Priority Area: Infectious Disease - Immunization

The Burden of Infectious Diseases - Immunization

The prevention of vaccine preventable diseases is an extremely important public health goal achieved through immunization. Vaccine preventable diseases are at an all-time low in New York State (NYS) and in the U.S. as a whole. Among children, immunization rates are high because of school entry requirements, the Vaccines for Children Program, and insurance coverage for vaccines. Among adults, coverage is not optimal because of lack of awareness of the importance of immunization for adults and lack of insurance coverage. Indeed, the majority of vaccine preventable diseases now occur among adults in the United States.


By the year 2013:

  • Increase the percent of children aged 2 years who receive recommended vaccine (4 DTaP, 3 polio, 1 MMR, 3 Hib, and 3 hep b*) to 90%.
  • Increase the percent of adults aged 65 years and older who received a flu shot in the last year to 90%.
  • Increase the percent of adults aged 65 years and older who have ever received a pneumococcal (pneumonia) vaccine to 90%.

* 4 diphtheria, tetanus, and acellular pertussis (DTaP), 3 polio, 1 measles, mumps, and rubella (MMR), 3 Haemophilus influenzae (Hib), and 3 hepatitis b (hep b) vaccines.

Indicators for Tracking Public Health Priority Areas

Each community's progress towards reaching these Prevention Agenda Objectives will be tracked so members can see how close each community is to meeting the objectives.

Data and Statistics

  • Vaccination Coverage Among U.S. Adults, National Immunization Survey-Adult, 2007 (pdf, 2 pages)
    Table with national vaccination coverage data from the National Adult Immunization Survey
    State-Specific Influenza Vaccination Coverage Among Adults- United States, 2006-2007 Influenza Season MMWR, September 26, 2008, Vol. 57, No. 38.
    The report has tables of self-reported influenza coverage rates among adults 18 years and older by state, region, age and racial sub-groups using the Behavioral Risk Factor Surveillance System (BRFSS). The tables illustrate that the influenza vaccination coverage significantly increased during the 2006--07 season among all adult groups for whom vaccination is recommended as compared to the previous season. However, the coverage did not achieve the Healthy People 2010 target of 60% for persons aged 18--64 years with high-risk conditions and 90% for persons aged greater than 65 years. For Asians, the racial/ethnic gap as compared to Caucasians was eliminated. The gap in vaccination coverage between Caucasians and other racial/ethnic groups remained essentially the same for the 2005--06 and 2006--07 seasons.
    National, State, and Local Area Vaccination Coverage Among Children Aged 19-35 Months - United States, 2008. MMWR, August 28, 2009, Vol. 58, No. 33
    The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19--35 months for each of the 50 states and selected urban areas. This report describes the results of the 2008 NIS, which provided coverage estimates among children born during January 2005--July 2007. Healthy People 2010 established vaccination coverage targets of 90% for each of the vaccines included in the combined 4:3:1:3:3:1 vaccine series and a target of 80% for the combined series. Findings from the 2008 NIS indicated that equal to and greater than 90% coverage was achieved for most of the routinely recommended vaccines. However, increasing coverage for the fourth dose of diphtheria, tetanus toxoid, and pertussis vaccine (DtaP) and the fourth dose of 7-variant pneumococcal conjugate vaccine (PCV7) was less than 90 %, and could be improved.
    April 30, 2010/ Vol. 59 / No. 16 : Interim Results: State Specific Seasonal Influenza Vaccination Coverage -- United States, August 2009-January 2010
    The advent of the 2009 influenza A (H1N1) pandemic in April 2009 made the 2009--10 influenza season highly unusual. Public awareness of the potential seriousness of influenza was heightened by media coverage of pandemic-associated hospitalizations and deaths, especially among younger persons. In the fall, the distribution of two separate influenza vaccines began, with distinct, although overlapping, recommendations from the Advisory Committee on Immunization Practices (ACIP). ...These results, compared with the previous season (3), suggest large increases in coverage for children and a moderate increase for adults aged 18--49 years without high-risk conditions. Health departments should identify best practices that lead to higher vaccination coverage and should support effective vaccination services (e.g., school-located vaccination programs and office-based protocols, such as reminder/recall and standing orders).

