vided by CDC). Funds are likewise not available within the Section 317 program to support the training needs for outbreak control recommended by NVAC (1999a); such support may be provided by a new bioterrorism initiative financed elsewhere within CDC.
Surveillance and monitoring—During the 1990s, CDC maintained support for the NIS (see Chapter 4). CDC also encouraged the development of immunization registries as a key component of the future immunization surveillance system. Between 1994 and 1999, CDC allocated a total of $178.4 million in Section 317 funds within the state infrastructure awards to support immunization registries, but the size of these awards has declined in recent years (see Box 5–4) (A.Bauer, CDC, personal communication, May 21, 1999). Cutbacks in federal grants have caused several states to reduce their own surveillance and monitoring efforts, as discussed earlier. These reduced efforts represent critical omissions in the development of important baseline and benchmark coverage measures in certain key areas, such as the immunization status of Medicaid or VFC-eligible clients. The cutbacks also diminished the states’ abilities to expand surveillance for diseases such as varicella that are now vaccine-preventable while maintaining current surveillance efforts for traditional vaccine-preventable diseases. Furthermore, in areas where states are designated for special immunization initiatives (such as the ACIP recommendation that 11 states universally vaccinate children against hepatitis A), additional funds are not available to help these states with program implementation or enhanced surveillance. In such cases, states are given further program responsibilities by federal agencies without additional federal funding.
BOX 5–4 Total Section 317 Funds Awarded to Support Registries as of July 1, 1999 (in millions of dollars)*