Texas Immunization System

Dr. Adolfo ValadezAssistant Commissioner

Prevention and Preparedness Services

• Essential Public Health Functions• Top 10 Public Health Achievements• Public Health Impact of

Immunizations• Economics of Immunizations • Vaccine Coverage Levels• Disease Incidence Trends• Texas Vaccines for Children Program • ImmTrac

Agenda

Essential Public Health Functions

• Monitor health status of community• Investigate health problems in community• Inform, educate, and empower stakeholders• Forge community partnerships• Develop health policy and support planning• Enforce health code and regulations• Link people to appropriate health resources• Assure a competent public health workforce• Evaluate the quality and effectiveness of efforts• Research and innovation in community health

10 Greatest Public Health Achievements 1900-1999

Healthier moms and babies

Safer workplace

Safer and healthier

foods

Tobacco as a health hazard

Decline in deaths from coronary heart disease

Fluoridation of drinking water

Motor-vehicle safety Family Planning

Vaccinations

&

Control of Infectious Disease

Public Health Impact of Immunizations

• Considered one of the greatest public health achievements of the 20th century

• At the beginning of the 20th century vaccine-preventable disease morbidity and associated mortality was widespread

• Morbidity for 9 vaccine-preventable diseases has declined dramatically

• Smallpox eradicated, wild polio eliminated from Western Hemisphere

Source: Centers for Disease Control & Prevention

• For each birth cohort vaccinated in accordance with the schedule*– 33,000 deaths are prevented– 10.5 million cases of diseases are

prevented

• Vaccinations have huge cost savings– $10.5 billion in direct costs– $42 billion in societal costs

Economics of Immunizations

Zhou F, et al. Archives of Pediatrics and Adolescent Medicine, in press

*(DTaP, Td, Hib, MMR, Hep B and Varicella)

• For every $1 spent on an individual vaccine:– DTaP saves $27– MMR saves $26– Perinatal Hep. B saves $14.70– Varicella saves $5.40– Inactivated Polio (IPV) saves $5.45

Economics of Immunizations

Zhou F, et al. Archives of Pediatrics and Adolescent Medicine, in press

Healthy People 2010 Goal-Individual Vaccines-90%

Vaccine TX

DTP/DTaP 4+ 82.1%

Polio 3+ 92.6%

MMR 1+ 90.4%

Hib 3+ 93.8%

Hep B 3+ 91.7%

Varicella 1+ 90.0%

2007 National Immunization Survey

Healthy People 2010 Goal-4:3:1:3:3:1 Combination-80%

Texas 2007 National Immunization Survey Data--77.3%, 2.7 percentage points away from the national goal

2007 National Immunization Survey

National Immunization Survey2002–2007, Texas and US Rates Compared

(Texas Ranking Among the States Appears in Bold Below Data Points)

60

65

70

75

80

85

4:3

:1:3

:3:1

Vaccin

e C

overa

ge L

evel

Texas United States

Texas 65 69.8 69.3 76.8 74.7 77.3

United States 65.5 72.5 76 76.1 77 77.4

2002 2003 2004 2005 2006 2007

4129

24

24

*4-3-1-3-3-1: 4 doses DTP, 3 doses Polio, 1 dose MMR, 3 doses of Hib, and 1 or more doses of varicella

34

22

• 1985 (7)

– Measles

– Rubella

– Mumps

– Diphtheria

– Tetanus

– Pertussis

– Polio

Number of Vaccines in the Routine Childhood Schedule

• 1996 (10)

– Measles

– Rubella

– Mumps

– Diphtheria

– Tetanus

– Pertussis

– Polio

– Hib (infant)

– Hepatitis B

– Varicella

• 2008 (16)– Measles

– Rubella

– Mumps

– Diphtheria

– Tetanus

– Pertussis

– Polio

– Hib (infant)

– Hepatitis B

– Varicella

– Hepatitis A

– Pneumococcal Disease

– Influenza

– Meningococcal

– Rotavirus

– HPV

• 2001 (12)

– Measles

– Rubella

– Mumps

– Diphtheria

– Tetanus

– Pertussis

– Polio

– Hib (infant)

– Hepatitis B

– Varicella

– Hepatitis A

– Pneumococcal

Conjugate

Nationally Proven Strategies to Raise Vaccine Coverage Levels

• Promote the medical home concept• Promote the use of registries• Promote reminder/recall• Public education• Provider education• Utilize community partners to improve in the

strategies listed above

TVFC Public vs. Private Doses Administered Percentage

80

.7

19

.3

75

.82

4.2

73

.82

6.2

66

.43

3.6

62

.6

37

.4

58

.4

41

.6

56

.24

3.8

55

.84

4.2

55

.54

4.5

51

.24

8.8

53

47

49

.65

0.4

44

56

37

.86

2.2

36

.96

3.1

34

66

0

10

20

30

40

50

60

70

80

90

FY 92 FY 93 FY 94 FY 95 FY 96 FY 97 FY 98 FY 99 FY 00 FY 01 FY 02 FY 03 FY 04 FY05 FY06 FY07

Public Private

Per

cent

of T

otal

ed E

nrol

led

$5,432,585

$92,070,825

$15,450,714

$3,299,278

$143,773,200

$17,902,978

$6,501,248

$203,135,422

$15,265,808

$19,846,223

$224,822,864

$10,711,609

$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

2004 2005 2006 2007

317 Vaccine (DA + FA) VFC Vaccine (DA) State GR Vaccine Purchases

TEXAS Total Vaccine Purchases: 2004-2007

Federal Vaccine Purchases based on a calendar year (January through December)Texas GR Vaccine Purchases based on a state fiscal year (September through following August)

TVFC Site Visits by YearPublic & Private Clinics

354

872 831 884

2,408

328

2,405

247

2,646

300

2,775

273

0

500

1,000

1,500

2,000

2,500

3,000

2001 2002 2003 2004 2005 2006

TMF HSR/LHD

ImmTrac Health Plan Participation

• 35 health plans reporting• >5 million immunizations added to

ImmTrac client records in 2007 (Medicaid and health plans)

• 23 immunization history request files submitted by 8 health plans

• >27 million immunizations conveyed to health plans for their members

ImmTrac Snapshot: Q4 2007

• >67 million immunizations recorded

• 5.6 million Texas children

• 2 million children under age 6

• >4,300 active online user sites

• >62,000 immunization history reports generated online per month (avg)

Immunizations Reported by Electronic Data Import - 2007

Public Health 3.6 M

Local Registries 1.7 M

Private Providers, Hospitals 1.0 M

Medicaid, Health Plans 5.1 M

>11 Million Immunizations Reported +47% over 2006

ImmTrac Active User Sites

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

2003 2004 2005 2006 2007

33% Increase in 2007

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

2002 2003 2004 2005 2006 2007

ImmTrac Immunization Histories Generated

>80% Increase in

2007

Immunization Branch

512-458-7264 or 800-252-9152

www.ImmunizeTexas.com