Immunization and Infectious Diseases

Diseases Preventable Through Universal Vaccination


14-1		Vaccine-preventable diseases


14-1a		Congenital rubella syndrome


14-1b		Diphtheria


14-1c		Haemophilus influenzae type b


14-1d		Hepatitis B


14-1e		Measles


14-1f		Mumps


14-1g		Pertussis


14-1h		Polio (wild-type virus)


14-1i		Rubella


14-1j		Tetanus


14-1k		Varicella (chicken pox)


14-2		Hepatitis B in infants and young children


14-3		Hepatitis B in adults and high-risk groups


14-3a		19 to 24 years


14-3b		25 to 39 years


14-3c		40 years and older


14-3d		Injection drug users


14-3e		Heterosexually active persons


14-3f		Men who have sex with men


14-3g		Occupationally exposed workers


14-4		Bacterial meningitis in young children


14-5		Invasive pneumococcal infections

New invasive pneumococcal infections:


14-5a		Children under age 5 years


14-5b		Adults aged 65 years and older

Invasive penicillin-resistant pneumococcal infections:


14-5c		Children under age 5 years


14-5d		Adults aged 65 years and older

Diseases Preventable Through Targeted Vaccination


14-6		Hepatitis A


14-7		Meningococcal disease


14-8		Lyme disease

Infectious Diseases and Emerging Antimicrobial Resistance


14-9		Hepatitis C


14-10		Identification of persons with chronic hepatitis C


14-11		Tuberculosis


14-12		Curative therapy for tuberculosis


14-13		Treatment for high-risk persons with latent tuberculosis infection


14-14		Timely laboratory confirmation of tuberculosis cases


14-15		Prevention services for international travelers


14-16		Invasive early onset group B streptococcal disease


14-17		Peptic ulcer hospitalizations


14-18		Antibiotics prescribed for ear infections


14-19		Antibiotics prescribed for common cold


14-20		Hospital-acquired infections

Adults:


14-20a		Catheter-associated urinary tract infection


14-20b		Central line-associated bloodstream infection


14-20c		Ventilator-associated pneumonia

Infants less than or equal to 1000g:


14-20d		Central line-associated bloodstream infection


14-20e		Ventilator-associated pneumonia


14-21		Antimicrobial use in intensive care units

Vaccination Coverage and Strategies


14-22		Universally recommended vaccination of children aged 19 to 35 months


14-22a		4 doses diphtheria-tetanus-pertussis (DTaP) vaccine


14-22b		3 doses Haemophilus influenzae type b (Hib) vaccine


14-22c		3 doses hepatitis B vaccine (hep B)


14-22d		1 dose measles-mumps-rubella (MMR) vaccine


14-22e		3 doses polio vaccine


14-22f		1 dose varicella vaccine


14-23		Vaccination coverage for children in day care, kindergarten, and first grade

Day care:


14-23a		Diphtheria-tetanus-acellular pertussis (DTaP) vaccine


14-23b		Measles/mumps/rubella vaccines


14-23c		Polio vaccine


14-23d		Hepatitis B vaccine


14-23e		Varicella vaccine

K through 1st grade:


14-23f		Diphtheria-tetanus-pertussis (DTaP) vaccine


14-23g		Measles/mumps/rubella vaccines


14-23h		Polio vaccine


14-23i		Hepatitis B vaccine


14-23j		Varicella vaccine


14-24		Fully immunized young children and adolescents


14-24a		Children aged 19 to 35 months


14-24b		Adolescents aged 13 to 15 years


14-25		Providers who measure childhood vaccination coverage levels


14-25a		Public health providers


14-25b		Private providers


14-26		Children participating in population-based immunization registries


14-27		Vaccination coverage among adolescents


14-27a		Hepatitis B


14-27b		Measles-mumps-rubella


14-27c		Tetanus-diphtheria booster


14-27d		Varicella


14-28		Hepatitis B vaccination among high-risk groups


14-28a		Long-term hemodialysis patients


14-28b		Men who have sex with men


14-28c		Occupationally exposed workers


14-29		Influenza and pneumococcal vaccination of high-risk adults

Noninstitutionalized adults 65 years and over


14-29a		Influenza vaccine


14-29b		Pneumococcal vaccine

Noninstitutionalized high-risk adults 18 to 64 years


14-29c		Influenza vaccine


14-29d		Pneumococcal vaccine

Institutionalized adults


14-29e		Influenza vaccine


14-29f		Pneumococcal vaccine

Vaccine Safety


14-30		Adverse events from vaccinations


14-30a		Vaccine-associated paralytic polio


14-30b		Febrile seizures following pertussis vaccines


14-31		Active surveillance for vaccine safety

Diseases Preventable Through Universal Vaccination


14-1.		Reduce or eliminate indigenous cases of vaccine-preventable diseases.

