Immunization and Infectious Diseases

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The decline in vaccine preventable disease is one of the most significant public health accomplishments of the 20th century. Immunization can prevent the debilitating, sometimes fatal, effects of infectious diseases such as polio, measles and rubella. Additional benefits include prevention of work loss by parents to care for ill children and prevention of lost earnings from disability. 
      Organisms that cause vaccine preventable diseases have not disappeared. Rather, they have receded and will reemerge if vaccination coverage drops. Vaccines protect both vaccinated individuals and protect communities as well. When vaccination levels in a community are high, the few who are not vaccinated often are indirectly protected. Vaccination coverage levels above 90% of the population are usually sufficient to prevent circulation of viruses and bacteria causing vaccine preventable disease. 
     Vaccine preventable diseases can cause illness in all age groups, but elderly persons with chronic health conditions such as heart disease, diabetes and chronic respiratory disease are particularly at risk. In 1998, 296 New Hampshire residents died of pneumonia and influenza. An annual influenza vaccine and a lifetime dose of pneumococcal vaccine are effective strategies to prevent and reduce illness and deaths from these highly infectious diseases. 
     Strategies to protect people from vaccine-preventable diseases include: educating health care providers about the importance of childhood and adult immunization; minimizing financial barriers to obtaining vaccinations; improving vaccine service delivery and monitoring of vaccinations; increasing community participation, education and partnership; and entry requirements for school and childcare.
     State registries that enroll children and record their vaccinations are another valuable tool for helping parents and providers identify immunization needs of individual children, assessing coverage in individual practices, and generating community wide estimates of immunization status. New Hampshire’s immunization registry moved from pilot testing to provider enrollment in late 2000.

Objective: 
Increase the percentage of two year olds who receive all universally recommended vaccines.

	NH Baseline 1999	78%24
	US Baseline 1998	73% (does not include varicella)6
	NH Target 2010	90%

Objective: 
Increase the percentage of adolescents who receive all recommended vaccines.

	NH Baseline 1999	98% (without 3 Hepatitis B)25
	US Baseline	NA
	NH Target 2010	98% (with 3  Hepatitis B)

The threat of illness and disability caused by vaccine preventable diseases, such as hepatitis B and measles, continue beyond childhood. Public health partnerships with schools help to ensure high vaccination levels among adolescents. 

Objective: 
Increase the percentage of independently living adults age 65 or over who report ever having been vaccinated against pneumococcal disease.

	NH Baseline 1999	60%21
	US Baseline 1999	55%22
	NH Target 2010	90%

In the United States, the estimated annual incidence of pneumococcal infection among the population aged 65 years and older is 50-83 cases per 100,000 persons. One of every 20 individuals who contract pneumococcal pneumonia dies from the infection. The death rate among adults age 65 years and over is even higher. 

Objective: 
Increase the percentage of independently living adults, age 50 or over, who report having been vaccinated against influenza in the last 12 months.

	NH Baseline 1997	46%16
	US Baseline 1997	NA
	NH Target 2010	80%

Seniors account for 90% of influenza related deaths in the United States. In April 2000, the Advisory Committee on Immunization Practices (ACIP) recommended universal vaccination of all adults 50 years of age and older for influenza. 

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