Transcript for CDC Telebriefing: CDC officials to discuss vaccine exemption levels and infant vaccination coverage

OPERATOR: Good afternoon. Thank you all for standing by. Welcome to today’s conference call. At this time all lines are on listen only for today’s conference until the question-and-answer portion of our call, at which time you will be prompted to press star one on your touchtone phone. Please ensure that your line is unmuted so that i may introduce you to ask your question.  We do ask that you keep your questions to one question and one follow-up for today’s conference call.  Our conference is being recorded. If you have any objections you may disconnect at this time.  I’ll now turn the conference over to your host, Mr. Dave Daigle. Sir, you may proceed.

DAVE DAIGLE: Thank you, Jill. Thank you for joining us for this release of CDC’s estimates of vaccine exemption levels among children entering kindergarten for the 2014-2015 school year.  and our release of data from the 2014 national survey which details vaccination estimates among children from ages 19 to 35 months. Joining us today is Dr. Anne Schuchat, she is the director of CDC’s National Center for Immunization and Respiratory Diseases.  We’ll begin with remarks by Dr. Schuchat and then we’ll take questions following. With that I’ll turn it over to Dr. Schuchat. 

ANNE SCHUCHAT: Hello, everybody and thanks for joining us for this update. For our nation’s immunization system, today is report card day, even before many schools open. Today we’re releasing new data from two articles published in the MMWR or Morbidity and Mortality Weekly Report. I’m going to first talk about vaccination coverage and exemption levels among children entering kindergarten for the 2014 to ’15 school year, and then I’ll briefly mention the other article which provides results from the 2014 National Immunization Survey or NIS, which details vaccination coverage among children ages 19 to 35 months or the toddler age group. Overall, the news is gratifying. Though they may not always get the headlines, the overwhelming majority of parents continue to protect their children with recommended vaccinations. The data for children entering kindergarten found state-wide vaccine exemptions remains low for the 2014-15 school year. The median exemption level was 1.7 percent across the states. The median vaccination coverage for reporting states for MMR was 94.0 percent for two doses of MMR. So let me give you a little bit of background about this kindergarten survey. The vaccination coverage data was reported for over 4 million kindergartners.  Exemption data including the number of children with at least one exemption was reported for more than 3.8 million kindergartners. Exemption levels varied from state to state. They ranged from a low of less than .1 percent in Mississippi to a high of 6.5 percent in Idaho. In the full report you can see each state’s data on exemptions as well as their MMR and other coverage.  Parents might have claimed exemptions resulting in their child not receiving certain requirement vaccines, but you need to know some qualifications about the exemptions that were claimed. The type of exemptions allowed varies by states. Every state allows medical exemptions, while many states allow religious or philosophical or personal belief exemptions or both religious and philosophical or personal belief exemptions. It’s important to note that an exemption doesn’t necessarily mean that a child didn’t get vaccinated or was completely unvaccinated. An exemption might be requested for all vaccines, even if a child only missed a single vaccine or a single vaccine dose. In some states, a parent or guardian might actually claim an exemption if they don’t have the child’s vaccination record available. So-called vaccine exemption of convenience if you will. In the questions and answers, I’m happy to talk a bit more about the types of exemptions and these issues. From 2013 to 2014, we saw an increase in the number of states that provided local coverage and exemption data online. This is something I’m really excited about and want to say a few more words about. We saw an increase from 18 states providing the local exemption data for the 2013-14 school year to 21 states providing that data for this recent school year, the 2014-15 year. If we go back a little further, we’ve actually seen a major increase in states making these valuable data accessible. We went from 11 states who made their data available for 2012-13 school year to 21 states who have shared that data locally for the 2014 to 2015 school year. I really want to applaud and recognize the states that routinely are making this information available to parents and families in their own jurisdictions. I’d like to encourage parents who live in these states to find out what’s going on around them, what are the exemption levels or the coverage levels in their area. Remember that not everyone can receive vaccines due to their age or medical reasons, and this past year we’ve seen measles outbreaks affect babies who were too young to receive the MMR vaccine, and of course we always worry about children and others with leukemia or similar medical problems who can’t actually receive the MMR vaccine themselves. Pockets of children who miss vaccinations exist in our communities and they leave these communities vulnerable to outbreaks of vaccine-preventable diseases. I want to turn now to the second report, the NIS report, and you’ll notice that the coverage rates in that article are different from what you saw in the kindergarten report. I’ll just briefly mention why these numbers are different in the two papers. The reports covered different ages of children, and they also differ in how they collect and report the data. The NIS measures vaccinations recommended by age two years, while the kindergarten report describes coverage including for additional booster doses that are recommended by age six years. The NIS is a huge telephone survey of children 19-35 months of age and it also includes a step involving verifying the specific vaccines that a child got through their doctors office or clinic. So recording every single vaccine and the date that the vaccine was delivered. So the NIS, the report that we’re issuing today is based on 14,893 children for whom we had adequate provider data and that provider data allows a number of statistical analyses to be performed. When we look at coverage rates from CDC we’ll typically use these NIS data as the primary source of knowing how we’re doing as a country and across the states in younger children. I can say that there are a number of reasons to be pleased about the data among children ages 19 to 35 months from the NIS. For another year, rates remain high. Vaccination coverage remained over 90 percent for measles, mumps rubella or MMR, polio, hepatitis b and varicella vaccines. The percentage of children who received no vaccines at all remains low, less than 1 percent. There is no significant change in coverage from 2013 to 2014 for the specific vaccines, except we did see an increase in hepatitis a, which is one of the newer recommended vaccines of the ones that we’re tracking. Collaborative efforts from a number of key stakeholders involving federal, state and local government, clinicians, parents, and community organizations have allowed us to achieve such high vaccination rates among children. Achieving these high levels has greatly reduced infectious disease like polio and bacterial meningitis that once routinely killed or harmed many infants and children. However, there’s still work to be done to raise vaccination rates in communities or local pockets where children aren’t fully vaccinated. So this is good news on the whole in that we’ve maintained low levels of exemptions and sustained high national vaccination rates. But when a virus like measles reaches a group of unvaccinated people, trouble can follow. Protecting people from this kind of threat is why achieving and sustaining high local vaccination coverage is so important.  With back to school season here, the latest reports are a reminder to make sure all children are vaccinated against serious diseases. So I urge parents to give their children the best protection from vaccine-preventable diseases by talking with their clinicians to see if any vaccines are needed for their child. You can make sure your kids begin with a good report card even before they start kindergarten. By getting the recommended vaccines. I can turn things back over to Mr. Daigle for questions. 

