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Immunization and Infectious Diseases Data Details

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  • IID-1 Reduce, eliminate, or maintain elimination of cases of vaccine-preventable diseases

    • IID-1.1 Maintain elimination of cases of vaccine-preventable congenital rubella syndrome (CRS) among children under 1 year of age (U.S.-acquired cases)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      2008
      Target: 
      0
      Target-Setting Method: 
      Total elimination
      Target-Setting Method Justification: 
      Endemic transmission of rubella was declared eliminated from the United States in 2004. In 2007 and 2008, a total of 9 and 13 U.S.-acquired rubella cases were reported in the United States, respectively. The Pan American Health Organization (PAHO) developed a comprehensive strategy in 2004 to eliminate rubella and CRS from the Americas by 2010. Countries have demonstrated progress toward the rubella and CRS elimination goal. Until rubella is eliminated from the Americas and other countries, rubella cases and possibly CRS cases will be likely in the United States. Subject matter experts have given the continued risk of rubella transmission in the United States consideration in setting the HP2020 target.
      Numerator: 

      Number of confirmed and probable U.S.-acquired cases of congenital rubella syndrome among children less than 1 year of age

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A case definition for confirmed and probable US acquired cases of congenital rubella syndrome (CRS) is available from CDC. Imported cases of CRS are not included. CRS counts are based on year of birth, not year of report.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
    • IID-1.2 Reduce serotype b cases of Haemophilus influenzae (Hib) invasive disease among children under age 5 years

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Active Bacterial Core Surveillance
      Population Estimates
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      0.30 (2008)
      Target: 
      0.27
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Estimated number of all reported confirmed and probable cases of Haemophilus influenzae invasive disease for children under age 5 years

      Denominator: 

      Number of children under age 5 years

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the ABCs surveillance areas for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009).

        Data reflect cases of Hib disease among children less than 5 years of age submitted to Active Bacterial Core surveillance.

        The Active Bacterial Core surveillance (ABCs) system is an active laboratory and population-based surveillance system that provides reports of H. influenzae cases from all or parts of 10 states in the United States. ABCs is supported by the CDC as part of its Emerging Infections Program network. The population under surveillance was 36,748,349 in 2009 (representing 12.0% of the US population).

        A case was defined as isolation of H. influenzae from a normally sterile body site (eg, blood or cerebrospinal fluid) in a person aged <5 years. Illness outcome was based on patient status at the time of hospital discharge. Serotyping of H. influenzae was performed by using slide agglutination or polymerase chain reaction. All isolates from ABCs sites were sent to the CDC, where serotype was confirmed by using slide agglutination, Haemophilus quad identification plates or API Neisseria-Haemophilus strips, and polymerase chain reaction. The CDC result was used as the final serotype in the ABCs data set. This measure includes confirmed cases of H. influenzae type b disease.

      Caveats and Limitations: 
      ABCs Areas California (3 county San Francisco Bay area); Colorado (5 county Denver area); Connecticut; Georgia; Maryland; Minnesota; New Mexico; New York (15 county Rochester and Albany areas); Oregon; Tennessee (20 urban counties)
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-01c in that the measure was revised from a count to a rate per 100,000. In addition, the National Notifiable Disease Surveillance System (NNDSS) data source was removed, while the Active Bacterial Core Surveillance (ABCs) data source was retained.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the objective statement was changed from "aged 5 years or under" to "under age 5 years" to make the age group consistent with the numerator definition. In 2013, the National Notifiable Disease Surveillance System (NNDSS) data source was removed. NNDSS data were insufficient to assess Hib with any degree of confidence because Haemophilus influenzae serotyping information was often missing. The Active Bacterial Core Surveillance (ABCs) was retained. In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly Report 46 (RR-10), 1997. (See reference for updated case definitions.)
    • IID-1.3 Reduce new hepatitis B cases among persons aged 2 to 18 years

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Bridged-race Population Estimates
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      0.1 (2007)
      Target: 
      0.0
      Target-Setting Method: 
      Total elimination
      Target-Setting Method Justification: 
      The target is based on the low baseline rate, the strong childhood immunization program infrastructure, and the Advisory Committee on Immunization Practices (ACIP) immunization policy statement that was updated in 2005 and that asserted the feasibility of eliminating hepatitis B virus transmission in this age group.
      Numerator: 

      Number of reported new symptomatic hepatitis B cases among persons aged 2 to 18 years reported in the past 12 months

      Denominator: 

      Total population aged 2-18 years in reporting states

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data are rates per 100,000 population based on the number of symptomatic cases of acute hepatitis B reported to NNDSS. A case definition for new symptomatic cases of hepatitis B is available from CDC.

        In 1991, CDC published comprehensive strategies for eliminating transmission of hepatitis B within the United States. This strategy included universal childhood vaccination. With full implementation of this strategy, the number and rate of hepatitis B cases among persons aged 2 to 18 years should be eliminated. To obtain state-specific measures, local Viral Hepatitis Surveillance Program data are used to determine the number of symptomatic hepatitis B cases among persons aged 2 to 18 years occurring in the state in the past 12 months.

        FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-01d in that the measure was revised from a count to a rate per 100,000 population.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Population Estimates was added as a data source to reflect the measure's population denominator. The data and target were not revised. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

      References

      Additional resources about the objective

      1. CDC. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. Part 1: Immunization of Infants, Children and Adolescents: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, December 23, 2005, Vol. 54(RR-16):1-39.
      2. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
    • IID-1.4 Reduce measles cases (U.S.-acquired cases)

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      115 (2008)
      Target: 
      30
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      The United States maintained measles elimination (defined as the absence of endemic disease transmission) from 2000 when elimination was declared by an expert panel to 2008 when 140 cases of measles were reported, the most reported cases since 1996. Of the 140 cases, 115 were classified as U.S. acquired. Until measles is eliminated globally, a risk of measles transmission to U.S. residents persists. Between 2001 and 2008, 325 cases of measles were acquired in the United States, for an average of 41 cases per year. Of the 325 cases, 196 (25 per year) were preventable if ACIP recommendations were followed, and 129 (16 per year) were not preventable. If the preventable fraction is lowered by half during the following 10 years, the mean number of U.S.-acquired cases would be approximately 29. Subject matter experts have given the continued risk of measles transmission in the United States consideration in setting the target.
      Numerator: 

      Number of confirmed U.S.-acquired cases of measles

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A case definition for confirmed U.S.-acquired cases of measles is available from CDC. Imported cases of measles were not included.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Measure: 
      number
      Numerator: 

      Number of confirmed U.S.-acquired cases of measles

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          A case definition for confirmed U.S.-acquired cases of measles is available from CDC. Imported cases of measles were not included.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
    • IID-1.5 Reduce cases of mumps (U.S.-acquired cases)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      421 (2008)
      Target: 
      500
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Prior to 2004, some progress was made in mumps disease reduction, reflected by a two-thirds reduction in cases from 1998 (666 cases) to 2003 (231 cases), thus meeting the reduction target of 250 cases for that year. However, in 2004, the reduction target was 200, and the number of reported mumps cases was 258. The disease reduction target was not met for that year or for 2005.
      Numerator: 

      Number of confirmed and probable U.S.-acquired cases of mumps

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A case definition for confirmed and probable U.S.-acquired cases of mumps is available from CDC.

        Although the measles-mumps-rubella (MMR) vaccine is very effective, protection against mumps is not complete. Two doses of measles-mumps-rubella (MMR) vaccine are 88% effective at protecting against mumps; one dose is 78% effective. Outbreaks can still occur in highly vaccinated U.S. communities, particularly in close-contact settings. In recent years, outbreaks have occurred in schools, colleges, and camps. High vaccination coverage helps limit the size, duration, and spread of mumps outbreaks.

      Target Calculation Methods: 
      The Healthy People 2020 target for IID-1.5 of 500 mumps cases was set aiming for a realistic target and keeping in mind that the number of mumps cases vary from year to year. The baseline year, 2008, happened to be a year without an outbreak.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
    • IID-1.6 Reduce cases of pertussis among children under 1 year of age

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      2,777 (2004–08)
      Target: 
      2,500
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of confirmed and probable cases of pertussis (including cases identified in outbreak settings) among children under age 1 year

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Estimates represent the mean number of Confirmed, Probable, and Unknown cases (aged

        A case definition for confirmed and probable cases of pertussis (including cases identified in outbreak settings) is available from CDC. Estimates are a five-year moving average of confirmed and probable cases of pertussis reported to the National Notifiable Disease Surveillance System (NNDSS).

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-01g in that the measure was revised from an annual to a 5-year moving average. In addition, the target population was revised from children under age 7 years to children under age 1 year.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly Report 46 (RR-10), 1997. (See reference for updated case definitions.)
    • IID-1.7 Reduce cases of pertussis among adolescents aged 11 to 18 years

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      3,995 (2000–04)
      Target: 
      2,000
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      The duration of protection afforded by the Tdap vaccine is unclear. As adolescent vaccination coverage of Tdap increases, a reduction of disease in adolescents will occur. Results from observational vaccine effectiveness evaluation have shown Tdap vaccine to be approximately 80 percent effective. Within the adolescent population(11 to 18 years of age), Tdap coverage will reach 70 percent. Therefore, with 70 percent Tdap coverage and approximately 80 percent effectiveness, reported pertussis incidence may reasonably be reduced by approximately 50 percent.
      Numerator: 

      Number of confirmed and probable cases of pertussis (including cases identified in outbreak settings) among persons aged 11 to 18 years

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Estimates represent the mean number of Confirmed, Probable, and Unknown cases (aged 11-18 years) of pertussis reported to NNDSS during the relevant data years. Only adolescent cases with known sex and race/ethnicity are included for sex and race/ethnicity estimates.

        A case definition for confirmed and probable cases of pertussis (including cases identified in outbreak settings) is available from CDC. Estimates are a five-year moving average of confirmed and probable cases of pertussis reported to the National Notifiable Disease Surveillance System (NNDSS).

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly Report 46 (RR-10), 1997. (See reference for updated case definitions.)
    • IID-1.8 Maintain elimination of acute paralytic poliomyelitis (U.S.-acquired cases)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      2008
      Target: 
      0
      Target-Setting Method: 
      Total elimination
      Target-Setting Method Justification: 
      Polio was declared eliminated from the Americas in 2004. Worldwide efforts at polio eradication still are under way, and importations of poliovirus into the United States resulting in additional cases continue to be possible. Although the objective is domestic, maintaining U.S. elimination depends on interrupting polio transmission in the remaining four endemic countries (India, Nigeria, Afghanistan, and Pakistan). Low routine immunization coverage in the polio endemic countries presents a challenge to the eradication efforts in the most critical areas. Unfortunately, in recent years, a number of re-introductions of polio have occurred in countries in western and central Africa and the Horn of Africa. During 2008, 1,660 cases of polio were reported from 4 endemic countries and 14 previously polio-free countries worldwide. CDC will continue to work with State health departments and immunization partners to ensure high routine polio vaccine coverage in the United States. CDC also will ensure that appropriate laboratory procedures and capabilities are available for the timely confirmation of cases, and continue to be a major partner in the global polio eradication initiative.
      Numerator: 

      Number of U.S.-acquired cases of acute paralytic poliomyelitis

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data are the number US-acquired cases of acute paralytic poliomyelitis.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Surveillance of Poliomyelitis. See reference for the case definition.
    • IID-1.9 Maintain elimination of rubella (U.S.-acquired cases)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      10 (2008)
      Target: 
      10
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Endemic transmission of rubella was declared eliminated from the United States in 2004. PAHO developed a comprehensive strategy in 2004 to eliminate rubella and CRS from the Americas by 2010. Countries have demonstrated progress toward the rubella and CRS elimination goal. In 2007 and 2008, a total of nine and six U.S.-acquired rubella cases were reported in the United States, respectively. Until rubella is eliminated from the Americas and other countries, U.S.-acquired rubella cases will occur.
      Numerator: 

      Number of confirmed U.S.-acquired cases of rubella

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A case definition for confirmed and probable U.S.-acquired cases of rubella is available from CDC. Imported cases of rubella were not included.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
    • IID-1.10 Reduce cases of varicella (chicken pox) among persons aged 17 years of age or under

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      586,000 (2008)
      Target: 
      100,000
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      The HP2010 target was a 90 percent reduction in cases, compared with the pre-vaccine period. The HP2020 target is a 95 percent reduction in cases, compared with the pre-vaccine period. Varicella incidence, based on NHIS data, indicate a decline from a baseline of 2,228,000 cases in 1999 to 582,535 cases in 2007. Further declines in cases are expected because of the implementation of routine 2-dose varicella vaccination of all children recommended in 2006.
      Numerator: 

      Number of persons aged 17 years and under who are reported to have had chicken pox (varicella) in the past year

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2011 National Health Interview Survey:

        [NUMERATOR:]

        For persons age 17 years or under:

        Has [PERSON] EVER had chickenpox?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        Has [PERSON] had chickenpox DURING THE PAST 12 MONTHS?

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Persons are classified as having had chickenpox (varicella) in the past year if they responded “yes” to both questions on chickenpox listed under Numerator.

  • IID-2 Reduce early onset group B streptococcal disease

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Active Bacterial Core Surveillance
    National Vital Statistics System-Natality
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    per 1,000
    Baseline (Year): 
    0.30 (2008)
    Target: 
    0.25
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of newborns aged 0 to 6 days with a newly reported laboratory-confirmed case of early-onset group B streptococcal disease

    Denominator: 

    Number of live births

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      A laboratory-confirmed case of group B Streptococcus is defined as either the isolation of group B Streptococcus from cerebrospinal fluid or a positive culture of group B Streptococcus from a different normally sterile site (blood, pleural fluid, etc.) in a newborn aged 0 to 6 days in the surveillance area.

      The denominator for the most recent data year is based on live births in the study area for the year prior to the data year. For all other data years, the denominator is based on the live births in the study area for that data year. Missing race data was multiply imputed and surveillance rates were standardized to the racial distribution of the live birth estimates using vital statistics data from the CDC National Center for Health Statistics (NCHS).

    Caveats and Limitations: 
    ABCs Areas California (3 county San Francisco Bay area); Colorado (children

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, the 2010 data were revised from 0.30 per 1,000 to 0.26 per 1,000 to update the denominator from the 2009 to the 2010 number of live births in the study area.
  • IID-3 Reduce meningococcal disease

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Notifiable Diseases Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    number
    Baseline (Year): 
    1,215 (2004–08)
    Target: 
    1,094
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of new laboratory-confirmed meningococcal disease cases reported in past 12 months

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Estimates represent the mean number of Confirmed, Probable, and Unknown cases of meningococcal disease reported to NNDSS during the relevant data years. Only cases with known sex and race/ethnicity are included for sex and race/ethnicity estimates.

      A case definition for laboratory-confirmed cases of meningococcal disease is available from CDC. Estimates are a five-year moving average of confirmed and probable cases of meningococcal disease reported to the National Notifiable Disease Surveillance System (NNDSS).

    Caveats and Limitations: 
    Race/Ethnicity: Only those cases with known Race and Ethnicity are included.
    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 14-07 in that the measure was revised from a rate per 100,000 population to a count.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, the measure for this objective was changed from a rate per 100,000 population to the number of cases because reports of meningococcal disease occur relatively infrequently. The baseline and baseline years were revised from 0.3 cases per 100,000 (2004-2006) to 1,215 cases (2004-2008). The target was adjusted accordingly from 0.3 cases per 100,000 to 1,094 cases to reflect the revised baseline using the original target-setting method. In 2014, this measure was revised from a rate to a count. Therefore, the denominator "U.S. Population" was removed.

    References

    Additional resources about the objective

    1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly Report 46 (RR-10), 1997. (See reference for updated case definitions.)
  • IID-4 Reduce invasive pneumococcal infections

    • IID-4.1 Reduce new invasive pneumococcal infections among children under age 5 years

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Active Bacterial Core Surveillance
      Bridged-race Population Estimates
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      21.1 (2008)
      Target: 
      12.0
      Target-Setting Method: 
      Projection/trend analysis
      Numerator: 

      Number of children under age 5 years with a laboratory-confirmed invasive pneumococcal infection in the past 12 months

      Denominator: 

      Number of children under age 5 years

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        An invasive pneumococcal infection is defined as a laboratory-confirmed isolation of Streptococcus pneumoniae from a normally sterile site (blood, cerebral spinal fluid, etc.).

        FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the ABCs surveillance areas for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2010 –July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories. Missing race data was multiply imputed and surveillance rates were standardized to the racial distribution of the US population using the NCHS bridged-race vintage 2010 postcensal file.

      Caveats and Limitations: 
      Cases with missing race data were multiply imputed using sequential regression imputation methods. ABCs Areas California (San Francisco County and children

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised. In 2014, the baseline statement was revised for clarity. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Active Bacterial Core surveillance (ABCs).
    • IID-4.2 Reduce new invasive pneumococcal infections among adults aged 65 years and older

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Active Bacterial Core Surveillance
      Bridged-race Population Estimates
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      40.7 (2008)
      Target: 
      31.0
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Whenever possible, the assumptions used in the analysis were based on published data. The effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13, licensed in February 2010) was assumed to be similar to that of the 7-valent pneumococcal conjugate vaccine (PCV7, licensed in 2000). Also, invasive pneumococcal infections caused by strains not covered by PCV13 were assumed to increase modestly. Estimates were adjusted to account for the lower proportion of pneumococcal infections caused by PCV13 strains, compared with the proportion covered by PCV7 before that vaccine was introduced. When published data were not available, assumptions were based on data available from CDC (www.cdc.gov/ABCs).
      Numerator: 

      Number of persons aged 65 years and older with a laboratory-confirmed invasive pneumococcal infection in the past 12 months

      Denominator: 

      Number of persons aged 65 years and older

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        An invasive pneumococcal infection is defined as a laboratory-confirmed isolation of Streptococcus pneumoniae from a normally sterile site (blood, cerebral spinal fluid, etc.).

        FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the ABCs surveillance areas for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2010 –July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories. Missing race data was multiply imputed and surveillance rates were standardized to the racial distribution of the US population using the NCHS bridged-race vintage 2010 postcensal file.

      Caveats and Limitations: 
      Cases with missing race data were multiply imputed using sequential regression imputation methods. ABCs Areas California (San Francisco County and children

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Active Bacterial Core surveillance (ABCs).
    • IID-4.3 Reduce invasive antibiotic-resistant pneumococcal infections among children under age 5 years

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Active Bacterial Core Surveillance
      Bridged-race Population Estimates
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      8.3 (2008)
      Target: 
      6.0
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Whenever possible, assumptions used in the analysis were based on published data. The effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13, licensed in February 2010) was assumed to be similar to that of the 7-valent pneumococcal conjugate vaccine (PCV7, licensed in 2000). Also, invasive pneumococcal infections caused by strains not covered by PCV13 were assumed to increase modestly. Estimates were adjusted to account for the lower proportion of pneumococcal infections caused by PCV13 strains, compared with the proportion covered by PCV7 before that vaccine was introduced. Where published data were not available, assumptions were based on data available from CDC (www.cdc.gov/ABCs).
      Numerator: 

      Number of children under age 5 years with a laboratory-confirmed invasive antibiotic-resistant pneumococcal infection in the past 12 months

      Denominator: 

      Number of children under age 5 years

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A laboratory-confirmed invasive antibiotic-resistant pneumococcal infection is defined as the isolation of Streptococcus pneumoniae, from a normally sterile site (blood, cerebral spinal fluid, etc.), that is not susceptible to penicillin, amoxicillin, erythromycin, cefotaxime, ceftriaxone, cefuroxime, tetracycline, vancomycin, or levofloxacin according to the 2012 breakpoints defined by the Clinical and Laboratory Standards Institute.

        FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the ABCs surveillance areas for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2010 –July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories. Missing race data was multiply imputed and surveillance rates were standardized to the racial distribution of the US population using the NCHS bridged-race vintage 2010 postcensal file.

      Caveats and Limitations: 
      Cases with missing race data were multiply imputed using sequential regression imputation methods. ABCs Areas California (San Francisco County and children
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-05c in that the objective was revised from "penicillin-resistant pneumococcal infection" to "antibiotic-resistant pneumococcal infection."

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the objective statement was changed from "Reduce invasive penicillin-resistant pneumococcal infections among children under age 5 years" to "Reduce invasive antibiotic-resistant pneumococcal infections among children under age 5 years." Doctors use many drugs to treat pneumococcal infections. Although penicillin still works well, it is not used often because other drugs can be taken once a day instead of four times a day. To make the Healthy People 2020 measure more useful to doctors and patients, the objective was revised to include infections resistant to several antibiotics, not just penicillin. The numerator definition was revised accordingly. The original baseline was revised from 4.3 to 8.2 cases per 100,000. The target was revised from 3.0 to 6.0 cases per 100,000 to reflect the revised baseline using the original target-setting method. In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Active Bacterial Core surveillance (ABCs).
    • IID-4.4 Reduce invasive antibiotic-resistant pneumococcal infections among adults aged 65 years and older

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Active Bacterial Core Surveillance
      Bridged-race Population Estimates
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      12.2 (2008)
      Target: 
      9.0
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Whenever possible, assumptions used in the analysis were based on published data. The effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13, licensed in February 2010) was assumed to be similar to that of the 7-valent pneumococcal conjugate vaccine (PCV7, licensed in 2000). Also, invasive pneumococcal infections caused by strains not covered by PCV13 were assumed to increase modestly. Estimates were adjusted to account for the lower proportion of pneumococcal infections caused by PCV13 strains, compared with the proportion covered by PCV7 before that vaccine was introduced. Whenever published data were not available, assumptions were based on data available from CDC (www.cdc.gov/ABCs).
      Numerator: 

      Number of persons aged 65 years and older with a laboratory-confirmed invasive antibiotic-resistant pneumococcal infection in the past 12 months

      Denominator: 

      Number of persons aged 65 years and older

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A laboratory-confirmed invasive antibiotic-resistant pneumococcal infection is defined as the isolation of Streptococcus pneumoniae, from a normally sterile site (blood, cerebral spinal fluid, etc.), that is not susceptible to penicillin, amoxicillin, erythromycin, cefotaxime, ceftriaxone, cefuroxime, tetracycline, vancomycin, or levofloxacin according to the 2012 breakpoints defined by the Clinical and Laboratory Standards Institute.

        FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the ABCs surveillance areas for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2010 –July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories. Missing race data was multiply imputed and surveillance rates were standardized to the racial distribution of the US population using the NCHS bridged-race vintage 2010 postcensal file.

      Caveats and Limitations: 
      Cases with missing race data were multiply imputed using sequential regression imputation methods. ABCs Areas California (San Francisco County and children
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-056 in that the objective was revised from "penicillin-resistant pneumococcal infection" to "antibiotic-resistant pneumococcal infection."

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the objective statement was changed from "Reduce invasive penicillin-resistant pneumococcal infections among adults aged 65 years and older" to "Reduce invasive antibiotic-resistant pneumococcal infections among adults aged 65 years and older." Doctors use many drugs to treat pneumococcal infections. Although penicillin still works well, it is not used often because other drugs can be taken once a day instead of four times a day. To make the Healthy People 2020 measure more useful to doctors and patients, the objective was revised to include infections resistant to several antibiotics, not just penicillin. The numerator definition was revised accordingly. The original baseline was revised from 2.6 to 12.2 cases per 100,000. The target was also recalculated and was revised from 2.0 to 9.0 cases per 100,000 to reflect the revised baseline using the original target-setting method. In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention (CDC). Active Bacterial Core surveillance (ABCs).
  • IID-5 Reduce outpatient visits for ear infections where antibiotics were prescribed to young children

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Ambulatory Medical Care Survey
    National Hospital Ambulatory Medical Care Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    77.8 (2006–07)
    Target: 
    70.0
    Target-Setting Method: 
    10 percent improvement
    Target-Setting Method Justification: 
    CDC’s public health campaign Get Smart: Know When Antibiotics Work is the focus of this measure. The campaign involves an alliance of partners working to reduce inappropriate antibiotic use and the spread of resistance to antibiotics. The campaign is continuing to grow partnership activities to increase public and health care provider awareness regarding appropriate antibiotic use. In addition, the campaign funded the update of pediatric prescribing guidelines that was published in 2011. The initial decreases in prescribing will be highest immediately following publication and dissemination of the guidelines. The anticipated overall decrease in prescribing attributed to the campaign is anticipated to be approximately 15 percent. This decrease in prescribing was estimated using historical data from NAMCS and NHAMCS. Data were fitted to a curve, taking into account the introduction of new guidelines and enhanced campaign efforts.
    Numerator: 

    Number of outpatient visits with an antibiotic course ordered, supplied, administered, or continued among children under age 5 years diagnosed with an ear infection (ICD-9-CM codes 381.0, 381.4, 382.0, 382.4, or 382.9)

    Denominator: 

    Number of outpatient visits for children under age 5 years diagnosed with an ear infection (ICD-9-CM codes 381.0, 381.4, 382.0, 382.4, or 382.9)

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Biennial
    Methodology Notes: 

      The number of visits for ear infections among young children are the sum of cases reported by NAMCS and NHAMCS that have ear infections listed as any diagnosis (including the primary diagnosis).

    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 14-18 in that the measure was revised from a population-based prescribing rate (prescriptions per 100 children) to a visit-based prescribing rate (percent of outpatient visits).

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, the unit of measurement changed from "percent" to "per 100" to be consistent with the objective statement. In 2013, a phrase was added to the denominator to clarify the target population which is children with an ear infection: diagnosed with an ear infection (ICD-9-CM codes 381.0, 381.4, 382.0, 382.4, or 382.9). The population estimates produced by the U.S. Census Bureau are used solely to weight the estimates produced by the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey. Consequently, in 2013, Population Estimates were removed from the list of Data Sources for this objective. In 2014, the measure was revised from a population-based prescribing rate (prescriptions per 100,000 population) to a visit-based prescribing rate (percent of outpatient visits) to be more aligned with the N/HAMCS data source and tol capture antibiotic prescribing behavior once a visit has occurred. As as result, the original baseline was revised from 48.7 per 100 children to 77.8 percent of visits. The target was adjusted from 37.0 per 100 children to 70.0 percent of visits to reflect the revised baseline using a new target-setting method: 10 percent improvement. 2008-09 follow-up data were also revised as a result of this methodology change.
  • IID-6 Reduce outpatient visits where antibiotics were prescribed for the sole diagnosis of the common cold

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Ambulatory Medical Care Survey
    National Hospital Ambulatory Medical Care Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    28.6 (2006–07)
    Target: 
    21.0
    Target-Setting Method: 
    Minimal statistical significance
    Target-Setting Method Justification: 
    CDC’s public health campaign Get Smart: Know When Antibiotics Work is the focus of this measure. The campaign involves an alliance of partners working to reduce inappropriate antibiotic use and reduce the spread of resistance to antibiotics. The campaign is continuing to grow partnership activities to increase public and healthcare provider awareness for appropriate antibiotic use. In addition, the campaign funded the update of pediatric prescribing guidelines that was published in 2011. An update of the adult prescribing guidelines is under way. The initial decreases in prescribing will be highest immediately following publication and dissemination of the guidelines. The overall decrease in prescribing attributed to the campaign is anticipated to be 50 percent. This decrease in prescribing was estimated using historical data from NAMCS and NHAMCS; data were fitted to a curve, taking into account the introduction of new guidelines and enhanced campaign efforts.
    Numerator: 

    Number of outpatient visits with antibiotic courses ordered, supplied, administered, or continued among persons diagnosed with the common cold (ICD-9- CM codes 460.0, 465.0)

    Denominator: 

    Number of outpatient visits for persons diagnosed with the common cold (ICD-9-CM codes 460.0, 465.0)

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Biennial
    Methodology Notes: 

      The number of courses of antibiotics for the sole diagnosis of the common cold among all ages are the sum of cases reported by NAMCS and NHAMCS that are listed as any diagnosis (including the primary diagnosis).

    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 14-19 in that the measure was revised from a population-based prescribing rate (prescriptions per 100,000 population) to a visit-based prescribing rate (prescriptions per 100 outpatient visits).

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    The population estimates produced by the U.S. Census Bureau are used solely to weight the estimates produced by the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey. Consequently, in 2013, Population Estimates have been removed from the list of Data Sources for this objective. In 2014, the measure was revised from a population-based prescribing rate (prescriptions per 100,000 population) to a visit-based prescribing rate (percent of outpatient visits) to be more aligned with the N/HAMCS data sources and to capture antibiotic prescribing behavior once a visit has occurred. The original baseline was revised from 1,458.4 per 100,000 population 28.6 percent of outpatient visits. As a result, the target was adjusted from 756.0 per 100,000 population to 21.0 percent of visits to reflect the revised baseline using a new target-setting method: minimal statistical significance. 2008-09 follow-up data were also revised as a result of this methodology change.
  • IID-7 Achieve and maintain effective vaccination coverage levels for universally recommended vaccines among young children

    • IID-7.1 Maintain an effective vaccination coverage level of 4 doses of the diphtheria-tetanus-acellular pertussis (DTaP) vaccine among children by age 19 to 35 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      82.5 (2012)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Ninety-percent coverage targets have allowed for dramatic control of vaccine-preventable diseases in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th Century. Achieving and maintaining 90 percent coverage is an important way of maintaining herd immunity for this population.
      Numerator: 

      Number of children aged 19 to 35 months receiving at least four doses of the combination of diphtheria, tetanus, and acellular pertussis antigens

      Denominator: 

      Number of children aged 19 to 35 months

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving at least 4 doses of the combination diphtheria, tetanus toxoids and acellular pertussis vaccine, the combination diphtheria, tetanus toxoids, and pertussis vaccine (DTP), or the combination diphtheria and tetanus toxoids vaccine (DT).

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children aged 19 to 35 months receiving at least four doses of the combination of diphtheria, tetanus, and acellular pertussis antigens

      Denominator: 

      Number of children aged 19 to 35 months

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 19 to 35 months receiving at least 4 doses of the combination diphtheria, tetanus toxoids and acellular pertussis vaccine, the combination diphtheria, tetanus toxoids, and pertussis vaccine (DTP), or the combination diphtheria and tetanus toxoids vaccine (DT).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, 2008 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "84.6 percent of children aged 19 to 35 months in 2008 received 4 or more doses of the combination of diphtheria, tetanus, and acellular pertussis antigens" to "82.5 percent of children aged 19 to 35 months in 2012 received 4 or more doses of the combination of diphtheria, tetanus, and acellular pertussis antigens." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2008. MMWR 2009: 58(33);921-926.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      4. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
    • IID-7.2 Achieve and maintain an effective vaccination coverage level of 3 or 4 doses of Haemophilus influenzae type b (Hib) vaccine among children by age 19 to 35 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      80.9 (2012)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Ninety-percent coverage targets have allowed for dramatic control of vaccine-preventable diseases in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 90 percent coverage is an important way of maintaining herd immunity for this population.
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 3 or 4 doses of Hib, depending on the vaccine brand

      Denominator: 

      Number of children aged 19 to 35 months

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving at least 3 or 4 doses (the full series including the primary series and booster) of the Haemophilus influenzae type b (Hib) vaccine. The number of Hib vaccine doses required differs according to manufacturer (brand). This measure does take into account the brand of vaccine used and assumes that doses with missing Hib type/brand information are a type requiring 4 doses to be up-to-date.

      Trend Issues: 
      The Hib shortage from Dec 2007 to Sept 2009 and the resulting ACIP recommendation to suspend the booster dose of Hib.
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-22b in that the numerator for this objective was revised from "the number of children aged 19 to 35 months receiving at least 3 doses of Hib" to "the number of children aged 19 to 35 months receiving at least 3 or 4 doses of Hib, depending on the vaccine brand."

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 3 or 4 doses of Hib, depending on the vaccine brand

      Denominator: 

      Number of children aged 19 to 35 months

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 19 to 35 months receiving at least 3 or 4 doses (the full series including the primary series and booster) of the Haemophilus influenzae type b (Hib) vaccine. The number of Hib vaccine doses required differs according to manufacturer (brand). This measure does take into account the brand of vaccine used and assumes that doses with missing Hib type/brand information are a type requiring 4 doses to be up-to-date.

      Trend Issues: 
      The Hib shortage from Dec 2007 to Sept 2009 and the resulting ACIP recommendation to suspend the booster dose of Hib.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the original baseline was revised from 57 (2009, first two quarters of data) to 54.8 (2009, full year). This change was made because the 2009 National Immunization Survey (NIS) introduced a new method for measuring Hib vaccination coverage to distinguish between Hib vaccine product types that require a different number of doses for full vaccination. These 2009 NIS data were not available during the target-setting process in early 2010. The target was not revised. In 2014, 2009 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2009 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "54.8 percent of children aged 19 to 35 months in 2009 received 3 or more, or 4 or more doses of Hib antigen, depending on product type received " to "80.9 percent of children aged 19 to 35 months in 2012 received 3 or more, or 4 or more doses of Hib antigen, depending on product type received." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
    • IID-7.3 Maintain an effective vaccination coverage level of 3 doses of hepatitis B (hep B) vaccine among children by age 19 to 35 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      89.7 (2012)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Ninety-percent coverage targets have allowed for dramatic control of vaccine-preventable diseases in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 90 percent coverage is an important way of maintaining herd immunity for this population.
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 3 doses of the hepatitis B antigen

      Denominator: 

      Number of children aged 19 to 35 months

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving at least 3 doses of the hepatitis B (HepB) vaccine.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 3 doses of the hepatitis B antigen

      Denominator: 

      Number of children aged 19 to 35 months

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 19 to 35 months receiving at least 3 doses of the hepatitis B (HepB) vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, 2008 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "93.5 percent of children aged 19 to 35 months in 2008 received at least 3 doses of the hepatitis B antigen" to "89.7 percent of children aged 19 to 35 months in 2012 received at least 3 doses of the hepatitis B antigen." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2008. MMWR 2009: 58(33);921-926.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      4. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
    • IID-7.4 Maintain an effective coverage level of 1 dose of measles-mumps-rubella (MMR) vaccine among children by age 19 to 35 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      90.8 (2012)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Ninety-percent coverage targets have allowed for dramatic control of vaccine-preventable diseases in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 90 percent coverage is an important way of maintaining herd immunity for this population.
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 1 dose of the combination of measles, mumps, and rubella antigens

      Denominator: 

      Number of children aged 19 to 35 months

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving at least 1 dose of the combination measles-mumps-rubella (MMR) vaccine.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 1 dose of the combination of measles, mumps, and rubella antigens

      Denominator: 

      Number of children aged 19 to 35 months

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 19 to 35 months receiving at least 1 dose of the combination measles-mumps-rubella (MMR) vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, 2008 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "92.1 percent of children aged 19 to 35 months in 2008 received at least 1 dose of measles-mumps-rubella (MMR) vaccine" to "90.8 percent of children aged 19 to 35 months in 2012 received at least 1 dose of measles-mumps-rubella (MMR) vaccine." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2008. MMWR 2009: 58(33);921-926.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      4. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
    • IID-7.5 Maintain an effective coverage level of 3 doses of polio vaccine among children by age 19 to 35 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      92.8 (2012)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Ninety-percent coverage targets have allowed for dramatic control of vaccine-preventable diseases in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 90 percent coverage is an important way of maintaining herd immunity for this population.
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 3 doses of the polio antigen

      Denominator: 

      Number of children aged 19 to 35 months

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving at least 3 doses of the poliovirus vaccine.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 3 doses of the polio antigen

      Denominator: 

      Number of children aged 19 to 35 months

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 19 to 35 months receiving at least 3 doses of the poliovirus vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, 2008 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "93.6 percent of children aged 19 to 35 months in 2008 received at least 3 doses of polio vaccine" to "92.8 percent of children aged 19 to 35 months in 2012 received at least 3 doses of polio vaccine." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2008. MMWR 2009: 58(33);921-926.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      4. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
    • IID-7.6 Maintain an effective coverage level of 1 dose of varicella vaccine among children by age 19 to 35 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      90.2 (2012)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Ninety-percent coverage targets have allowed for dramatic control of vaccine-preventable diseases in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 90 percent coverage is an important way of maintaining herd immunity for this population.
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 1 dose of the varicella antigen

      Denominator: 

      Number of children aged 19 to 35 months

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving at least 1 dose of the varicella (chickenpox) vaccine.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 1 dose of the varicella antigen

      Denominator: 

      Number of children aged 19 to 35 months

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 19 to 35 months receiving at least 1 dose of the varicella (chickenpox) vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, 2008 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "90.7 percent of children aged 19 to 35 months in 2008 received at least 1 dose of the varicella antigen" to "90.2 percent of children aged 19 to 35 months in 2012 received at least 1 dose of the varicella antigen." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2008. MMWR 2009: 58(33);921-926.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      4. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
    • IID-7.7 Achieve and maintain an effective coverage level of 4 doses of pneumococcal conjugate vaccine (PCV) among children by age 19 to 35 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      81.9 (2012)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Ninety-percent coverage targets have allowed for dramatic control of vaccine-preventable diseases in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 90 percent coverage is an important way of maintaining herd immunity for this population.
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 4 doses of the pneumococcal conjugate vaccine

      Denominator: 

      Number of children aged 19 to 35 months

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving at least 4 doses of the pneumococcal conjugate vaccine (PCV).

