Acknowledgements 1 The Georgia Department of Public Health Epidemiology and Immunization Programs would like to thank the public health representatives who participated in this study for all of their hard work, support and dedication. This study could not have been completed successfully without the cooperation of the Immunization Regional Consultants and State staff throughout Georgia. A profound thank you and sincere appreciation is also given to the public and private schools and their immunization staff and nurses that participated in this collaborative effort. Their cooperation and assistance throughout the study is greatly appreciated. Additional gratitude goes to Karl Soetebier for the development and maintenance of our data collection system; and LaTonya Thomas and Ben Sloat for their collaborative effort in making this study possible. "This publication was supported by the Cooperative Agreement Number 5H23IP000744-02 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention." Abbreviations and Vaccine Names 2 Abbreviation ACIP CDC GAIS IRC GRITS UTD HepB MMR Varicella Tdap MCV4 HPV Definition Advisory Committee on Immunization Practices Centers for Disease Control and Prevention Georgia Adolescent Immunization Study Immunization Regional Consultant (data collectors) Georgia Registry of Immunization Transactions and Services Up-to-date [immunization history] Hepatitis B [vaccine] Measles, Mumps, Rubella [vaccine] Varicella (chicken pox) [vaccine] Tetanus, Diphtheria and acellular Pertussis [vaccine] Meningococcal Conjugate [vaccine] Human Papillomavirus [vaccine] Table of Contents Contents Acknowledgements Abbreviations Table of Contents Section I: Project Overview Purpose of Study Methods Section II: Statewide Results State-Level Immunization Study Staff State of Georgia Immunization Report Section III: Health District Immunization Reports District-Level Immunization Study Team District 1-1 Immunization Report (Rome District) District 1-2 Immunization Report (Dalton District) District 2-0 Immunization Report (Gainesville District) District 3-1 Immunization Report (Cobb-Douglas District) District 3-2 Immunization Report (Fulton District) District 3-3 Immunization Report (Clayton District) District 3-4 Immunization Report (Lawrenceville District) District 3-5 Immunization Report (DeKalb District) District 4-0 Immunization Report (LaGrange District) District 5-1 Immunization Report (Dublin District) District 5-2 Immunization Report (Macon District) District 6-0 Immunization Report (Augusta District) District 7-0 Immunization Report (Columbus District) District 8-1 Immunization Report (Valdosta District) District 8-2 Immunization Report (Albany District) District 9-1 Immunization Report (Savannah District) District 9-2 Immunization Report (Waycross District) District 10-0 Immunization Report (Athens District) Appendices Appendix A: Immunization coverage measures Appendix B: Frequency of exemptions Appendix C: Reasons for incomplete vaccination Additional Resources 3 Page (s) 1 2 3 5--7 5 6-7 9--10 9 10 11-29 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 i-iii i ii iii iv Section I: Project Overview 5 Purpose of Study The Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommend that adolescents routinely receive Tdap, MCV4, and HPV vaccinations at 11 to 12 years of age1. Beginning in the 2014-2015 school year, Tdap and MCV4 were added to the list of required vaccines for Georgia students entering seventh grade who were born on or after January 1, 2002. This report summarizes the annual assessment of immunization coverage for school-required vaccinations as well as one -dose and complete dose coverage of HPV among seventh grade students in Georgia's 18 Public Health Districts. HPV coverage was assessed using the 2016 ACIP recommendations of a 2 or 3-dose schedule based on the age of the recipient2. 1. Kroger AT, Duchin J, Vzquez M. General Best Practice Guidelines for Immunization. Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP). https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html. Accessed on 12/22/2017 2. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination -- Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016;65:14051408. DOI: http://dx.doi.org/10.15585/ mmwr.mm6549a5 Methods 6 Study Design The annual Georgia Adolescent Immunization Study (GAIS) employs a cross-sectional research design to ascertain the vaccine coverage rate for 7th grade children in the State of Georgia. Immunization history data for 7th grade students from 18 Health Districts were analyzed to calculate these rates. Identifying information and immunization history data were obtained from school 3231 files and the Georgia Registry of Immunization Transactions and Services (GRITS). Immunization rates for Tdap, Polio, MMR, MCV4 (meningococcal), Hepatitis B, Varicella and HPV vaccines were calculated. Data collection for the 2017 GAIS study began February 