DAVE DAIGLE: Thank you. Jill, we’re ready to take questions at this time. 

OPERATOR: Thank you. Once again if you would like to ask a question, please press star one on your touchtone phone. Please ensure that your line is unmuted and please record your name slowly and clearly to be produced. Once again, we are limiting questions to one question and one follow-up.  Our first question is from Mike Stobbe with the Associated Press. Your line is open. 

MIKE STOBBE: Hi, thank you for taking the question.  I just wanted to make sure I was clear about when you were talking about the 21 states and their posting information about vaccinations so that parents and others can see it at the local level. You’re talking about data that’s school specific or school — maybe it varies from state to state, but are you talking about both coverage and exemption information for each community or are you talking at the school level?  And I do have a follow-up. 

ANNE SCHUCHAT: Thank you, Mike. The states that are posting data post different amounts of data and different granularity. In general health departments will not post information for a very small school, one with ten kids or something like that. But some of the states are posting information for other regions of the state or the county or the school district or the school, and this is varying across the states based on their own assessment of what would be useful. We think it’s great that 21 states are making that more local data available and the specifics will vary by state. At the CDC level, we just get the aggregate state-wide information and of course that’s what we share in your MMWR on the website. You had a follow-up question? 

MIKE STOBBE: First, to clarify you’re talking about coverage and exemption information? 

ANNE SCHUCHAT: It varies by state, right. 

MIKE STOBBE:  My follow-up was, what do you think or hope parents would do with this if they find out that there’s a high exemption rate, for example, in their community, how would that be useful? 

ANNE SCHUCHAT: The communities play a key role in protecting the health of the families within them. We know that most parents believe that vaccinating their children are the right thing to do. But they are also dependent on people around them and so we hope there will be greater recognition protection at the family level is dependent on the community. This past year we did see cities and states begin discussions about school requirements and so forth and so we think it’s important for us to recognize when we have vulnerabilities, perhaps we should get together about what’s important to them to keep kids healthy. 

