Disease Burden Among Adults for Vaccine Preventable Diseases

National Center for Immunization & Respiratory Diseases

Disease Burden Among Adults for Vaccine Preventable Diseases: Medical, Social, and Economic Costs

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Carolyn B Bridges, MD, FACP Associate Director of Adult and Influenza Immunizations, Immunization Services Division, NCIRD

CDC Netconference April 12, 2017

Objectives  Describe adult immunization schedule

 Provide updates on impact of diseases among adults for which vaccines are

available and current vaccination rates

U.S. Census Bureau, 2015

Incidence Of Acute Hepatitis B, By Age Group, Per 100,000 Persons— United States, 2000–2014



Estimated 19,200 cases acute Hepatitis B reported in US in 2014 Persons with diabetes at twice risk of hepatitis B

6 0-19 yrs 20-29 yrs 30-39 yrs 40-49 yrs 50-59 yrs > 60 yrs

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Year Source: National Notifiable Diseases Surveillance System (NNDSS)

 Most commonly reported risks were injection drug use, having multiple sexual partners, and surgery

Source: National Notifiable Diseases Surveillance System (NNDSS)

* Includes case reports indicating the presence of at least one of the following risks 6 weeks to 6 months prior to onset of acute, symptomatic hepatitis B: 1) using injection drugs; 2) having sexual contact with suspected/confirmed hepatitis B patient; 3) being a man who has sex with men; 4) having multiple sex partners concurrently; 5) having household contact with suspected/confirmed hepatitis B patient; 6) occupational exposure to blood; 7) being a hemodialysis patient; 8) having received a blood transfusion; 9) having sustained a percutaneous injury; and 10) having undergone surgery.

662 24%

1062 38%

1067 38%

Risk identified* No risk identified Risk data missing

Hepatitis B Outbreaks Reported to CDC, 2008-15  23 outbreaks, 175 outbreak-associated cases, >10,700 persons notified

for screening  17 outbreaks in long-term care facilities

–

at least 129 outbreak-associated HBV and approximately 1,600 at- risk persons notified for screening 82% (14/17) outbreaks associated with infection control breaks during assisted monitoring of blood glucose (AMBG)

 5 other outbreaks: free dental clinic in school gymnasium, an outpatient oncology clinic, a hospital surgery service, and two at pain remediation clinics

46 outbreak-associated cases of HBV and > 8,500 persons at-risk persons notified for screening

www.cdc.gov/hepatitis/statistics/healthcareoutbreaktable.htmhttps://www.cdc.gov/hepatitis/statistics/healthcareoutbreaktable.htm

Impact of Vaccination – Hepatitis B • In 2011, added adults with diabetes to those recommended for HepB vaccination

– –

– – – –

<60 years: vaccinate as soon as feasible after diagnosis of diabetes 60 years and older: at provider discretion depending on risk of HVB, need for assisted blood glucose monitoring, likely immune response to vaccination

• 90% vaccine effectiveness (VE) after completing 3-dose series • Effectiveness estimated to be lower in persons with diabetes with increasing age

at time of vaccination 90% VE age <40 years 80% VE 41‒59 years 65% VE 60‒69 years <40% VE if 70 years or older with diabetes

CDC. Use of hepat it is B vaccine for adults with diabetes mellitus. MMWR 2011;60:1709-1711.

Incidence Of Acute Hepatitis A, By Age Group — United States, 2000–2014

Source: CDC, National Not ifiable Diseases Surveillance System (NNDSS)

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0-9 yrs 10-19 yrs

Year

20-29 yrs 30-39 yrs 40-49 yrs 50-59 yrs 60+ yrs

Availability Of Risk Exposures/Behaviors Associated With Acute Hepatitis A — United States, 2014

Source: CDC, National Notifiable Diseases Surveillance System (NNDSS) * Includes case reports indicating the presence of at least one of the following risks 2–6 weeks prior to onset of acute, symptomatic hepatitis A: 1) having traveled to hepatitis A-endemic regions of Mexico, South/Central America, Africa, Asia/South Pacific, or the Middle East; 2) having sexual/household or other contact with suspected/confirmed hepatitis A patient; 3) being a child/employee in day care center/nursery/preschool or having had contact with such persons; 4) being involved in a foodborne/waterborne outbreak; 5) being a man who has sex with men; and 6) using injection drugs.