1, 2017 and lasted for three months. A two-stage clustersampling scheme was developed to randomly select the study sample. Stage one of the cluster sampling scheme involved randomly selecting up to 30 middle schools from each of the 18 Health Districts. The number of schools sampled from each district was determined using the following factors: target population size per district estimated percent response rate estimate design effect confidence interval width If a District had fewer than 30 schools, then all schools in that District were sampled. Stage two of the sampling scheme involved randomly selecting an established number of students from each school. This number varied by District depending on the number of schools sampled and population. Basic coverage rates were then calculated for each of the specific vaccines of interest. Target and Sample Populations The target population of the 2017 GAIS included all 7th grade children in the State of Georgia during the 20162017 school year. A sample of 6,191 seventh grade students, attending both private and public Georgia schools, were selected for the study. The sample design allowed for independent estimates to be calculated for each of the 18 Health Districts in the State. Data Collection An electronic web-based data collection system named "GAIS" was created to systematically collect the required information for each child. This system interfaces with GRITS to extract immunization data for students enrolled in the study. Data collection was carried out by the State's Immunization Regional Consultants (IRCs), who are responsible for 13 health regions of the state which may overlap Health District boundaries. The IRCs participated in training at the start of the data collection period. A Training Manual was also provided and made available on the GAIS log-in screen. Data Collection Protocol Step #1: Obtain student sample Before the data collection process began, IRCs were assigned a maximum of 30 schools in their respective Districts and assigned a required number of students per school to be sampled. Once at a school, the IRC obtained an alphabetized roster of all current 7th graders attending that school. Using the total number of seventh graders, a random number generator was applied to randomly select the 13 students chosen as the 2017 GAIS sample. Step #2: Collect immunization forms at public and private schools Once the IRC selected the school sample, each specific child's 3231 form was located to obtain their immunization history. A comparison of the GRITS record and the 3231 form was conducted for each child to make sure all vaccines received matched between sources. If any dates were missing from either source, steps were taken to update the 3231 form and/or the GRITS record to match. If a 3231 was found to be expired, a new one was printed out from GRITS for the school's record. Step #3: Input children to data collection website A record was created by the IRC for each sampled child in the GAIS website. Information collected included first and last name, date of birth, county, school, exemption and waiver status and lab confirmation of immunity. A blank vaccine list was also available in the GAIS record for the IRC to either: 1) add each of the vaccine dates of interest in the table; or, 2) perform a direct upload from GRITS into the GAIS record. Step #4: Record review As the records were completed using the web GAIS system, problematic records were reviewed by the Principal Investigator and resolved before data analysis began. 7 Data Analysis The data cleaning and analysis for the 2017 GAIS were performed using R (ver. 3.4.2) software. Immunization data were used to determine what percentage of 7th graders were up-to-date (UTD), which was defined as having at least 3 doses of Hepatitis B, 2 doses of MMR, 2 doses of Varicella, 1 dose of Tdap and 1 dose of MCV4 vaccines. UTD immunization rates as well as individual vaccine coverage rates were assessed at both the State and Health District level. A vaccination was considered valid if it met ACIP's recommendations for dosing and spacing and was given prior to January 1, 2017. Margins of error are provided for all immunization coverage estimates. The margin of error is a convenient notation of the 95% confidence interval range. For example, 94.4 0.6 represents the confidence interval (93.8, 95.0) for the statewide UTD estimate of 94.4%. Immunization rate differences between comparison groups were tested with R (ver 3.4.2, Epi package), utilizing a 2 sample test for equality of proportions. Significant differences (p<0.05) are bolded and italicized in the appropriate tables. Comparison groups are defined as: 2017 State rates vs individual 2017 District rates Individual District rates for 2016 vs 2017 2017 coverage rates for male vs. female students 2017 coverage rates for students attending public vs. private schools Sample Table 1 serves to illustrate these