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 4 doses of the pneumococcal conjugate vaccine

      Denominator: 

      Number of children aged 19 to 35 months

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 19 to 35 months receiving at least 4 doses of the pneumococcal conjugate vaccine (PCV).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, 2008 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "80.1 percent of children aged 19 to 35 months received at least 4 doses of pneumococcal conjugate vaccine in 2008" to "81.9 percent of children aged 19 to 35 months received at least 4 doses of pneumococcal conjugate vaccine in 2012." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2008. MMWR 2009: 58(33);921-926.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      4. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
    • IID-7.8 Achieve and maintain an effective coverage level of 2 doses of hepatitis A vaccine among children by age 19 to 35 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      53.0 (2012)
      Target: 
      85.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Despite low hepatitis A vaccination coverage levels compared with other recommended childhood vaccinations, incidence of acute infections has declined to the lowest level ever recorded. Thus, 85 percent is an achievable target.
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 2 doses of Hepatitis A vaccine

      Denominator: 

      Number of children aged 19 to 35 months

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving at least 2 doses of the hepatitis A (HepA) vaccine.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 2 doses of Hepatitis A vaccine

      Denominator: 

      Number of children aged 19 to 35 months

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 19 to 35 months receiving at least 2 doses of the hepatitis A (HepA) vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, 2008 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "40.4 percent of children aged 19 to 35 months in 2008 received 2 or more doses of hepatitis A vaccine" to "53.0 percent of children aged 19 to 35 months in 2012 received 2 or more doses of hepatitis A vaccine." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2008. MMWR 2009: 58(33);921-926.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      4. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
    • IID-7.9 Achieve and maintain an effective coverage level of a birth dose of hepatitis B vaccine (0 to 3 days between birth date and date of vaccination, reported by annual birth cohort)

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      70.6 (2010–12)
      Target: 
      85.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      High hepatitis B vaccine birth dose coverage protects infants whose mothers were not identified to be chronically infected at the time of delivery. Modeling of National Immunization Survey data from 2003–08 shows an average increase of 2.46-percentage points per year, making 85 percent coverage an achievable target.
      Numerator: 

      Number of children who received the first dose of hepatitis B vaccine within three days of birth

      Denominator: 

      Number of children in the birth cohort

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 0 to 3 days receiving at least a single birth dose of hepatitis B vaccine (calculated as the date of vaccination minus the child's birth date). Data for children in a given birth cohort are obtained from data collected during the ensuing 3 year period. For example, data for children born in 2005 were gathered in the 2006-2008 NIS surveys.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children who received the first dose of hepatitis B vaccine within three days of birth

      Denominator: 

      Number of children in the birth cohort

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 0 to 3 days receiving at least a single birth dose of hepatitis B vaccine (calculated as the date of vaccination minus the child's birth date). Data for children in a given birth cohort are obtained from data collected during the ensuing 3 year period. For example, data for children born in 2005 were gathered in the 2006-2008 NIS surveys.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, 2006-08 through 2009-11 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2006-2008 to 2010-2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "50.9 percent of the 2005 birth cohort received the first dose of hepatitis B vaccine within 3 days of birth based on National Immunization Survey data from 2006–08" to "70.6 percent of the 2005 birth cohort received the first dose of hepatitis B vaccine within 3 days of birth based on National Immunization Survey data from 2010–12." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2008. MMWR 2009: 58(33);921-926.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      4. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
    • IID-7.10 Achieve and maintain an effective coverage level of 2 or more or 3 or more doses rotavirus vaccine among children by age 19 to 35 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      68.6 (2012)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Rotavirus vaccine was first recommended by the Advisory Committee on Immunization Practice in 2006. The first national coverage estimates were published in fall 2010. National Immunization Survey data from Q1 and Q2 2009 are available but have not been published. Because this vaccine is new and no catchup is possible (doses of rotavirus cannot be given after 8 months of age), 80 percent is an achievable target.
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 2 or 3 doses of rotavirus vaccine, depending on the vaccine brand

      Denominator: 

      Number of children aged 19 to 35 months

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving at least 2 or 3 doses of the rotavirus vaccine. The number of rotavirus vaccine doses required differs according to manufacturer (brand). This measure does take into account the brand of vaccine used and assumes that doses with missing rotavirus
        type/brand information are a type requiring 3 doses to be up-to-date.

      Trend Issues: 
      In 2011, the NIS sampling frame was expanded from sampling landline phones to sampling landline and cell phones, creating a dual frame sample.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of children aged 19 to 35 months receiving at least 2 or 3 doses of rotavirus vaccine, depending on the vaccine brand

      Denominator: 

      Number of children aged 19 to 35 months

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

          This measure tracks the proportion of children aged 19 to 35 months receiving at least 2 or 3 doses of the rotavirus vaccine. The number of rotavirus vaccine doses required differs according to manufacturer (brand). This measure does take into account the brand of vaccine used and assumes that doses with missing rotavirus
          type/brand information are a type requiring 3 doses to be up-to-date.

      Trend Issues: 
      In 2011, the NIS sampling frame was expanded from sampling landline phones to sampling landline and cell phones, creating a dual frame sample.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, 2009 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2009 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "43.9 percent of children aged 19 to 35 months in 2009 received 2 or more, or 3 or more doses of rotavirus vaccine by age 19 to 35 months, depending on product type received" to "68.6 percent of children aged 19 to 35 months in 2012 received 2 or more, or 3 or more doses of rotavirus vaccine by age 19 to 35 months, depending on product type received." The target remains unchanged.

      References

      Additional resources about the objective

      1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
      2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
      3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
  • IID-8 Increase the percentage of children aged 19 to 35 months who receive the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella and pneumococcal conjugate vaccine (PCV)
    LHI

    Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Immunization Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    68.4 (2012)
    Target: 
    80.0
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    Although measuring coverage estimates for individual vaccines is necessary, capturing a measure of “completeness” of ACIP-recommended vaccines for young children also is important. High coverage targets have allowed for dramatic control of vaccine-preventable diseases in the United States. A completeness measure has a target of 80 percent because not all of the vaccines included in this series have reached 90 percent coverage. Achieving this target will be more difficult than for the individual vaccines.
    Numerator: 

    Number of children aged 19 to 35 months receiving at least four doses of diphtheria-tetanus-acellular pertussis (DTaP), at least three doses of polio, at least one dose of measles-containing vaccine, at least three or four doses of Haemophilus influenzae B (Hib) depending on the brand used, at least three doses of hepatitis B antigens, at least one dose of varicella, and at least four doses of PCV

    Denominator: 

    Number of children aged 19 to 35 months

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

      [NUMERATOR:]

      Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

    Data Collection Frequency: 
    Annual
    Leading Health Indicator:
    Methodology Notes: 

      The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

      This measure tracks the proportion of children aged 19 to 35 months receiving the routine series of recommended vaccinations, referred to as 4:3:1:3:3:1:4 series. This series includes at least four doses of diphtheria-tetanus-acellular pertussis (DTaP), at least three doses of polio, at least one dose of measles-containing vaccine, at least three or four doses of Haemophilus influenzae B (Hib) vaccine depending on the brand used, at least three doses of hepatitis B, at least one dose of varicella antigens, and at least 4 doses of pneumococcal conjugate vaccine (PCV). The number of Hib vaccine doses required differs according to manufacturer (brand). This measure does take into account the brand of vaccine used and assumes that doses with missing Hib type/brand information are a type requiring 4 doses to be up-to-date.

    Trend Issues: 
    The Hib shortage from Dec 2007 to Sept 2009 and the resulting ACIP recommendation to suspend the booster dose of Hib.
    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 14-24a in that the list of vaccines included was revised from DTaP, polio, MMR, Hib, and hepatitis B to DTaP, polio, MMR, Hib, hepatitis B, varicella, and PCV. In addition, the Hib definition was revised from children receiving "at least 3 doses of Hib" to "at least 3 or 4 doses of Hib, depending on the vaccine brand."

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    National Immunization Survey
    Measure: 
    percent
    Numerator: 

    Number of children aged 19 to 35 months receiving at least four doses of diphtheria-tetanus-acellular pertussis (DTaP), at least three doses of polio, at least one dose of measles-containing vaccine, at least three or four doses of Haemophilus influenzae B (Hib) depending on the brand used, at least three doses of hepatitis B antigens, at least one dose of varicella, and at least four doses of PCV

    Denominator: 

    Number of children aged 19 to 35 months

    Questions Used to Obtain the State Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving the routine series of recommended vaccinations, referred to as 4:3:1:3:3:1:4 series. This series includes at least four doses of diphtheria-tetanus-acellular pertussis (DTaP), at least three doses of polio, at least one dose of measles-containing vaccine, at least three or four doses of Haemophilus influenzae B (Hib) vaccine depending on the brand used, at least three doses of hepatitis B, at least one dose of varicella antigens, and at least 4 doses of pneumococcal conjugate vaccine (PCV). The number of Hib vaccine doses required differs according to manufacturer (brand). This measure does take into account the brand of vaccine used and assumes that doses with missing Hib type/brand information are a type requiring 4 doses to be up-to-date.

    Trend Issues: 
    The Hib shortage from Dec 2007 to Sept 2009 and the resulting ACIP recommendation to suspend the booster dose of Hib.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2012, the original baseline was revised from 68 (2008) to 44.3 (2009). This change was made because the 2009 National Immunization Survey (NIS) introduced a new method for measuring Hib vaccination coverage to distinguish between Hib vaccine product types that require a different number of doses for full vaccination. These 2009 NIS data were not available during the target-setting process in early 2010. The target was not revised. In 2015, the baseline year was revised from 2009 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "44.3 percent of children aged 19 to 35 months in 2009 received the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella, and PCV " to "68.4 percent of children aged 19 to 35 months in 2012 received the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella, and PCV." The target remains unchanged. In 2014, 2009 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same.

    References

    Additional resources about the objective

    1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
    2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
    3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
  • IID-9 Decrease the percentage of children in the United States who receive 0 doses of recommended vaccines by age 19 to 35 months

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Immunization Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    0.8 (2012)
    Target: 
    Not applicable
    Target-Setting Method: 
    This measure is being tracked for informational purposes. If warranted, a target will be set during the decade.
    Numerator: 

    Number of children aged 19 to 35 months who receive zero doses of any recommended vaccines (including DTaP, Hib, measles-containing vaccine, polio, HepB, varicella, PCV, HepA, rotavirus, or influenza)

    Denominator: 

    Number of children aged 19 to 35 months

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

      [NUMERATOR:]

      Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

      This measure tracks the proportion of children aged 19 to 35 months receiving zero doses of any recommended vaccines (including DTaP, Hib, measles-containing vaccine, polio, HepB, varicella, PCV, HepA, rotavirus, or influenza).

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    National Immunization Survey
    Measure: 
    percent
    Numerator: 

    Number of children aged 19 to 35 months who receive zero doses of any recommended vaccines (including DTaP, Hib, measles-containing vaccine, polio, HepB, varicella, PCV, HepA, rotavirus, or influenza)

    Denominator: 

    Number of children aged 19 to 35 months

    Questions Used to Obtain the State Data: 

        From the 2013 National Immunization Survey Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        The National Immunization Survey (NIS) uses a quarterly, random-digit-dialed sample of telephone numbers to reach households with children aged 19–35 months in the 50 states and selected local areas and territories, followed by a mail survey sent to the children's vaccination providers to collect vaccination information. Data are weighted to represent the population of children aged 19–35 months, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. Beginning in 2011, surveys include landline and cellular telephone households.

        This measure tracks the proportion of children aged 19 to 35 months receiving zero doses of any recommended vaccines (including DTaP, Hib, measles-containing vaccine, polio, HepB, varicella, PCV, HepA, rotavirus, or influenza).

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2014, 2008 through 2011 data were revised to correct errors in programming, in particular the estimates by sex and country of birth. The baseline estimate for the total population and target remained the same. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "0.6 percent of children aged 19 to 35 months in 2008 in the United States received 0 doses of recommended vaccines by age 19 to 35 months" to "0.8 percent of children aged 19 to 35 months in 2012 in the United States received 0 doses of recommended vaccines by age 19 to 35 months." The target remains unchanged.

    References

    Additional resources about the objective

    1. CDC. National and State Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2010. MMWR 2011:60(34):1157-1163.
    2. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2008. MMWR 2009: 58(33);921-926.
    3. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19--35 Months --- United States, 2009. MMWR 2010;59(36):1171-1177.
    4. CDC. National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011. MMWR 2012;61(35):689-696.
  • IID-10 Maintain vaccination coverage levels for children in kindergarten

    • IID-10.1 Maintain the vaccination coverage level of 4 doses of diphtheria-tetanus-acellular pertussis (DTaP) vaccine for children in kindergarten

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Annual School Assessment Reports
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      97.2 (2009–10)
      Target: 
      95.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      For these objectives, 95-percent coverage targets as set for Healthy People 2010 have allowed for dramatic control of vaccine-preventable disease in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 95 percent coverage for these vaccines also is an important way of maintaining herd immunity for children who are in close contact—often for the first times in their lives—in a school setting.
      Numerator: 

      Number of surveyed enrollees in kindergarten who received 4 or more doses of DTaP vaccine

      Denominator: 

      Number of surveyed enrollees in kindergarten during the survey school year

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Data reflect the median of state vaccination coverage estimates. State estimates reflect coverage of the required number of DTaP doses for kindergarten entry in each state. Most states require 5 doses of DTaP for school entry, or 4 doses if the fourth dose was received on or after the fourth birthday. Estimates are obtained by combining states’ estimates and weighting the vaccine-specific coverage levels reported by states and territories to their respective birth cohorts. Data are provided for a school year and reflect vaccination status at entry into school. For example, vaccination for the 2009-10 school year reflects vaccination coverage for kindergarteners as of start of the school year in 2009. States may collect and/or report data on selective antigens depending upon school entry requirements.

      Caveats and Limitations: 
      Sampling methodology varies by state, which is a major limitation (e.g., some states selected a random sample of kindergarten children and others conducted a census of all kindergarten children). Changes in median coverage over time might reflect changes in number of DTaP doses required for kindergarten entry in some states rather than actual changes in vaccination coverage.
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-23f in that the objective was revised from at least one dose of the combination of diphtheria, tetanus, and either acellular pertussis or pertussis (DTaP or DTP) antigens to 4 or more doses of the DTaP vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the original baseline was revised from 95.0 (2007-2008) to 97.2 (2009-2010) because data prior to 2009-2010 could not be appropriately weighted and verified. The target was not revised.
    • IID-10.2 Maintain the vaccination coverage level of 2 doses of measles-mumps-rubella (MMR) vaccine for children in kindergarten

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Annual School Assessment Reports
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      95.0 (2009–10)
      Target: 
      95.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      For these objectives, 95-percent coverage targets as set for Healthy People 2010 have allowed for dramatic control of vaccine-preventable disease in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 95 percent coverage for these vaccines also is an important way of maintaining herd immunity for children who are in close contact—often for the first times in their lives—in a school setting.
      Numerator: 

      Number of surveyed enrollees in kindergarten who received 2 or more doses of MMR vaccine

      Denominator: 

      Number of surveyed enrollees in kindergarten during the survey year

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Data reflect the median of state vaccination coverage estimates. Estimates are obtained by combining states’ estimates and weighting the vaccine-specific coverage levels reported by states and territories to their respective birth cohorts. Data are provided for a school year and reflect vaccination status at entry into school. For example, vaccination for the 2009-10 school year reflects vaccination coverage for kindergarteners as of start of the school year in 2009. States may collect and/or report data on selective antigens depending upon school entry requirements.

      Caveats and Limitations: 
      Sampling methodology vary by state, which is a major limitation (e.g., some states selected a random sample of kindergarten children and others conducted a census of all kindergarten children).
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-23g in that the objective was revised from at least one dose of the combination of measles, mumps, and rubella (MMR) antigens to 2 or more doses of the MMR vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the original baseline was revised from 95.0 (2007-2008) to 95.0 (2009-2010) because data prior to 2009-2010 could not be appropriately weighted and verified. The target was not revised.
    • IID-10.3 Maintain the vaccination coverage level of 3 doses of polio vaccine for children in kindergarten

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Annual School Assessment Reports
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      96.2 (2009–10)
      Target: 
      95.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      For these objectives, 95-percent coverage targets as set for Healthy People 2010 have allowed for dramatic control of vaccine-preventable disease in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 95 percent coverage for these vaccines is also an important way of maintaining herd immunity for children who are in close contact—often for the first times in their lives—in a school setting.
      Numerator: 

      Number of surveyed enrollees in kindergarten who received 3 or more doses of polio vaccine

      Denominator: 

      Number of surveyed enrollees in kindergarten during the survey school year

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Data reflect the median of state vaccination coverage estimates. State estimates reflect coverage of the required number of polio vaccine doses for kindergarten entry in each state. Most states require 4 doses of DTaP for school entry, or 3 doses if the fourth dose was received on or after the fourth birthday. Estimates are obtained by combining states’ estimates and weighting the vaccine-specific coverage levels reported by states and territories to their respective birth cohorts. Data are provided for a school year and reflect vaccination status at entry into school. For example, vaccination for the 2009-10 school year reflects vaccination coverage for kindergarteners as of start of the school year in 2009. States may collect and/or report data on selective antigens depending upon school entry requirements.

      Caveats and Limitations: 
      Sampling methodology vary by state, which is a major limitation (e.g., some states selected a random sample of kindergarten children and others conducted a census of all kindergarten children). Changes in median coverage over time might reflect changes in number of polio vaccine doses required for kindergarten entry in some states rather than actual changes in vaccination coverage.
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-23h in that the objective was revised from at least one dose of the polio antigen to 3 or more doses of the polio vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the original baseline was revised from 96.0 (2007-2008) to 96.2 (2009-2010) because data prior to 2009-2010 could not be appropriately weighted and verified. The target was not revised.
    • IID-10.4 Maintain the vaccination coverage level of 3 doses of hepatitis B vaccine for children in kindergarten

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Annual School Assessment Reports
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      97.0 (2009–10)
      Target: 
      95.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      For these objectives, 95-coverage targets as set for Healthy People 2010 have allowed for dramatic control of vaccine-preventable disease in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 95 percent coverage for these vaccines also is an important way of maintaining herd immunity for children who are in close contact—often for the first times in their lives—in a school setting.
      Numerator: 

      Number of surveyed enrollees in kindergarten who received 3 or more doses of hepatitis B vaccine

      Denominator: 

      Number of surveyed enrollees in kindergarten during the survey year

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Data reflect the median of state vaccination coverage estimates. Estimates are obtained by combining states’ estimates and weighting the vaccine-specific coverage levels reported by states and territories to their respective birth cohorts. Data are provided for a school year and reflect vaccination status at entry into school. For example, vaccination for the 2009-10 school year reflects vaccination coverage for kindergarteners as of start of the school year in 2009. States may collect and/or report data on selective antigens depending upon school entry requirements.

      Caveats and Limitations: 
      Sampling methodology vary by state, which is a major limitation (e.g., some states selected a random sample of kindergarten children and others conducted a census of all kindergarten children).
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-23i in that the objective was revised from at least one dose of the hepatitis B antigen to 3 or more doses of the hepatitis B vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the original baseline was revised from 96.0 (2007-2008) to 97.0 (2009-2010) because data prior to 2009-2010 could not be appropriately weighted and verified. The target was not revised.
    • IID-10.5 Maintain the vaccination coverage level of 2 doses of varicella vaccine for children in kindergarten

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Annual School Assessment Reports
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      91.3 (2009–10)
      Target: 
      95.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      For these objectives, 95-percent coverage targets as set for Healthy People 2010 have allowed for dramatic control of vaccine-preventable disease in the United States. Morbidity has declined at least 99 percent for most diseases from levels in the 20th century. Achieving and maintaining 95 percent coverage for these vaccines also is an important way of maintaining herd immunity for children who are in close contact—often for the first times in their lives—in a school setting.
      Numerator: 

      Number of surveyed enrollees in kindergarten who received 2 or more doses of varicella vaccine

      Denominator: 

      Number of surveyed enrollees in kindergarten during the survey school year

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Data reflect the median of state vaccination coverage estimates. Estimates are obtained by combining states’ estimates and weighting the vaccine-specific coverage levels reported by states and territories to their respective birth cohorts. Data are provided for a school year and reflect vaccination status at entry into school. For example, vaccination for the 2009-10 school year reflects vaccination coverage for kindergarteners as of start of the school year in 2009. States may collect and/or report data on selective antigens depending upon school entry requirements.