DAVE DAIGLE: Next question, please, Jill. 

OPERATOR: The next question is from Betsy McKay with the Wall Street Journal. Your line is open. 

BETSY MCKAY: Hi.  I have a follow-up on Mike’s questions which are, is it the ultimate goal to try to get all the states to do this? I assume so, so that you could create, rather than data — aggregate data at the federal level, that you might actually have something like a complete picture of the U.S. which would show where every pocket of vaccination is? 

ANNE SCHUCHAT: I think information is very powerful and when we have information it’s important to share it with the people who have an interest in it. We do encourage states to share the data with consumers and we’ve seen how for many conditions consumers knowing about health conditions can start to help improve them. On the one hand, I think parents may want to know, in that school that I’m thinking of sending my child to, is there a risk of vaccine-preventable diseases because there’s such a high exemption rate. On the other hand, as public health experts, local data can be very helpful for us to understand where do we need to put our attention, where do we have real risks for vaccine-preventable diseases, 25 years ago the neighborhoods that had the lowest vaccination rights were poor communities and parents wanted to get their kids vaccinated. The vaccines for children program helped us recognize that we had to take care of those pockets of vulnerability. Currently we don’t have a good feel for what’s going on at the local level and so we hope that public health and community groups can learn what’s going on at the local level and try to improve the areas that need improvement. 

DAVE DAIGLE: Thank you, Betsy. Next question, please, Jill. 

OPERATOR: Our next question is from Dan Childs with ABC News. Your line is open. 

DAN CHILDS: Thank you very much for taking my question. Some states are really examining now their religious and personal beliefs exemption laws. What’s the CDC’s position on whether such exemptions should exist at all in any state? 

ANNE SCHUCHAT: The decision to — the nature of requirements for immunization for school attendance is a state or local jurisdiction matter, but there’s a very strong evidence base that shows that enforcement of school requirements for measles coverage was very important in our finally getting control and then eventually eliminating measles transmission in the U.S.  We know that the more difficult it is to obtain an exemption, the more — the fewer people will exempt their children from vaccines and we certainly think it should be easier to get a vaccine than to get an exemption from a required vaccination. So these policy decisions are made at the state level and we think that’s helpful because it will reflect the community or local values.  What CDC does is tries to share the evidence base about the science of exemptions and school requirements and disease risk and outbreak risk and really encourage an environment where children are protected from vaccine-preventable diseases when they go to school. 

DAN CHILDS: Just one follow-up question.  I know that with this last outbreak, given the spread that we saw between states — it wasn’t just confined to California but it spread to other states as well. Is this an issue that the CDC believes should be handled by the states and not by the federal government? 

ANNE SCHUCHAT: One thing to say about this past year’s outbreak is we did see a large outbreak and we saw it spread to six states beyond California, but the largest outbreak spread from the Disney exposures was in Canada when the virus got into a community with a school with very low coverage rates. So we were lucky that in the U.S. we do have high coverage rates and most schools have high coverage rates and low exemptions and we didn’t see large outbreaks in schools. In one of the provinces in Canada they had more than 100 cases attributed to the spread from the Disney exposure because of a big pocket of under vaccinated. CDC really wants to get the information to consumers and to communities and to the health departments so that they can protect people locally and we do think that vaccines are saving lives. They’re safe and effective, and most parents do want to protect their children. We just remind people that babies under 12 months aren’t routinely vaccinated against measles and they really need the other people in the community to be vaccinated to protect them. 

DAVE DAIGLE: Next question. 

OPERATOR: It’s from Melissa Jenco with AAP News. Your line is open. 

MELISSA JENCO: Can you address the kindergarten numbers compared to last year? It looked like they were down a little bit for MMR vaccinations. 

ANNE SCHUCHAT: Right. The median MMR two-dose coverage was 94.0 percent. In the median across the states for MMR kindergarten coverage for two doses last year was 94.7 percent. We don’t actually do statistical analyses on these medians. As I mentioned, the way that the kindergarten data are gathered differ state to state and sometimes year to year. Some of the states conducting full census of all the kindergartners in the state and some of them do samples. So a .7 percentage point difference wouldn’t be something that we would statistically analyze and it may not be a very important change. Obviously we do want to share the data and continue to look at them. Our target is 95 percent. So we haven’t reached our target yet and we would like to reach it. 

