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FY 2007 HHS Annual PlanStrategic Goal 1
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Performance Measure Table |
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Performance Measure: Achieve or sustain immunization coverage of at least 90% in children 19- to 35-months of age for: 4 doses DTaP vaccine1, 3 doses Hib vaccine, 1 dose MMR vaccine2, 3 doses hepatitis B vaccine, 3 doses polio vaccine, 1 dose varicella vaccine, 4 doses pneumococcal conjugate vaccine (PCV7)3 |
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Year |
Target |
Result |
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2007 |
90% coverage |
8/2008 |
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2006 |
90% coverage |
8/2007 |
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2005 |
90% coverage |
8/2006 |
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2004 |
90% coverage |
DTaP 86%; Hib 94%; MMR 93%; Hepatitis B 92%; Polio 92%; Varicella 88% |
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2003 |
90% coverage |
DTaP 96%; Hib 94%; MMR 93%; Hepatitis B 92%; Polio 92%; Varicella 85% |
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2002 |
90% coverage |
DTaP 95%; Hib 93%; MMR 91%; Hepatitis B 90%; Polio 90%; Varicella 81% (exceeded with the exception of Varicella) |
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Data Source: Data are collected through the National Immunization Survey (NIS) and reflect calendar years. |
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Data Validation: The NIS uses random-digit-dialing to find households with children aged 19 to 35 months. Parents or guardians verbally provide the vaccines-with dates-that appear on the child's "shot card" kept in the home; and demographic and socioeconomic information is asked. Permission is asked to contact the child's vaccination providers. Providers are contacted by mail to verify each child's vaccinations. The NIS uses a nationally representative sample, and provides estimates of coverage that are weighted to represent the entire population, nationally, and by region, state, and selected large metro areas. The large sample size allows for stratification of the data so that vaccination rates among different groups, for instance, by income level, race, education level of mothers, and other factors can be examined. |
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Performance Budget Reference: CDC FY 2007 CJ. |
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Due to a shortage in vaccine and temporary change in recommendations, 3 doses were reported from 2002 - 2003. |
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Includes any measles-containing vaccine. |
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Performance targets for any newly recommended vaccines, such as pneumococcal conjugate vaccine and influenza vaccine, are reported in GPRA five years after ACIP recommendation. Measures for pneumococcal conjugate vaccine (PCV7) will begin in 2006 and influenza in 2009. |
The target of 90 percent coverage was met in 2004 for most individual vaccines, except varicella and diphtheria-tetanus-acellular pertussis (DTaP). In 2004, the coverage rate for four doses of DTaP containing vaccine did not yet achieve the 90 percent goal. However, the coverage rate for the fourth dose has steadily increased since the change to a four dose schedule, as recommended by the Advisory Committee on Immunization Practices (ACIP) in 1991. This goal continues to be difficult to achieve because it requires that the fourth dose be given to the child between 15 and 18 months of age. The administration of DTaP tends to coincide with regular well-baby visits through the third dose; however, the fourth dose does not, requiring a visit specifically for this purpose. Coverage rates are 96 percent for the first three DTaP doses. In 2002 and 2003, CDC modified reporting on DTaP from four doses to three doses because vaccine shortages limited the availability of the fourth dose. This change was made because the ACIP recommends that if this vaccine is in short supply, or not available, the fourth dose of DTaP may be dropped. The performance reporting change was temporary and reporting for the fourth dose has now been implemented.
Varicella is the most recently introduced vaccine that has a measurable target. Varicella vaccination rates are rising with coverage at only 43 percent in 1998, reaching 88 percent in 2004. CDC is close to meeting the 90 percent varicella vaccine coverage goal which is especially impressive this soon after the introduction of this particular vaccine, since a child that has already been exposed to chickenpox does not receive the varicella vaccine.
The prevention of pneumococcal infections with pneumococcal conjugate vaccine (PCV) is becoming more important due to problems with treatment as a result of increasing antibiotic resistance. ACIP added PCV to the 2001 Recommended Childhood Immunization Schedule. As this vaccine was recently recommended, accountability for performance targets will begin in 2006. The vaccination coverage level for PCV in 2004 is 73.2 percent.
