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The Importance of Effective Vaccine
Communication
Kristine Sheedy, PhD
Associate Director for Communication Science
National Center for Immunization
and Respiratory Diseases
VICNetwork 2011 Virtual Immunization Symposium
May 25, 2011
National Center for Immunization & Respiratory Diseases
Office of the Director
Comparison of 20th Century Annual Morbidity and Current
Morbidity: Vaccine-Preventable Diseases
Disease
20th Century
Annual
Morbidity†
Smallpox
29,005
0
100%
Diphtheria
21,053
0
100%
Measles
530,217
61
> 99%
Mumps
162,344
982
99%
Pertussis
200,752
13,506
93%
Polio (paralytic)
16,316
0
100%
Rubella
47,745
4
> 99%
Congenital Rubella Syndrome
152
1
99%
Tetanus
580
14
98%
20,000
243*
99%
Haemophilus influenzae
†Source:
2009
Reported Cases †
†
JAMA. 2007;298(18):2155-2163
CDC. MMWR January 8, 2010;58(51,52);1458-1468. (provisional, 2009 week 52 NNDSS data)
* 25 type b and 218 unknown (< 5 years of age)
† † Source:
Percent
Decrease
Vaccines Routinely Recommended
for Children and Adolescents
7
1985
1995
2006
Measles
Rubella
Mumps
Diphtheria
Tetanus
Pertussis
Polio
Measles
Rubella
Mumps
Diphtheria
Tetanus
Pertussis
Polio
Hib (infant)
HepB
Varicella
Measles
Rubella
Mumps
Diphtheria
Tetanus
Pertussis
Polio
Hib (infant)
Hepatitis B
Varicella
Pneumococcal disease
Influenza
Meningococcal disease
Hepatitis A
Rotavirus
HPV
10
16
Increasing Vaccine-Specific Coverage Rates
Among Preschool-Aged Children
2010 Target
DTP / DTaP(3+)†
MMR(1+)
Hep B
(3+)
PCV 7
(4+)
Polio (3+)
Rotavirus
(3+)
Hib (3+)
Varicella
(1+)
0.6% of toddlers had received no vaccines at all
Source: USIS (1967-1985), NHIS (1991-1993) CDC, NCHS, and NIS (1994-2009), CDC, NIP and NCHS;
No data from 1986-1990 due to cancellation of USIS because of budget reductions.
Estimated Return on Investment
of Childhood Vaccines, United States, 2011
• For each birth cohort vaccinated against 13 diseases in
accordance with the childhood schedule for DTaP, Hib, IPV,
MMR, hep B, Varicella, Hepatitis A, Pneumo-7, and Rotavirus
vaccines:
–
–
–
–
–
42,000 lives are saved
20M cases of disease are prevented
13.6 billion dollars in direct costs are saved
68.9 billion dollars in direct plus indirect (societal) costs are saved
For each dollar invested in these vaccinations, $10.20 is saved
Preliminary results of updated analysis from Zhou et al, Arch of Ped and Adolesc Med 2005
Confidence in Vaccine Safety
Percent
Percent of parents of at least one child 6 years of age or younger
who reported that they were confident or very confident
in the safety of routine childhood vaccines
Year
Source: PN HealthStyles and ConsumerStyles Surveys
The Good News
•
•
•
•
•
•
Protect children from 16 VPDs
Record low rates for most VPDs
Record high toddler immunization rates
Less than 1% zero dose children
Several newer vaccines in routine use
Narrowing racial and economic
disparities
• Generally a high level of confidence in
vaccine safety
Less Disease and More Vaccines =
More Attention to Vaccine Risks
• Low disease awareness = increased focus
on vaccine risks
• Low tolerance for vaccine risks
• Full and complicated immunization
schedule
Highly Concerned Parents seem to
Cluster Geographically
• Although < 1% of all children have received no
vaccines, these children cluster geographically and
increase the risk of transmitting vaccinepreventable diseases to others in their
communities
• Zero-dose children tend to have higher SES and
are frequently source cases in VPD outbreaks
Smith, P, Chu, S, Barker L. Children who have received no vaccines: Who are they and where do they live? Pediatrics,
2004; 114;187-195.
Measles 2008
 Highest number of
reported cases/year
since 1996
 No increase in
imported cases
 Increase in spread
within the U.S.
 7 “outbreaks”
 Parent vaccine
refusal common
Measles Importations
United States, 2011
• 98 measles cases reported
to date in 2011
• Importations into > 20
states from 12-15
countries
– > 10 from France
• 8 outbreaks (3-21 cases)
Slide: Courtesy of Kathleen Winter, Source: California Department of Public Health
Multiple Factors Can Lead to VaccinePreventable Disease Increases
 Failure to vaccinate (e.g., due to access, supply, acceptance)
 Accumulation of unvaccinated susceptible persons permits
infectious agent to spread (e.g., measles outbreaks in 2008)
 Waning immunity following childhood vaccination
 Pertussis rise in CA 2010
 Less than optimal vaccine effectiveness and high
force of infection
 Mumps (Midwest universities 2006, NE religious schools 2010)
 Change in circulating strains
 Pneumococcal infectious caused by nonvaccine types
Many Parents Have Questions and
Concerns
Which concerns, if any, do you have about childhood vaccines?
2010
Weighted %
It is painful for children to
receive so many shots during
one doctor’s visit.
38
My child getting too many vaccines
in one doctor’s visit.
36
Children get too many vaccines in
the first two years of life.
34
Vaccines causing fevers in my child.
32
Vaccines may cause learning
disabilities (such as autism).
30
Preliminary results from PN HealthStyles and ConsumerStyles Surveys
What are the three most important sources of
information that have helped you make decisions
about your youngest child’s vaccinations?
Child’s healthcare provider, such as a doctor
or nurse (85%)
 Family (46%)
 American Academy of Pediatrics (28%)
 CDC (26%)
 Internet (24%)
Preliminary results: Health Styles 2010, parents of children <6
2009 Focus Groups:
Vaccine Schedule and Timing



Mothers were generally knowledgeable about the
timing of vaccines
Many reacted negatively to receiving multiple
injections during one visit
Most were vaccinating according to the
recommended schedule, but several across
race/education/location segments reported
(generally short-term) spreading vaccinations
 Variety of reasons for spreading: concerns about children’s
ability to “handle” multiple vaccines; concerns about ability
to pinpoint source of adverse events; some concerns about
pain
2009 Focus Groups:
VPD Knowledge and Beliefs


After reading brief descriptions of the 14 VPDs,
many mothers said they were surprised to find
out how many could be fatal, including some they
previously did not consider serious
Many mothers shared personal stories that
impacted their view of particular VPDs
 Some knew a baby who had whooping cough
(heightened their perception of severity)
 Most talked about their own experience with flu or
chickenpox (lessened their perception of severity)
www.cdc.gov/vaccines/conversations
Websites




Provider Resources for Vaccine Conversations with
Parents
 www.cdc.gov/vaccines/conversations
Give Feedback on Provider Resources
 www.cdc.gov/vaccines/tellus
Health Care Professional Home Page
 www.cdc.gov/vaccines/hcp
“Get the Picture” Childhood Video
 www.youtube.com/user/CDCStreamingHealth
Thank you
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