School Immunization Requirements

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• School Immunization Requirements
• Melinda Wharton, M.D., M.P.H.
• Deputy Director
• National Center for Immunization and Respiratory
  Diseases
• Centers for Disease Control and Prevention
• 14 August 2007

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Comparison of 20th Century Annual Morbidity and
Current Morbidity Vaccine-Preventable Diseases
Source CDC. MMWR April 2, 1999. 48 242-264
Source CDC. MMWR. August 18, 2006 /
55(32)880-893 Imported vaccine-associated
paralytic polio (VAPP) Type b and unknown (lt 5
years of age)
Numbers in yellow indicate at or near record
lows in 2005
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Impact of Newer Vaccines on Disease in US
Unpublished CDC data, reported November
2006 Type b and unknown (lt 5 years of age)
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Childhood Immunization Program Successes

• Record high coverage rates
• Vaccine-preventable diseases at or near all time
  lows
• Largest public/private partnership
• Advancing polio eradication disease endemic to
  only 4 countries
• Measles is no longer endemic in the U.S. and
  Western Hemisphere
• Rubella eliminated in the United States

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Health Benefit and Beyond Return on Investment
for Childhood Immunization Program

• Immunization is one of the few clinical
  preventive services that saves dollars as well as
  lives
• For each birth cohort vaccinated in accordance
  with the schedule
• Society saves 43.3B
• Health care costs are reduced by 9.9B
• 33,000 lives are saved
• 14M cases of disease are prevented

Source Zhou et al Archives of Pediatric and
Adolescent Medicine 2005
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Number of Vaccines in the Routine Childhood and
Adolescent Immunization Schedule
1985
1995
2006
Measles Rubella Mumps Diphtheria Tetanus Pertussis
Polio Hib (infant) HepB Varicella
Measles Rubella Mumps Diphtheria Tetanus Pertussis
Polio Hib (infant) Hep B Varicella Pneumococcal
disease Influenza Meningococcal disease Hep
A Rotavirus HPV
Measles Rubella Mumps Diphtheria Tetanus Pertussis
Polio
7
10
16
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U.S. Federal Contract Prices for Vaccines
Recommended Universally for Children and
Adolescents 1985, 1995, April 2007
1,214
924
155
45
1985 and 1995 represent the average federal
contract price to account for price changes
within the respective year. April 2007
represents the minimum cost to vaccinate children
and adolescents and is based on the federal
contract price as of April 16, 2007. Last
updated April 19, 2007
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For Girls Only

• HPV vaccine is first routine vaccine in US
  recommended only in girls or women
• Opportunities for new outreach and partners

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2005-2006 School Laws

• Kindergarten Requirements
• Diphtheria 50 states DC
• Tetanus 49 states DC
• Pertussis 46 states DC
• Middle School
• Diphtheria 22 states DC
• Tetanus 22 states DC

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School Entry Immunization Status 2002-2005, States
Year
Polio
DTaP
Measles
2002-2003
96
95
95
93
91
93
2003-2004
96
96
2004-2005
96
2005-2006
95
95
95
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Issues With School Laws

• Courts have upheld
• All have exemptions
• Exemptions moderate criticism
• Objections to vaccination remain
• Many Public Health officials concerned about
  exemptions

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Controversies Regarding Immunization Requirements

• Expansion of laws to new vaccines
• Philosophic exemptions
• Involvement of drug companies in legislative
  process

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State Bills Introduced on HPV Vaccine
As of June 2007
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Considerations in Adding Immunization Requirements

• Availability of vaccine
• Financing
• Parent and provider acceptance
• Safety data
• Feasibility

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Potential Unintended Consequences

• Broadening of exemptions
• Loss of public support for vaccination
• Loss of public support for vaccination
  requirements
• Erosion of program gains
• Lack of enforcement

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Keys to Successful Implementation of Immunization
Requirements

• Parental acceptance
• Provider support and capacity to deliver
• Mechanism for enforcement

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Thank You

• Hotline 800.CDC.INFO
• Email nipinfo_at_cdc.gov
• Website www.cdc.gov/vaccines/