14-1a. Congenital rubella syndrome (children under age 1 year).

National Data Source	National Congenital Syndrome Registry, CDC, NCID.
State Data Source	National Congenital Syndrome Registry, CDC, NCID.
Healthy People 2000 Objective	20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	7 (1998).
Numerator	Number of confirmed and probable cases of congenital rubella syndrome among children under age 1 year.
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC Congenital Rubella Syndrome Case Report, Form 71.17, Rev. 03/97.
Expected Periodicity	Annual.
Comments	A case definition for confirmed and probable cases of congenital rubella syndrome is available from CDC.1
	See Appendix A for focus area contact information.

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14-1b. Diphtheria (persons under age 35 years).
National Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
State Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
Healthy People 2000 Objective	Adapted from 20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	1 (1998).
Numerator	Number of confirmed cases of diphtheria among persons under age 35 years.
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC Diphtheria Worksheet.
Expected Periodicity	Annual.
Comments	A case definition for confirmed cases of diphtheria is available from CDC.1
	This objective is a modification of Healthy People 2000 objective 20.1, which tracked the number of confirmed cases of diphtheria among persons aged 25 years and under. This measure tracks the number of confirmed cases of diphtheria among persons under age 35 years.
	See Part C for a description of NNDSS and Appendix A for focus area contact information.

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14-1c. Haemophilus influenzae type b (children under age 5 years).
National Data Sources	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO; Active Bacterial Core Surveillance (ABCs), Emerging Infection Programs, CDC, NCID.
State Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
Healthy People 2000 Objective	Adapted from 20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	163 (1998).
Numerator	Estimated number of all reported confirmed and probable cases of Haemophilus influenzae invasive disease (see Comments).
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC National Bacterial Meningitis and Bacteremia Case Report, CDC 52.15N, Rev. 02/93.
Expected Periodicity	Annual.
Comments	This measure includes confirmed cases of H. influenzae type b disease and cases in which the isolate of H. influenzae is of unknown serotype (based on the eight States with specific regions under surveillance).
	A case definition for confirmed and probable cases of Haemophilus influenzae type b is available from CDC.1
	This objective is a modification of Healthy People 2000 objective 20.1, which tracked the number of cases of vaccine-preventable diseases. Haemophilus influenzae type b was previously not included as a vaccine-preventable disease.
	See Part C for a description of NNDSS and Appendix A for focus area contact information.

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14-1d. Hepatitis B (persons aged 2 to 18 years).
National Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
State Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
Healthy People 2000 Objective	Adapted from 20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	945 (1997).
Numerator	Number of laboratory-confirmed new symptomatic hepatitis B cases among persons aged 2 to 18 years.
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC Viral Hepatitis Case Record for Reporting of Patients With Symptomatic Acute Viral Hepatitis, Form 53.1, Rev. 06/93.
Expected Periodicity	Annual.
Comments	A case definition for laboratory-confirmed new symptomatic cases of hepatitis B is available from CDC.1
	This objective is a modification of Healthy People 2000 objective 20.1, which tracked the number of cases of vaccine-preventable diseases. Hepatitis B previously was not included as a vaccine-preventable disease.
	See Part C for a description of NNDSS and Appendix A for focus area contact information.

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14-1e. Measles (persons of all ages).
National Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
State Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
Healthy People 2000 Objective	20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	74 (1998).
Numerator	Number of confirmed indigenous measles cases.
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC Measles Surveillance Worksheet, Rev. 05/98.
Expected Periodicity	Annual.
Comments	A case definition for confirmed indigenous cases of measles is available from CDC.1
	See Part C for a description of NNDSS and Appendix A for focus area contact information.

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14-1f. Mumps (persons of all ages).
National Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
State Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
Healthy People 2000 Objective	20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	666 (1998).
Numerator	Number of confirmed and probably indigenous cases of mumps.
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC Mumps Surveillance Worksheet.
Expected Periodicity	Annual.
Comments	A case definition for confirmed and probable indigenous cases of mumps is available from CDC.1
	See Part C for a description of NNDSS and Appendix A for focus area contact information.

