Focus Area 2: Prevent Vaccine-Preventable Diseases

• Goals and Objectives
• Goal #1: Improve Childhood and Adolescent Immunization Rates
• Goal #1: Levels of Health Impact Pyramid
• Goal #2: Educate all parents about the importance of Immunizations
• Goal #2: Levels of Health Impact Pyramid
• Goal #3: Decrease the burden of pertussis disease
• Goal #3: Levels of Health Impact Pyramid
• Goal #4: Decrease the Burden of Influenza Disease
• Goal #4: Levels of Health Impact Pyramid
• Goal #5: Decrease the burden of disease caused by human papillomavirus (HPV)
• Goal #5: Levels of Health Impact Pyramid
• Goal #6: Increase adult immunizations
• Goal #6: Levels of Health Impact Pyramid
• Interventions by Sector

Defining the problem

Immunization is one of the most successful and safest public health strategies for preventing communicable diseases. High immunization rates have reduced vaccine-preventable disease (VPD) to extremely low levels in the United States. In New York State (NYS), high immunization levels are achieved by the time children reach school age and are supported by school entry laws. However, the immunization rates of very young children, 19-35 months of age, are still below the Healthy People 2020 goal of 80 percent. For vaccines recommended for adolescents, NYS has achieved the Healthy People 2020 goal only for Tdap, which is a school entry requirement for sixth grade. Parent education is needed to ensure that all children are immunized on schedule. Finally, pertussis, influenza and disease caused by human papilloma virus (HPV) remain priorities for intervention because of their high prevalence, their levels of morbidity and mortality, and the opportunity for prevention through vaccination.

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Goals and Objectives for Action

Goal #1: Improve childhood and adolescent immunization rates.

Objective 1.1:

Increase the rates of immunization among 19-35 month olds with the 4:3:1:3:3:1:4 series (4 Tdap, 3 polio, 1 MMR, 3 Hep B, 3 Hib, 1 varicella, 4 PCV13) by 23% to 80% or higher.

(Baseline: 65.1%, Year: 2011; Data Source: NIS; Data Availability: State, county (NYSIIS/CIR)

Objective 1.2:

Increase the three-dose HPV immunization rate among adolescent females, ages 13-17 years, by 45% to 50%.

(Baseline: 34.2%, Year: 2011; Data Source: NIS; Data Availability: State, county (NYSIIS/CIR))

Objective 1.3:

Identify and reduce disparities in vaccine coverage rates by race, geography (rural, suburban, urban) and socioeconomic status.

Goal #2: Educate all parents about the importance of immunizations.

Objective 2.1:

Identify and reduce vaccine hesitancy. Identify and reduce racial and geographic (rural, suburban, urban) disparities.

(Baseline: Private school student medical exemptions, 0.167% and religious exemptions 1.265%, public school medical exemptions 0.095% and religious exemptions 0.305%; Year: School year 2011-2012; Data Source: NYSDOH School Survey; Data Availability: Statewide)

Goal #3: Decrease the burden of pertussis disease.

Objective 3.1:

Increase Tdap immunization rates. Increase Tdap rates among adolescents to 95% or higher.

(Baseline rate 2011: 88.5% NYS, 87% NYC, 89.5 Upstate, Source: NIS; Data Availability: State, county (NYSIIS/CIR))

• Increase the number of hospitals that offer Tdap to families and caregivers of newborns (including post-partum mothers).
• Increase the number of doses given by hospitals to families and caregivers of newborns (including post-partum mothers).
• Increase the number of adult providers, including OB/GYNs, who offer Tdap.
• Identify and reduce disparities in vaccine coverage rates by race, geography (rural, suburban, urban) and socioeconomic status.

Goal #4: Decrease the burden of influenza disease.

Objective 4.1:

Increase influenza immunization rates of adults aged 65 years and older by 10% to 66.2%.
In November 2015, a revised target of 70% was set for 2018.
Baseline: 60.2%; Year 2011; Data Source: BRFSS and Expanded BRFSS; Data Availability: state, county), HP 2020 (IID ‐ 12.7) target: 90%

• Increase the number of hospitals that offer influenza vaccine to families and caregivers of newborns (including post-partum mothers).
• Increase the number of doses given by hospitals to families and caregivers of newborns (including post-partum mothers).
• Increase the number of doses given by hospitals to adults aged 65 years and older.
• Increase the number of health care personnel vaccinated with influenza vaccine each year.
• Increase the number of providers who offer influenza vaccine to adults.
• Identify and reduce disparities in vaccine coverage rates by race, geography (rural, suburban, urban) and socioeconomic status.