comparisons. For example, in Sample Table 1, the rates for having 1 dose of HPV are significantly different (p<0.05) between : The State (50.1%) and District X (58.6%) in 2017 Male (52.6%) and female students (65.5%) in District X in 2017 Similarly, the rates for completing the HPV series are significantly different (p<0.05) between : The State (28.0%) and District X (20.2%) in 2017 2016 (12.4%) and 2017 (20.2%) for District X Students attending public (24.9%) and private schools (14.2%) in District X in 2017 Limitations When interpreting the study results, the following limitations of the study should be considered: 1. Compared to other sampling methods, cluster sampling is least representative of the population. Individuals within a cluster tend to have similar characteristics and there is a chance of over- or underrepresentation of the population, leading to skewed results. The two-stage cluster sampling scheme was used because of its low-cost and efficient method of collecting a larger sample size across a wide area. 2. Some IRCs had less than 30 middle schools in their District and were therefore required to sample all middle schools. Larger Districts were restricted to a maximum sample of 30 schools, due to time and resource restraints. This may lead to underrepresentation in Districts that have more than 30 schools. We tried to overcome this limitation by randomly selecting schools with equal probability of selection. Sample Table 1 1 HPV Complete HPV series 2017, State n = 6,191 (%) 50.1 1.2 28.0 1.1 Year, District X 2016 n = 363 (%) 2017 n = 370 (%) 52.7 5.1 58.6 5.2 12.4 3.6 20.2 4.3 Gender, 2017, District X Male n = 195 (%) Female n = 170 (%) 52.6 7.5 65.5 7.2 19.4 5.8 21.7 6.5 School type, 2017, District X Public n = 312 (%) Private n = 58 (%) 59.9 6.3 55.8 9.2 24.9 6.1 14.2 5.6 Section II: Statewide Results 9 State-Level Immunization Study Staff, 2017 Georgia Adolescent Immunization Study Fabio R. Machado, MPH Immunization Study Epidemiologist Principal Investigator Primary Author Jessica Tuttle, MD Medical Epidemiologist Primary Editor Figure 1: Georgia Health Districts Metro Atlanta Districts State of Georgia 10 The 2017 Georgia Adolescent Immunization Study (GAIS) sampled 6,191 seventh grade adolescents statewide (Table 1). Of the students sampled, 50.5% were male, 48.6% were female, and 0.9% had missing gender information. Students enrolled in public schools accounted for 71.7% of the sample; 28.3% were enrolled in private schools. A total of 479 schools were sampled (315 public, 164 private). Adolescents were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. Statewide, the 2017 UTD immunization rate for 7th graders was 94.4%, lower than the 2016 rate (94.7%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 2). Statewide, the 2017 coverage rates were higher than the 2016 rates except for the UTD rate, which showed a nonsignificant decrease. The statewide rates for Hepatitis B, MMR, Varicella, Polio and HPV (1-dose and series completion) showed a significant increase from 2016. Statewide coverage rates for HPV vaccinations (1-dose or series completion) differed significantly between male and female adolescents. Statewide coverage rates for all vaccines were significantly higher for students enrolled in public schools vs. private schools (Table 2). Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Only ten (0.2%) of the students in the State Table 1: Gender, school type, waiver and exemptions among Georgia adolescents, 2017 (n = 6,191). Gender Male Female Unknown # of Percent of students sample (%) 3127 50.5 3011 48.6 53 0.9 School type Public (315) 4436 71.7 Private (164) 1755 28.3 Within waiver period? Yes No 10 0.2 6181 99.8 Exemptions Religious 135 2.2 Medical 6 0.1 No exemption 6050 97.7 sample were found to be in the school waiver period (Table 1). Six (0.1%) of the students in the State sample had a medical exemption for one or more vaccines; 135 (2.2%) students had a religious exemption on file (Table 1). Fourteen adolescents had documentation of serologic immunity in lieu of vaccination: 4 had varicella immunity, 1 had measles, mumps, rubella (MMR) immunity, and 9 had hepatitis B immunity. Thirty-two (32) students had either documentation of physician-diagnosed or a history of varicella (not shown). All of these students were excluded from the respective statewide vaccination rate determinations which were calculated based only on receipt of vaccine. Table 2: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, 2017 Year Gender, 2017 School type, 2017 2016 n = 6,191 (%) 2017 n = 6,191 (%) Male n = 3,125 (%) Female n = 3,011 (%) Public n = 4,435 (%) Private n = 1,755 (%) UTD rate* 94.7 0.6 94.4 0.6 94.6 0.8 94.9 0.8 94.9 0.6 93.3 1.2 3+ Hepatitis B 97.7 0.4 98.3 0.3 98.4 0.4 98.8 0.4 98.5 0.4 97.7 0.7 2+ MMR 97.6 0.4 98.3 0.3 98.4 0.4 98.8 0.4 98.8 0.3 97.2 0.8 2+ Varicella 96.5 0.5 97.2 0.4 97.2 0.6 97.7 0.5 97.6 0.5 96.2 0.9 1 