87 7%

646 52%

506 41%

Risk identified* No risk identified Risk data missing

• Among those with reported risk, most commonly reported were international travel, injection drug use, contact with daycare center, child or employee, and foodborne or waterborne outbreak.

Burden of Disease Among U.S. Adults for Selected Diseases with Vaccines Available – Zoster

 Zoster (shingles)1

 About 1 million cases of zoster annually U.S.  10-11/1000 per year in persons >60 yrs  Lifetime risk 32%

 Thoracic, cervical, and ophthalmic involvement are most common

 Approximately 10-25% with complication herpes zoster ophthalmicus (HZO)

 Risk of severe prolonged pain, post-herpetic neuralgia, increases with age

1. CDC. Prevent ion of Herpes Zoster. MMWR 2008. 57(RR-5): 1-30.

Drolet M, et al. The impact of herpes zoster and postherpet ic neuralgia on health-related quality of life: a prospect ive study. CMAJ 2010.

Impact of Vaccination – Zoster

 Vaccine effectiveness varies by the disease outcome

 Zoster (Shingles) live attenuated vaccine effectiveness (VE): • 51% against shingles • 66% against post-herpetic neuralgia (PHN), • 80% against most prolonged and extreme cases of PHN1

1. Oxman MN, et al. NEJM 2005;352:2271-84.

Unlicensed Zoster Vaccine – Results of Clinical Trials Presented to Advisory Committee on Immunization Practices (ACIP)

 Inactivated adjuvanted herpes zoster subunit vaccine – –

–

Not licensed – Biologics License Application submitted to US FDA in October 2016 VE against shingles: 96% (95% CI=93-98%) with VE estimates similar for 50, 60, and 70 year old participants1 17% of vaccinated and 3% of placebo with Grade 3 symptoms

 Subsequent studies done on adults >70 years found VE=90% (CI 84-94%)2  Points to need for improved platform for delivery of current and future

adult vaccines and potential for additional vaccines with high VE in older adults

1. Lal H, et al. NEJM 2015

2. Cunningham AL, et al NEJM 2016

Burden of Disease – Streptococcus pneumoniae

 Significant declines invasive pneumococcal disease (IPD) since pneumococcal conjugate vaccines introduced in United States (PCV7 in 2000 and PCV13 in 2010) for children1

 For children <5 years of age:  100 cases/100,000 in 1998 to 9 cases/100,000 in 2015.  IPD caused by PCV13 serotypes: 91/100,000 in 1998 to 2/100,000 in 2015.

 Adults >65 years with highest rates of IPD  59 cases/100,000 in 1998 to 23 cases/100,000 in 2015  Reductions mostly attributable to the conjugate vaccines 1998-2015

 PPSV vaccination first covered by Medicare in 19812

1. www.cdc.gov/pneumococcal/surveillance.html 2. Hinman, et al. Financing immunizations in the United State. Clin Infect Dis (2004) 38 (10): 1440-1446.https://www.cdc.gov/pneumococcal/surveillance.html

www.cdc.gov/abcs/reports-findings/survreports/spneu-types.htmlhttps://www.cdc.gov/abcs/reports-findings/survreports/spneu-types.html

Incidence of IPD in adults aged 18–64 years with selected underlying condit ions, United States, 2009

Kyaw, JID 2005;192:377-86

8 26 28 32

41 52 59

173 186

100

120

140

160

180

200

HEALTHY CVD DIABETES PULMONARY KIDNEY LIVER ALCOHOL HIV/AIDS HEMATOLGICAL CANCER

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3-7 fold increased risk

20 fold increased risk

Impact of Vaccination – Pneumococcal Vaccines

 PCV13 (pneumococcal conjugate vaccine): • 45% efficacy against vaccine-type pneumococcal pneumonia • 75% efficacy against vaccine-type invasive pneumococcal disease