Objective 4.2:

Increase pneumococcal immunization rates of adults aged 65 years and older by 10% to 71.7% to prevent secondary pneumococcal infection.

(Baseline: 65.2%, Year: 2010; Data Source: BRFSS and Expanded BRFSS; Data Availability: State, county)

• Increase the number of doses given by hospitals to adults aged 65 years and older.
• Increase the number of providers who offer pneumococcal vaccine to adults.
• Identify and reduce disparities in vaccine coverage rates by race, geography (rural, suburban, urban) and socioeconomic status.

Goal #5: Goal 5: Decrease the burden of disease caused by human papillomavirus.

Objective 5.1:

Increase HPV immunization rates. Increase the three-dose HPV immunization rate among adolescent females, ages 13-17 years, by 45% to 50%.

(Baseline: 34.2%, Year: 2011; Data Source: NIS; Data Availability: State, county (NYSIIS))

• Increase the number of providers who offer HPV vaccine.
• Identify and reduce disparities in vaccine coverage rates by race, geography (rural, suburban, urban) and socioeconomic status.

Goal #6: Increase adult immunization rates.

Objective 6.1:

Increase Tdap immunization rates in adults, as in Objective 3.1

Objective 6.2:

Increase influenza immunization rates in adults, as in Objective 4.1.

Objective 6.3:

Increase pneumococcal immunization rates in adults, as in Objective 4.2.

Objective 6.4:

Increase HPV immunization rates in adults, as in Objective 5.1.

Objective 6.5:

Identify and reduce disparities in vaccine coverage rates by race, geography (rural, suburban, urban) and socioeconomic status.

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Goal #1: Improve Childhood and Adolescent Immunization Rates

Goal #1: Improve Childhood and Adolescent Immunization Rates
Levels of Health Impact Pyramid *	Interventions
Counseling and Education	Improve efforts to educate patients, parents, children and schools about immunization and the importance of low exemption rates. Ensure and enforce strong immunization requirements for school entry. Reach out proactively to media outlets to educate them on immunization.
Clinical Interventions	Disseminate and work to implement best practices in immunization to change the practice context and ensure that immunizations are given at every opportunity. Provide immunizations for adolescents in schools. Consider alternate distribution methods for vaccines to ensure that health care providers have adequate supply. Ensure that hospitals offer vaccinations to families of newborns.
Long-Lasting Protective Interventions	Provide immunizations for adolescents in schools. Improve the ability to exchange immunization information between the New York State Immunization Information System/city-wide Immunization Registry (NYSIIS/CIR) and electronic health records. Increase adult immunization rates.
Changing the Context to Make Individuals' Decisions Healthy	Ensure and enforce strong immunization requirements for school entry. Improve the ability to exchange immunization information between the New York State Immunization Information System/city-wide Immunization Registry (NYSIIS/CIR) and electronic health records. Ensure immunization coverage by insurers. Disseminate and work to implement best practices in immunization to change the practice context and ensure that immunizations are given at every opportunity.
Socioeconomic Factors	Investigate, research and work to eliminate disparities in vaccination rates.
* Frieden T., "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

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Goal #2: Educate all parents about the importance of Immunizations
Levels of Health Impact Pyramid *	Interventions
Counseling and Education	Improve efforts to educate patients, parents, children and schools about immunization. Reach out proactively to media outlets to educate them on immunization.
Clinical Interventions	Provide educational materials to patients, parents and schools about the importance of immunization. Work to increase the number of adults vaccinated during health care visits. Offer immunizations in the birthing hospital to parents, caregivers and families of newborns.
Long-Lasting Protective Interventions	Ensure that laws are implemented requiring hospitals to offer vaccinations to parents, caregivers and families of newborns. Monitor the number of providers who immunize pregnant women and to other adults in routine health care settings.
Changing the Context to Make Individuals' Decisions Healthy	Ensure strong immunization requirements for school entry. Analyze exemption rates by school and publish results by county. Reach out proactively to media outlets to educate them on immunization.
Socioeconomic Factors	Investigate, research and work eliminate disparities in vaccination rates by race, geography (rural, suburban, urban) and socioeconomic status.
* Frieden T., "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

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Goal #3: Decrease the burden of pertussis disease
Levels of Health Impact Pyramid *	Interventions
Counseling and Education	Educate parents, patients, health care providers and schools about the importance of vaccination against pertussis.
Clinical Interventions
Long-Lasting Protective Interventions	Enhance vaccination of adults with Tdap.
Changing the Context to Make Individuals' Decisions Healthy	Ensure that the law requiring hospitals to offer Tdap to families and caregivers of newborns is implemented and enforced.
Socioeconomic Factors	Investigate, research and work eliminate disparities in vaccination rates by race, geography (rural, suburban, urban) and socioeconomic status.
* Frieden T., "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

