vaccine Received, 2016 100 90 18 -29 30 -44 80 45 to 64 65+ Percentage 70 60 50 40 30 20 10 0 Yes, received Tdap Yes, but not Tdap Yes, not sure what type Type of Shot 11/28/2017 Texas Immunization Conference No 31

Coverage Estimate for Ever Received Any Pneumococcal Vaccine in Adults by Age Group, 2016 100 90 Percent Vaccinated 80 71, 3 70 60 50 40 30 25, 4 21, 0 25, 5 20 10 0 18 -29 11/28/2017 30 -44 45 -64 Age Group (in years) Texas Immunization Conference 65+ 32

School Coverage 2016 -17 Annual School Survey • Survey sent to 1, 195 public school districts and 1, 046 accredited private schools • 88. 22% response rate overall • Public - 95. 98% • Private - 79. 35% Conscientious Exemption Data • Exemption Requests processed at DSHS 11/28/2017 Texas Immunization Conference 33

Texas Students in Grades K-12 with a Conscientious Exemption on File, Annual Report of Immunization Status, 2010 -2017 Conscientious Exemptions 60 000 6 % Total 50 000 5 40 000 4 30 000 3 20 000 2 Percent Exempt Number Exempt # COs [VALUE]% 10 000 1 [VALUE]% 0 20 10 -2 0 20 11 11 -2 01 20 2 12 - 20 1 20 3 20 13 -2 01 4 14 -2 20 01 15 5 0 -2 0 20 16 16 -2 0 17 School Year 11/28/2017 Texas Immunization Conference 34

Texas Kindergarten Annual Report of Immunization Status, School Year 2016 -2017 Vaccine Category DTa. P Hepatitis A Hepatitis B MMR Polio Varicella* Reported Reasons for Lack of Completion by Vaccine Percent Completely Conscientious Vaccinated Exemptions Medically Provisional Delinquent Exempt Enrollment 97. 15% 1. 34% 0. 09% 0. 52% 0. 90% 96. 78% 1. 32% 0. 08% 1. 20% 0. 62% 97. 88% 97. 34% 97. 31% 96. 53% 1. 29% 1. 41% 1. 37% 1. 43% 0. 06% 0. 11% 0. 08% 0. 13% 0. 22% 0. 28% 0. 52% 0. 54% 0. 92% 0. 96% 0. 98% *An additional 0. 41% of Kindergarten students met school entry requirements through proven history of varicella (chickenpox) disease. 11/28/2017 Texas Immunization Conference 37

Texas 7 th Grade Annual Report of Immunization Status, School Year 2016 -2017 Vaccine Category Tdap Reported Reasons for Lack of Completion by Vaccine Percent Completely Conscientious Medically Provisional Vaccinated Exemptions Exempt Enrollment Delinquent 96. 93% 0. 95% 0. 08% 0. 25% 1. 79% 98. 16% 0. 71% 0. 06% 0. 62% 0. 45% 98. 77% 0. 64% 0. 04% 0. 18% 0. 37% 97. 25% 0. 95% 0. 07% 0. 16% 1. 57% MMR 98. 86% 0. 65% 0. 06% 0. 11% 0. 33% Polio 98. 68% 0. 69% 0. 05% 0. 20% 0. 38% Varicella* 96. 78% 0. 71% 0. 10% 0. 20% 0. 39% Hepatitis A Hepatitis B MCV 4 *An additional 1. 81% of 7 th grade students met school entry requirements through proven history of varicella (chickenpox) disease. 11/28/2017 Texas Immunization Conference 38

Conscientious Exemption Requests, 2012 -2017 YTD 70000 60943 Number of Requests 60000 54933 50000 45571 47650 2014 2015 40000 31193 30000 20000 10000 0 2012 11/28/2017 2013 Year of Request Texas Immunization Conference 2016 2017 YTD 39

Seasonality of Conscientious Exemption Requests, 2016 -17 16000 2016 (total 54, 933) 14000 Number of Requests 2017 (60, 943 YTD) 12000 10000 8000 6000 4000 2000 r em be r D ec em be er N ov ct ob r O be em Se pt Au gu st ly Ju ne Ju ay M ril Ap ar ch M ua y br Fe Ja nu ar y 0 Month of Request 11/28/2017 Texas Immunization Conference 40

Summary • Overall, Texas children continue to be well-vaccinated • Gaps remain HPV, Hep A, Adult Tdap • Learn from success stories Dallas: Hep B birth dose El Paso: HPV Houston: Flu 11/28/2017 Texas Immunization Conference 41

Thank you Rachel Wiseman, MPH Assessment, Compliance, & Evaluation Group Manager Rachel. Wiseman@DSHS. Texas. gov 11/28/2017 Texas Immunization Conference 42