      Caveats and Limitations: 
      Sampling methodology vary by state, which is a major limitation (e.g., some states selected a random sample of kindergarten children and others conducted a census of all kindergarten children).
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-23j in that the objective was revised from at least one dose of the varicella antigen to 2 or more doses of the varicella vaccine.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the original baseline was revised from 94.0 (2007-2008) to 91.3 (2009-2010) because data prior to 2009-2010 could not be appropriately weighted and verified. The target was not revised.
  • IID-11 Increase routine vaccination coverage levels for adolescents

    • IID-11.1 Increase the vaccination coverage level of 1 dose of tetanus-diphtheria-acellular pertussis (Tdap) booster vaccine for adolescents by age 13 to 15 years

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey-Teen
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      85.3 (2012)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      High coverage rates for adolescents are important, but many of the adolescent vaccines are relatively recent additions to the ACIP recommendations. Additionally, vaccinating adolescents is more challenging than vaccinating young children (e.g., recommended vaccines for young children often coincide with well-child visits in the first years of life), and adolescents make fewer medical visits on average, compared with younger children. Thus, an 80 percent target for these adolescent vaccines is both ambitious and achievable. Varicella vaccine has been routinely recommended for many years for preschool-aged children, with catchup for older kids. The target for adolescent varicella is lower than kindergarten varicella because approximately two to three cohorts of children will have missed the kindergarten varicella vaccine requirement during the Healthy People 2020 reporting period.
      Numerator: 

      Number of persons aged 13 to 15 years receiving at least 1 dose of a tetanus-diphtheria-acelluar pertussis (Tdap) booster vaccine

      Denominator: 

      Number of persons aged 13 to 15 years

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey-Teen Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure are restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service.

        In 2006, the Advisory Committee on Immunization Practices (ACIP) recommended that 1) adolescents aged 11–18 years should receive a single dose of Tdap for booster immunization if they had completed the recommended childhood DTP/DTaP vaccination series and have not received Td or Tdap; 2) adolescents aged 11–18 years who received Td, but not Tdap, are encouraged to receive a single dose of Tdap to provide protection against pertussis if they have completed the recommended childhood DTP/DTaP vaccination series; and 3) vaccine providers should administer Tdap and tetravalent meningococcal conjugate vaccine (tracked in Healthy People objective to adolescents aged 11–18 years during the same visit if both vaccines are indicated and available. In 2010, ACIP approved the following additional recommendations: 1) use of Tdap regardless of interval since the last tetanus- or diphtheria-toxoid containing vaccine, 2) use of Tdap in certain adults aged 65 years and older, and 3) use of Tdap in undervaccinated children aged 7 through 10 years.

        This measure tracks the proportion of adolescents aged 13–15 years receiving at least 1 dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) since the age of ten years.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-27c in that the vaccine was revised from "tetanus and diphtheria" to "tetanus-diphtheria-acelluar pertussis (Tdap) booster."

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey-Teen
      Measure: 
      percent
      Numerator: 

      Number of persons aged 13 to 15 years receiving at least 1 dose of a tetanus-diphtheria-acelluar pertussis (Tdap) booster vaccine

      Denominator: 

      Number of persons aged 13 to 15 years

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey-Teen Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure are restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service.

          In 2006, the Advisory Committee on Immunization Practices (ACIP) recommended that 1) adolescents aged 11–18 years should receive a single dose of Tdap for booster immunization if they had completed the recommended childhood DTP/DTaP vaccination series and have not received Td or Tdap; 2) adolescents aged 11–18 years who received Td, but not Tdap, are encouraged to receive a single dose of Tdap to provide protection against pertussis if they have completed the recommended childhood DTP/DTaP vaccination series; and 3) vaccine providers should administer Tdap and tetravalent meningococcal conjugate vaccine (tracked in Healthy People objective to adolescents aged 11–18 years during the same visit if both vaccines are indicated and available. In 2010, ACIP approved the following additional recommendations: 1) use of Tdap regardless of interval since the last tetanus- or diphtheria-toxoid containing vaccine, 2) use of Tdap in certain adults aged 65 years and older, and 3) use of Tdap in undervaccinated children aged 7 through 10 years.

          This measure tracks the proportion of adolescents aged 13–15 years receiving at least 1 dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) since the age of ten years.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, the data source name was revised to the “National Immunization Survey (NIS) – Teen” to distinguish this survey from the “National Immunization Survey (NIS),” which samples children between the ages of 19 and 35 months. Neither the data nor the target were revised. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "46.7 percent of adolescents aged 13 to 15 years had received at least 1 dose of a Tdap booster in 2008" to "85.3 percent of adolescents aged 13 to 15 years had received at least 1 dose of a Tdap booster in 2012." The target remains unchanged.

      References

      Additional resources about the objective

      1. Datasets for the National Immunization Survey - Teen [online]. Atlanta (GA): National Center for Immunization and Respiratory Diseases. c2013 – [cited 2013 June 6].
    • IID-11.2 Increase the vaccination coverage level of 2 doses of varicella vaccine for adolescents by age 13 to 15 years (excluding children who have had varicella)

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey-Teen
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      76.8 (2012)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      High coverage rates for adolescents are important, but many of the adolescent vaccines are relatively recent additions to the ACIP recommendations. Additionally, vaccinating adolescents is more challenging than vaccinating young children (e.g., recommended vaccines for young children often coincide with well-child visits in the first years of life), and adolescents make fewer medical visits on average, compared with younger children. The target for adolescent varicella is lower than kindergarten varicella because approximately two to three cohorts of children will have missed the kindergarten varicella vaccine requirement during the Healthy People 2020 reporting period.
      Numerator: 

      Number of persons aged 13 to 15 years receiving at least 2 doses of varicella (excluding those who have had varicella)

      Denominator: 

      Number of persons aged 13 to 15 years (excluding those who have had varicella)

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey-Teen Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure are restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service.

        In 2005, the Advisory Committee on Immunization Practices (ACIP) recommended 1) a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12–15 months and the second dose at age 4–6 years; and 2) a second dose catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose.

        This measure tracks the proportion of adolescents aged 13–15 years receiving at least 2 doses of the varicella vaccine among those who have not had varicella disease.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-27d in that the number of doses of varicella was revised from "1 or more" to "at least 2 doses."

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey-Teen
      Measure: 
      percent
      Numerator: 

      Number of persons aged 13 to 15 years receiving at least 2 doses of varicella (excluding those who have had varicella)

      Denominator: 

      Number of persons aged 13 to 15 years (excluding those who have had varicella)

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey-Teen Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure are restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service.

          In 2005, the Advisory Committee on Immunization Practices (ACIP) recommended 1) a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12–15 months and the second dose at age 4–6 years; and 2) a second dose catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose.

          This measure tracks the proportion of adolescents aged 13–15 years receiving at least 2 doses of the varicella vaccine among those who have not had varicella disease.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, the data source name was revised to the “National Immunization Survey (NIS) – Teen” to distinguish this survey from the “National Immunization Survey (NIS),” which samples children between the ages of 19 and 35 months. Neither the data nor the target were revised. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from " 36.7 percent of adolescents aged 13 to 15 years had received at least 2 doses of varicella vaccine (excluding adolescents who have had varicella) in 2008 " to " 76.8 percent of adolescents aged 13 to 15 years had received at least 2 doses of varicella vaccine (excluding adolescents who have had varicella) in 2012." The target remains unchanged.

      References

      Additional resources about the objective

      1. Datasets for the National Immunization Survey - Teen [online]. Atlanta (GA): National Center for Immunization and Respiratory Diseases. c2013 – [cited 2013 June 6].
    • IID-11.3 Increase the vaccination coverage level of 1 dose meningococcal conjugate vaccine for adolescents by age 13 to 15 years

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey-Teen
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      73.8 (2012)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      High coverage rates for adolescents are important, but many of the adolescent vaccines are relatively recent additions to the ACIP recommendations. Additionally, vaccinating adolescents is more challenging than vaccinating young children (e.g., recommended vaccines for young children often coincide with well-child visits in the first years of life), and adolescents make fewer medical visits on average compared to younger children. Thus, an 80 percent target for these adolescent vaccines is both ambitious and achievable. Varicella vaccine has been routinely recommended for many years for preschool-aged children, with catchup for older kids. The target for adolescent varicella is lower than kindergarten varicella because approximately two to three cohorts of children will have missed the kindergarten varicella vaccine requirement during the Healthy People 2020 reporting period.
      Numerator: 

      Number of persons aged 13 to 15 years receiving at least 1 dose of meningococcal conjugate vaccine

      Denominator: 

      Number of persons aged 13 to 15 years

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2013 National Immunization Survey-Teen Provider-Immunization History Questionnaire:

        [NUMERATOR:]

        Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure are restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service.

        In 2005, the Advisory Committee on Immunization Practices (ACIP) recommended the routine vaccination of adolescents aged 11–12 years at the preadolescent health care visit and for adolescents before high school entry. In 2008, the ACIP expanded its recommendations to the routine administration of meningococcal vaccine at 11–12 years of age and 13–18 years of age if not previously vaccinated. In 2011, the ACIP recommended that a single dose of vaccine be administered at age 11 or 12 years, with a booster dose at age 16 years for persons who receive the first dose before age 16 years.

        This measure tracks the proportion of adolescents aged 13–15 years receiving at least 1 of the meningococcal conjugate vaccine (MenACWY) and meningococcal-unknown type vaccine.

      Trend Issues: 
      In 2011, the NIS sampling frame was expanded from sampling landline phones to sampling landline and cell phones, creating a dual frame sample.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey-Teen
      Measure: 
      percent
      Numerator: 

      Number of persons aged 13 to 15 years receiving at least 1 dose of meningococcal conjugate vaccine

      Denominator: 

      Number of persons aged 13 to 15 years

      Questions Used to Obtain the State Data: 

          From the 2013 National Immunization Survey-Teen Provider-Immunization History Questionnaire:

          [NUMERATOR:]

          Specify month, day, and year that each vaccine was given, either by the office or another provider, and type of vaccine, as documented in the records.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure are restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service.

          In 2005, the Advisory Committee on Immunization Practices (ACIP) recommended the routine vaccination of adolescents aged 11–12 years at the preadolescent health care visit and for adolescents before high school entry. In 2008, the ACIP expanded its recommendations to the routine administration of meningococcal vaccine at 11–12 years of age and 13–18 years of age if not previously vaccinated. In 2011, the ACIP recommended that a single dose of vaccine be administered at age 11 or 12 years, with a booster dose at age 16 years for persons who receive the first dose before age 16 years.

          This measure tracks the proportion of adolescents aged 13–15 years receiving at least 1 of the meningococcal conjugate vaccine (MenACWY) and meningococcal-unknown type vaccine.

      Trend Issues: 
      In 2011, the NIS sampling frame was expanded from sampling landline phones to sampling landline and cell phones, creating a dual frame sample.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, the data source name was revised to the “National Immunization Survey (NIS) – Teen” to distinguish this survey from the “National Immunization Survey (NIS),” which samples children between the ages of 19 and 35 months. Neither the data nor the target were revised. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "43.9 percent of adolescents aged 13 to 15 years had received at least 1 dose of meningococcal conjugate vaccine in 2008" to "73.8 percent of adolescents aged 13 to 15 years had received at least 1 dose of meningococcal conjugate vaccine in 2012." The target remains unchanged.

      References

      Additional resources about the objective

      1. Datasets for the National Immunization Survey - Teen [online]. Atlanta (GA): National Center for Immunization and Respiratory Diseases. c2013 – [cited 2013 June 6].
    • IID-11.4 Increase the percentage of female adolescents aged 13 through 15 years who receive 2 or 3 doses of human papillomavirus (HPV) vaccine as recommended

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey-Teen
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      45.1 (2016)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      High coverage rates for adolescents are important, but many of the adolescent vaccines are relatively recent additions to the ACIP recommendations. Additionally, vaccinating adolescents is more challenging than vaccinating young children (e.g., recommended vaccines for young children often coincide with well-child visits in the first years of life), and adolescents make fewer medical visits on average, compared with younger children. Thus, an 80 percent target for these adolescent vaccines is both ambitious and achievable. Varicella vaccine has been routinely recommended for many years for preschool-aged children, with catchup for older kids. The target for adolescent varicella is lower than kindergarten varicella because approximately two to three cohorts of children will have missed the kindergarten varicella vaccine requirement during the Healthy People 2020 reporting period.
      Numerator: 

      Number of females aged 13 to 15 years who receive 2 or 3 doses of the human papillomavirus (HPV) vaccine

      Denominator: 

      Number of females aged 13 to 15 years

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure were restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. A recent report outlining the methodology of the NIS Surveys is available at National Immunization Surveys (NIS) Methods - National Immunization Surveys.

        In December 2016, the ACIP updated the HPV vaccine recommendation to include a 2-dose schedule for immunocompetent adolescents initiating the vaccination series before their 15th birthday1. Three doses are still recommended for persons initiating the series at ages 15 through 26 years or who are immunocompromised1. To account for the revisions to the HPV vaccine recommendation, a new measure of being up to date with HPV vaccination was reported in the 2016 NIS-Teen MMWR article2. As measured by the NIS-Teen, an adolescent is considered up to date with the HPV vaccine series if they receive 3 or more doses of HPV vaccine, or if each of the following three conditions are met: 1) they receive 2 doses of HPV vaccine; 2) the first dose of HPV vaccine is received before their 15th birthday; and 3) the difference between dates of first and second doses is greater than or equal to 5 months minus 4 days–the absolute minimum interval between the first and second doses.

        This measure tracks the proportion of female adolescents aged 13–15 years who received 2 or 3 doses of the human papillomavirus (HPV) vaccine as recommended.

        References

        1. 1. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–8.
        2. 2. Walker TY, Elam-Evans LD, Singleton JA, Yankey D, Markowitz LE, Fredua B, Williams CL, Meyer SA, Stokley S. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years – United States, 2016. MMWR. 2017 Aug 25;66 (33):874-82. DOI: National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2016 | MMWR.
      Caveats and Limitations: 
      Data for this revised HPV measure in 2016 will not be comparable to measures prior to 2016 because the definition changed.
      Trend Issues: 
      Data for this revised HPV measure in 2016 will not be comparable to measures prior to 2016 because the definition changed.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey-Teen
      Measure: 
      percent
      Numerator: 

      Number of females aged 13 to 15 years who receive 2 or 3 doses of the human papillomavirus (HPV) vaccine

      Denominator: 

      Number of females aged 13 to 15 years

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure were restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. A recent report outlining the methodology of the NIS Surveys is available at National Immunization Surveys (NIS) Methods - National Immunization Surveys.

          In December 2016, the ACIP updated the HPV vaccine recommendation to include a 2-dose schedule for immunocompetent adolescents initiating the vaccination series before their 15th birthday1. Three doses are still recommended for persons initiating the series at ages 15 through 26 years or who are immunocompromised1. To account for the revisions to the HPV vaccine recommendation, a new measure of being up to date with HPV vaccination was reported in the 2016 NIS-Teen MMWR article2. As measured by the NIS-Teen, an adolescent is considered up to date with the HPV vaccine series if they receive 3 or more doses of HPV vaccine, or if each of the following three conditions are met: 1) they receive 2 doses of HPV vaccine; 2) the first dose of HPV vaccine is received before their 15th birthday; and 3) the difference between dates of first and second doses is greater than or equal to 5 months minus 4 days–the absolute minimum interval between the first and second doses.

          This measure tracks the proportion of female adolescents aged 13–15 years who received 2 or 3 doses of the human papillomavirus (HPV) vaccine as recommended.

          References

          1. 1. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–8.
          2. 2. Walker TY, Elam-Evans LD, Singleton JA, Yankey D, Markowitz LE, Fredua B, Williams CL, Meyer SA, Stokley S. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years – United States, 2016. MMWR. 2017 Aug 25;66 (33):874-82. DOI: National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2016 | MMWR.
      Caveats and Limitations: 
      Data for this revised HPV measure in 2016 will not be comparable to measures prior to 2016 because the definition changed.
      Trend Issues: 
      Data for this revised HPV measure in 2016 will not be comparable to measures prior to 2016 because the definition changed.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, the data source name was revised to the “National Immunization Survey (NIS) – Teen” to distinguish this survey from the “National Immunization Survey (NIS),” which samples children between the ages of 19 and 35 months. Neither the data nor the target were revised. In 2015, the baseline year was revised from 2008 to 2012 due to expanding the sampling frame from landline phones only to a dual frame sample including landline and cell phones. The baseline statement was changed from "16.6 percent of females aged 13 to 15 years had received at least 3 doses of human papillomavirus (HPV) vaccine in 2008" to "28.1 percent of females aged 13 to 15 years had received at least 3 doses of human papillomavirus (HPV) vaccine in 2012." The target remains unchanged. In 2018, to reflect the updated Advisory Committee on Immunization Practices (ACIP) 2016 recommendation on HPV vaccination, the objective statement and the methodology were changed. The baseline was changed from "28.1 percent of females aged 13 to 15 years had received at least 3 doses of human papillomavirus (HPV) vaccine in 2012." to "45.1 percent of females aged 13 to 15 years had received 2 or 3 doses of human papillomavirus (HPV) vaccine in 2016." The target remains unchanged.

      References

      Additional resources about the objective

      1. Datasets for the National Immunization Survey - Teen [online]. Atlanta (GA): National Center for Immunization and Respiratory Diseases. c2013 – [cited 2013 June 6].
    • IID-11.5 Increase the percentage of male adolescents aged 13 through 15 years who receive 2 or 3 doses of human papillomavirus (HPV) vaccine as recommended

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey-Teen
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      36.4 (2016)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Given the baseline of 6.9%, the target of 80% is ambitious. 80% was selected to keep this measure consistent with all other national adolescent targets. Our ultimate goal is to combine this measure with the objective for girls, thereby establishing one HPV measure for the entire adolescent population. However, given the difference in the number of years since the female recommendation passed versus the relatively new male recommendation, combining the measures at this point would skew the current picture. Increasing HPV vaccination coverage rates for all adolescents is one of the top 5 goals for the Centers for Disease Control and Prevention in 2014. Given the resources focused on improving coverage rates for males and females, 80% is extremely ambitious, but also achievable. In 2014, CDC is providing technical assistance to 11 immunization program awardees that received funding to improve HPV vaccination coverage levels among adolescent boys and girls. We will also continue outreach and education to clinicians through continuing medical education, partnership with professional associations, and other educational opportunities to help strengthen vaccine recommendations and eliminate missed opportunities for HPV vaccination. Finally, using partnership building and media outreach, CDC will continue awareness activities aimed at parents of 11 and 12 year olds to help promote understanding and uptake of HPV vaccine.
      Numerator: 

      Number of males aged 13 to 15 years who receive 2 or 3 doses of the human papillomavirus (HPV) vaccine

      Denominator: 

      Number of males aged 13 to 15 years

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure were restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. A recent report outlining the methodology of the NIS Surveys is available at National Immunization Surveys (NIS) Methods - National Immunization Surveys.