(IPD) among adults aged ≥65 years

 PPSV23 (pneumococcal polysaccharide) • 74% (CI 55-86% ) in meta-analysis against IPD • Limited evidence regarding effective against non-IPD pneumonia

Bonten MJ, et al. NEJM 2015;372:1114-25. Moberley S, et al. Cochrane Database Syst Rev 2013

Receipt of claims for pneumococcal vaccination among Medicare beneficiaries ≥65 years, CMS, United States, September 2009-September 2015

100

Sept 19, 2009- Sept 18, 2010

Sept 19, 2010- Sept 18, 2011

Sept 19, 2011- Oct 12, 2012

Oct 13, 2012- Sept 18, 2013

Sept 19, 2013- Sept 18, 2014

Sept 19, 2014- Sept 18, 2015

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es *

PPSV23 only PCV13 only Both PCV13 and PPSV23

* Denominator in each time period includes all beneficiaries continuously enrolled in Medicare parts A and B for the duration of the period. Slide courtesy of Carla Black, CDC, Presented at National Immunization Conference 2016, Atlanta

Influenza Health Impact

1. Thompson WW, et al. Influenza-Associated Hospitalizations in the United States. JAMA 2004; 292: 1333-1340 2. CDC. Estimates of deaths associated with seasonal influenza – United States, 1976-2007. MMWR. 2010;59(33):1057-1062. 3. Molinari, et al. The annual impact of seasonal influenza in the US: Measuring disease burden and costs. Vaccine 2007;25 :5086–5096. 4. www.cdc.gov/flu/about/disease/2015-16.htm.

 Influenza disease burden varies year to year  Millions of cases and average of 226,000 hospitalizations annually

with >75% among adults1

 3,000-56,000 deaths annually, >90% among adults2,4

 Direct medical costs in U.S.: ~$10.4 billion3

 Add in loss of work and life: ~$87 billionhttps://www.cdc.gov/flu/about/disease/2015-16.htm

Impact of Vaccination – Influenza

 Vaccine Effectiveness (VE) varies based on antigenic match and age and health of person being vaccinated –

–

– –

~30% VE in adults >65 years against medically attended influenza when good match1

Generally higher VE in younger adults and children compared to older adults when good match

• Reduces antibiotic use, medical visits, loss work  Preliminary VE estimate for 2016-172

48% (37 to 57) for all ages combined 46% (4 to 70) among adults 65 years and older

1. C DC. Prevent ion and Control of Seasonal Influenza: Recommendations of the ACIP – U.S., 2016-17. MMWR 2016 2. www.cdc.gov/mmwr/volumes/66/wr/mm6606a3.htmhttps://www.cdc.gov/mmwr/volumes/66/wr/mm6606a3.htm

Impact of Influenza Vaccination, Illnesses and Hospitalizations Prevented, 2011-2016

Date of download: 3/27/2017 Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US

Case-Control Study of Vaccine Effectiveness in Preventing Laboratory- Confirmed Influenza Hospitalizations in Older Adults, United States, 2010–2011

Clin Infect Dis. 2016;63(10):1304-1311. doi:10.1093/cid/ciw512

Sensitivity analysis examining the effect of including self-reported influenza vaccination, without date and location, in adjusted estimates of influenza vaccine effectiveness (VE) in preventing hospitalization among adults aged ≥50 years in US Emerging Infections Program hospital surveillance sites, 2010–2011 influenza season.