Vaccines are one of the most successful and cost effective public health tools for preventing disease and death. An economic evaluation of the impact of seven vaccines (DTaP, Td, Hib, polio, MMR, hepatitis B, and varicella) routinely given as part of the childhood immunization schedule found that vaccines are tremendously cost effective. One dollar spent on these seven vaccines results in $16.50 saved. Routine childhood vaccination with these seven vaccines, which prevents over 14 million cases of disease and over 33,500 deaths, resulted in annual cost saving of $10 billion in direct medical cost and over $40 billion in indirect societal costs. This study in the Archive of Pediatrics and Adolescent Medicine is the first time the seven vaccine series has been examined together with a common methodology.1
Cost-Effectiveness of Childhood Vaccines2
For every $1 spent on an individual vaccine:
For every $1 spent:
* (DTaP, Td, Hib, IPV, MMR, Hep B and Varicella)
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Zhou, et al., Archives Pediatric Adolescent Medicine, 159(Dec 2005):1136-1144 |
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DTaP: Ekwueme et al, Archives Pediatric Adolescent Medicine, 154(Aug 2000): 797-803 MMR: Zhou, et al., J Infectious Disease, 189(2004): S131-145 Hib: Zhou, et al., Pediatrics, 110:4(Oct 2002): 653-661 HepB: Zhou, et al., CDC unpublished data Varicella: Lieu, et al., JAMA, 271(1994): 375-81 IPV: Zhou, et al., CDC unpublished data. |
Performance Measures
CDC's overarching goal in HIV is to reduce the number of new HIV infections in the U.S. as measured by the number of HIV infections diagnosed each year among people less than 25 years of age. CDC's goal is consistent with HHS's strategic goal to reduce the major threats to the health and well-being of Americans.
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Performance Measure Table |
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Performance Measure: Reduce the number of HIV infection cases diagnosed each year among people under 25 years of age, from 2,100 in 2000. |
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Year |
Target1 |
Result |
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2007 |
<4,000 reported cases in 30 areas |
11/2008 |
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2006 |
**2,420 reported cases in 30 areas |
11/2007 |
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2005 |
1,800 reported cases in 25 states |
11/2006 |
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2004 |
1,900 reported cases in 25 states |
2,606* in 25 states*; |
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2003 |
N/A |
2,286*** in 25 states*; |
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2002 |
N/A |
2,154*** in 25 states*; |
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Data Source: HIV/AIDS Reporting System (HARS ) |
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Data Validation: HIV data collection systems vary between areas (e.g., name-based code, coded identifier, name-to-code data collection systems). CDC recommends that all states and territories adopt confidential name-based HIV surveillance systems. As of November 2005, 43 states and territories use confidential name-based HIV surveillance while 13 other state and local health departments used code-based or name-to-code methods. *The 25 states with mature, stable HIV surveillance systems at baseline are: Alabama, Arizona, Arkansas, Colorado, Idaho, Indiana, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia, West Virginia, Wisconsin, Wyoming. **The 30 area comparison group includes the 25 states listed above plus Florida, Iowa, Nebraska, New Mexico, and the U.S. Virgin Islands. ***The period of time between a diagnosis of HIV or AIDS and the arrival of a case report at CDC is called the "reporting delay". In order to provide the best estimates of recent trends, HIV and AIDS surveillance data are analyzed by date of diagnosis and are statistically adjusted for reporting delays and incomplete information on some cases. CDC requires a minimum of 12 months after the end of a calendar year to provide accurate estimates of trends for that year. All data have been modified to update annual "actual performance" numbers based on the most recent HIV/AIDS surveillance data. Therefore, estimates vary slightly from year to year. |
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Performance Budget Reference: CDC FY 2007 CJ. |
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This measure was first reported in FY 2004 and therefore, targets begin in FY 2004. However, actual performance is shown for previous years because the data was available, even though it was not reported in the form of a measure. |
The number of HIV infection cases among persons under 25 years of age diagnosed each year is currently the best data available to monitor new HIV infections. HIV infections occurring in this group are likely to have been acquired recently and thus are a relatively good proxy measure of HIV incidence. In 2004, there were 2,606 cases reported in 25 areas with confidential name-based reporting. The increase in number of reported cases of HIV/AIDS may reflect both increases in testing for HIV and true increases in HIV among those under 25. For example, recent initiatives to promote HIV testing may have resulted in an increase in the identification of HIV infections among the previously undiagnosed, thus increasing the number of cases that are reported to the health departments. True increases in HIV may have occurred and may be related to recent increases in syphilis and other STDs, which increase risk of HIV transmission and have been reported among men who have sex with men in the U.S. Further, with better survival due to treatment, the overall number of persons living with HIV is increasing, which in turn increases the probability of infection for young persons engaging in high-risk behaviors. Recent initiatives to greatly expand HIV testing are expected to have a substantial impact on the proportion of infected persons who are diagnosed. Therefore, in the short term, the number of cases diagnosed and reported to CDC is expected to rise. The FY 2007 target has been adjusted accordingly. In the long-term, helping people learn of their infection and providing them prevention services is expected to decrease the number of new infections.
Initially, targets were set when only 25 states had stable, confidential name-based HIV reporting. In 2004, additional data were available from five states and territories and the FY 2006 and FY 2007 targets were adjusted to reflect the total 30 areas. Both are reported for purposes of comparison.