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Goal #4: Decrease the Burden of Influenza Disease

Goal #4: Decrease the Burden of Influenza Disease
Levels of Health Impact Pyramid *	Interventions
Counseling and Education
Clinical Interventions
Long-Lasting Protective Interventions	Consider alternate distribution methods for influenza vaccine to ensure that health care providers have adequate supplies. Provide immunizations for adolescents in schools. Enhance vaccination of adults with influenza vaccine. Enhance vaccination of adults with influenza vaccine.
Changing the Context to Make Individuals' Decisions Healthy	Ensure that law requiring hospitals to offer influenza vaccine to families of newborns is implemented and enforced.
Socioeconomic Factors	Investigate, research and work eliminate disparities in vaccination rates by race, geography (rural, suburban, urban) and socioeconomic status.
* Frieden T., "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

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Goal #5: Decrease the burden of disease caused by human papillomavirus (HPV)

Goal #5: Decrease the burden of disease caused by human papillomavirus (HPV)
Levels of Health Impact Pyramid *	Interventions
Counseling and Education	Educate the public and providers on the importance of HPV vaccine.
Clinical Interventions
Long-Lasting Protective Interventions	Enhance vaccination of adults with HPV vaccine. Make HPV vaccine available in family planning, STD treatment and other primary care settings.
Changing the Context to Make Individuals' Decisions Healthy	Ensure that insurance coverage and reimbursement of HPV vaccine is adequate.
Socioeconomic Factors	Investigate, research and work eliminate disparities in vaccination rates by race, geography (rural, suburban, urban) and socioeconomic status.
* Frieden T., "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

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Goal #6: Increase Adult Immunization Rates

Levels of Health Impact Pyramid *	Interventions
Counseling and Education	Educate the public and providers on the importance of HPV vaccine.
Clinical Interventions	Increase the number of hospitals that offer Tdap to families and caregivers of newborns (including post-partum mothers). Increase the number of adult providers, including OB/GYNs, who offer HPV, Tdap, influenza and pneumococcal immunizations. Increase the number of doses given by hospitals to families and caregivers of adults.
Long-Lasting Protective Interventions	Enhance vaccination of adults with HPV, Tdap, influenza and pneumococcal vaccines. Make HPV vaccine available in family planning, STD treatment and other primary care settings.
Changing the Context to Make Individuals' Decisions Healthy	Ensure that insurance coverage and reimbursement for adult immunizations, with HPV, Tdap, influenza and pneumococcal vaccines, are adequate.
Socioeconomic Factors	Identify and reduce disparities in vaccine coverage rates and availability by race, geography (rural, suburban, urban) and socioeconomic status.
* Frieden T., "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

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Interventions and Activities by Sector

Change can be made across all sectors to improve health outcomes for people living with HIV/AIDS. Below are examples of how your sector can make a difference.

Healthcare Delivery System

Goal #1:

Improve childhood/adolescent vaccination rates.

• Disseminate and work to implement best practices in immunization to change the practice context and ensure that immunizations are available at every opportunity.
  • Audit and provide feedback on practices' rates and rank practices within their county, city and Statewide.
  • Maximize the use of NYSIIS and the CIR to provide feedback to practices.
  • Promote use of reminder and recall systems in practices.
  • Ensure children receive all vaccines for which they are eligible at each encounter. Avoid missed opportunities.
  • Promote use of standing orders where possible.
  • Promote knowledge of evidence-based medical exemptions.
• Improve the ability to exchange immunization information between NYSIIS/CIR and electronic health records.
  • Work to influence EHR vendors to enable data exchange between NYSIIS/CIR and their products.

Goal #2:

Educate all parents about the importance of immunizations.

• Improve efforts to educate patients, parents, children and schools about immunization and the importance of low exemption rates.
  • Disseminate materials that address misconceptions.
  • Address adult hesitancy, especially for influenza vaccine and for health care workers.

Goal #3:

Decrease the burden of pertussis.

• Ensure that laws are implemented and enforced requiring hospitals to offer Tdap to families of newborns.
  • Survey and monitor the number of hospitals that offer Tdap to families and caregivers of newborns.
  • Survey number of Tdap doses that hospitals administer to families and caregivers of newborns.
• Enhance vaccination of adults with Tdap.
  • Survey and monitor the number of adult providers that vaccinate with Tdap.
  • Support vaccination of family members with Tdap in pediatricians™ office and hospitals.
• Educate parents, patients, health care providers and schools about the importance of vaccination against pertussis.