Tdap 96.1 0.5 96.6 0.5 96.8 0.6 96.9 0.6 97.0 0.5 95.5 1.0 1 MCV4 96.0 0.5 96.4 0.5 96.4 0.7 96.8 0.6 96.8 0.5 95.3 1.0 4+ Polio 1 HPV Complete HPV series 96.0 0.5 43.8 1.2 14.5 0.9 97.6 0.4 47.9 1.2 23.3 1.0 97.7 0.5 45.9 1.7 22.3 1.5 98.0 0.5 50.4 1.8 24.6 1.5 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.0 0.4 51.9 1.5 24.5 1.3 96.5 0.9 37.9 2.3 20.2 1.9 Section III: Health District Immunization Reports11 Immunization Study Data Collection Team by Health District, Georgia Adolescent Immunization Study, 2017 District 1-1 1-2 2-0 3-1 3-2 3-3 3-4 3-5 4-0 5-1 5-2 6-0 7-0 8-1 8-2 9-1 9-2 10-0 Immunization Regional Consultant Jamie Henley Farrah Machida Jamie Henley Farrah Machida Farrah Machida Angie Webster Saron Ephraim Janet Kelly Saron Ephraim Angie Webster Janet Kelly Farrah Machida Janet Kelly Tina Dempsey Kelly Duke Kelly Seegmueller Kelly Duke Shelia Fultz Kelly Seegmueller Lisa Jenkins Lisa Jenkins Kelly Seegmueller Kelly Duke Kelly Duke Lisa Jenkins Shelia Fultz Angie Webster District 1-1 12 The 2017 GAIS sampled 370 seventh grade adolescents in District 1-1 (Table 11-A). Of the students sampled, 52.7% were male, 45.9% were female, and 1.4% had missing gender information. Students enrolled in public schools accounted for 84.3% of the sample; 15.7% were enrolled in private schools. A total of 30 schools were sampled (24 public, 6 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 1-1, the 2017 UTD immunization rate for 7th graders was 94.3%, lower than the 2016 rate (96.1%) and higher than the State rate for 2017 (94.1%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 1-1-B). The 2017 District 1-1 coverage rates for most vaccines varied slightly from the 2016 rates except for HPV completion which showed a significant increase from 9.9% to 21.9%. The UTD coverage rate differed significantly among adolescents who attended public vs. private schools. District 1-1 coverage rates did not differ significantly from overall State rates, or by gender (Table 1-1-B). Table 1-1-A: Gender, school type, waiver and exemptions among District 1-1 adolescents, 2017 (n = 370). Gender Male Female Unknown # of Percent of students sample (%) 195 52.7 170 45.9 5 1.4 School type Public (24) 312 84.3 Private (6) 58 15.7 Within waiver period? Yes No 1 0.3 369 99.7 Exemptions Religious 9 2.4 Medical 0 0 No exemption 361 97.6 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Only one (0.3%) of the students in the District 1-1 sample was found to be in the school waiver period (Table 1-1-A). None of the students in the District 1-1 sample had a medical exemption for one more vaccines; 9 (2.4%) students had a religious exemption on file (Table 1-1-A). Table 1-1-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 1-1, 2017 2017, Year, Gender, 2017, School type, 2017, State District 1-1 District 1-1 District 1-1 Overall n = 6,191 (%) 2016 n = 363 (%) 2017 n = 370 (%) Male n = 195 (%) Female n = 170 (%) Public n = 312 (%) Private n = 58 (%) UTD rate* 94.4 0.6 96.1 2.0 94.3 2.4 94.9 3.1 94.7 3.4 95.5 2.3 87.9 8.4 3+ Hepatitis B 98.3 0.3 98.6 1.2 97.3 1.7 98.5 1.7 97.1 2.5 97.8 1.6 94.8 5.7 2+ MMR 98.3 0.3 98.3 1.3 97.6 1.6 98.5 1.7 97.6 2.3 98.1 1.5 94.8 5.7 2+ Varicella 97.2 0.4 97.0 1.8 97.3 1.7 97.9 2.0 97.6 2.3 98.1 1.5 93.1 6.5 1 Tdap 96.6 0.5 97.2 1.7 95.9 2.0 96.4 2.6 96.5 2.8 96.5 2.0 93.1 6.5 1 MCV4 96.4 0.5 97.2 1.7 94.9 2.3 95.4 2.9 95.3 3.2 95.8 2.2 89.7 7.8 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 97.0 1.8 43.8 5.1 9.9 3.1 97.3 1.7 47.6 5.1 21.9 4.2 98.5 1.7 50.8 7.0 23.1 5.9 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg 7). 97.1 2.5 43.5 7.5 20.6 6.1 98.1 1.5 48.1 5.6 21.8 4.6 93.1 6.5 44.8 12.8 22.4 10.7 District 1-2 13 The 2017 GAIS sampled 314 seventh grade adolescents in District 1-2 (Table 12-A). Of the students sampled, 51.0% were male, 48.4% were female, and 0.6% had missing gender information. Students enrolled in public schools accounted for 72.0% of the sample; 28.0% were enrolled in private schools. A total of 29 schools were sampled (18 public, 11 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 1-2, the 2017 UTD immunization rate for 7th graders was 92.0%, higher than the 2016 rate (90.5%) and lower than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 1-2-B). The 2017 District 1-2 coverage rates for all vaccines were slightly higher than the 2016 rates except for HPV completion which was significantly higher. The 2017 coverage rates for MMR, Varicella, Tdap, MCV4, Polio and HPV (1-dose) were significantly lower in District 1-2 when compared to the State rates. The 2017 District 1-2 coverage rates did not vary by gender, however, the rates for all vaccines were significantly higher for students enrolled in public vs. private schools (Table 1-2-B). Table 1-2-A: Gender, school type, waiver and exemptions among District 1-2 adolescents, 2017 (n = 314). Gender Male Female Unknown # of Percent of students sample (%) 160 