A dramatic reduction in perinatal (mother-to-child) HIV transmission cases has been noted in the U.S., a result of the widespread implementation of the Public Health Service (PHS) recommendations made in 1994 and 1995. Recommendations included routinely counseling and voluntarily testing pregnant women for HIV, and offering zidovudine (AZT) to infected women during pregnancy and delivery, and their infants, post-partum. Further decreasing perinatal HIV transmission is one of four strategies included in CDC's Advancing HIV Prevention (AHP) Initiative. To support this key strategy, CDC issued recommendations that clinicians routinely screen all pregnant women for HIV infection and that jurisdictions with statutory barriers to such routine prenatal screening consider revising them. With these efforts and increased treatment of those infected, the number of perinatally acquired AIDS cases is likely to remain low. However, declines may be affected by treatment failures and missed opportunities to prevent transmission. Data for 2004 continues to show low levels of perinatally acquired AIDS cases. The target for FY 2007 is less than 100 cases.
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Performance Measure Table |
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Performance Measure: Decrease the number of perinatally acquired AIDS cases from the 1998 base of 235 cases. |
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Year |
Target |
Result |
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2007 |
<100 cases |
11/2008 |
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2006 |
<100 cases |
11/2007 |
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2005 |
<100 cases |
11/2006 |
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2004 |
<100 cases |
48* |
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2003 |
<139 cases |
69* (Exceeded) |
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2002 |
141 cases |
109* (Exceeded) |
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Data Source: Adult and Pediatric Confidential HIV/AIDS Case Reports (OMB Control No. 0920-0573) |
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Data Validation: HIV/AIDS data are collected by state and local health departments and forwarded to CDC, without identifying information, and are published in annual surveillance reports. AIDS data presented here are from all 50 States, DC, Guam, PR, the Pacific Islands and the U.S. VI. |
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Performance Budget Reference: CDC FY 2007 CJ |
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All data have been modified to update annual "actual performance" numbers based on the most recent HIV and AIDS Surveillance data. Therefore, some values have changed for prior years. |
Performance Measure: Increase the number of clients served.
The goal of SAMHSA's Substance Abuse Prevention and Treatment Block Grant is to improve the health of the Nation by bringing effective alcohol and drug treatment and prevention services to States and Territories through block grants. The block grant supports and expands substance abuse prevention and treatment, while providing maximum flexibility to the states. States and territories may expend block grant funds only for the purpose of planning, carrying out, and evaluating activities related to these services. The block grant is the cornerstone of states' substance abuse programs and is central to HHS's strategic goal of reducing substance abuse. States are heavily dependent upon block grant funding for urgently needed substance abuse services.
The FY 2007 target for treatment admissions is 2,003,324. The FY 2003 target was missed slightly; because, the data from SAMHSA's Treatment Episode Data Set (TEDS) is a proxy for this measure, representing treatment admissions rather than the total number served. Proxy data are used because many states currently are unable to employ a unique client identifier, which is necessary in order to track unduplicated numbers of clients served. The FY 2003 is the most recent year for which data are currently available, because of the time required for states to report data on the number of admissions in any given year.
This measure is one of SAMHSA's National Outcome Measures, which, when fully implemented by the end of FY 2007, will provide more direct and accurate data on number of clients served by reporting an unduplicated count of clients. The unduplicated reporting will be phased in among the States. States are working toward providing unduplicated counts of the number of clients served. As States begin to report unduplicated counts, TEDS might show that that the number of admissions has gone down, since readmissions of the same individual in the reporting period would be counted as a single client served. Targets may be adjusted to reflect this change. Performance is also affected by the status of the national economy, including changes in employment and insurance coverage for substance abuse and mental health services; the amount of resources that states and communities are able to allocate to prevention and treatment of substance abuse; and the variation in the supply of (and demand for) illegal drugs such as heroin and cocaine, as well as new addictive substances.
An evaluability assessment of the Substance Abuse Prevention and Treatment Block Grant was completed in December 2004. A comprehensive evaluation is under development, with results expected in late 2006.
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Performance Measure Table |
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| Performance Measure: Increase the number of clients served. |
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Year |
Target |
Result |
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2007 |
2,003,324 |
10/2009 |
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2006 |
1,983,490 |
10/2008 |
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2005 |
1,963,851 |
10/2007 |
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2004 |
1,925,345 |
10/2006 |
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2003 |
1,884,654 |
1,840,275 |
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2002 |
1,751,537 |
1,882,584 |
| Data Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Treatment Episode Data Set (TEDS) |
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| Data Validation: Treatment Episode Data Set data represent admissions to treatment, not the total number of individual clients served, and are used as a proxy for this measure. Detailed instructions for data submission, review, and cleaning are available at http://wwwdasis.samhsa.gov/dasis2/teds.htm |
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Performance Budget Reference: SAMHSAFY 2007 CJ, Pg. PD33. |
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Last revised: February 20, 2006
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