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14-1g. Pertussis (children under age 7 years).
National Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
State Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
Healthy People 2000 Objective	Adapted from 20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	3,417 (1998).
Numerator	Number of confirmed and probable cases of pertussis (including cases identified in outbreak settings) among children under age 7 years.
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC Pertussis Report, Form 71.14A, Rev. 06/86.
Expected Periodicity	Annual.
Comments	A case definition for confirmed and probable cases of pertussis (including cases identified in outbreak settings) is available from CDC.1
	This objective is a modification of Healthy People 2000 objective 20.1, which tracked the number of confirmed and probable cases of pertussis among persons of all ages. This measure tracks the number of confirmed and probable cases among children under age 7 years.
	See Part C for a description of NNDSS and Appendix A for focus area contact information.

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14-1h. Polio (wild-type virus) (persons of all ages).
National Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
State Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
Healthy People 2000 Objective	20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	0 (1998).
Numerator	Number of indigenously acquired cases of polio (wild-type virus, excludes imported or vaccine-associated cases).
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC Suspected Polio Case Worksheet.
Expected Periodicity	Annual.
Comments	A case definition for indigenously acquired cases of polio (wild-type virus, excluding imported or vaccine-associated cases) is available from CDC.1
	See Part C for a description of NNDSS and Appendix A for focus area contact information.

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14-1i. Rubella (persons of all ages).
National Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
State Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
Healthy People 2000 Objective	20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	364 (1998).
Numerator	Number of confirmed indigenous cases of rubella.
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC Rubella Surveillance Worksheet.
Expected Periodicity	Annual.
Comments	A case definition for confirmed indigenous cases of rubella is available from CDC.1
	See Part C for a description of NNDSS and Appendix A for focus area contact information.

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14-1j. Tetanus (persons under age 35 years).
National Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
State Data Source	National Notifiable Disease Surveillance System (NNDSS), CDC, EPO.
Healthy People 2000 Objective	Adapted from 20.1 (Immunization and Infectious Diseases).
Measure	Number.
Baseline	14 (1998).
Numerator	Number of confirmed cases of tetanus among persons under age 35 years.
Denominator	Not applicable.
Population Targeted	U.S. resident population.
Questions Used To Obtain the National Data	CDC Tetanus Surveillance Case Report, Form 71.16, Rev. 06/86.
Expected Periodicity	Annual.
Comments	A case definition for confirmed cases of tetanus is available from CDC.1
	This objective is a modification of Healthy People 2000 objective 20.1, which tracked the number of confirmed cases of tetanus among persons aged 25 years and under. This measure tracks the number of confirmed cases of tetanus among persons under age 35 years.
	See Part C for a description of NNDSS and Appendix A for focus area contact information.

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14-1k. Varicella (chicken pox) (persons under age 18 years).
National Data Source	National Health Interview Survey (NHIS), CDC, NCHS.
State Data Source	Not identified.
Healthy People 2000 Objective	Adapted from 20.1 (Immunization and Infectious Diseases).
Measure	Number (4-year average).
Baseline	4 million (1990–94).
Numerator	Number of persons (all ages) who are reported to have had chicken pox (varicella) in the past year.
Denominator	Not applicable.
Population Targeted	U.S. civilian, noninstitutionalized population.
Questions Used To Obtain the National Data	From the 1999 National Health Interview Survey (see Comments):
	Ø Has (Sample child) ever had chicken pox?
	[If yes:] o Has (Sample child) had chicken pox during the past 12 months?
Expected Periodicity	Annual.
Comments	A case of chicken pox is identified as any person who reported missing either more than half of 1 day of school or work due to an illness or injury or staying in bed more than half of a day due to an illness or injury and who also reported that the condition that caused the day(s) of missed school/work or day(s) of staying in bed was varicella or chicken pox. These data are adjusted from a 2-week incidence to a 12-month incidence by multiplying the estimates by a factor of 26.
	The baseline data for persons of all ages are a proxy measure for this objective and were calculated using the 1990–94 NHIS. NHIS was redesigned in 1997 to measure prevalence, and starting in 1999 NHIS included questions on incidence and asks if children aged under 18 years have ever had chicken pox, and if they had a case of the chicken pox/varicella in the past 12 months. This annual estimate will be the measure used to track this objective over the course of the decade.