51.0 152 48.4 2 0.6 School type Public (18) 226 72.0 Private (11) 88 28.0 Within waiver period? Yes No 0 0 314 100 Exemptions Religious 19 6.1 Medical 0 0 No exemption 295 93.9 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. None of the students in the District 1-2 sample were found to be in the school waiver period (Table 1-2-A). None of the students in the District 1-2 sample had a medical exemption for one or more vaccines; 19 (6.1%) students had a religious exemption on file (Table 1-2-A). Table 1-2-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 1-2, 2017 2017, Year, Gender, 2017, School type, 2017, State District 1-2 District 1-2 District 1-2 Overall n = 6,191 (%) 2016 n = 326 (%) 2017 n = 314 (%) Male n = 160 (%) Female n = 152 (%) Public n = 226 (%) Private n = 88 (%) UTD rate* 94.4 0.6 90.5 3.2 92.0 3.0 90.6 4.5 94.1 3.8 94.7 2.9 85.2 7.4 3+ Hepatitis B 98.3 0.3 96.0 2.1 97.5 1.7 96.9 2.7 98.7 1.8 98.7 1.5 94.3 4.8 2+ MMR 98.3 0.3 95.1 2.3 95.2 2.4 93.8 3.8 97.4 2.5 97.3 2.1 89.8 6.3 2+ Varicella 97.2 0.4 93.9 2.6 94.6 2.5 93.1 3.9 96.7 2.8 96.9 2.3 88.6 6.6 1 Tdap 96.6 0.5 92.6 2.8 93.9 2.6 93.1 3.9 95.4 3.3 96.9 2.3 86.4 7.2 1 MCV4 96.4 0.5 91.4 3.0 93.3 2.8 92.5 4.1 94.7 3.6 96.0 2.6 86.4 7.2 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 92.0 2.9 39.9 5.3 14.1 3.8 94.6 2.5 40.8 5.4 20.4 4.5 93.1 3.9 38.1 7.5 18.8 6.1 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 96.7 2.8 44.1 7.9 22.4 6.6 96.5 2.4 46.9 6.5 23.5 5.5 89.8 6.3 25.0 9.1 12.5 6.9 District 2-0 14 The 2017 GAIS sampled 323 seventh grade adolescents in District 2-0 (Table 20-A). Of the students sampled, 47.1% were male, 52.3% were female, and 0.6% had missing gender information. Students enrolled in public schools accounted for 72.4% of the sample; 27.6% were enrolled in private schools. A total of 29 schools were sampled (18 public, 11 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 2, the 2017 UTD immunization rate for 7th graders was 92.9%, lower than the 2016 rate (94.8%) and lower than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 2-0-B). The 2017 District 2-0 coverage rates for all vaccines were slightly higher than the 2016 rates except for HPV completion which was significantly higher than the 2016 rate. The 2017 coverage rates for HPV (1-dose and series completion) were significantly lower in District 2-0 when compared to the State rates. The 2017 District 2-0 coverage rates did not vary by gender, however, the rates for Tdap, MCV4, Polio and HPV (1-dose and series completion) were significantly higher for students enrolled in public vs. private schools (Table 2-0-B). Table 2-0-A: Gender, school type, waiver and exemptions among District 2-0 adolescents, 2017 (n = 323). Gender Male Female Unknown # of Percent of students sample (%) 152 47.1 169 52.3 2 0.6 School type Public (18) 234 72.4 Private (11) 89 27.6 Within waiver period? Yes No 0 0 323 100 Exemptions Religious 8 2.5 Medical 0 0 No exemption 315 97.5 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. None of the students in the District 2-0 sample were found to be in the school waiver period (Table 2-0-A). None of the students in the District 2 sample had a medical exemption for one or more vaccines; 8 (2.5%) students had a religious exemption on file (Table 2-0-A). Table 2-0-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 2-0, 2017 2017, Year, Gender, 2017, School type, 2017, State District 2-0 District 2-0 District 2-0 Overall n = 6,191 (%) 2016 n = 344 (%) 2017 n = 323 (%) Male n = 152 (%) Female n = 169 (%) Public n = 234 (%) Private n = 89 (%) UTD rate* 94.4 0.6 94.8 2.4 92.9 2.8 92.8 4.1 93.5 3.7 94.0 3.0 89.9 6.3 3+ Hepatitis B 98.3 0.3 97.4 1.7 99.4 0.9 99.3 1.3 100.0 0.0 99.6 0.8 98.9 2.2 2+ MMR 98.3 0.3 96.8 1.9 99.1 1.0 99.3 1.3 99.4 1.2 99.6 0.8 97.8 3.1 2+ Varicella 97.2 0.4 95.9 2.1 96.9 1.9 96.1 3.1 98.2 2.0 97.0 2.2 96.6 3.8 1 Tdap 96.6 0.5 94.8 2.4 95.4 2.3 96.7 2.8 94.7 3.4 97.0 2.2 91.0 6.0 1 MCV4 96.4 0.5 95.1 2.3 95.7 2.2 96.7 2.8 95.3 3.2 97.4 2.0 91.0 6.0 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 95.3 2.2 34.9 5.0 11.3 3.4 97.8 1.6 37.2 5.3 17.3 4.1 98.7 1.8 34.9 7.6 15.8 5.8 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 97.6 2.3 39.1 7.4 18.3 5.8 99.1 1.2 44.0 6.4 20.5 5.2 94.4 4.8 19.1 8.2 9.0 6.0 District 3-1 15 The 2017 GAIS sampled 267 seventh grade adolescents in District 3-1 (Table 31-A). Of the students sampled, 54.7% were male, 44.9% were female, and 0.4% had missing gender information. Students enrolled in public schools accounted for 48.3% of the sample; 51.7% were enrolled in private schools. A total of 22 schools were sampled (10 public, 12 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 3-1, the 2017 UTD immunization rate for 7th graders was 93.3%, lower than the 2016 rate (94.1%) and lower than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 3-1-B). The 2017 District 3-1 coverage rates for all vaccines were similar to the 2016 rates and the 2017 State rates. Rates also did not vary for District 3-1 based on student gender or school type (Table 3-1-B). Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. None of the students in the District 3-1 sample were found to be in the school waiver period (Table 3-1-A). Table 3-1-A: Gender, school type, waiver and exemptions among District 3-1 adolescents, 2017 (n = 267). Gender Male Female Unknown # of Percent of students sample (%) 146 54.7 120 44.9 1 0.4 School type Public (10) 129 48.3 Private (12) 138 51.7 Within waiver period? Yes No 0 0 267 100 Exemptions Religious 5 1.9 Medical 0 0 No exemption 262 98.1 None of the students in the District 3-1 sample had a medical exemption for one or more vaccines; 5 (1.9%) students had a religious exemption on file (Table 3-1-A). Table 3-1-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 3-1, 2017 2017, Year, Gender, 2017, School type, 2017, State District 3-1 District 3-1 District 3-1 Overall n = 6,191 (%) 2016 n = 358 (%) 2017 n = 267 (%) Male n = 145 (%) Female n = 120 (%) Public n = 129 (%) Private n = 138 (%) UTD rate* 94.4 0.6 94.1 2.4 93.3 3.0 93.8 3.9 92.5 4.7 91.5 4.8 94.9 3.7 3+ Hepatitis B 98.3 0.3 99.2 0.9 98.1 1.6 96.6 3.0 100.0 0.0 96.1 3.3 100.0 0.0 2+ MMR 98.3 0.3 99.2 0.9 98.9 1.3 97.9 2.3 100.0 0.0 97.7 2.6 100.0 0.0 2+ Varicella 97.2 0.4 96.4 1.9 97.4 1.9 96.6 3.0 98.3 2.3 95.3 3.6 99.3 1.4 1 Tdap 96.6 0.5 95.3 2.2 96.6 2.2 97.9 2.3 95.0 3.9 96.9 3.0 96.4 3.1 1 MCV4 96.4 0.5 95.5 2.1 95.9 2.4 96.6 3.0 95.0 3.9 95.3 3.6 96.4 3.1 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 97.5 1.6 48.0 5.2 17.0 3.9 97.0 2.0 43.1 6.0 21.0 4.9 95.9 3.2 39.7 8.0 22.6 6.8 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.3 2.3 47.5 9.0 19.2 7.1 95.3 3.6 45.7 8.6 20.9 7.0 98.6 2.0 40.6 8.2 21.0 6.8 District 3-2 16 The 2017 GAIS sampled 378 seventh grade adolescents in District 3-2 (Table 32-A). Of the students sampled, 52.6% were male, 46.8% were female, and 0.5% had missing gender information. Students enrolled in public schools accounted for 55.0% of the sample; 45.0% were enrolled in private schools. A total of 30 schools were sampled (16 public, 14 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 3-2, the 2017 UTD immunization rate for 7th graders was 94.7%, lower than the 2016 rate (95.3%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 3-2-B). The 2017 District 3-2 coverage rates for most vaccines were similar to the 2016 rates except for HPV (1-dose and series completion) which showed a significant increase. No significant differences in the 2017 coverage rates were observed between the State and District 3-2, or between male and female students in District 3-2. Within District 32 the rate for HPV series completion was significantly lower among children attending public vs. private schools (Table 3-2-B). Table 3-2-A: Gender, school type, waiver and exemptions among District 3-2 adolescents, 2017 (n = 378). Gender Male Female Unknown # of Percent of students sample (%) 199 52.6 177 46.8 2 0.5 School type Public (16) 208 55.0 Private (14) 170 45.0 Within waiver period? Yes No 0 0 378 100 Exemptions Religious 6 1.6 Medical 1 0.3 No exemption 371 98.1 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. None of the students in the District 3-2 sample were found to be in the school waiver period (Table 3-2-A). One (0.3%) of the students in the District 3-2 sample had a medical exemption for one or more vaccines; 6 (1.6%) students had a religious exemption on file (Table 3-2-A). Table 3-2-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 3-2, 2017 2017, Year, Gender, 2017, School type, 2017, State District 3-2 District 3-2 District 3-2 Overall n = 6,191 (%) 2016 n = 362 (%) 2017 n = 378 (%) Male n = 199 (%) Female n = 177 (%) Public n = 208 (%) Private n = 170 (%) UTD rate* 94.4 0.6 95.3 2.2 94.7 2.3 94.0 3.3 95.5 3.1 93.8 3.3 95.9 3.0 3+ Hepatitis B 98.3 0.3 97.5 1.6 98.9 1.0 99.0 1.4 98.9 1.6 99.5 0.9 98.2 2.0 2+ MMR 98.3 0.3 97.5 1.6 98.4 1.3 98.0 2.0 98.9 1.6 98.6 1.6 98.2 2.0 2+ Varicella 97.2 0.4 96.7 1.8 97.1 1.7 96.0 2.7 98.3 1.9 96.2 2.6 98.2 2.0 1 Tdap 96.6 0.5 96.7 1.8 97.9 1.5 98.0 2.0 97.7 2.2 97.6 2.1 98.2 2.0 1 MCV4 96.4 0.5 97.0 1.8 97.1 1.7 96.5 2.6 97.7 2.2 97.1 2.3 97.1 2.5 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 96.4 1.9 43.1 5.1 11.9 3.3 98.4 1.3 51.6 5.0 25.1 4.4 98.0 2.0 51.3 7.0 28.1 6.3 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.9 1.6 52.0 7.4 21.5 6.1 99.0 1.3 51.9 6.8 20.7 5.5 97.6 2.3 51.2 7.5 30.6 6.9 District 3-3 17 The 2017 GAIS sampled 294 seventh grade adolescents in District 3-3 (Table 33-A). Of the students sampled, 49.0% were male, 50.7% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 99.7% of the sample; only 0.3% were enrolled in private schools, a number too small to generate any meaningful estimates or comparisons. A total of 21 schools were sampled (20 public, 1 