Impact of Vaccination – Influenza

 Effective in preventing major cardiac events among persons with existing cardiovascular disease1-4

–

Meta-analysis of case control studies: 3 • Acute respiratory illness/ILI increases acute MI risk by 2-fold • Influenza vaccination efficacy (VE) 29% (95% CI=9-44%) against

acute MI

Meta-analysis of randomized studies of persons with existing CVD:4 influenza VE 36% (95% CI=14% to 53%)

1. CDC. Prevention and Control of Seasonal Influenza: Recommendations of the ACIP – U.S., 2014-15 Influenza Season. MMWR 2014; 63(32); 691-697. 2. American College of Cardiology recommendations for secondary prevention of atherosclerotic cardiovascular disease. 3. Barnes M, et al. Acute myocardial infarction and influenza: a meta-analysis of case–control studies. Heart 2015;101:1738–1747. 4. Udell JA, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA 2013;310:1711–20.

Impact of Vaccination – Influenza

 “We calculated a pooled VE of 29% (95% CI 9% to 44%) in preventing AMI, on a par with or better than accepted AMI preventive measures, with the estimates of the efficacy of statins for secondary prevention of 36%, anti- hypertensives of 15%–18% and smoking cessation interventions of 26%.”1

 Influenza vaccination recommended as secondary prevention by American

College of Cardiology and American Heart Association

1. Udell JA, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA 2013;310:1711–20.

CDC. The State of Aging and Health in America (SAHA), 2013 report

Vaccination of Adults 65 Years and Older

Falsey, et al. J Infect Dis 2009 DiazGranados, et al. NEJM 2015. Izurieta, et al Lancet Infect Dis 2015.

• High dose influenza vaccine –

–

Inactivated trivalent vaccine – 4 times the antigen as standard dose (60 µg antigen per vaccine strain vs 15 µg in standard dose)

Licensed 2009 based on improved immunogenicity compared to standard dose for influenza A (H1N1) and A (H3N2) and non-inferior immune response for influenza B.

RCT found efficacy of high-dose relative to standard dose vaccine of 24% (CI 9.7-36.5) against laboratory confirmed influenza

Cohort study by CMS comparing persons with a claim for standard versus high dose vaccine found 22% (CI 16-27%) reduction in influenza-related hospitalization

Date of download: 3/27/2017 Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

From: Comparative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries in Preventing Post-influenza Deaths During 2012–2013 and 2013–2014

Outcome rates (per 10000 person-weeks) for each of 3 influenza outcomes, by influenza season and during periods of high, medium, and low influenza activity.

Shay et al. J Infect Dis. Published online March 02, 2017.

Vaccination of Adults 65 Years and Older

FDA accelerated approval letter http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm473989.htm. Black S. Safety and effectiveness of MF-59 adjuvanted influenza vaccines in children and adults. Vaccine 2015;335:B3-B5. Mannino S, et al. Effectiveness of adjuvanted influenza vaccination in elderly subjects in northern Italy. Am J Epidemiol. 2012;176(6):527-33.

• Adjuvanted inactivated trivalent influenza vaccine – – – –

MF-59 adjuvant is oil-in-water emulsion Licensed in Europe for many years Licensed in US in November 2015 based on immunogenicity > 65 yrs No RCT in older adults, however clinical efficacy trial of quadrivalent MF-59 vaccine post-licensure required

• Cohort study in Italy using administrative database estimated 25% (CI 2-43) lower risk influenza-related hospitalization for MF-59 adjuvanted vaccine vs non-adjuvanted influenza vaccinehttp://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm473989.htm

Influenza Vaccine during Pregnancy Protects Infants < 6 Months of Age from Laboratory-Proven Influenza

Zaman et al., N Engl J Med 359:1555-64, 2008

Maternal Influenza Vaccination Effects on Fetus/Newborn

 Observational study from Georgia PRAMS1 –

–

Infants whose mothers who received influenza vaccine prenatally were less likely to be preterm (aOR=0.60, 95% CI 0.38-0.94) and SGA (aOR= 0.31, 95% CI 0.13-0.75).

 Observational study from Ontario2 Infants whose mothers received H1N1 vaccine prenatally less likely to be SGA (aRR=0.90; 95% CI 0.85, 0.96) or preterm (<32 weeks) (aRR = 0.73; 95% CI = 0.58, 0.91). Fetal loss aRR = 0.66; 95% CI = 0.47, 0.91.