Goal #4:

Decrease burden of influenza.

• Ensure vaccination of adults with influenza vaccine.
  • Support vaccination of family members with influenza vaccine in all types of health provider offices.
• Provide influenza immunizations for adolescents in schools.

Goal #5:

Decrease the burden of HPV.

• Educate the public and providers on the importance of HPV vaccine.
  • Educate the public and providers on the safety of HPV vaccine.
  • Educate the public and patients on the misconceptions surrounding HPV vaccine.
• Make HPV vaccine available in family planning, STD treatment and other relevant care settings.
• Enhance vaccination of adults with HPV vaccine.
• Ensure that insurance coverage and reimbursement of HPV vaccine is adequate.

Employers, Businesses and Unions

Goal #4:

Decrease the burden of influenza.

• Enhance vaccination of adults with influenza vaccine.

Goal #5:

Decrease the burden of HPV.

• Educate the public and providers on the importance of HPV vaccine.
• Ensure that insurance coverage and reimbursement of HPV vaccine is adequate.

Media

Goal #2:

Educate all parents about the importance of immunizations.

• Improve current efforts to educate patients, parents, children and schools about immunization and the importance of vaccination against pertussis.
  • Disseminate materials to assist health providers to speak with patients and families.
  • Disseminate materials to the media to alert them to misconceptions that were disseminated in the past.
  • Provide education and support to health providers regarding vaccine information; and address parental hesitancy.
  • Educate providers about evidence-based medical exemptions.
  • Address adult hesitancy, especially for influenza vaccine and for health care workers.

Goal #3:

Decrease the burden of pertussis.

• Work with organizations that can influence the media to proactively educate media outlets on immunization.
  • Educate parents and patients regarding pertussis disease and how best to prevent it.
  • Educate new parents in hospitals.
  • Educate health care personnel in all settings.

Goal #5:

Decrease burden of HPV

• Educate the public and providers on the importance of HPV vaccine.

Academia

Goal #1:

Improve childhood and adolescent vaccination rates.

• Disseminate and work to implement best practices in immunization to change the practice context and ensure that immunizations are given at every opportunity.
• Investigate, research and work to eliminate disparities in vaccination rates.

Goal #2:

Educate all parents about the importance of immunizations.

• Improve efforts to educate patients, parents, children and schools about immunization and the importance of low exemption rates.
  • Develop materials to assist health care providers in speaking with patients and families.
  • Develop materials that address misconceptions.
  • Develop education on vaccine information to address adult and parental hesitancy.

Community-Based Organizations

Goal #1:

Improve childhood/adolescent vaccination rates.

• Disseminate and work to implement best practices in immunization to change the practice context and ensure that immunizations are given at every opportunity.

Goal #2:

Educate all parents about the importance of immunizations.

• Improve efforts to educate patients, parents, children and schools about immunization and the importance of low exemption rates.
• Reach out proactively to media outlets to educate them on immunization.

Goal #3:

Decrease burden of pertussis.

• Educate parents, patients, health care providers and schools about the importance of vaccination against pertussis.

Goal #4:

Decrease burden of influenza.

• Enhance vaccination of adults with influenza vaccine.

Goal #5:

Decrease burden of HPV.

• Educate the public and providers on the importance of HPV vaccine.

Other Governmental Agencies

• Disseminate and work to implement best practices in immunization to change the practice context and ensure that immunizations are given at every opportunity.
• Ensure and enforce strong immunization requirements for school entry.
• Ensure immunization coverage through State and Federal law.
  • Expand insurance law to include adequate reimbursement for immunizations and administration fees.
  • Monitor implementation of the Affordable Care Act.

Goal #2:

Educate all parents about the importance of immunizations.

• Improve efforts to educate patients, parents, children and schools about immunization and the importance of low exemption rates.
• Ensure and enforce strong immunization requirements for school entry.

Goal #3:

Decrease burden of pertussis.

• Enhance vaccination of adults with Tdap.
  • Survey and monitor the number of adult providers that vaccinate with Tdap.
  • Support vaccination of family members with Tdap in pediatricians' offices and birthing hospitals.
  • Include adults in the mandate for reporting to NYSIIS/CIR.
  • Monitor that vaccines are covered for adults through the Affordable Care Act.

Goal #4:

Decrease burden of influenza.

• Provide immunizations for adolescents in schools.