        In December 2016, the ACIP updated the HPV vaccine recommendation to include a 2-dose schedule for immunocompetent adolescents initiating the vaccination series before their 15th birthday1. Three doses are still recommended for persons initiating the series at ages 15 through 26 years or who are immunocompromised1. To account for the revisions to the HPV vaccine recommendation, a new measure of being up to date with HPV vaccination was reported in the 2016 NIS-Teen MMWR article2. As measured by the NIS-Teen, an adolescent is considered up to date with the HPV vaccine series if they receive 3 or more doses of HPV vaccine, or if each of the following three conditions are met: 1) they receive 2 doses of HPV vaccine; 2) the first dose of HPV vaccine is received before their 15th birthday; and 3) the difference between dates of first and second doses is greater than or equal to 5 months minus 4 days–the absolute minimum interval between the first and second doses.

        This measure tracks the proportion of male adolescents aged 13–15 years receiving at least 3 doses of the quadrivalent human papillomavirus vaccine.

        References

        1. 1. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–8.
        2. 2. Walker TY, Elam-Evans LD, Singleton JA, Yankey D, Markowitz LE, Fredua B, Williams CL, Meyer SA, Stokley S. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years – United States, 2016. MMWR. 2017 Aug 25;66 (33):874-82. DOI: National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2016 | MMWR.
      Caveats and Limitations: 
      Data for this revised HPV measure in 2016 will not be comparable to measures prior to 2016 because the definition changed.
      Trend Issues: 
      Data for this revised HPV measure in 2016 will not be comparable to measures prior to 2016 because the definition changed.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey-Teen
      Measure: 
      percent
      Numerator: 

      Number of males aged 13 to 15 years who receive 2 or 3 doses of the human papillomavirus (HPV) vaccine

      Denominator: 

      Number of males aged 13 to 15 years

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          The National Immunization Survey-Teen (NIS-Teen) collects vaccination information for adolescents aged 13–17 years in the 50 states, the District of Columbia, selected areas, and the U.S. Virgin Islands, using a random-digit-dialed sample of landline and, starting in 2011, cellular telephone numbers. Parent/guardian respondents provide vaccination and sociodemographic information on adolescents in their care. After the parent/guardian grants permission to contact their child's vaccination provider, a questionnaire is mailed to that provider to obtain a vaccination history from the medical record. Data for this measure were restricted to adolescents aged 13–15 and weighted to represent the population of adolescents age 13–15, with adjustments for households with multiple telephone lines and mixed telephone use (landline and cellular), household nonresponse, and exclusion of households without telephone service. A recent report outlining the methodology of the NIS Surveys is available at National Immunization Surveys (NIS) Methods - National Immunization Surveys.

          In December 2016, the ACIP updated the HPV vaccine recommendation to include a 2-dose schedule for immunocompetent adolescents initiating the vaccination series before their 15th birthday1. Three doses are still recommended for persons initiating the series at ages 15 through 26 years or who are immunocompromised1. To account for the revisions to the HPV vaccine recommendation, a new measure of being up to date with HPV vaccination was reported in the 2016 NIS-Teen MMWR article2. As measured by the NIS-Teen, an adolescent is considered up to date with the HPV vaccine series if they receive 3 or more doses of HPV vaccine, or if each of the following three conditions are met: 1) they receive 2 doses of HPV vaccine; 2) the first dose of HPV vaccine is received before their 15th birthday; and 3) the difference between dates of first and second doses is greater than or equal to 5 months minus 4 days–the absolute minimum interval between the first and second doses.

          This measure tracks the proportion of male adolescents aged 13–15 years receiving at least 3 doses of the quadrivalent human papillomavirus vaccine.

          References

          1. 1. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination—updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:1405–8.
          2. 2. Walker TY, Elam-Evans LD, Singleton JA, Yankey D, Markowitz LE, Fredua B, Williams CL, Meyer SA, Stokley S. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years – United States, 2016. MMWR. 2017 Aug 25;66 (33):874-82. DOI: National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2016 | MMWR.
      Caveats and Limitations: 
      Data for this revised HPV measure in 2016 will not be comparable to measures prior to 2016 because the definition changed.
      Trend Issues: 
      Data for this revised HPV measure in 2016 will not be comparable to measures prior to 2016 because the definition changed.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      This objective was added to Healthy People 2020 in 2014. In 2018, to reflect the updated Advisory Committee on Immunization Practices (ACIP) 2016 recommendation on HPV vaccination, the objective statement and the methodology were changed. In 2016, the baseline was changed “from " 6.9 percent of males aged 13 to 15 years had received at least 3 doses of human papillomavirus (HPV) vaccine in 2012." to "36.4 percent of males aged 13 to 15 years had received 2 or 3 doses of human papillomavirus (HPV) vaccine in 2016." The target remains unchanged.

      References

      Additional resources about the objective

      1. Datasets for the National Immunization Survey - Teen [online]. Atlanta (GA): National Center for Immunization and Respiratory Diseases. c2013 – [cited 2013 June 6].
  • IID-12 Increase the percentage of children and adults who are vaccinated annually against seasonal influenza

    • IID-12.1 Increase the percentage of children aged 6 to 23 months who are vaccinated annually against seasonal influenza (1 or 2 doses, depending on age-appropriateness and previous doses received)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      23.4 (2008)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Numerator: 

      Number of children aged 6 to 23 months fully vaccinated (1, 2, or more doses) with influenza vaccine in the NIS sample

      Denominator: 

      The subset of children aged 6 to 23 months during the beginning of the influenza season (September-December) within the NIS sample of children aged 19-35 months at the time of the household interview

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Methodology Notes: 

        Only children in the National Immunization Survey (NIS) sample aged 6-23 months during the entire span of September-December are included in the measure.

        Children in the NIS sample are 19-35 months at the time of the interview. Children’s entire history of influenza vaccination is obtained. Only provider reported vaccinations are used for NIS estimates.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.1 through 12.4 objectives were consolidated and revised to IID-12.11.
    • IID-12.2 Increase the percentage of children aged 2 to 4 years who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      39.6 (2008)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Numerator: 

      Number of children aged 2 to 4 years who receive 1 dose of influenza vaccine during the most recent influenza season

      Denominator: 

      Children aged 2 to 4 years at the time of the interview. Only interviews conducted from March through August of the data year are included.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey:

        [NUMERATOR:]

        During the PAST 12 MONTHS, has (Sample child) had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.

      Methodology Notes: 

        This measure tracks the number of children aged 2 to 4 years who receive 1 dose influenza vaccine within the past influenza season.

        The Advisory Committee on Immunization Practices (ACIP) recommends two doses of influenza vaccine when needed for children 6 months to 8 years of age. However, the National Health Interview Survey (NHIS) does not ask about more than one dose for children less than 9 years of age, nor does it ask about prior season vaccinations (this would be required to determine if two doses were indicated for the current season).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.1 through 12.4 objectives were consolidated and revised to IID-12.11.
    • IID-12.3 Increase the percentage of children aged 5 to 12 years who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      25.8 (2008)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Numerator: 

      Number of children aged 5 to 12 years who receive 1 dose influenza vaccine during the most recent influenza season

      Denominator: 

      Children aged 5 to 12 years at the time of the interview. Only interviews conducted from March through August of the data year are included.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Methodology Notes: 

        This measure tracks the number of children aged 5 to 12 years who receive 1 dose influenza vaccine within last flu season.

        The Advisory Committee on Immunization Practices (ACIP) recommends two doses of influenza vaccine when needed for children 6 months to 8 years of age. However, the National Health Interview Survey (NHIS) does not ask about more than one dose for children less than 9 years of age, nor does it ask about prior season vaccinations (this would be required to determine if two doses were indicated for the current season).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.1 through 12.4 objectives were consolidated and revised to IID-12.11.
    • IID-12.4 Increase the percentage of children aged 13 to 17 years who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      9.8 (2008)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Numerator: 

      Number of persons aged 13 to 17 years reported to be vaccinated with influenza vaccine within the past flu season

      Denominator: 

      Number of persons aged 13 to 17 years at the time of the household interview

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Methodology Notes: 

        In 2007 the Advisory Committee for Immunization Practices (ACIP) recommended that all children ages 6-59 months and their close contacts receive the influenza vaccine. Annual influenza vaccination was also recommended for persons with certain risk factors, health care personnel, and other persons in close contact with persons in groups at high risk. In 2008, the ACIP expanded its recommendation to include annual influenza vaccination of children aged 5-18 years beginning in the 2008-09 influenza season.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.1 through 12.4 objectives were consolidated and revised to IID-12.11.
    • IID-12.5 Increase the percentage of noninstitutionalized adults aged 18 to 64 years who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      24.9 (2008)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Numerator: 

      Number of persons aged 18 to 64 years who report receiving an influenza vaccination during September through February of the survey year

      Denominator: 

      Number of persons aged 18 to 64 years. Only interviews conducted from March through August of the data year are included.

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey:

        [NUMERATOR:]

        During the PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season. During what month and year did you receive your most recent flu shot?

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.5 through 12.8 objectives were consolidated and revised to IID-12.12.
    • IID-12.6 Increase the percentage of noninstitutionalized high-risk adults aged 18 to 64 years who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      38.6 (2008)
      Target: 
      90.0
      Target-Setting Method: 
      Retention of Healthy People 2010 target
      Numerator: 

      Number of high-risk persons aged 18 to 64 years who report receiving an influenza vaccination during September through February

      Denominator: 

      Number of high-risk persons aged 18 to 64 years Only interviews conducted during March through August of the data are included

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey:

        [NUMERATOR:]

        During the PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season. During what month and year did you receive your most recent flu shot?

        [NUMERATOR AND DENOMINATOR:]

        Have you EVER been told by a doctor or other health professional that you had...

        • Coronary heart disease?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Angina, also called angina pectoris?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • A heart attack (also called myocardial infarction)?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Any kind of heart condition or heart disease (other than the ones I just asked about)?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • A stroke?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Emphysema?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Asthma?
        1. Yes
        2. No
        3. Refused
        4. Don’t know

        During the PAST 12 MONTHS, have you had an episode of asthma or asthma attack?

        1. Yes
        2. No
        3. Refused
        4. Don’t know

        Have you EVER been told by a doctor or other health professional that you had ...

        ... Cancer or a malignancy of any kind?

        1. Yes
        2. No
        3. Refused
        4. Don’t know

        [If yes:] What kind of cancer was it?

        1. Bladder
        2. Blood
        3. Bone
        4. Brain
        5. Breast
        6. Cervix
        7. Colon
        8. Esophagus
        9. Gallbladder
        10. Kidney
        11. Larynx – windpipe
        12. Leukemia
        13. Liver
        14. Lung
        15. Lymphoma
        16. Melanoma
        17. Mouth/tongue/lip
        18. Ovary
        19. Pancreas
        20. Prostate
        21. Rectum
        22. Skin (non-melanoma)
        23. Skin (Don’t know what kind)
        24. Soft Tissue (muscle or fat)
        25. Stomach
        26. Testes
        27. Throat – pharynx
        28. Thyroid
        29. Uterus
        30. Other
        31. More than 3 kinds

        (Other than during pregnancy,) Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

        1. Yes
        2. No
        3. Refused
        4. Don’t know

        During the PAST 12 MONTHS, have you been told by a doctor or other health professional that you had..

        • Chronic bronchitis?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Weak or failing kidneys? - Do not include kidney stones, bladder infections or incontinence.
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Any kind of liver condition?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      Methodology Notes: 

        High-risk adults are defined by the Advisory Committee on Immunization Practices (ACIP). A high-risk person is a respondent who answered "yes" to one or more of the conditions listed in the Numerator and Denominator questions. Skin cancer is the only listed condition not included in the definition of high risk (skin, non-melanoma and skin, don’t know what kind).

        Not all high-risk conditions for complications of influenza disease (e.g., immunocompromised) can be ascertained through the National Health Interview Survey (NHIS) and the sample size for some groups may be too small.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.5 through 12.8 objectives were consolidated and revised to IID-12.12.
    • IID-12.7 Increase the percentage of noninstitutionalized adults aged 65 years and older who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      66.6 (2008)
      Target: 
      90.0
      Target-Setting Method: 
      Retention of Healthy People 2010 target
      Numerator: 

      Number of persons aged 65 years and over who report receiving an influenza vaccination during September through February of the survey year

      Denominator: 

      Number of persons aged 65 years and over. Only interviews conducted from March through August of the data year are included.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey:

        [NUMERATOR:]

        During the PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.
        During what month and year did you receive your most recent flu shot?

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.5 through 12.8 objectives were consolidated and revised to IID-12.12.
    • IID-12.8 Increase the percentage of institutionalized adults aged 18 years and older in long-term or nursing homes who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Minimum Data Set
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      71.4 (2005–06)
      Target: 
      90.0
      Target-Setting Method: 
      Retention of Healthy People 2010 target
      Numerator: 

      Number of persons in long-term care facilities and nursing homes reported to have received an influenza vaccination during the influenza season

      Denominator: 

      Number of persons in nursing homes certified by the Centers for Medicare and Medicaid Services who had resident assessments conducted with a target date between October 1 and March 31

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data are from the population residing in long-term care facilities or nursing homes certified by the Centers for Medicare and Medicaid Services. These data represent a census of all residents of CMS-certified nursing homes during the influenza season of interest.

        Data include residents of CMS-certified nursing homes who had at least one assessment with a target date between October 1 and March 31. Residents have an average of 5 assessments per year. Percentage includes U.S. resident nursing home population (i.e., not adjusted for state or facility). Residents who lived in multiple states during a single year were included once in each state they lived in.

        Vaccination status is ascertained by the staff member completing the resident assessment instrument based on medical records when available, self-report by the resident, or report from a resident’s care taker. Residents were considered vaccinated based on a “yes” response to the question “Did the resident receive the influenza vaccine in this facility for this year's influenza season?” or, if not, if the reason stated for not receiving vaccination was because the vaccination was received outside of the facility. Residents were considered vaccinated if they were ever reported to be vaccinated for the current influenza season at any assessment conducted from October 1 through June 30 of each influenza season.

        Prior to the 2010-11 influenza season, Native Hawaiians and other Pacific Islanders are included in the Asian race/ethnicity estimates.

      Caveats and Limitations: 
      Approximately 2-5% of residents are excluded from the estimates each season due to missing information regarding influenza vaccination. Additionally, approximately 5% of residents each influenza season had inconsistent vaccination information wherein they were reported as having been vaccinated for the current influenza season on at least one assessment followed by at least one subsequent assessment in which they were reported as not having been vaccinated. In the estimates reported here, residents were considered to be vaccinated if the resident was reported to be vaccinated on any assessment conducted during the current influenza season.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.5 through 12.8 objectives were consolidated and revised to IID-12.12. In 2017, objective IID-12.8 was moved from archived to measurable, as the influenza vaccination of institutionalized adults was no longer being tracked by objective IID-12.12.

      References

      Additional resources about the objective

      1. Klein, R.J.; Proctor, S.E.; Boudreault, M.A.; Turczyn, K.M. Healthy People 2010 Criteria for Data Suppression. Statistical Notes No. 24. Hyattsville, MD: National Center for Health Statistics. 2002.
    • IID-12.9 Increase the percentage of health care personnel who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      45.5 (2008)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Numerator: 

      Number of health care personnel who potentially have contact with patients in the workplace (persons who report they currently volunteer or work in a hospital, medical clinic, doctor’s office, dentist’s office, nursing home or some other health care facility) who have received one or more doses of influenza vaccine during September through February

      Denominator: 

      Health care personnel who potentially have contact with patients in the workplace (persons who report they currently volunteer or work in a hospital, medical clinic, doctor’s office, dentist’s office, nursing home or some other health care facility) Only interviews conducted during March through August of the data year are included

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey:

        [NUMERATOR:]

        During the PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season. During what month and year did you receive your most recent flu shot?

        [NUMERATOR AND DENOMINATOR:]

        Do you currently volunteer or work in a hospital, medical clinic, doctor’s office, dentist’s office, nursing home or some other health-care facility? This includes part-time and unpaid work in a health care facility as well as professional nursing care provided in the home. This includes non-health care professionals, such as administrative staff, who work in a health-care facility.

      Methodology Notes: 

        Health care personnel are identified as persons reporting that they work in a health care facility.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objective IID-12.9 was revised to IID-12.13.
    • IID-12.10 Increase the percentage of pregnant women who are vaccinated against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      27.6 (2008)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Numerator: 

      Number of pregnant women aged 18 to 44 years who report being pregnant at time of interview, and received an influenza vaccination from September through February

      Denominator: 

      Number of pregnant women aged 18 to 44 years who report being pregnant at time of interview, and who were interviewed from December of the first data year through April of the second data year

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey:

        [NUMERATOR:]

        During the PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season. During what month and year did you receive your most recent flu shot?

        [NUMERATOR AND DENOMINATOR:]

        Are you currently pregnant?

      Methodology Notes: 

        The National Health Interview Survey (NHIS) asks about current pregnancy status, so this measure will exclude some women who were pregnant during the September through February vaccination period (e.g., pregnant in December, delivered in February, and interviewed in April), and include some women who were not pregnant during the vaccination period (e.g., became pregnant in February and interviewed in April). Pregnant women interviewed during the vaccination period may have received an influenza vaccination while pregnant after the date of their interview.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objective IID-12.10 was revised to IID-12.14.
    • IID-12.11 Increase the percentage of children aged 6 months through 17 years who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      46.9 (2010–11)
      Target: 
      70.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      This proposed change to the influenza vaccination coverage measures better reflects the universal vaccination recommendation as well as NCIRD’s work to meet our national targets and goals. We are proposing targets for the general population groups that are still ambitious (given current coverage) but are still achievable, given the time-limited influenza vaccination season, as well as the combined age categories and varying access to the specific populations rolled up into these new, more general, age categories.
      Numerator: 

      Number of persons aged 6 months through 17 years reported to be vaccinated with at least one dose of influenza vaccine within the past influenza season

      Denominator: 

      Number of persons aged 6 months through 17 years as of November 1 of the influenza season

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2010 National Health Interview Survey:

        [NUMERATOR:]

        DURING THE PAST 12 MONTHS, has [sample child] had a flu vaccination? This vaccine is usually given in the fall and protects against influenza for the flu season.

        1. Yes
        2. No

        During what month and year did [sample child] receive his or her most recent flu vaccine?

        1. January
        2. February
        3. March
        4. April
        5. May
        6. June
        7. July
        8. August
        9. September
        10. October
        11. November
        12. December

        Enter year of most recent flu vaccine.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        In the 2010-2011 season, the Advisory Committee for Immunization Practices (ACIP) recommended that all persons aged 6 months and over receive the influenza vaccine. To better assess influenza vaccination coverage (1 or more doses) for each season, we reported coverage restricted to individuals interviewed during September through June, and vaccinated during August through May, using the Kaplan-Meier survival analysis procedure. Vaccination month was imputed when the child was reported to have been vaccinated but was missing the month and/or year of vaccination.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-22h, which was intended to assess influenza vaccination of children aged 6 to 23 months. The objective was developmental during Healthy People 2010. It became measurable as of the Healthy People 2020 launch and was revised to include four Healthy People 2020 objectives: IID-12.1 (children aged 6 years to 23 months), IID-12.2 (children aged 2 to 4 years), IID-12.3 (children aged 5 to 12 years), and IID-12.4 (children aged 13 to 17 years).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.1 through 12.4 assessing seasonal influenza vaccine coverage among children were consolidated into objective IID-12.11. The age groups of the individual objectives were combined to cover children aged 6 months through 17 years. The data source was changed from the National Immunization Survey to the National Health Interview Survey. The annual time period was revised from calendar year to influenza season.

