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% -3 - 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 - 4 -