Georgia epidemiology report, Vol. 17, no. 5 (May 2001)

May 2001

volume 17 number 05

Division of Public Health http://health.state.ga.us
Kathleen E. Toomey, M.D., M.P.H. Director
State Health Officer
Epidemiology Branch http://health.state.ga.us/epi
Paul A. Blake, M.D., M.P.H. Director
State Epidemiologist
Mel Ralston Public Health Advisor
Georgia Epidemiology Report Editorial Board
Carol A. Hoban, M.S., M.P.H. - Editor Kathryn E. Arnold, M.D. Paul A. Blake, M.D., M.P.H.
Susan Lance-Parker, D.V.M., Ph.D. Kathleen E. Toomey, M.D., M.P.H.
Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer
Georgia Department of Human Resources
Division of Public Health Epidemiology Branch Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588 Fax: (404) 657-7517
Please send comments to: Gaepinfo@dhr.state.ga.us
The Georgia Epidemiology Report is a publication of the Epidemiology Branch,
Division of Public Health, Georgia Department of Human Resources

Georgia Immunization Study Results 1999-2000
The Division of Public Health, Epidemiology Branch, Immunization Program and Health Districts collaborated on the 1999-2000 Georgia Immunization Study to assess immunization coverage rates of two-year-old children in Georgia.

Research Design A survey was conducted to determine immunization rates for children born in Georgia in November 1997. These children turned two in November 1999. Information from both public and private providers was included. Children and their parents were identified through birth certificate data. The results of the 1999-2000 survey were compared with those of similar surveys conducted for 1996-97, 1997-98, and 1998-99.

This study only assessed children born in Georgia and still residing in one of the 159 counties. It does not address the immunization level of children who moved to Georgia from outside of the state. Thus, immunization coverage levels presented here reflect the quality of Georgia's immunization programs rather than the current level of immunity of the children living in each county.

Statewide Immunization Results The final sample used to calculate the 1999-2000 immunization rates consisted of the 2,793 children who were located; 1,136 children were excluded because they could not be located (Table 1). Only immunizations received before the child's second birthday were included, except for the varicella vaccine. In comparisons of varicella immunization rates from year to year, any documented varicella vaccination at any age was accepted.

Table 1: 1999-00 Eligible Sample, Sample and Response Rates by District

Health District
Rome 1-1 Dalton 1-2 Gainesvil2le Marietta 3-1 Fulton 3-2 Clayton 3-3 Lawrence3v-i4lle Decatur 3-5 LaGrange4 Dublin 5-1 Macon 5-2 Augusta 6 Columbu7s Valdosta8-1 Albancy 8-2 Savannah9-1 Waycross9-2 Brunswic9k-3 Athens 10 State State

Eligible Sample (Number)
192 186 230 360 480 177 482 370 300 83 71 53 247 116 179 134 146 91 189 4,086

Sample* (Number Located)
170 150 140 197 224 91 386 244 201 83 55 48 174 111 160 132 137 76 171 2,950

Response Rate ** (% of eligible
Sample located)
88.5% 80.6% 60.9% 54.7% 46.7% 51.4% 80.1% 65.9% 67.0% 99.0% 77.5% 90.6% 70.4% 95.7% 89.4% 98.5% 93.8% 83.5% 90.5% 72.2%

* sample includes parental refusals and records transferred to other health district(n=157) ** number located/Eligible sample

Table 2: Immunization coverage by vaccine and study year, Georgia

Immunization Status
4:3:1 Adequately Immunized 4:3:1+3 Adequately Immunized 3 DTP/DTaP 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 Hep B 1 Varicella*

1996-97 Percent
N/A N/A 90.9 81.9 90.1 85.3 84.4 83.0 NA

1997-98 Percent
71.3 N/A 87.3 72.9 85.4 80.8 83.6 83.2 19.0

1998-99 Percent
73.3 N/A 84.9 74.2 83.6 80.2 83.6 82.9 47.1

1999-00 Percent
78.8 77.4 89.2 79.9 84.4 84.6 87.4 86.7 64.3

* Immunization coverage status for the varicella vaccine was not measured in the 1996-97 study, and was not restricted to immunization before the second birthday in successive study years. Note: State rates based on data weighted by health district.

Figure 1: Changes in vaccine coverage by two definitions, 4:3:1 and 4:3:1+3. Georgia, 1996-2000

100

90

80 70

4:3:1

60

4:3:1+3

50

40

30

20

10

0

1996-97 1997-98 1998-99 1999-00

The dramatic increase in children who were adequately immunized with the 4:3:1+3 series largely reflects an increase in the use of varicella vaccine. During 1997-2000, only small increases occurred in the use of Hib and Hep B vaccines, but the proportion of children who had received varicella vaccine increased from 19.0% to 64.3% (Table 2).
The Georgia Immunization Study evaluated "adequate immunization status" in two different ways for analysis: "4:3:1" status (the traditional standard for immunization status): A
child has received four DTP/DTaP (Diphtheria,Tetanus, Pertussis), three OPV/IPV (Polio oral or injected), one MMR (Measles,

Mumps, Rubella), vaccination by age two

"4:3:1+3" status: A child has

Table 3 : 4:3:1 Georgia Health District and Statewide Coverage Rates by Study Year

received four DTP/DTaP, three

District

1996-97 Percent + Margin of

1997-98 Percent + Margin of

1998-99 Percent + Margin of

1999-00 Percent + Margin of

OPV/IPV, one MMR, three Hib (Haemophilus Influenzae), vaccination by age two

Rome Dalton

Error 90+4.4%
875.6%

Error
826.6%
728.3%

Error
786.8%
756.4%

Error
687.1%
757.0%

The proportion of the children in the survey who were adequately immunized at the 4:3:1 level has been quite

Gainesville Marietta Fulton

904.4% 736.1% 705.8%

799.2% 755.6% 507.1%

676.8% 586.5% 545.4%

895.5% 766.1% 706.5%

stable, varying from 71.3% to 78.8% during 1996-2000 (Table 2, Figure 1). Varicella was not recorded in the 199697 survey, so no data on the 4:3:1+3

Clayton Lawrenceville Decatur

508.1% 845.7% 76 5.7%

865.4% 579.6% 587.6%

767.1% 655.6% 635.5%

6110.4% 952.3% 656.3%

level, which includes the three more recently available vaccines (Hib, Hep B, and varicella), are available for that year. However, during the next three years,

LaGrange Dublin Macon

855.5% 838.6% 765.9%

599.5% 787.8% 727.2%

685.6% 877.1% 952.8%

805.7% 916.2% 849.8%

the proportion of children adequately immunized with the 4:3:1+3 series increased dramatically from 16.0% percent in 1997-98 to 56.3% in 1999-00

Augusta

836.0% 777.1%

962.8%

7212.8%

(Table 2, Figure 1).

Columbus

757.8%

725.8%

687.8%

776.3%

In 1997-98, 1998-99, and 1999-00

Valdosta Albany Savannah

895.5% 923.9% 806.4%

886.8% 819.1% 667.8%

808.1% 846.1% 806.5%

866.6% 845.9% 797.1%

none of the immunization rates for single vaccines met the State goal of 90 percent coverage (Table 2). Hib vaccine status can be considered adequate with

Waycross Brunswick Athens

924.9% 698.1% 797.8%

818.6% 697.7% 747.6%

846.6% 619.2% 796.1%

856.1% 828.8% 737.0%

three or four shots, depending on the manufacturer of the vaccine. For this study, adequate immunization status for Hib vaccines was calculated

State

801.5%

711.8%

731.5%

791.5%

Note: State rates based on data weighted by health district.

considering three Hib shots as "adequate".

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Table 4: Immunization coverage of two-year old children by definition, health district, and Medicaid status of mother, Georgia, 1999-2000

District
Rome Dalton Gainesville Marietta Fulton Clayton Lawrenceville Decatur LaGrange Dublin Macon Augusta Columbus Valdosta Albany Savannah Waycross Brunswick Athens State

Sample Size

Medicaid

Non-Medicaid

Mother

Mother

66

100

70

76

48

83

60

133

54

140

38

45

107

256

85

137

93

99

47

33

30

25

26

21

105

65

57

50

91

62

65

65

77

56

45

28

71

83

1,235

1,557

4:3:1+3

Medicaid Mother

Non-Medicaid Mother

71%

63%

71%

74%

85%

89%

68%

76%

63%

67%

42%

67%

88%

96%

57%

69%

79%

77%

94%

85%

77%

88%

77%

67%

79%

72%

81%

90%

79%

79%

82%

71%

77%

86%

82%

79%

87%

61%

76%

78%

4:3:1

Medicaid Mother

Non-Medicaid Mother

74%

63%

74%

76%

85%

90%

68%

78%

67%

70%

50%

69%

88%

97%

57%

70%

81%

79%

96%

85%

77%

92%

77%

67%

79%

74%

83%

90%

84%

82%

82%

75%

81%

89%

82%

82%

87%

61%

78%

79%

Table 3 shows 4:3:1 immunization rates for each of Georgia's 19 health districts. Since the number of children included in the survey in each health district is small, the margins of error, which indicate the confidence limits surrounding the immunization rates, are substantial; hence, small differences in the point estimates between districts are insignificant. Immunization rates varied widely among health districts, ranging from 61 percent to 95 percent. In 1999-00, two of the 19 health districts had immunization coverage rates exceeding the goal of 90%, seven districts had coverage rates of 8089%, and 10 had coverage rates less than 80%. During the fouryear period with survey data, three districts--Valdosta, Albany, and Waycross--had point estimates of immunization rates of 80% or better every year. Five districts--Marietta, Fulton, Decatur, Columbus, and Athens--had immunization rates below 80% every year.
The proportion of children in the survey who were adequately immunized by either schedule varied little in the state as a whole by whether or not their mothers were receiving Medicaid (Table 4).

However, there was variation from district to district. For the 4:3:1+3 level, one district (Dublin) met the 90% coverage goal for children of mothers receiving Medicaid, while two (Lawrenceville and Valdosta) met that goal for children of non-Medicaid mothers. Immunization coverage was 10+% higher for children of mothers receiving Medicaid in three districts (Athens, Augusta, and Savannah), and 10+% lower for children of mothers receiving Medicaid in three districts (Clayton, Decatur, and Macon).
The results of the recent immunization assessment demonstrate that the newly introduced varicella vaccine is now given to approximately two thirds of the children in Georgia by their second birthday. Maintaining high immunization rates among two-year old children for varicella and other vaccines requires persistent effort by parents, providers and health departments because there is a new cohort of children each year. The task is increasingly difficult because of the increasingly complexity of childhood immunization schedule as new and beneficial vaccines are added to it.
This article was written by: Carol A. Hoban, M.S., M.P.H

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The Georgia Epidemiology Report Epidemiology Branch Two Peachtree St., NW Atlanta, GA 30303-3186

PRESORTED STANDARD U.S. POSTAGE
PAID ATLANTA, GA PERMIT NO. 4528

May 2001

Volume 17 Number 05

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for February 2000

Selected Notifiable Diseases

Total Reported for February 2001
2001

Previous 3 Months Total

Ending in February

1999

2000 2001

Previous 12 Months Total Ending in February 1999 2000 2001

Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Congenital Tuberculosis

38 2309
9 2 63 1283 6 40 29 0 0 8 0 1 1 49 20 3 14 31 0 29

180 6496
44 6
281 4505
24 145
46 0 0
19 0 7 0
347 106
29 76 235
5 144

97 6850
44 8
296 4396
24 58 51
1 0 28 1 20 0 281 67 30 74 137 4 170

97 7585
30 5
239 4175
33 142 109
1 0 20 0 4 1 264 71 16 42 102 2 189

806 25097
170 84
1280 20165
66 853 191
8 3 81 2 40 0 1890 1041 127 256 856 18 606

664 31926
165 43
1345 22040
83 432 236
6 0 76 5 63 0 1936 282 146 283 627 18 655

614 31685
178 44
1167 20047
86 435 354
10 0
51 1
37 1
1712 327 108 254 507 15 700

* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.

Report Period
Latest 12 Months: 03/00 - 02/01 Five Years Ago: 03/95 - 02/96 Cumulative: 7/81 - 02/01

Total Cases Reported*

Percent Female

AIDS Profile Update
Risk Group Distribution (%) MSM IDU MSM&IDU HS Blood

Unknown

1215

27.1

28.7

9.9

1.7

12.1

1.9

45.8

2342

19.0

47.6

20.3

5.1

16.2

1.3

9.5

22807

16.7

48.6

18.4

5.6

13.1

1.9

12.5

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section

- 4 -

Race Distribution (%) White Black Other

18.7 77.8

3.5

35.7 61.1

3.2

35.8 62.1

2.1