Strategies – The Evidence Base for Effective Interventions

A systematic review of published studies looking at the effectiveness of population based approaches to increasing vaccination coverage for routinely recommended vaccines, conducted by the Task Force on Community Preventive Services and coordinated with a diverse team of experts at the CDC, found a number of effective approaches. Among the effective approaches identified are:

  • Client Reminder/Recall Systems.
    Reminding members of a target population that vaccinations are due (reminders) or late (recall). Delivered through: telephone calls, letters or post cards.
    Assessment and Feedback for Providers.
    Retrospectively evaluating the performance of providers in delivering one or more vaccinations to a client population and providing data back to providers. Delivered through: surveys, chart reviews, payment reviews.
    Provider Reminder/Recall Systems.
    Developing strategies to inform health care providers their patients are due (reminder) or overdue (recall) for vaccinations. Delivered through: chart stickers, computer notification, vital sign stamps, medical record flow sheets and checklists.
    Patient Reminder/Recall.
    Sending patients a reminder (if they are due) or a recall (if they are overdue) for vaccinations. Delivered through: mail, telephone, electronic medium or combination in individual practice settings or communities.
    Standing Orders.
    Established protocols that enable non-physician personnel to prescribe or deliver vaccinations to patients without direct physician involvement during patient visits. Effective in particular for increasing flu and pneumococcal vaccination for adults older than 65 years. Delivered through: interaction with patients at time of visits in clinics, hospitals, nursing homes and other healthcare settings.
    Reducing Out of Pocket Costs.
    Providing insurance for, reducing co-payments associated with, or offering free vaccinations. Delivered through: provision programs, insurance coverage or reduction of co-pays at the point of service.
    Expanding Access.
    Increasing availability of vaccinations in health care settings. Delivered through: increasing or changing the hours during which services are provided, reducing the distance from the client to the setting, delivering services where not previously provided (e.g., emergency rooms, inpatient clinics), or reducing administrative barriers to obtaining services within clinics (e.g., "express-lane" vaccination services).

More information on these strategies are available through the references listed below.