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 3-3, the 2017 UTD immunization rate for 7th graders was 95.9%, higher than the 2016 rate (92.8%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 3-3 -B). The 2017 District 3-3 coverage rates varied only slightly from the 2016 rates except for MMR, Varicella, Tdap, and Polio which showed significant increases. The 2017 rate of 1-dose HPV vaccination was significantly higher for District 3-3 when compared with the State. No significant differences were observed in District 3-3 coverage rates by gender or by school type (Table 3-3-B). Table 3-3-A: Gender, school type, waiver and exemptions among District 3-3 adolescents, 2017 (n = 294). Gender Male Female Unknown # of Percent of students sample (%) 144 49.0 149 50.7 1 0.3 School type Public (20) 293 99.7 Private (1) 1 0.3 Within waiver period? Yes No 0 0 294 100 Exemptions Religious 3 1.0 Medical 0 0 No exemption 291 99.0 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. None of the students in the District 3-3 sample were found to be in the school waiver period (Table 3-3-A). None of the students in the District 3-3 sample had a medical exemption for one or more vaccines; 3 (1.0%) students had a religious exemption on file (Table 3-3-A). Table 3-3-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 3-3, 2017 2017, Year, Gender, 2017, School type, 2017, State District 3-3 District 3-3 District 3-3 Overall n = 6,191 (%) 2016 n = 293 (%) 2017 n = 294 (%) Male n = 144 (%) Female n = 149 (%) Public n = 293 (%) Private n = 1 (%) UTD rate* 94.4 0.6 92.8 3.0 95.9 2.3 96.5 3.0 95.3 3.4 95.9 2.3 3+ Hepatitis B 98.3 0.3 95.6 2.4 98.3 1.5 97.9 2.3 98.7 1.9 98.3 1.5 2+ MMR 2+ Varicella 1 Tdap 1 MCV4 4+ Polio 1 HPV 98.3 0.3 97.2 0.4 96.6 0.5 96.4 0.5 95.2 2.4 94.5 2.6 93.9 2.8 93.9 2.8 99.7 0.7 98.3 1.5 98.0 1.6 97.6 1.7 97.6 0.4 47.9 1.2 94.2 2.7 57.7 5.7 98.6 1.3 58.5 5.6 100.0 0.0 98.6 1.9 98.6 1.9 97.9 2.3 99.3 1.3 98.0 2.3 97.3 2.6 97.3 2.6 98.6 1.9 58.3 8.1 98.7 1.9 59.1 7.9 99.7 0.7 98.3 1.5 98.0 1.6 97.6 1.8 98.6 1.3 58.4 5.7 Sample size is too small to generate meaningful estimates or comparisons Complete HPV series 23.3 1.0 16.7 4.3 23.1 4.8 22.9 6.9 23.5 6.8 22.9 4.8 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). District 3-4 18 The 2017 GAIS sampled 362 seventh grade adolescents in District 3-4 (Table 34-A). Of the students sampled, 48.3% were male, 50.8% were female, and 0.8% had missing gender information. Students enrolled in public schools accounted for 68.5% of the sample; 31.5% were enrolled in private schools. A total of 30 schools were sampled (20 public, 10 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 3-4, the 2017 UTD immunization rate for 7th graders was 91.4%, lower than the 2016 rate (92.1%) and lower than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 3-4-B). The 2017 District 3-4 coverage rates varied only slightly from the 2016 rates except for MCV4, Polio and HPV series completion which showed significant increases. The 2017 UTD and Varicella coverage rates were significantly lower in District 3-4 compared to the State. The 2017 District 3-4 coverage rates did not vary by gender, but the rates for MMR, and HPV (1-dose and series completion) were significantly higher in children attending public vs. private schools (Table 3-4-B). Table 3-4-A: Gender, school type, waiver and exemptions among District 3-4 adolescents, 2017 (n = 362). Gender Male Female Unknown # of Percent of students sample (%) 175 48.3 184 50.8 3 0.8 School type Public (20) 248 68.5 Private (10) 114 31.5 Within waiver period? Yes No 0 0 362 100 Exemptions Religious 13 3.6 Medical 0 0 No exemption 349 96.4 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. None of the students in the District 3-4 sample were found to be in the school waiver period (Table 3-4-A). None of the students in the District 3-4 sample had a medical exemption for one or more vaccines; 13 (3.6%) students had a religious exemption on file (Table 3-4-A). Table 3-4-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 3-4, 2017 2017, Year, Gender, 2017, School type, 2017, State District 3-4 District 3-4 District 3-4 Overall n = 6,191 (%) 2016 n = 353 (%) 2017 n = 362 (%) Male n = 175 (%) Female n = 184 (%) Public n = 248 (%) Private n = 114 (%) UTD rate* 94.4 0.6 92.1 2.8 91.4 2.9 90.3 4.4 93.5 3.6 91.9 3.4 90.4 5.4 3+ Hepatitis B 98.3 0.3 96.3 2.0 97.0 1.8 96.6 2.7 97.8 2.1 98.0 1.8 94.7 4.1 2+ MMR 98.3 0.3 96.0 2.0 97.8 1.5 98.3 1.9 97.8 2.1 99.2 1.1 94.7 4.1 2+ Varicella 97.2 0.4 95.5 2.2 95.0 2.2 94.9 3.3 95.7 3.0 95.2 2.7 94.7 4.1 1 Tdap 96.6 0.5 94.1 2.5 96.4 1.9 96.6 2.7 97.3 2.4 97.6 1.9 93.9 4.4 1 MCV4 96.4 0.5 93.8 2.5 97.0 1.8 96.6 2.7 98.4 1.8 98.0 1.8 94.7 4.1 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 93.2 2.6 39.4 5.1 15.6 3.8 97.0 1.8 45.9 5.1 24.3 4.4 96.6 2.7 42.3 7.3 21.1 6.1 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 97.8 2.1 49.5 7.2 27.7 6.5 97.6 1.9 