DAVE DAIGLE: Thank you.  Next question, please, Jill. 

OPERATOR: As a reminder, if you would like to ask a question, please press star one on your touchtone phone. Please record your name and affiliation to be introduced and please limit your question to one question and one follow-up. We have a question from Tim Darragh with The Star Ledger.  Your line is open, sir. 

TIM DARRAGH: Thank you for taking my call. You just answered my primary question but I’ll ask you to follow up with a little bit more information about what happened in that Canadian province. 

ANNE SCHUCHAT: Right. Unfortunately, I’ll have to refer you to the Canadian authorities to give more information, but as I understand it, they did have a relatively large outbreak. We know the measles was exported from California, from that outbreak, to six other states and to Mexico and Canada. When the virus reached one part of Canada, there was several generations of spread, including a large school affected outbreak. But the Canadian authorities would be able to give you more information about that. 

DAVE DAIGLE: Thank you, Tim.  Jill, next question, please. 

OPERATOR: Our next question comes from Maggie Fox with NBC News.  Your line is open, ma’am. 

MAGGIE FOX: Thanks very much. I’m afraid I didn’t quite understand what you were saying when you said we’re not sure what’s happening at the local level. Can you clarify a little bit on that? Is it the case that you’re not sure that the 1 percent or so who aren’t being fully immunized, what the reasons are because they can’t access the vaccines or what? 

ANNE SCHUCHAT: I’m sorry, let me clarify. We measure the toddler coverage through a sample of about 15,000 children, and that allows us to make estimates for every state with a certain margin of error, but it doesn’t let us know what’s going on in every county or every neighborhood in terms of toddler vaccinations. What we found over the past 25 years during certain outbreaks is while things looked reasonably good at the state level, there were sometimes areas within the state where there were many unvaccinated people. You may remember last year in 2014 Ohio experienced a large outbreak of measles. It was in an Amish community that was very under vaccinated. The disease didn’t spread to the rest of the state, but that particular community wasn’t necessarily on the radar as a highly vulnerable population.  When I say we don’t know what’s going on at the local level, our data are at the level of the state.  With the kindergarten data, we get the aggregate for the state.  We don’t get the data at every school, whereas the states will get data at a more local level. Viruses spread locally.  Measles can be on any airplane going to the state, but when it gets here it’s going to likely spread in the geographic proximity of where a person is, and we don’t have data at that level right now for immunization coverage. Perhaps one day with our immunization registries we’ll have data at a smaller area than just the state level, but right now, we are missing that kind of precision in our estimates. You can have over 95 percent coverage in a state and still have some communities with much lower coverage. 

DAVE DAIGLE: Next question, please, Jill. 

OPERATOR: Our final question is from the Mike Stobbe with Associated Press. Your line is open, sir. 

MIKE STOBBE: Thanks. I just wanted to get one more. I think some people may wonder regarding that earlier discussion about the 21 states sharing the information, some people may wonder why doesn’t CDC just post the information. Do you have local level kindergarten information about school district exemption rates or their complications or challenges in getting contracts to the states for them to share the data and CDC to be the distributor of it? Why doesn’t the CDC just post it? 

ANNE SCHUCHAT: The CDC doesn’t have it. That’s why we don’t post it. 

MIKE STOBBE: Thank you. 

ANNE SCHUCHAT: That doesn’t mean we will never get it, but, the states that are posting it, have the data to post. The states report to us. 

ANNE SCHUCHAT:  I do want to just say that it’s exactly the right time of year for parents to be checking whether their children are fully vaccinated and to remember the parents need vaccines, too. We are pleased with this year’s work on the state’s kindergarten coverage and the toddler coverage across the country, but we know that we can’t stop now because babies are being born every day and need a number of vaccines to keep them healthy and safe throughout their life. Thanks for calling and check your kids’ vaccinations records. 

DAVE DAIGLE: Thank you Jill and thank you all reporters who participated on this call. A transcript of this call will be made available through the CDC media relations website later this afternoon. For additional information, reporters may call the CDC press office at 404-639-3286. 

OPERATOR: We thank you all for participating.  You may disconnect, and have a great rest of your day.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES