Georgia epidemiology report, Vol. 18, no. 3 (Mar. 2002)

March 2002

volume 18 number 03

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, 2001

Introduction The Division of Public Health (Epidemiology Branch, Immunization Program and Public Health Districts) partnered with private providers on the 2001 Georgia Immunization Study to assess immunization coverage rates of two-year-old children in Georgia.
Research Design The study conducted a survey to determine immunization rates for children born in Georgia in January 1999. These children were 24 months of age in January 2001. Information from both public and private providers was included. Children and their parents were identified through birth certificate data. The results of the 2001 survey were compared with those of similar surveys conducted for 1996-97, 1997-98, 1998-99, and 1999-00.
Statewide Immunization Results The final sample used to calculate the 2001 immunization rates consisted of the 2,755 children who were located.
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/DaTP (Diphtheria,Tetanus, Pertussis), three OPV/IPV (Polio oral or injected), one MMR (Measles, Mumps, Rubella) "4:3:1+3" status: A child has received four DTP/DaTP, three OPV/IPV, one MMR, three Hib (Haemophilus Influenzae), three Hep B (Hepatitis B), and one Varicella or documented history of Chicken Pox

Table 1: Immunization coverage by vaccine and study year, Georgia

Immunization Status
4:3:1 Adequately Immunized

1996-97 Percent
79.6

1997-98 Percent
71.3

1998-99 Percent 73.3

1999-00 Percent 78.8

2001 Percent 75.1

4:3:1+3 Adequately Immunized

N/A

16.0

41.9

56.3

66.7

3 DTP/DTaP

90.9

87.3

84.9

89.2

86.8

4 DTP/DTaP

81.9

72.9

74.2

79.9

76.0

3 OPV/IPV

90.1

85.4

83.6

84.4

80.8

1 MMR

85.3

80.8

80.2

84.6

82.0

3 Hib

84.4

83.6

83.6

87.4

84.3

3 Hep B

83.0

83.2

82.9

86.7

83.8

1 Varicella*

NA

19.0

47.1

64.3

77.9

* 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.

Acknowledgements
We would like to thank the private providers in Georgia for their support and cooperation throughout this study. Nearly seventy percent of all immunizations in this year's study were received at a physician's office. Without their cooperation with the public health representatives attempting to retrieve this information, this study would not have been possible.

The proportion of the children in the survey who were adequately immunized at the 4:3:1 level has been quite stable, varying from 71.3% to 75.1% during 19962001 (Table 1, Figure 1). Varicella was not recorded in the 1996-97 survey, so data on the 4:3:1+3 level, which includes the three more recently available vaccines (Hib, Hep B, and varicella), are not available for that year. However, during the next four years, 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, and again to 66.7% in 2001 (Table 1, Figure 1).
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 19972000, 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 77.9% (Table 1).

Figure 1. Changes in vaccine coverage by two definitions, 4:3:1 and 4:3:1+3. Georgia, 1996 - 2001

100

4:3:1

4:3:1+3

90

80

70

60

50

40

30

20

10

0

96-97 97-98 98-99 99-00 2001

Table 2: 4:3:1 Georgia Health District and Statewide Coverage Rates by Study Year

Health District

1996-97

1997-98

1998-99

Rome Dalton Gainesville Cobb/Douglas Fulton Clayton Lawrenceville DeKalb LaGrange Dublin Macon Augusta Columbus Valdosta Albany Savannah Waycross Brunswick Athens State

Percent Margin of
Error
90+4.4%

Percent Margin of
Error
826.6%

Percent Margin of
Error
786.8%

875.6%

728.3%

756.4%

904.4%

799.2%

676.8%

736.1%

755.6%

586.5%

705.8%

507.1%

545.4%

508.1%

865.4%

767.1%

845.7%

579.6%

655.6%

76 5.7%

587.6%

635.5%

855.5%

599.5%

685.6%

838.6%

787.8%

877.1%

765.9%

727.2%

952.8%

836.0%

777.1%

962.8%

757.8%

725.8%

687.8%

895.5%

886.8%

808.1%

923.9%

819.1%

846.1%

806.4%

667.8%

806.5%

924.9%

818.6%

846.6%

698.1%

697.7%

619.2%

797.8%

747.6%

796.1%

801.5%

711.8%

731.5%

Note: State rates based on data weighted by health district. -2 -

1999-00
Percent Margin of
Error 687.1% 757.0% 895.5% 766.1% 706.5% 6110.4% 952.3% 656.3% 805.7% 916.2% 849.8% 7212.8% 776.3% 866.6% 845.9% 797.1% 856.1% 828.8% 737.0% 791.5%

2001
Percent Margin of
Error 796.2% 786.7% 953.7% 716.8% 425.6% 588.9% 769.4% 766.0% 845.1% 859.0% 698.6% 894.8% 736.7% 778.2% 934.3% 698.2% 914.9% 729.1% 845.7% 751.5%

In 1997-98, 1998-99, 1999-00, and 2001 none of the immunization rates for single vaccines met the State goal of 90 percent coverage (Table 1). Hib vaccine status can be considered adequate with three or four vaccines, depending on the manufacturer of the vaccine. For this study, adequate immunization status for Hib vaccines was calculated considering three Hib shots as "adequate".
Table 2 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 42 percent to 95 percent. In 2001, three of the 19 health districts had immunization coverage rates exceeding the goal of 90 percent, four districts had coverage rates of 80-89%, eight districts had coverage rates of 70-80% and four had coverage rates less than 70%. During the fiveyear period with survey data, two districts--Albany and Waycross--had point estimates of immunization rates of 80% or better every year. Four districts--Marietta, Fulton, Decatur, and Columbus--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 they were receiving Medicaid (Table 3). However, there was variation from district to district. For the 4:3:1+3 level, none of the districts met the 90% coverage goal for children receiving Medicaid, while two (Gainesville and Albany) met that goal for non-Medicaid children. For the 4:3:1 level, three of the districts met the 90% coverage level for children regardless of their Medicaid status (Gainesville, Albany, and Waycross).
The results of the recent immunization assessment demonstrate that the newly introduced varicella vaccine is now given to more than seventy-five percent of the children in Georgia. 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 expanding 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, Del Carvell, Mike Chaney, and Susan LanceParker, D.V.M., Ph.D.

Table 3: Immunization coverage of two-year old children by definition, health district, and Medicaid status, Georgia

Health District

Sample size

4:3:1+3

4:3:1

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

Medicaid 80 62 51 61 93 71 24 98 102 35 63 93 104 68 90 64 76 53 69
1,357

Non-Medicaid 86 84 84 113 204 47 55 98 104 25 47 69 63 35 43 59 55 42 85
1,398

Medicaid 68% 76% 86% 59% 41% 54% 50% 63% 73% 80% 57% 72% 61% 59% 84% 53% 79% 60% 74% 66%

Non-Medicaid 69% 68% 91% 67% 40% 47% 86% 76% 78% 80% 53% 73% 59% 80% 91% 54% 82% 62% 81% 68%

Medicaid 78% 84% 94% 64% 44% 59% 54% 70% 83% 83% 70% 89% 76% 74% 91% 67% 90% 72% 83% 76%

Non-Medicaid 80% 74% 95% 74% 42% 55% 86% 81% 84% 88% 68% 88% 68% 83% 98% 71% 93% 71% 86% 75%

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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

March 2002

Volume 1 8 Number 0 3

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for December 2001

Selected Notifiable Diseases
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 - Other** Syphilis - Congenital Tuberculosis

Total Reported for Dec2001 2001 22 2017 6 1 29 1210 15 35 0 1 0 6 0 0 0 86 51 7 13 46 21 0 110

Previous 3 Months Total

Ending in Dec

1999

2000 2001

149

122

80

5646

7079

7560

37

37

34

14

7

14

358

271

178

4277

4723

4280

21

30

34

77

112

182

66

113

46

3

3

1

0

0

0

19

11

17

0

0

0

12

5

0

0

0

0

488

390

365

52

91

304

28

26

19

66

52

62

138

111

157

183

169

114

4

2

1

210

219

213

Previous 12 Months Total

Ending in Dec

1999

2000

2001

729

607

599

30796

29179

31405

165

190

157

42

44

40

1357

1201

940

21480

19240

17396

80

86

105

482

376

919

232

352

347

5

10

11

0

0

0

72

53

56

4

2

7

52

52

15

0

1

0

1977

1688

1648

284

339

571

135

123

92

270

290

279

688

527

599

784

701

709

18

21

18

662

685

549

* 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.

** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.

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

Total Cases Reported* <13yrs >=13yrs Total

2

1774

1776

18

2340

2358

210

24196 24406

Percent Female

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

Unknown

25.6

34.4

8.7

2.4

12.2

1.5

40.9

19.2

46.0

18.1

5.0

18.2

1.3

11.4

17.3

47.9

17.8

5.5

13.3

1.9

13.6

Race Distribution (%) White Black Other

18.9 76.5

4.7

32.9 64.7

2.4

34.7 63.0

2.3

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

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

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