      References

      Additional resources about the objective

      1. CDC. Prevention and Control of Seasonal Influenza with Vaccines Recommendations of the Advisory Committee on Immunization Practices — United States, 2013–2014. MMWR 2013;62(No. RR-7):1-43.
      2. CDC. Flu Vaccination Coverage, United States, 2012-13 Influenza Season. 2013 Sept [cited 2013 Dec 20].
      3. CDC. Surveillance of influenza vaccination coverage – United States, 2007-08 through 2011-12 influenza seasons. MMWR Surveillance Summaries 2013;62(4):1-28. [cited 2013 Dec 20].
    • IID-12.12 Increase the percentage of noninstitutionalized adults aged 18 and older who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      38.1 (2010–11)
      Target: 
      70.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      This proposed change to the influenza vaccination coverage measures better reflects the universal vaccination recommendation as well as NCIRD’s work to meet our national targets and goals. We are proposing targets for the general population groups that are still ambitious (given current coverage) but are still achievable, given the time-limited influenza vaccination season, as well as the combined age categories and varying access to the specific populations rolled up into these new, more general, age categories.
      Numerator: 

      Number of persons aged 18 years and over reported to be vaccinated with influenza vaccine within the past influenza season

      Denominator: 

      Number of persons aged 18 years and over at the time of the household interview  

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2010 National Health Interview Survey:

        [NUMERATOR:]

        DURING THE PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.

        1. Yes
        2. No

        During what month and year did you receive your most recent flu shot?

        1. January
        2. February
        3. March
        4. April
        5. May
        6. June
        7. July
        8. August
        9. September
        10. October
        11. November
        12. December

        Enter year of most recent flu vaccine.

        DURING THE PAST 12 MONTHS, have you had a flu vaccine sprayed in your nose by a doctor or other health professional? A health professional may have let you spray it. This vaccine is usually given in the fall and protects against influenza for the flu season.

        1. Yes
        2. No

        During what month and year did you receive your most recent flu nasal spray?

        1. January
        2. February
        3. March
        4. April
        5. May
        6. June
        7. July
        8. August
        9. September
        10. October
        11. November
        12. December

        Enter year of most recent flu nasal spray.

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        In the 2010-11 season, the Advisory Committee for Immunization Practices (ACIP) recommended that all persons aged 6 months and over receive the influenza vaccine. To better assess influenza vaccination coverage for each season, we reported coverage restricted to individuals interviewed during September through June, and vaccinated during August through May, using the Kaplan-Meier survival analysis procedure. Vaccination month was imputed when the adult was reported to have been vaccinated but was missing the month and/or year of vaccination.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objectives 14-29a, 14-29c, and 14-29e, which tracked influenza vaccination coverage in noninstitutionalized persons aged 65 and over (14-29a), high risk noninstitutionalized persons aged 18 to 64 years (14-29c) and institutionalized persons (14-29e). These Healthy People 2010 objectives were revised to include Healthy People 2020 objectives which tracked influenza vaccination coverage among noninstitutionalized persons aged 18 to 64 years (IID-12.5), noninstitutionalized high-risk persons aged 18 to 64 years (IID-12.6), noninstitutionalized persons aged 65 years and over (IID-12.7).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objectives IID-12.5 through 12.8, assessing seasonal influenza vaccination coverage among adults were consolidated into objective IID-12.12. The age and risk groups of the individual objectives were combined to cover all persons aged 18 years and over. The annual time period was revised from calendar year to influenza season. In 2015, objective IID-12.12 began reporting influenza vaccine coverage estimates for adults in long-term or nursing homes for the 2013 data year. These estimates are from the Minimum Data Set (MDS), CMS. Data for all other population lines are from the National Health Interview Survey (NHIS), CDC/NCHS. In 2017, objective IID-12.12 was no longer tracking the influenza vaccination of institutionalized adults. Estimates from the Minimum Data Set (MDS), CMS were no longer used for this objective. Data for all population lines are from the National Health Interview Survey (NHIS), CDC/NCHS. The influenza vaccination of institutionalized adults is now tracked in IID-12.8.

      References

      Additional resources about the objective

      1. CDC. Flu Vaccination Coverage, United States, 2012-13 Influenza Season. 2013 Sept [cited 2013 Dec 20].
      2. CDC. Prevention and Control of Seasonal Influenza with Vaccines Recommendations of the Advisory Committee on Immunization Practices — United States, 2013–2014. MMWR 2013;62(No. RR-7):1-43.
      3. CDC. Surveillance of influenza vaccination coverage – United States, 2007-08 through 2011-12 influenza seasons. MMWR Surveillance Summaries 2013;62(4):1-28. [cited 2013 Dec 20].
    • IID-12.13 Increase the percentage of health care personnel who are vaccinated annually against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      55.8 (2010–11)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      This proposed change to the influenza vaccination coverage measures better reflects the universal vaccination recommendation as well as NCIRD’s work to meet our national targets and goals. We are proposing targets for the general population groups that are still ambitious (given current coverage) but are still achievable, given the time-limited influenza vaccination season, as well as the combined age categories and varying access to the specific populations rolled up into these new, more general, age categories.
      Numerator: 

      Number of healthcare personnel aged 18 years and over reporting they have had influenza vaccination in the past season

      Denominator: 

      Number of healthcare personnel aged 18 years and over at the time of the household interview  

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2010 National Health Interview Survey:

        [NUMERATOR:]

        DURING THE PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.

        1. Yes
        2. No

        During what month and year did you receive your most recent flu shot?

        1. January
        2. February
        3. March
        4. April
        5. May
        6. June
        7. July
        8. August
        9. September
        10. October
        11. November
        12. December

        Enter year of most recent flu vaccine.

        DURING THE PAST 12 MONTHS, have you had a flu vaccine sprayed in your nose by a doctor or other health professional? A health professional may have let you spray it. This vaccine is usually given in the fall and protects against influenza for the flu season.

        1. Yes
        2. No

        During what month and year did you receive your most recent flu nasal spray?

        1. January
        2. February
        3. March
        4. April
        5. May
        6. June
        7. July
        8. August
        9. September
        10. October
        11. November
        12. December

        Enter year of most recent flu nasal spray.

        [DENOMINATOR:]

        Do you currently volunteer or work in a hospital, medical clinic, doctor’s office, dentist’s office, nursing home or some other health-care facility? This includes part-time and unpaid work in a health care facility as well as professional nursing care provided in the home.

        1. Yes
        2. No
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The Advisory Committee for Immunization Practices (ACIP) recommends that all persons aged 6 months and over receive the influenza vaccine, with continued emphasis placed on vaccination of persons who live with or care for persons at higher risk for influenza-related complications, including health-care personnel. Annual influenza vaccination is recommended for all health-care personnel and persons in training for health-care professions. Personnel in health-care settings who should be vaccinated include physicians, nurses, and other workers in inpatient and outpatient-care settings, medical emergency-response workers (e.g., paramedics and emergency medical technicians), employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients.

        Based on the National Health Interview Survey (NHIS), health-care personnel are defined as persons aged 18 years and over who reported that they currently volunteer or work in a hospital, medical clinic, doctor’s office, dentist’s office, nursing home or some other health-care facility, including part-time and unpaid work in a health care facility as well as professional nursing care provided in the home.

        To better assess influenza vaccination coverage for each season, we reported coverage restricted to individuals interviewed during September through June, and vaccinated during August through May, using the Kaplan-Meier survival analysis procedure. Vaccination month was imputed when the adult was reported to have been vaccinated but was missing the month and/or year of vaccination.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-29g, which tracked the influenza vaccination coverage among health care workers aged 18 to 64 years. Objective 14-29g was adapted to Healthy People 2020 objective IID-12.9, which tracked influenza vaccination coverage among health care workers aged 18 years and over.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, objective IID-12.9 was revised to objective IID-12.13. The annual time period was revised from calendar year to influenza season.

      References

      Additional resources about the objective

      1. CDC. Flu Vaccination Coverage, United States, 2012-13 Influenza Season. 2013 Sept [cited 2013 Dec 20].
      2. CDC. Prevention and Control of Seasonal Influenza with Vaccines Recommendations of the Advisory Committee on Immunization Practices — United States, 2013–2014. MMWR 2013;62(No. RR-7):1-43.
      3. CDC. Surveillance of influenza vaccination coverage – United States, 2007-08 through 2011-12 influenza seasons. MMWR Surveillance Summaries 2013;62(4):1-28. [cited 2013 Dec 20].
    • IID-12.14 Increase the percentage of pregnant women who are vaccinated against seasonal influenza

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      40.4 (2012–13)
      Target: 
      80.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Target-Setting Method: Maintain consistency with national immunization programs, regulations, policies, and laws. Since 2004, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination for all women who are or will be pregnant during the influenza season, regardless of trimester, because pregnant women and their infants are at increased risk for complications and hospitalization from influenza (2). Influenza vaccination of pregnant women is safe and effective. The 80% target was chosen to be higher than the 70% target currently set for the general population of adults (IID-12.12), reflecting the higher risk for influenza-related complications among pregnant women and their infants, and lower than the 90% target currently set for health care personnel (IID-12.13), for which systems to reach higher coverage can more easily be implemented (e.g. workplace requirements).
      Numerator: 

      Number of women aged 18-49 years who reported being pregnant some time during August through March of the respective influenza season and reported to be vaccinated with influenza vaccine before or during pregnancy during July through March of the respective influenza season

      Denominator: 

      Number of women aged 18-49 years who reported being pregnant some time during August through March of the respective influenza season

      Questions Used to Obtain the National Baseline Data: 

        From the 2012 National Health Interview Survey:

        [NUMERATOR:]

        DURING THE PAST 12 MONTHS, have you had a flu shot? A flu shot is usually given in the fall and protects against influenza for the flu season.

        1. Yes
        2. No

        During what month and year did you receive your most recent flu shot?

        1. January
        2. February
        3. March
        4. April
        5. May
        6. June
        7. July
        8. August
        9. September
        10. October
        11. November
        12. December

        Enter year of most recent flu vaccine.

        DURING THE PAST 12 MONTHS, have you had a flu vaccine sprayed in your nose by a doctor or other health professional? A health professional may have let you spray it. This vaccine is usually given in the fall and protects against influenza for the flu season.

        1. Yes
        2. No

        During what month and year did you receive your most recent flu nasal spray?

        1. January
        2. February
        3. March
        4. April
        5. May
        6. June
        7. July
        8. August
        9. September
        10. October
        11. November
        12. December

        Enter year of most recent flu nasal spray.

        Did you get a flu shot before or during your current pregnancy?

        1. Before this pregnancy
        2. During this pregnancy

        Earlier you said you were pregnant sometime since August 1st/sometime between August and March. Did you get a flu shot before, during or after this pregnancy?

        1. Before this pregnancy
        2. During this pregnancy
        3. After this pregnancy

        [DENOMINATOR:]

        Are you currently pregnant?

        1. Yes
        2. No

        Were you pregnant any time since August 1st, [fill: LAST YEAR]?/Were you pregnant any time from August [fill: LAST YEAR] through March [fill: CURYEAR]?/Were you pregnant any time since August 1st, [fill: CURYEAR]?

        1. Yes
        2. No
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Questions used to determine pregnancy status during August through March of each influenza season were added to the NHIS in 2012. To assess influenza vaccination coverage for each season, reported coverage is restricted to women interviewed during August through July, and vaccinated during July through March, using the Kaplan-Meier survival analysis procedure. For women not pregnant at time of interview, follow-up time was estimated by assuming that the pregnancy ended at the mid-point between August 1 and the date of interview. Vaccination month was imputed when the woman was reported to have been vaccinated before or during pregnancy but was missing the month and/or year of vaccination. Weighted data are used to produce national vaccination coverage estimates. Point estimates and 95% confidence intervals (CIs) are calculated by using statistical software to account for the complex sample design.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, Objective IID-12.10 was revised to objective IID-12.14 and the objective reverted to developmental status. Potential data sources included the National Health Interview Survey (NHIS), CDC/NCHS; Behavioral Risk Factor Surveillance System (BRFSS), CDC/NCCDPHP; Pregnancy Risk Assessment Monitoring System (PRAMS), CDC/NCCDPHP; and Internet Panel Survey, CDC/NCIRD. In 2016, objective IID-12.14 reverted to measurable status with the NHIS as the data source.
  • IID-13 Increase the percentage of adults who are vaccinated against pneumococcal disease

    • IID-13.1 Increase the percentage of noninstitutionalized adults aged 65 years and older who are vaccinated against pneumococcal disease

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      60.0 (2008)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The target remains 90 percent. Rates have been relatively stagnant, but a variety of new adult vaccination initiatives are expected.
      Numerator: 

      Number of persons aged 65 years and over who report ever receiving a pneumococcal vaccination

      Denominator: 

      Number of persons aged 65 years and over

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey:

        [NUMERATOR:]

        Have you EVER had a pneumonia shot? This shot is usually given only once or twice in a person's lifetime and is different from the flu shot. It is also called the
        pneumococcal vaccine.

        1. Yes
        2. No
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Annual
    • IID-13.2 Increase the percentage of noninstitutionalized high-risk adults aged 18 to 64 years who are vaccinated against pneumococcal disease

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      16.6 (2008)
      Target: 
      60.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The target remains 60 percent. Rates have been relatively stagnant, and no new general initiatives are planned to reach high-risk adults. Additionally, pneumococcal conjugate vaccination of children has had significant indirect effects on disease in adults, supporting justification not to raise vaccination targets for adults at this time.
      Numerator: 

      Number of high-risk persons aged 18 to 64 years who report ever receiving a pneumococcal vaccination

      Denominator: 

      Number of high-risk persons aged 18 to 64 years

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey:

        [NUMERATOR:]

        Have you EVER had a pneumonia vaccination? This shot is usually given only once in a person's lifetime and is different from the flu shot.

        [NUMERATOR AND DENOMINATOR:]

        Have you EVER been told by a doctor or other health professional that you had...

        • Coronary heart disease?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Angina, also called angina pectoris?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • A heart attack (also called myocardial infarction)?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Any kind of heart condition or heart disease (other than the ones I just asked about)?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • A stroke?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Emphysema?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Asthma?
        1. Yes
        2. No
        3. Refused
        4. Don’t know

        During the PAST 12 MONTHS, have you had an episode of asthma or asthma attack?

        1. Yes
        2. No
        3. Refused
        4. Don’t know

        Have you EVER been told by a doctor or other health professional that you had ...

        ... Cancer or a malignancy of any kind?

        1. Yes
        2. No
        3. Refused
        4. Don’t know

        [If yes:] What kind of cancer was it?

        1. Bladder
        2. Blood
        3. Bone
        4. Brain
        5. Breast
        6. Cervix
        7. Colon
        8. Esophagus
        9. Gallbladder
        10. Kidney
        11. Larynx – windpipe
        12. Leukemia
        13. Liver
        14. Lung
        15. Lymphoma
        16. Melanoma
        17. Mouth/tongue/lip
        18. Ovary
        19. Pancreas
        20. Prostate
        21. Rectum
        22. Skin (non-melanoma)
        23. Skin (Don’t know what kind)
        24. Soft Tissue (muscle or fat)
        25. Stomach
        26. Testes
        27. Throat – pharynx
        28. Thyroid
        29. Uterus
        30. Other
        31. More than 3 kinds

        (Other than during pregnancy,) Have you EVER been told by a doctor or health professional that you have diabetes or sugar diabetes?

        1. Yes
        2. No
        3. Refused
        4. Don’t know

        During the PAST 12 MONTHS, have you been told by a doctor or other health professional that you had..

        • Chronic bronchitis?
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Weak or failing kidneys? - Do not include kidney stones, bladder infections or incontinence.
        1. Yes
        2. No
        3. Refused
        4. Don’t know
      • Any kind of liver condition?
        1. Yes
        2. No
        3. Refused
        4. Don’t know

        Have you smoked at least 100 cigarettes in your ENTIRE LIFE?

        • Yes
        • No
        • Refused
        • Don't know

        [IF YES:] Do you NOW smoke cigarettes every day, some days or not at all?

        • Every day
        • Some days
        • Not at all
        • Refused
        • Don't know
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        High-risk adults are defined by the Advisory Committee on Immunization Practices (ACIP). A high-risk person is a respondent who answered "yes" to one or more of the conditions listed in the Numerator and Denominator questions. Skin cancer is the only listed condition not included in the definition of high risk (skin, non-melanoma and skin, don’t know what kind).

        Not all high-risk conditions for complications of influenza disease (e.g., immunocompromised) can be ascertained through the National Health Interview Survey (NHIS) and the sample size for some groups may be too small.

    • IID-13.3 Increase the percentage of institutionalized adults (persons aged 18 years and older in long-term or nursing homes) who are vaccinated against pneumococcal disease

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Minimum Data Set
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      70.8 (2015)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The target remains 90.0 percent. Several ongoing State initiatives are expected to improve vaccination of residents in long-term care facilities.
      Numerator: 

      Number of persons in long-term care facilities and nursing homes certified by the Centers for Medicare and Medicaid Services (CMS) reported to have up to date pneumococcal vaccination

      Denominator: 

      Number of persons in long-term care facilities and nursing homes certified by the Centers for Medicare and Medicaid Services (CMS).

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data include residents of CMS-certified nursing homes who had at least one assessment from January 1 through December 31 of the respective year. Residents have an average of 5 assessments per year. Percentage includes US resident nursing home population (i.e., not adjusted for state or facility). Residents who lived in multiple states during a single year were included once in each state they lived in.

        Vaccination status is ascertained by the staff member completing the resident assessment instrument based on medical records when available, self-report by the resident, or report from a resident’s care taker. Prior to 2015, residents were considered vaccinated if they were ever reported to be up-to-date with pneumococcal vaccination at any assessment. Beginning with the 2015 estimates, residents were considered vaccinated if they were ever reported to be up-to-date with pneumococcal vaccination at any assessment conducted during the calendar year of interest.

        Prior to 2010, Native Hawaiians and other Pacific Islanders are included in the Asian race/ethnicity estimates.

      Caveats and Limitations: 
      These data do not allow us to tell if a resident lived in multiple states. Thus, a resident will be included not more than once in a state, but may be included in more than one state. Past data show that only about 2-4 percent of residents lived in more than one state during the target period. Approximately 3-5% of residents are excluded from the estimates each year due to missing information regarding pneumococcal vaccination. Additionally, approximately 20% of residents in each assessment year have inconsistent vaccination information wherein they were reported as up-to-date for pneumococcal vaccination on at least one assessment followed by at least one subsequent assessment in which they were reported as not up-to-date. Prior to 2014, most adults only needed one dose of pneumococcal vaccine to be considered up-to-date. In the estimates reported here, residents were considered to be vaccinated if the resident’s pneumococcal vaccination was ever reported to be up-to-date in any assessment.
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2020 objective 14-29f in that the data source was revised from the "National Nursing Home Survey (NNHS), CDC/NCHS" to the "Minimum Data Set, CMS."