 Observational study: Kaiser Permanente3 Infants whose mothers who received H1N1 vaccine prenatally had 37% lower odds of being born preterm (aOR 0.63; 95%CI 0.47-0.84).

1. Omer et al., PLoS Med 8:e1000441, 2011. 2. Fell et al., Am J Public Health 102:e33-40, 2012; 3. Richards et al., Clin Infect Dis 56, 1216-22, 2013 SGA=small for gestational age; aOR=adjusted odds ratio; aRR=adjusted relative risk.

Pertussis (Whooping Cough) • Caused by Bordetella pertussis

• Infection leads to respiratory tract inflammation and difficulty clearing pulmonary secretions

• ~21,000 cases reported in 2015, 22% in adults

• Most severe cases among infants – complications among hospitalized infants: apnea (61%), pneumonia (23%), seizures (1.1%), death (1%), and encephalopathy (0.3%)

• Complications in adults: pneumonia (2%), weight loss (33%), urinary incontinence (28%), syncope (6%), and rib fractures from severe coughing (4%)

• Pregnant women recommended to get Tdap vaccine 3rd trimester each pregnancy to protect infants

• Other adults should have a single dose of Tdap vaccine

Pertussis cases reported in US by year and age group, 1990-2015

 Source: National Notifiable Disease Surveillance System (NNDSS)

www.cdc.gov/pertussis/surv-reporting.htmlhttps://www.cdc.gov/pertussis/surv-reporting.html

Effectiveness of Maternal Pertussis Vaccination — United Kingdom

 Observational study  Vaccine effectiveness (VE) calculated by comparing vaccination status for mothers

of confirmed cases with estimates of vaccine coverage for national population of pregnant women

Amirthalingam, et al. Lancet. 2014, 384(9953):1521-8

Vaccine effectiveness Timing of maternal vaccination

91% (83-95) At least 28 days before birth

38% (-95-80) 0-6 days before or 1-13 days after birth

Effectiveness of maternal pertussis vaccine for infants <3 months of age at onset

www.cdc.gov/mmwr/preview/mmwrhtml/mm6012a1.htm

U.S. Tetanus Surveillance 2001-2008https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6012a1.htm

Measles

 Although year-round transmission eliminated from US, cases still reported in U.S., including among adults. – Most cases importation-related

 January 1 to March 25, 2017, 28 cases reported from 10 states (CA, CO, FL, MI, NE, NJ, NY, PA, UT, WA)

Measles  Important to be able to recognize quickly since highly transmissible  Incubation period 7-21 days,  Clinical features: fever, cough, coryza, conjunctivitis

–

Koplick spots (small, red, irregularly-shaped spots with blue-white centers on the mucosal) followed by maculopapular rash.

 Complications can include pneumonia (1 in 20), encephalitis (1 in 1,000) Most often in children <5 and adults >20 years

Mumps  Most common symptoms include: fever, headache, muscle aches, fatigue,

and swollen and tender salivary glands on one or both sides (parotitis)  Symptoms typically 16-18 days after infection, range from 12-25 days  Some people who get mumps have very mild or no symptoms  Most people with mumps recover completely in a few weeks.  Complications: orchitis in 3.3-10% of adolescent and adult males

–

Very rare complications (<1%): mastitis, oophoritis, pancreatitis, deafness, meningitis, and encephalitis Death exceedingly rare

 Recent outbreaks often among college students

Mumps

 Recent outbreaks often among college students

 Factors contributing to transmission included crowded settings like dormitories, and exposure to saliva from an infected person

