Modifications to Objectives and Subobjectives

The following discussion highlights the modifications, including changes, additions, and deletions, to this focus area’s objectives and subobjectives as a result of the midcourse review.

Chronic hepatitis C became a nationally notifiable disease in January 2003. The objective for identifying persons with chronic hepatitis C infection (14-10) was changed from monitoring the proportion of persons with chronic hepatitis C to the number of States and the District of Columbia that report these persons. States began reporting hepatitis C cases as they established laboratory reporting and developed registries.

Objective 14-13 was reworded from "increase the proportion of contacts and other high-risk persons with latent tuberculosis infection who complete a course of treatment" to "increase the proportion of persons with latent tuberculosis infection who complete a course of treatment."

Monitoring antibiotic use in intensive care units (ICUs) (14-21) was changed to focus exclusively on vancomycin use. A focus on vancomycin as a specific antimicrobial agent rather than a varying collection of antimicrobials is important because vancomycin is a last line of defense in combating some infections.

Two subobjectives were added for effective vaccination coverage levels for universally recommended vaccines among children aged 19 to 35 months: four doses of pneumococcal vaccine (14-22g) and one dose of influenza vaccine (recommended for children aged 6 to 23 months) (14-22h). In response to recommendations for new vaccines from the Advisory Committee on Immunization Practices (ACIP),² two subobjectives were added to vaccination coverage for children in day care. The first (14-23k) monitors pneumococcal conjugate vaccine, and the second (14-23l) tracks Haemophilus influenzae type (Hib) vaccine. Objective 14-25 was reworded from "increase the proportion of providers who have measured the vaccination coverage levels among children in their practice population within the past 2 years" to "increase the proportion of providers who have had vaccination coverage levels among children in their practice population measured within the past 2 years." In addition, a new subobjective was added to track influenza vaccine rates of health care workers (14-29g).

To reflect the commitment of the U.S. Department of Health and Human Services (HHS) to the safety of vaccines, objective 14-31 was modified to "increase the scientific knowledge on vaccines and adverse events," and two subobjectives were added. Subobjective 14-31a aims to increase the number of persons under active surveillance for vaccine safety (previously 14-31, now 14-31a). Subobjective 14-31b seeks to increase the proportion of total Vaccine Adverse Event Reporting System (VAERS) reports submitted electronically. VAERS serves as the national surveillance system for detecting possible new vaccine safety concerns.³

As stated in Healthy People 2010: "Most developmental objectives have a potential data source with a reasonable expectation of data points by the year 2004 to facilitate setting 2010 targets in the mid-decade review. Developmental objectives with no baseline at the midcourse will be dropped." Accordingly, at the midcourse review, the objective for prevention services for international travelers (14-15) was deleted because it lacked a data source. However, HHS and the agencies that serve as the leads for the Healthy People 2010 initiative will consider ways to ensure that these public health issues retain prominence despite the current lack of data.

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