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, the baseline estimate and year were revised from 66.4 percent (2005-06) to 67.4 percent (2006) to correct an error in data year. The target and target setting method were not revised. In 2017, the baseline estimate and year were revised from 67.4 percent in 2006 to 70.8 percent in 2015 due to a change in methodology. The target and target setting method were not revised.
  • IID-14 Increase the percentage of adults who are vaccinated against zoster (shingles)

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health Interview Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    6.7 (2008)
    Target: 
    30.0
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    In 2006, the Advisory Committee on Immunization Practices in 2006 recommended zoster (shingles) vaccine for adults aged 60 years and older. Coverage estimates are only available for 2 years (2 percent in 2007, 7 percent in 2008). The use of different survey methods for these estimates creates difficulty in projecting a target based on past coverage data.
    Numerator: 

    Number of persons aged 60 years and over who report having ever received zoster vaccine (shingles vaccine)

    Denominator: 

    Number of persons aged 60 years and over

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2008 National Health Interview Survey:

      [NUMERATOR:]

      Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is generally on one side of the body or face. Shingles is caused by the chicken pox virus. A vaccine for shingles has been available since May 2006. Have you ever had the Zoster (ZOSS-ter) or Shingles vaccine, also called Zostavax®?

      1. Yes
      2. No
      3. Refused
      4. Don't know
    Data Collection Frequency: 
    Annual
  • IID-15 (Developmental) Increase hepatitis B vaccine coverage among high-risk populations

    • IID-15.1 (Developmental) Increase hepatitis B vaccine coverage among long-term hemodialysis patients

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      *** Missing ***
      Numerator: 

      *** Missing ***

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
    • IID-15.2 (Developmental) Increase hepatitis B vaccine coverage among men who have sex with men

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      *** Missing ***
      Numerator: 

      Number of reported (in the past 12 months) symptomatic hepatitis B cases among males that indicated homosexual or bisexual preference who report ever receiving hepatitis B vaccine

      Denominator: 

      Number of men who report homosexual or bisexual preference

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults. MMWR December 8, 2006;55(No. RR-16): 1-33.
      2. Gallagher K, Sullivan P, Lansky A, Onorato I. Behavioral Surveillance Among People at Risk for HIV Infection in the U.S.: The National HIV Behavioral Surveillance System. Public Health Reports Volume 122/ Supplement (1): 32-38.
    • IID-15.3 Increase hepatitis B vaccine coverage among health care personnel

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Health Interview Survey
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      64.3 (2008)
      Target: 
      90.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      Target is consistent with that for influenza vaccination of health care personnel. OSHA requirements exist for employers to offer the hepatitis B vaccine series free to all employees who are exposed to blood or other potentially infectious materials as part of their job duties.
      Numerator: 

      Number of health care workers reporting they have had at least three doses of hepatitis B vaccine

      Denominator: 

      Number of employed health care workers

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Health Interview Survey:

        [NUMERATOR:]

        Have you EVER received the hepatitis B vaccine?

        1. Yes
        2. No
        3. Refused
        4. Don't know

        [IF YES:]

        Did you receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?

        1. Received at least 3 doses
        2. Received less than 3 doses
        3. Refused
        4. Don't know
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Data are the proportion of health care personnel who potentially have contact with patients in the workplace (persons who report they currently volunteer or work in a hospital, medical clinic, doctor’s office, dentist’s office, nursing home or some other health care facility) who have received three or more doses of the hepatitis B vaccine.

      References

      Additional resources about the objective

      1. Agerton, T.B.; Mahoney, F.J.; Polish, L.B.; et al. Impact of the bloodborne pathogens standard on vaccination of healthcare workers with hepatitis B vaccine. Infection Control and Hospital Epidemiology 16: 287-291, 1995.
      2. Mahoney, F.J.; Stewart, K.; Hu, H.; et al. Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States. Archives of Internal Medicine 157: 2601-2605, 1997.
    • IID-15.4 (Developmental) Increase hepatitis B vaccine coverage among injection drug users

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      *** Missing ***
      Numerator: 

      Number of reported symptomatic hepatitis B cases (in the last 12 months) among males that indicated homosexual or bisexual preference who report injecting drugs (in the last 12 months?) who ever received hepatitis B vaccine

      Denominator: 

      Number of men who report homosexual or bisexual preference who report injecting drugs (in the last 12 months?)

      Comparable Healthy People 2010 Objective: 
      Not applicable

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention. A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States
      2. Gallagher K, Sullivan P, Lansky A, Onorato I. Behavioral Surveillance Among People at Risk for HIV Infection in the U.S.: The National HIV Behavioral Surveillance System. Public Health Reports Volume 122/ Supplement (1): 32-38.
      3. Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults. MMWR December 8, 2006;55(No. RR-16): 1-33.
  • IID-16 (Developmental) Increase the scientific knowledge on vaccine safety and adverse events

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    *** Missing ***
    Numerator: 

    *** Missing ***

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, this objective was archived.
  • IID-17 Increase the percentage of providers who have had vaccination coverage levels among children in their practice population measured within the past year

    • IID-17.1 Increase the percentage of public health providers who have had vaccination coverage levels among children in their practice population measured within the past year

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Program Annual Progress Assessments
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      40.0 (2009)
      Target: 
      50.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      These targets are consistent with program policies and goals. Assessment and feedback is a critical method for increasing immunization rates, and current baseline levels are inadequate. Historically, programmatic goals placed greater emphasis on increasing private provider assessment than public provider assessment because more vaccines are given in the private sector. Despite this focus, private provider assessment rates have remained lower than public provider assessment rates. Setting the same target for public and private providers will encourage better overall participation in provider assessment and feedback.
      Numerator: 

      Number of public provider sites that routinely provided immunizations in the past year to children aged 6 years and under and participated in a provider assessment at least once in the past year

      Denominator: 

      Number of public provider sites that routinely provided immunizations in the past year to children aged 6 years and under

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data are the percent of Vaccines for Children (VFC) enrolled providers that had assessments of their immunization coverage rates as part of the Assessment, Feedback, Incentives, and eXchange (AFIX) process.

        A provider site is a service delivery location that maintains permanent records, excluding temporary locations or mobile immunization clinics or fairs and the like. Well-child clinics and immunization-only clinics in the same location were counted as separate sites only if they maintain separate sets of records.

        Public providers include health department clinics, community/migrant health centers, Indian Health Service/Tribal health clinics, or other public providers (e.g., any other public clinic that provides immunizations, such as a county medical center outpatient clinic).

        Private providers are individual or group primary care or pediatric practices and may include providers for which some or all of their clients are members of different managed care plans or managed care organizations. A public provider assessment is an assessment that includes a review of a random sample (or 100 percent) of immunization records. The assessment may have been conducted by project, clinic, or contractual personnel. A private provider assessment is an assessment that includes a review of immunization records either through a manual sample or through the use of an immunization registry. The assessment may have been conducted either by immunization project staff, through a contractual agreement that provides this service, or by the provider itself, in cooperation with the immunization project staff.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the data source changed from Annual Immunization Assessment Reports, CDC, National Center for Immunization and Respiratory Diseases (NCIRD) to Program Annual Progress Assessments, CDC, NCIRD. Program Annual Progress Assessments is a more accurate data source for this objective. The Annual Immunization Assessment Reports (former data source) is only one part of the Program Annual Progress Assessments. The former data source cannot be found using search engines; the updated data source is more user-friendly for all Healthy People 2020 stakeholders and the public audience.
    • IID-17.2 Increase the percentage of private providers who have had vaccination coverage levels among children in their practice population measured within the past year

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Program Annual Progress Assessments
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      33.0 (2009)
      Target: 
      50.0
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      These targets are consistent with program policies and goals. Assessment and feedback is a critical method for increasing immunization rates, and current baseline levels are inadequate. Historically, programmatic goals placed greater emphasis on increasing private provider assessment than public provider assessment because more vaccines are given in the private sector. Despite this focus, private provider assessment rates have remained lower than public provider assessment rates. Setting the same target for public and private providers will encourage better overall participation in provider assessment and feedback.
      Numerator: 

      Number of private provider sites that routinely provided immunizations in the past year to children aged 6 years and under and participated in a provider assessment at least once in the past year

      Denominator: 

      Number of private provider sites that routinely provided immunizations in the past year to children aged 6 years and under

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data are the percent of Vaccines for Children (VFC) enrolled providers that had assessments of their immunization coverage rates as part of the Assessment, Feedback, Incentives, and eXchange (AFIX) process.

        A provider site is a service delivery location that maintains permanent records, excluding temporary locations or mobile immunization clinics or fairs and the like. Well-child clinics and immunization-only clinics in the same location were counted as separate sites only if they maintain separate sets of records.

        Public providers include health department clinics, community/migrant health centers, Indian Health Service/Tribal health clinics, or other public providers (e.g., any other public clinic that provides immunizations, such as a county medical center outpatient clinic).

        Private providers are individual or group primary care or pediatric practices and may include providers for which some or all of their clients are members of different managed care plans or managed care organizations. A public provider assessment is an assessment that includes a review of a random sample (or 100 percent) of immunization records. The assessment may have been conducted by project, clinic, or contractual personnel. A private provider assessment is an assessment that includes a review of immunization records either through a manual sample or through the use of an immunization registry. The assessment may have been conducted either by immunization project staff, through a contractual agreement that provides this service, or by the provider itself, in cooperation with the immunization project staff.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the data source changed from Annual Immunization Assessment Reports, CDC, National Center for Immunization and Respiratory Diseases (NCIRD) to Program Annual Progress Assessments, CDC, NCIRD. Program Annual Progress Assessments is a more accurate data source for this objective. The Annual Immunization Assessment Reports (former data source) is only one part of the Program Annual Progress Assessments. The former data source cannot be found using search engines; the updated data source is more user-friendly for all Healthy People 2020 stakeholders and the public audience.
  • IID-18 Increase the percentage of children under age 6 years of age whose immunization records are in a fully operational, population-based immunization information system (IIS)

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Immunization Information Systems Annual Report
    Population Estimates
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    75.0 (2008)
    Target: 
    95.0
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    Trend data from the past 5 years show an increase of 4 to 5 percent per year. The 2009 participation is projected to be at 80 percent. With interoperability between immunization information systems (registries) and an increase in electronic health records, 95 percent is achievable.
    Numerator: 

    Number of children under 6 years of age with two or more immunizations recorded in the immunization information system

    Denominator: 

    Number of children under 6 years of age

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      55 of 56 CDC immunization information systems awardees (50 states excluding NH, the District of Columbia, and other reporting areas) track immunizations administered to children. "Other reporting areas" are defined as the following five cities: Houston, San Antonio, Chicago, Philadelphia, and New York City. These 5 cities operate separately from their state programs. Data from these cities are not included in the state data.

      The metric includes any vaccine administered to a child before their 6th birthday excluding pandemic influenza vaccination (e.g. influenza A (H1N1)pdm09 vaccination) and travel vaccinations.

      FOR SINGLE DATA YEARS: Percents are calculated based on the resident population of the CDC immunization information systems awardees (50 states, the District of Columbia, and other reporting areas) for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Because the city limits of some reporting areas do not correspond to Census county-level estimates, the American Community Survey population estimates are used in calculations for these reporting areas.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised.
  • IID-19 Increase the number of States collecting kindergarten vaccination coverage data according to CDC minimum standards

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Annual School Assessment Reports
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    number
    Baseline (Year): 
    11 (2009–10)
    Target: 
    51
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    This target will monitor compliance with school requirements and ensure optimal vaccine preventable disease risk outbreak management. An initiative has been launched to standardize kindergarten coverage assessment methods, which involves development of best practices, validation of assessment methods, provision of technical assistance, and close monitoring of State activities.
    Numerator: 

    Number of states (including the District of Columbia) who collect kindergarten vaccination coverage data according to CDC minimum standards

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      This measure is designed to encourage states to follow standard procedures and methodology that will result in quality data.

      States are asked to use comparable methods to allow comparison and to ensure that the information collected is accurate. States meeting the criteria for this objective must employ a methodology that meets the following standards: (1) all age-appropriate ACIP recommendations must be followed, including 2 doses of varicella, (2) appropriate sampling methodology must be used, (3) data collected must be validated, (4) data collection should only be done by trained personnel, (5) data on vaccination history should come from a provider, and (6) data should be collected collected by the appropriate date (December 31 of each year).

    Caveats and Limitations: 
    Sampling methodology varies by state for kindergarten vaccination status, which is a major limitation (e.g., some states selected a random sample of kindergarten children and others conducted a census of all kindergarten children). Measurement of this objective may be affected by improvements in the school assessment report questionnaire used to collect this data from states, which have led to a clearer understanding of methodology questions among the states and a more accurate and more complete understanding at CDC of methods states use to collect school vaccination assessment data.
    Trend Issues: 
    The IID-19 component that requires data to be collected by December 31 was not considered in 2009-10 nor in 2011-12, but was considered for 2013-14.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, the original baseline and baseline year were revised from 13 (2009) to 11 (2009-10) because reliable data were not available before the 2009-10 school year. The target was not revised.
  • IID-20 Increase the number of States, the District of Columbia, and other reporting areas that have 80 percent of adolescents with 2 or more age-appropriate immunizations recorded in an immunization information system (IIS) among adolescents aged 11 to 18 years

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Immunization Information Systems Annual Report
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    number
    Baseline (Year): 
    11 (2012)
    Target: 
    40
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    Approximately 88 percent of grantee immunization information systems collect immunization-related data from birth to death. Vaccines recommended for adolescents (e.g., Tdap, MCV, and HPV) are captured in immunization information systems. Because these are lifespan systems and because of increasing interoperability between electronic health records and immunization information systems, this target is achievable.
    Numerator: 

    Number of states, the District of Columbia, and other reporting areas that have 80 percent of persons aged 11 to 18 years with 2 or more age-appropriate immunizations recorded in their immunization information system

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      54 of 56 CDC immunization information systems awardees (50 states excluding CT and NH, the District of Columbia, and other reporting areas) track immunizations administered to children and adolescents. "Other reporting areas" are defined as the following five cities: Houston, San Antonio, Chicago, Philadelphia, and New York City. These 5 cities operate separately from their state programs. Data from these cities are not included in the state data.

      The following vaccines are included as age-appropriate immunizations for adolescents in this metric: Tdap/Td, HPV, meningococcal, seasonal influenza, pneumococcal, Hepatitis A, Hepatitis B, polio, MMR, and varicella.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, the original baseline and baseline year were revised from 14 (2009) to 11 (2012) because some reporting areas were using the old reporting definition (2+ immunizations administered at any age) rather than the new reporting definition (2+ immunizations age-appropriate immunizations). The target was not revised.
  • IID-21 Increase the number of States that use electronic data from rabies animal surveillance to inform public health prevention programs

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Rabies Surveillance Network
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    number
    Baseline (Year): 
    8 (2010)
    Target: 
    52
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    RabID data are being transmitted by the Public Health Laboratory Information System (PHLIS) in 8 States (Georgia, Maryland, Massachusetts, Michigan, North Dakota, Vermont, Virginia, and West Virginia), with a target of all 50 States by 2020. Two to five additional States per year are expected to send enhanced information, depending on the implementation of electronic messaging systems. Projection/trend analysis was the target-setting methodology. [DHHS17]
    Numerator: 

    Number of state public health laboratories (total 52 including the District of Columbia, Puerto Rico, and New York City, and excluding Hawaii) sending weekly data uploads to the RabID system

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      RabID is enhanced surveillance via a new comprehensive GIS-based real-time system that provides essential information on rabies occurrence for states and partnering organizations needed for timely prevention and control. RabID has integrated data sharing among local, state, and federal agencies for strategic responses to outbreaks.

      Data are collected routinely through the Public Health Laboratory Information System (PHLIS) or at the end of year when data is sent directly from states that have not implemented electronic messaging.

  • IID-22 Increase the number of public health laboratories monitoring influenza virus resistance to antiviral agents

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    State Public Health Laboratories Performing Antiviral Resistance Testing
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    number
    Baseline (Year): 
    3 (2009)
    Target: 
    25
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    As of July 2009, only three public health state laboratories (California, New York, and Wisconsin) monitor susceptibility to adamantanes (amantadine and rimantadine). More than 90 public health laboratories exist in the United States. Some States have multiple public health laboratories. Some large cities and counties have public health laboratories. In addition, the public health system is centralizing laboratories regionally across the United States. Reporting requirements vary State by State, and CDC can only request (not require) reporting. Increasing the number of public health laboratories that monitor antiviral resistance will require partnership, laboratory materials, and a regular reporting system. Increasing the number of public health laboratories to 25 by 2020 is achievable.
    Numerator: 

    Number of state public health laboratories that have submitted reports to CDC listing virus susceptibility to either class of antiviral drug (adamantanes or neuraminidase inhibitors)

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Antivirals are the only prescribed medication available to treat a patient once they have contracted influenza. Monitoring for viruses resistant to antivirals is key to inform prescription and other non-pharmaceutical and pharmaceutical intervention guidance. In 2009, CDC was the only public health laboratory conducting a comprehensive monitoring of influenza A and B virus susceptibilities to four licensed anti-influenza drugs in the United States.

  • IID-23 Reduce hepatitis A

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Bridged-race Population Estimates
    National Notifiable Diseases Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    per 100,000
    Baseline (Year): 
    1.0 (2007)
    Target: 
    0.3
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    The HP2020 hepatitis A virus incidence target reflects anticipated large reductions based on 1) the extent of decline in recent years, 2) data indicating that relatively low level of vaccination coverage can result in large declines in disease among the nonvaccinated population resulting in a herd immunity effect, and 3) adoption of universal vaccination of all children in 2006. [DHHS18]
    Numerator: 

    Number of new symptomatic hepatitis A cases reported in the past 12 months

    Denominator: 

    Total population in reporting states

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Data are rates per 100,000 population based on the number of symptomatic cases of hepatitis A reported to NNDSS. A case definition for new symptomatic cases of hepatitis A is available from CDC.

      To obtain state-specific measures for this measure, local Viral Hepatitis Surveillance Program data are used to determine the number of symptomatic hepatitis A cases occurring in the state in the past 12 months.

      FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

    References

    Additional resources about the objective

    1. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55 (No. RR-7).
    2. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
    3. Daniels D, Grytdal S, Wasley A. Surveillance for acute viral hepatitis - United States, 2007. MMWR Surveillance Summary. May 22 2009;58(3):1-27.
  • IID-24 Reduce chronic hepatitis B virus infections in infants and young children (perinatal infections)

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Vital Statistics System-Natality
    Perinatal Hepatitis B Prevention Program
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    number
    Baseline (Year): 
    799 (2007)
    Target: 
    400
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    Since HP2010 was launched, a 50 percent reduction has occurred in the estimated number of hepatitis B cases from perinatal transmission (baseline 1995). Yet, the United States remains far from reaching the 2010 target of 400 cases. A new programmatic emphasis has been placed on increasing universal hepatitis B vaccine birth dose coverage as a safety net to prevent perinatal transmission of hepatitis B virus to infants whose chronically infected mother is not identified by recommended screening programs. Because the annual number of immigrant women from hepatitis B endemic areas is expected to increased, maintaining the HP2010 target is proposed.
    Numerator: 

    Number of estimated chronic hepatitis B virus (HBV) infections occurring among infants and children aged 1-24 months of HBV-infected mothers

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      The estimated number of births to HBV-infected mothers is derived by applying race- and ethnicity- specific estimates of the prevalence of hepatitis B surface antigen to NVSS-N annual natality data.