Cancers Caused by HPV per Year, U.S., 2009-2013

Cancer site Number probably caused by any HPV type Percentage

probably caused by

any HPV type Male Female Both Sexes

Anus 1,600 3,200 4,800 91%

Cervix 0 10,600 10,600 91%

Oropharynx 9,600 2,000 11,600 70%

Penis 700 0 700 63%

Rectum 200 500 700 91%

Vagina 0 600 600 75%

Vulva 0 2,500 2,500 69%

TOTAL 12,100 19,400 31,500

HPV Vaccine Impact

• HPV Vaccine Effectiveness –

–

– – –

Clinical trials showed HPV vaccine provided close to 100% protection against pre-cancers of cervix HPV vaccination decreases HPV infection and genital warts

• HPV Vaccine Duration of Protection Protection lasts at least 10 years No sign that protection will decrease Similar to Hepatitis B vaccine which gives lifelong protection

Vaccination Coverage Rates

Vaccine-specific Coverage* among Children 19-35 Months, National Immunization Survey, United States, 1994-2014

* The Healthy People 2020 target for coverage is 90% for all vaccines with the exception of rotavirus (80%) and HepA (85%). † DTP (3+) is not a Healthy People 2020 objective. DTaP (4+) is used to assess Healthy People 2020 objectives. § Reflects 3+ doses through 2008, and Full Series (3 or 4 doses depending on type of vaccine received) 2009 and later.

100

1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

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Year

MMR (1+)

DTP/Dtap (3+ )†

Polio (3+)

Hib (3+)§

HepB (3+)

Varicella (1+)

PCV (4+)

Rotavirus*

HepA (2+)*

Rotavirus

3+ Hib

1+ Varicella

3+ HepB 2+ HepA

4+ PCV

U.S. Adult Vaccination Coverage, NHIS 2015  Brief update published online Feb 7 (full article pending publication in MMWR)

– Non-influenza vaccination coverage – National Health Interview Survey (NHIS)  Influenza vaccination coverage – Behavioral Risk Factor Surveillance System (BRFSS)  Key findings

– –

–

Pneumococcal vaccination for 19–64y high risk: 23.0% (↑2.8%) Tdap vaccination for ≥19y: 23.1% (↑3.1%); adults living with infants <1y: 41.9% (↑10.0%) Shingles vaccination for ≥60y: 30.6% (↑2.7%) Otherwise similar to 2014 estimates:

• Pneumococcal vaccination for ≥65y: 63.6% • Hepatitis B vaccination for 19–59 years among persons with diabetes: 24.4%

Disparities by race and ethnicity, insurance (highest for private), education, and income

www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/coverage-estimates/2015.html www.cdc.gov/flu/fluvaxview/coverage-1516estimates.htmhttps://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/coverage-estimates/2015.htmlhttps://www.cdc.gov/flu/fluvaxview/coverage-1516estimates.htm

Adult Vaccination Coverage for Selected Vaccines and Age Groups, National Health Interview Survey, 2010-15, and BRFSS

survey for influenza vaccine 2010-16 seasons

0 10 20 30 40 50 60 70 80

2010 2011 2012 2013 2014 2015

Tetanus 19+ Pneumococcal HR 19-64 Pneumococcal 65+

Tdap 19-64 Hepatitis B 19+ Zoster 60+

Influenza 65+

www.cdc.gov/fluhttps://www.cdc.gov/flu

Influenza Vaccination Coverage among Pregnant Women, 2010- 11 through 2014-15 seasons, Internet Panel Survey, United

States

43.9 43.2 50.5 51.8 50.3 49.9

100

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

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Influenza season

Influenza vaccination coverage* before and during pregnancy among women pregnant during October-January of each influenza season, Internet panel survey, United States

www.cdc.gov/flu

Tdap Coverage among Pregnant Women* by Timing of Vaccination, 2013-2014 through 2014-2015, Internet Panel

Survey, United States

34.2 26.2

27.0 42.1

19.7 13.7

19.1 18.0

100

2013-2014 (n=484) 2014-2015 (n=580)

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Before most recent pregnancy During most recent pregnancy After most recent pregnancy Never received

Conclusions

 Infections that can be prevented through vaccination impact persons of all ages –