Return on Investment

  • Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998. MMWR. 1999; 48:243-248.
    Dramatic declines in morbidity have been reported for the nine vaccine-preventable diseases for which vaccination was universally recommended for use in children before 1990 (excluding hepatitis B, rotavirus, and varicella). Morbidity associated with smallpox and polio caused by wild-type viruses has declined 100% and nearly 100% for each of the other seven diseases.
    Valuing Childhood Vaccines. Davis MM, Kemper AR. J Pediatr 2003; 143:283-284.
    Presents the case for valuing vaccines not solely on monetary aspects. Published analyses for currently recommended vaccines suggest that they are cost-effective, and even potentially cost-saving, from the societal perspective.
    Priorities Among Effective Clinical Preventive Services: Results of a Systematic Review and Analysis. Maciosek MV, Coffield AB, Edwards NM, Flottemesch TJ, Goodman MF, Solberg LI. Am J Prev Med 2006; 31:52-61.
    This study identifies the most valuable clinical preventive services that can be offered in medical practice and should help decision-makers select which services to emphasize. The three highest-ranking services each with a total score of 10 are discussed: aspirin use with high-risk adults, immunizing children, and tobacco-use screening and brief intervention.
    Influenza Vaccine Effectiveness Among Elderly Nursing Home Residents: A Cohort Study. Monto AS, Hornbuckle K, Ohmit SE. Am J Epidemiol. 2001; 154:155-160.
    Data were collected in 1991-1992 from 83 eligible skilled nursing homes located in southern lower Michigan to determine the effectiveness of inactivated influenza vaccine in preventing influenza-like illness and influenza-associated pneumonia. Vaccine was found to be 33% effective in preventing total respiratory illness (influenza-like illness and clinically diagnosed pneumonia). In prevention of pneumonia alone, vaccine was 43% effective. The estimate for prevention of pneumonia rose to 55% if the period under consideration was limited to the time of peak influenza activity. The study supported continuation of current policy, encouraging use of vaccine in all nursing home residents.
    Benefits of Influenza Vaccination for Low-Risk, Intermediate-Risk, and High-Risk Senior Citizens. Nichol KL, Wuorenma J, von Sternberg T. Arch Intern Med. 1998; 158:1769-1776.
    The study aimed to clarify the benefits of influenza vaccination among low-risk senior citizens while concurrently assessing the benefits for intermediate- and high-risk senior citizens. The study concluded immunization was also associated with a 50% reduction in all-cause mortality, and was effective in reducing hospitalizations. Vaccination was also associated with direct medical care cost savings of $73 per individual vaccinated for all subjects combined.
    Efficacy of Influenza Vaccine in Nursing Homes. Reduction in Illness and Complications During an Influenza A (H3N2) epidemic. Patriarca PA, Weber JA, Parker RA, Hall WN, Kendal AP, Bregman DJ et al. JAMA. 1985; 253:1136-1139.
    From December 10, 1982, to March 4, 1983, when influenza A (H3N2) viruses circulated in Michigan, outbreaks of influenza-lijke illness were identified in seven nuring homes in Genesee County. Unvaccinated residents were 2.6 times more likely than vaccinated residents to become ill and were subsequently more 2.4 times more likely to be hospitalized, or die.Similar observations were made during investigatons in six of the eight remaining nuring homes in Genesee County, in which 57 (12%) of 458 residents became ill sporadically. These findings suggest that influenza vannine can reduce the incidence and severity of influenza virus infectins among the elderly and chronically ill.
    Benefits of Influenza Vaccination on Influenza-Related Mortality Among Elderly in the US: An unexpected finding. Proceedings of the International Conference on Options for the Control of Influenza V. Simonsen L, Reichert TA, Blackwelder WC, Miller MA. New York.Elsevier Science B.B., 2004: 163-167
    Although elderly influenza vaccination coverage increased from about 15% to about 65% during 1980-1999 in the US, estimates of influenza-related mortality also increased during this period. The study authors examined these apparently conflicting findings by adjusting mortality estimates for aging within the elderly and the incidence of influenza A (H3N2) virus circulation. Using national mortality statistics for 1968 through 1999, age-specific monthly rates for pneumonia and influenza and all-cause mortality for persons greater than and equal to 65 years of age were generated. After adjusting for age and considering only A (H3N2)-dominated seasons, the authors found that excess mortality declined sharply among younger elderly (65-74 years) during 1968-1980, but remained level after 1980. Among the most elderly (85+ years), excess mortality rates were essentially unchanged over the entire study period. In conclusion, the increase in elderly influenza vaccination coverage in the US after 1980 was not accompanied by a decline in influenza-related mortality. The authors hypothesized that disparity in vaccination rates among frail elderly, combined with reduced responsiveness to vaccination with age, may account for these findings.
    Economic Evaluation of the 7-Vaccine Routine Childhood Immunizatio Schedule in the United States, 2001. Zhou F, Santoli J, Messionier ML et al. Arch Pediatr Adolesc Med 2005; 159:1136-1144.
    Concluded routine childhood immunization with the 7 vaccines was cost saving from the direct cost and societal perspectives, with net savings of $9.9 billion and $43.3 billion, respectively. Without routine vaccination, direct and societal costs of diphtheria, tetanus, pertussis, H influenzae type b, poliomyelitis, measles, mumps, rubella, congenital rubella syndrome, hepatitis B, and varicella would be $12.3 billion and $46.6 billion, respectively. Direct and societal costs for the vaccination program were an estimated $2.3 billion and $2.8 billion, respectively. Direct and societal benefit-cost ratios for routine childhood vaccination were 5.3 and 16.5, respectively.
    Financing of Childhood and Adolescent Vaccines. Pediatrics, Volume 124, Supplement 5, December 2009.
    This supplement to the journal Pediatrics provides commentaries, original research, reports from the National Vaccine Advisory Committee, stakeholder commentaries and additional resources for vaccine financing.


More Information

New York State Department of Health Bureau of Immunization
Corning Tower, Room 649
Empire State Plaza Albany, NY 12237
Voice: 518-473-4437
Fax: 518-474-1495