      Using data collected by the Perinatal Hepatitis B Prevention Program and NVSS-N, this measure is based on the following estimation procedure:

      Multiply the total births per year to HBsAg- positive women by the proportion of pregnant women screened for HBsAg and then by the proportion of infants born to identified HBsAg- positive women who receive the vaccine (this estimates the number of infants who were born to identified HBsAg-positive women and received at least one dose of vaccine). Multiply the total number of infants who were born to HBsAg-positive women and received at least one dose of vaccine by the proportion of vaccinated infants who will remain susceptible, and add to the number of infants born to HBsAg-positive women who are not vaccinated (this estimates the number of infants born to HBsAg-positive women who remain susceptible). Finally, multiply number of infants born to HBsAg- positive women remaining susceptible by the proportion of susceptible infants who will become infected and then by the proportion of infected infants who will remain chronically infected with HBV.

    References

    Additional resources about the objective

    1. CDC. Hepatitis Surveillance Report (56). 1995.
    2. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly Report 46 (RR-10), 1997. (See reference for updated case definitions.)
    3. Margolis, H.S.; Alter, M.J.; Hadler, S.C. Hepatitis B: Evolving epidemiology and implications for control. Seminars in Liver Disease 11(2): 84-92, 1991.
  • IID-25 Reduce hepatitis B

    • IID-25.1 Reduce new hepatitis B infections in adults aged 19 and older

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Bridged-race Population Estimates
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      2.0 (2007)
      Target: 
      1.5
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The target reflects anticipated large reductions based on 1) the high vaccination coverage among adolescents who will age into this cohort in the coming decade, 2) the long-term effectiveness of hepatitis B vaccination, and 3) national policies to increase vaccination coverage among adults at risk for hepatitis B.
      Numerator: 

      Number of symptomatic hepatitis B cases reported in the past 12 months among persons aged 19 years and over

      Denominator: 

      Total population of persons aged 19 years and over in reporting states

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data are rates per 100,000 population based on the number of symptomatic cases of acute hepatitis B reported to NNDSS. A case definition for new symptomatic cases of hepatitis B is available from CDC.

        FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objectives 14-03a, 14-03b, and 14-03c, which tracked the rate of new hepatitis B infections in adults 19 to 24 years (14-03a), 25 to 39 years (14-03b) and 40 years and over (14-03c).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

      References

      Additional resources about the objective

      1. CDC. Vaccination coverage among adolescents 13—17 years--- United States, 2007. MMWR 2008;57(40); 1100-1103
      2. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
      3. Daniels D, Grytdal S, Wasley A. Surveillance for acute viral hepatitis - United States, 2007. MMWR Surveillance Summary. May 22 2009;58(3):1-27.
    • IID-25.2 Reduce new hepatitis B infections among high-risk populations—Injection drug users

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      285 (2007)
      Target: 
      215
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Numerator: 

      Number of reported symptomatic hepatitis B cases among those who used needles for injection of street drugs

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the CDC Viral Hepatitis Case Record for Reporting of Patients With Symptomatic Acute Viral Hepatitis, Form 53.1:

        [NUMERATOR:]

        During the 6 weeks - 6 months prior to illness, did the patient use needles for injection of street drugs?

        1. Yes
        2. No
        3. Unknown

        [IF YES:]

        Reporting physician's diagnosis:

        1. Hepatitis A
        2. Hepatitis B
        3. Non-A, Non-B Hepatitis
        4. Hepatitis D (Delta)
        5. Hepatitis Unspecified
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data are the number of symptomatic cases of acute hepatitis B reported to NNDSS for which the case report included information regarding injection drug use. A case was defined as a new hepatitis B infection among the injection drug user population if the patient used needles for injection of street drugs and received a physician diagnosis of symptomatic acute viral hepatitis B. A case definition for new symptomatic cases of hepatitis B is available from CDC.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-03d in that the numerator was revised from an estimated count to a direct count.

      References

      Additional resources about the objective

      1. CDC. Vaccination coverage among adolescents 13—17 years--- United States, 2007. MMWR 2008;57(40); 1100-1103
      2. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
      3. Centers for Disease Control and Prevention (CDC). Viral Hepatitis Case Record for Reporting of Patients with Symptomatic Acute Viral Hepatitis, Form 53.1.
      4. Daniels D, Grytdal S, Wasley A. Surveillance for acute viral hepatitis - United States, 2007. MMWR Surveillance Summary. May 22 2009;58(3):1-27.
    • IID-25.3 Reduce new hepatitis B infections among high-risk populations—Men who have sex with men

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Notifiable Diseases Surveillance System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      62 (2007)
      Target: 
      45
      Target-Setting Method: 
      Maintain consistency with national programs, regulations, policies, and laws.
      Target-Setting Method Justification: 
      The target reflects anticipated large reductions based on 1) the high vaccination coverage among adolescents who will age into this cohort in the coming decade; 2) the long-term effectiveness of hepatitis B vaccination, and 3) national policies to increase vaccination coverage among adults at risk for hepatitis B.
      Numerator: 

      Number of reported (in the past 12 months) symptomatic hepatitis B cases among males who indicated homosexual or bisexual preference

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the CDC Viral Hepatitis Case Record for Reporting of Patients With Symptomatic Acute Viral Hepatitis, Form 53.1:

        [COUNT:]

        Sex:

        • Male
        • Female
        • Unknown

        During the 6 weeks - 6 months prior to illness, what was the patient's sexual preference?

        • Heterosexual
        • Homosexual
        • Bisexual
        • Unknown

        Reporting physician's diagnosis:

        • Hepatitis A
        • Hepatitis B
        • Non-A, Non-B Hepatitis
        • Hepatitis D (Delta)
        • Hepatitis Unspecified
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data are the number of symptomatic cases of acute hepatitis B reported to NNDSS for which the case report included sufficient information to determine sexual preference. A case was defined as a new hepatitis B infection among the men who have sex with men population if the patient was male, his sexual preference was homosexual or bisexual during the 6 weeks - 6 months prior to illness, and he received a physician diagnosis of symptomatic acute viral hepatitis B. A case definition for new symptomatic cases of hepatitis B is available from CDC.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 14-03f in that the numerator was revised from an estimated count to a direct count.

      References

      Additional resources about the objective

      1. CDC. Vaccination coverage among adolescents 13—17 years--- United States, 2007. MMWR 2008;57(40); 1100-1103
      2. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
      3. Daniels D, Grytdal S, Wasley A. Surveillance for acute viral hepatitis - United States, 2007. MMWR Surveillance Summary. May 22 2009;58(3):1-27.
  • IID-26 Reduce new hepatitis C infections

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Bridged-race Population Estimates
    National Notifiable Diseases Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    per 100,000
    Baseline (Year): 
    0.28 (2007)
    Target: 
    0.25
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    The target reflects program efforts to reduce new infections at a rate of 0.1 rather than 0.03 per 100,000. The program anticipates releasing new hepatitis recommendations that would increase the practice of screening persons at risk in settings in which they receive healthcare.
    Numerator: 

    Number of new symptomatic hepatitis C cases reported in the past 12 months

    Denominator: 

    Total population in reporting states

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Data are rates per 100,000 population based on the number of symptomatic cases of acute hepatitis C reported to NNDSS. A case definition for new symptomatic cases of hepatitis C is available from CDC.

      FOR SINGLE DATA YEARS: Case rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Postcensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 14-09 in that the numerator was revised from an estimated count to a direct count.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

    References

    Additional resources about the objective

    1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance.
    2. Daniels D, Grytdal S, Wasley A. Surveillance for acute viral hepatitis - United States, 2007. MMWR Surveillance Summary. May 22 2009;58(3):1-27.
  • IID-27 Increase the proportion of persons aware they have a hepatitis C infection

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    53.0 (2003–08)
    Target: 
    60.0
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    An 11 percent increase in the percentage of persons aware they have a chronic hepatitis C virus infection is projected. Although the number of new cases of hepatitis C has declined, a substantial burden of disease persists as a result of chronic hepatitis C infections. Approximately 3.2 million persons in the United States are infected with HCV. The peak prevalence occurred among person aged 40 to 49 years, the majority of whom likely became infected in the 1970s and 1980s when incidence was highest. The epidemiologic profile of chronic viral hepatitis C has implications for the demand for screening and treatment over the next decade. Screening is an essential component to chronic hepatitis C care because nearly half of persons with a chronic form of hepatitis C are unaware of their infection. A slightly more ambitious target is set to recognize the increased benefits of screening as highly effective HCV therapies are licensed in the next decade.
    Numerator: 

    Number of persons who tested positive for hepatitis C and who indicated they were aware they had hepatitis C prior to the NHANES laboratory testing

    Denominator: 

    Number of persons who tested positive for hepatitis C

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2003-04 National Health and Nutrition Examination Survey:

      [NUMERATOR:]

      Was the test result in our letter [report of findings (ROF) letter informing participants of their positive hepatitis C test result] the first time you were told (you had/SP has) hepatitis C?

      1. Yes
      2. No
      3. Refused
      4. Don't know
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Due to the small sample size, pooling data over multiple years is necessary to produce stable estimates.

    Caveats and Limitations: 
    Reported percentage is merely the percent of respondents to the NHANES Hepatitis C Follow-Up Survey reporting prior knowledge of their HCV status, not a population estimate. Standard errors and CIs are not applicable in this situation due to the low response rate and small number of respondents to the Hepatitis C Follow-Up Survey.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, the baseline was revised from 49.0 percent (2002-07) to 53.0 percent (2003-08) to correct a programming error. The target and target-setting method were not revised.

    References

    Additional resources about the objective

    1. Volk M, Tocco R, Saini S, Lok A. Public health impact of antiviral therapy for hepatitis C in the United States. Hepatology. 2009;50:1750-55.
  • IID-28 (Developmental) Increase the proportion of persons who have been tested for hepatitis B virus within minority communities experiencing health disparities

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Potential Data Source: 
    REACH (Racial and Ethnic Approaches to Community Health) Risk Factor Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    *** Missing ***
    Numerator: 

    *** Missing ***

    Comparable Healthy People 2010 Objective: 
    Not applicable

    References

    Additional resources about the objective

    1. Weinbaum C, Williams I, Wong S. CDC Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. MMWR September 19, 2008; 57(No. RR-08):1-20.
  • IID-29 Reduce tuberculosis (TB)

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Bridged-race Population Estimates
    National TB Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    per 100,000
    Baseline (Year): 
    4.8 (2005)
    Target: 
    1.0
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    The target is aligned with the National TB Indicator Project objectives. The algorithms for calculating the indicators for these objectives were standardized through consensus among stakeholder representatives from TB programs and laboratories at the State and local level. Targets were derived from recent results of programs ranked at the 90th percentile for the respective performance indicators.
    Numerator: 

    Number of confirmed new cases of tuberculosis reported to CDC by local health departments in all 50 States and the District of Columbia

    Denominator: 

    Number of persons

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      A confirmed case definition for tuberculosis is available from CDC.

      Rates are expressed as the number of cases reported each calendar year per 100,000 persons. Population denominators used in calculating TB rates were based on official census and midyear postcensal estimates from the U.S. Census Bureau. Tuberculosis case rates between 2005 to 2012 updated as of June 25, 2012, using Bridged-Race Intercensal Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2000 to July 1, 2010 and Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2012.

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    Bridged-race Population Estimates
    National TB Surveillance System
    Measure: 
    per 100,000
    Numerator: 

    Number of confirmed new cases of tuberculosis reported to CDC by local health departments in all 50 States and the District of Columbia

    Denominator: 

    Number of persons

    Data Collection Frequency: 
    Annual
    Methodology Notes: 

        A confirmed case definition for tuberculosis is available from CDC.

        Rates are expressed as the number of cases reported each calendar year per 100,000 persons. Population denominators used in calculating TB rates were based on official census and midyear postcensal estimates from the U.S. Census Bureau. Tuberculosis case rates between 2005 to 2012 updated as of June 25, 2012, using Bridged-Race Intercensal Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2000 to July 1, 2010 and Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2012.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, the rates for 2005-2009 were revised using intercensal population estimates based on the 2000 and 2010 censuses instead of the postcensal estimates for the denominator. Thus, the original 2005 baseline was revised from 4.9 to 4.8. The target was not revised. In 2014, Population Estimates was added as a data source to reflect measure's population denominator. The data and target were not revised. In 2015, 2005-2012 data were revised due to reporting delays. This revision occurs annually. The baseline of the total population and target remained the same. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged.

    References

    Additional resources about the objective

    1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly Report 46 (RR-10), 1997. (See reference for updated case definitions.)
  • IID-30 Increase treatment completion rate of all tuberculosis patients who are eligible to complete therapy

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National TB Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    81.9 (2005)
    Target: 
    93.0
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    The target is aligned with the National TB Indicator Project objectives. The algorithms for calculating the indicators for these objectives were standardized through consensus among stakeholder representatives from TB programs and laboratories at the State and local level. Targets were derived from recent results of programs ranked at the 90th percentile for the respective performance indicators.
    Numerator: 

    Number of persons with confirmed new cases of tuberculosis who were alive at diagnosis, with an initial drug regimen of one or more drugs prescribed, who did not die during therapy, and who completed curative therapy within 12 months of diagnosis

    Denominator: 

    Number of persons with confirmed new cases of tuberculosis who were alive at diagnosis, with an initial drug regimen of one or more drugs prescribed, and who did not die during therapy

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      A confirmed case definition for tuberculosis is available from CDC.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, the original baseline and baseline year were revised from 83.8 (2006) to 82.8 (2005) to make the baseline year and data consistent with IID-29 estimates. In addition, the revision incorporates new data that were not available at the HP2020 launch. The target was not revised. In 2015, 2005-2011 data were revised due to reporting delays. This revision occurs annually. The baseline of the total population and target remained the same.

    References

    Additional resources about the objective

    1. Centers for Disease Control and Prevention (CDC). Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly Report 46 (RR-10), 1997. (See reference for updated case definitions.)
  • IID-31 Increase the percentage of contacts to sputum smear-positive tuberculosis cases who complete treatment after being diagnosed with latent tuberculosis infection (LTBI) and initiated treatment for LTBI

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National TB Surveillance System
    Aggregate Reports for Tuberculosis Program Evaluation
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    68.1 (2007)
    Target: 
    79.0
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Target-Setting Method Justification: 
    The target is aligned with the National TB Indicator Project objectives. The algorithms for calculating the indicators for these objectives were standardized through consensus among stakeholder representatives from TB programs and laboratories at the state and local level. Targets were derived from recent results of programs ranked at the 90th percentile for the respective performance indicators.
    Numerator: 

    Number of persons completing treatment for latent tuberculosis infection (LTBI) who, during the contact investigations of AFB sputum-smear positive TB cases, have been found to have LTBI and initiated treatment

    Denominator: 

    Number of persons who, during the contact investigations of AFB sputum-smear positive TB cases, have been found to have LTBI and initiated treatment

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Treatment for latent TB infection substantially reduces the risk that TB infection will progress to disease. Certain groups are at very high risk of developing TB disease if infected. Identifiable population groups at high risk for TB vary in time and geographic area, depending on unique and changing TB related demographics.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, the original baseline estimate was revised from 64.3% (2007) to 68.1% (2007). The former estimate was submitted as preliminary data. The latter estimate reflects the final national estimate. The target was not revised. In 2013, the phrase "and initiated treatment" was added to the numerator and denominator for clarity because not everyone with LTBI actually starts treatment. In 2013, the objective statement was revised for clarity from "Increase the percentage of contact to sputum smear-positive cases who complete treatment after being diagnosed with latent tuberculosis infection" to "Increase the percentage of contacts to sputum smear-positive tuberculosis cases who complete treatment after being diagnosed with latent tuberculosis infection (LTBI) and initiated treatment for LTBI."

    References

    Additional resources about the objective

    1. Aggregate Reports for Tuberculosis Program Evaluation (ARPEs): Training Manual and Users Guide.
  • IID-32 Increase the proportion of culture-confirmed TB patients with a positive nucleic acid amplification test (NAAT) result reported within 2 days of specimen collection

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National TB Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    32.0 (2008)
    Target: 
    77.0
    Target-Setting Method: 
    Maintain consistency with national programs, regulations, policies, and laws.
    Numerator: 

    Number of patients with a positive NAAT result within 2 days of specimen collection

    Denominator: 

    Number of all the culture confirmed cases of tuberculosis

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the National TB Surveillance System's standard case report form, Report of Verified Case of Tuberculosis (RVCT):

      [NUMERATOR:]

      Nucleic Acid Amplification Test Result (select one):

      1. Positive
      2. Negative
      3. Not Done
      4. Unknown
      5. Indeterminate

      For positive or negative results of nucleic acid amplification testing, enter the month, day, and year the first sputum specimen was collected.

      For the first nucleic acid amplification test result reported positive for M. tuberculosis complex, enter the month, day, and year the result was reported by the laboratory.

    Methodology Notes: 

      Nucleic acid amplification tests are capable of detecting Mycobacterium tuberculosis in a specimen within 48 hours of collection. Concerns regarding sensitivity, cost, quality control, availability and special expertise requirements have hindered widespread use of such tests. Upgrading TB laboratory capabilities and facilities, improving training in state-of-the-art mycobacteriology, and evaluating proficiency should better enable laboratories to apply these rapid tests to the diagnosis of TB.

    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 14-14 in that the measure was revised from "the mean number of days it takes each state health laboratory to confirm 75 percent of the most rapidly confirmed cases out of all its laboratory-confirmed cases of tuberculosis" to "the proportion of patients with a positive NAAT result within 2 days of specimen collection."

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, the objective statement was revised from "Reduce the average time for laboratories to confirm and report tuberculosis cases" to "Increase the proportion of culture confirmed TB patients with a positive nucleic acid amplification test (NAAT) result reported within 2 days of specimen collection" in order to make the objective statement consistent with the desired direction and value label.

    References

    Additional resources about the objective

    1. Starks, A.M., T.L. Dalton, F. Tyrrell, B. Metchock. “Use of Nucleic Acid Amplification Tests (NAAT) by U.S. Public Health Laboratories (PHL) for detection of Mycobacterium tuberculosis complex in Clinical Specimens”. Poster presented as part of the North American Region of the International Union Against TB and Lung Disease, Orlando, Florida, 11-13 March 2010.
    2. Updated Guidelines for the Use of Nucleic Acid Amplification Tests in the Diagnosis of Tuberculosis. MMWR. January 16, 2009 / 58(01); 7-10.
  • IID-33 Increase the proportion of adults with tuberculosis (TB) who have been tested for HIV

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National TB Surveillance System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    73.3 (2008)
    Target: 
    80.6
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of reported TB cases among persons aged 25 to 44 years with a negative, positive or indeterminate HIV test result

    Denominator: 

    Number of reported TB cases (based on TB case report forms) among persons aged 25 to 44 years

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Methodology Notes: 

      The data are based on the CDC report of verified case of Tuberculosis, Form 72.9A, Rev. 5/93.

    Trend Issues: 
    California began reporting HIV test results to CDC in 2011, resulting in significant improvement in the completeness of HIV reporting. This accounts for the substantial percentage increase for that year.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, this objective was moved from HIV-15 to IID-33. In 2014, 2008-2010 data were revised due to reporting delays. This revision occurs annually. The baseline of the total population and target remained the same.