–

Adults and especially older adults often disproportionately impacted  Vaccines are available but are underutilized especially for adults, including

Vaccination of pregnant women to prevent influenza and pertussis in infants younger than 6 months Adults 19 and older with high risk conditions, e.g. diabetes

 Ensuring that adults are up-to-date on recommended vaccines, including vaccines they may not have received as a child or adolescent, is key to helping adults stay healthy and preventing hospitalizations, disability and premature deaths

Collaborators and Acknowledgements  Peng-Jun Lu, MD, PhD  Alissa O’Halloran, MSPH  Tamara Pilishvili, MPH  Rafael Harpaz, MD  Lauri E. Markowitz, MD  Walter W. Williams, MD  Aparna Ramakrishnan, MPH  Carla Black, PhD  LaDora Woods  Stacie Greby, DVM

For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Disease Burden Among Adults for Vaccine Preventable Diseases: Medical, Social, and Economic Costs
Objectives
Slide Number 3
Slide Number 4
Slide Number 5
Incidence Of Acute Hepatitis B, By Age Group, Per 100,000 Persons— United States, 2000–2014
Availability Of Risk Exposures/Behaviors Associated With Acute Hepatitis B — United States, 2014
Hepatitis B Outbreaks Reported to CDC, 2008-15
Impact of Vaccination – Hepatitis B
Incidence Of Acute Hepatitis A,� By Age Group — United States, 2000–2014
Availability Of Risk Exposures/Behaviors Associated With Acute Hepatitis A — United States, 2014
Burden of Disease Among U.S. Adults for Selected �Diseases with Vaccines Available – Zoster
Slide Number 13
Slide Number 14
Impact of Vaccination – Zoster
Unlicensed Zoster Vaccine – Results of Clinical Trials Presented to Advisory Committee on Immunization Practices (ACIP)
Burden of Disease – Streptococcus pneumoniae
Slide Number 18
Slide Number 19
Impact of Vaccination – Pneumococcal Vaccines
Receipt of claims for pneumococcal vaccination among Medicare beneficiaries ≥65 years, CMS, United States, September 2009-September 2015
Influenza Health Impact
Slide Number 23
Slide Number 24
Slide Number 25
Slide Number 26
Slide Number 27
Slide Number 28
Impact of Vaccination – Influenza
Impact of Influenza Vaccination, Illnesses and Hospitalizations Prevented, 2011-2016
Slide Number 31
Impact of Vaccination – Influenza
Impact of Vaccination – Influenza
Slide Number 34
Vaccination of Adults 65 Years and Older
Slide Number 36
Vaccination of Adults 65 Years and Older
Influenza Vaccine during Pregnancy Protects Infants < 6 Months of Age from Laboratory-Proven Influenza
Maternal Influenza Vaccination Effects on Fetus/Newborn
Slide Number 40
Pertussis cases reported in US by year and age group, 1990-2015
Effectiveness of Maternal Pertussis Vaccination — United Kingdom
Slide Number 43
Measles
Measles
Mumps
Mumps
Cancers Caused by HPV per Year, U.S., 2009-2013
HPV Vaccine Impact
Vaccination Coverage Rates
Vaccine-specific Coverage* among Children 19-35 Months, National Immunization Survey, United States, 1994-2014
U.S. Adult Vaccination Coverage, NHIS 2015
Adult Vaccination Coverage for Selected Vaccines and Age Groups, National Health Interview Survey, 2010-15, and BRFSS survey for influenza vaccine 2010-16 seasons
Slide Number 54
Influenza Vaccination Coverage among Pregnant Women, 2010-11 through 2014-15 seasons, Internet Panel Survey, United States
Tdap Coverage among Pregnant Women* by Timing of Vaccination, 2013-2014 through 2014-2015, Internet Panel Survey, United States
Conclusions
Conclusions
Collaborators and Acknowledgements
Slide Number 60
Untitled

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Disease Burden Among Adults for Vaccine Preventable Diseases

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