Goal #5:

Decrease the burden of disease caused by HPV

• Educate the public and providers on the importance of HPV vaccine.
• Make HPV vaccine available in family planning, STD treatment and other care settings.
• Ensure that coverage and reimbursement of HPV vaccine is adequate.

Governmental Public Health

Goal #1:

Improve childhood/adolescent vaccination rates.

• Disseminate and work to implement best practices in immunization to change the practice context and ensure that immunizations are given at every opportunity.
• Ensure and enforce strong immunization requirements for school entry.
• Improve the ability to exchange immunization information between NYSIIS/CIR and electronic medical records.
• Ensure immunization coverage through State and Federal law; ensure coverage and reimbursement of HPV vaccine is adequate.
• Investigate, research and work to eliminate disparities in vaccination rates.

Goal #2:

Educate all parents about the importance of immunizations.

• Improve efforts to educate patients, parents, children and schools about immunization and the importance of low exemption rates.
• Analyze exemption rates by school and publish results by county.
• Reach out proactively to media outlets to educate them on immunization.

Goal #3:

Decrease burden of pertussis.

• Ensure that laws are implemented and enforced requiring hospitals to offer Tdap to families of newborns.
• Enhance vaccination of adults with Tdap vaccine.
• Educate parents, patients, health care providers and schools about the importance of vaccination against pertussis.

Goal #4:

Decrease burden of influenza.

• Ensure that laws are implemented and enforced requiring hospitals to offer influenza to families of newborns.
  • Survey and monitor the number of hospitals that offer influenza vaccine to families and caregivers of newborns.
  • Survey and monitor the number of doses of influenza vaccine that hospitals administer to families and caregivers of newborns.
• Enhance vaccination of adults with influenza vaccine.
  • Survey and monitor the number of adult providers who vaccinate with influenza vaccine.
  • Survey and monitor the number of providers who vaccinate pregnant women against influenza.
  • Support the vaccination of family members with influenza vaccine in all health care settings.
  • Include adults in the mandate for reporting to NYSIIS/CIR.
  • Monitor that vaccines are covered for adults through the Affordable Care Act.
  • Monitor and survey the number of pharmacists who offer influenza vaccine.
• Provide influenza immunizations for adolescents in schools.
• Survey and monitor influenza immunization rates for health care personnel in hospitals and long-term care facilities.
• Consider alternate distribution methods for influenza vaccine to ensure that health care providers have adequate supply.

Goal #5:

Decrease the burden of disease caused by HPV.

• Educate the public and providers on the importance of HPV vaccine.
• Make HPV vaccine available in family planning, STD treatment and other care settings.

Non-Governmental Public Health

Goal #1:

Improve childhood/adolescent vaccination rates.

• Disseminate and work to implement best practices in immunization to change the practice context and ensure that immunizations are given at every opportunity.

Goal #2:

Educate all parents about the importance of immunizations.

• Improve efforts to educate patients, parents, children and schools about immunization and the importance of low exemption rates.
• Reach out proactively to media outlets to educate them on immunization proactively.

Goal #3:

Decrease burden of pertussis.

• Educate parents, patients, health care providers, and schools about the importance of vaccination against pertussis.

Goal #4:

Decrease burden of influenza.

• Enhance vaccination of adults with influenza vaccine.

Goal #5:

Decrease burden of HPV.

• Educate the public and providers on the importance of HPV vaccine.

Policymakers and Elected Officials

Goal #1:

Improve childhood/adolescent vaccination rates.

• Ensure and enforce strong immunization requirements for school entry.
• Ensure immunization insurance coverage through State and federal law.

Goal #3:

Decrease burden of pertussis.

• Ensure that laws are implemented and enforced requiring hospitals to offer Tdap to families of newborns.

Goal #4:

Decrease burden of influenza.

• Ensure that laws are implemented and enforced requiring hospitals to offer influenza vaccine to families of newborns.

Goal #5:

Decrease burden of HPV.

• Educate the public and providers on the importance of HPV vaccine.
• Ensure that coverage and reimbursement of HPV vaccine is adequate.
  • Monitor that vaccines are covered for adults through the Affordable Care Act.

Communities

Goal #2:

Educate all parents about the importance of immunizations.

• Improve efforts to educate patients, parents, children and schools about immunization and the importance of low exemption rates.

Goal #5:

Decrease burden of HPV.

• Educate the public and providers on the importance of HPV vaccine

Note: The Prevention Agenda 2013-2017 has been extended to 2018 to align its timeline with other state and federal health care reform initiatives.

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