53.6 6.2 29.4 5.7 95.6 3.8 28.9 8.3 13.2 6.2 District 3-5 19 The 2017 GAIS sampled 345 seventh grade adolescents in District 3-5 (Table 35-A). Of the students sampled, 50.1% were male, 48.7% were female, and 1.2% had missing gender information. Students enrolled in public schools accounted for 67.2% of the sample; 32.8% were enrolled in private schools. A total of 30 schools were sampled (18 public, 12 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 3-5, the 2017 UTD immunization rate for 7th graders was 87.2%, lower than the 2016 rate (88.2%) and lower than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 3-5-B). The 2017 District 3-5 coverage rates varied only slightly from the 2016 rates except for HPV series completion which showed a significant increase. Compared to the 2017 State coverage rates, the UTD, Hepatitis B, MMR, Varicella, Tdap, MCV and Polio coverage rates were significantly lower in District 3-5, but the 1-dose HPV was significantly higher. The 2017 District 3-5 coverage rates did not vary by gender, but the rates for UTD, Varicella, Tdap and MCV4 were significantly lower in children attending public vs. private schools (Table 3-5-B). Table 3-5-A: Gender, school type, waiver and exemptions among District 3-5 adolescents, 2017 (n = 345). Gender Male Female Unknown # of Percent of students sample (%) 173 50.1 168 48.7 4 1.2 School type Public (18) 232 67.2 Private (12) 113 32.8 Within waiver period? Yes No 2 0.6 343 99.4 Exemptions Religious 14 4.1 Medical 0 0 No exemption 331 95.9 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Two (0.6%) students in the District 3-5 sample were found to be in the school waiver period (Table 3-5-A). None of the students in the District 3-5 sample had a medical exemption for one or more vaccines; 14 (4.1%) students had a religious exemption on file (Table 3-5-A). Table 3-5-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 3-5, 2017 2017, Year, Gender, 2017, School type, 2017, State District 3-5 District 3-5 District 3-5 Overall n = 6,191 (%) 2016 n = 374 (%) 2017 n = 345 (%) Male n = 173 (%) Female n = 168 (%) Public n = 232 (%) Private n = 113 (%) UTD rate* 94.4 0.6 88.2 3.3 87.2 3.5 88.4 4.8 87.5 5.0 84.1 4.7 93.8 4.5 3+ Hepatitis B 98.3 0.3 95.7 2.1 93.6 2.6 95.4 3.1 93.5 3.7 92.2 3.4 96.5 3.4 2+ MMR 98.3 0.3 96.5 1.9 96.2 2.0 97.7 2.2 95.2 3.2 94.4 3.0 100.0 0.0 2+ Varicella 97.2 0.4 96.0 2.0 93.3 2.6 96.0 2.9 91.7 4.2 90.9 3.7 98.2 2.4 1 Tdap 96.6 0.5 92.2 2.7 93.9 2.5 93.6 3.6 94.6 3.4 91.4 3.6 99.1 1.7 1 MCV4 96.4 0.5 91.7 2.8 93.6 2.6 93.1 3.8 94.6 3.4 90.9 3.7 99.1 1.7 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 90.9 2.9 52.7 5.1 16.8 3.8 94.2 2.5 54.2 5.3 25.8 4.6 96.5 2.7 49.1 7.5 23.1 6.3 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 93.5 3.7 59.5 7.4 29.2 6.9 91.4 3.6 55.6 6.4 24.6 5.5 100.0 0.0 51.3 9.2 28.3 8.3 District 4-0 20 The 2017 GAIS sampled 341 seventh grade adolescents in District 4-0 (Table 40-A). Of the students sampled, 52.8% were male, 46.0% were female, and 1.2% had missing gender information. Students enrolled in public schools accounted for 56.6% of the sample; 43.4% were enrolled in private schools. A total of 30 schools were sampled (17 public, 13 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 4, the 2017 UTD immunization rate for 7th graders was 90.3%, lower than the 2016 rate (94.6%) and lower than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 4-0-B). The 2017 District 4-0 coverage rates varied only slightly from the 2016 rates except for the UTD rate which showed a significant decrease. Compared to the 2017 State coverage rates, most rates were significantly lower in District 4-0. The 2017 District 4-0 coverage rates did not vary by gender, but the rates for UTD, MMR, Varicella, Polio and 1-dose of HPV were significantly higher in children attending public vs. private schools (Table 4-0B). Table 4-0-A: Gender, school type, waiver and exemptions among District 4-0 adolescents, 2017 (n = 341). Gender Male Female Unknown # of Percent of students sample (%) 180 52.8 157 46.0 4 1.2 School type Public (17) 193 56.6 Private (13) 148 43.4 Within waiver period? Yes No 1 0.3 340 99.7 Exemptions Religious 13 3.8 Medical 1 0.3 No exemption 327 95.9 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Only one (0.3%) of the students in the District 4-0 sample was found to be in the school waiver period (Table 4-A). One (0.3%) of the students in the District 4-0 sample had a medical exemption for one or more vaccines; 13 (3.8%) students had a religious exemption on file (Table 4-0-A). Table 4-0-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 4-0, 2017 2017, Year, Gender, 2017, School type, 2017, State District 4-0 District 4-0 District 4-0 Overall n = 6,191 (%) 2016 n = 315 (%) 2017 n = 341 (%) Male n = 180 (%) Female n = 157 (%) Public n = 193 (%) Private n = 148 (%) UTD rate* 94.4 0.6 94.6 2.5 90.3 3.1 91.1 4.2 91.7 4.3 93.3 3.5 86.5 5.5 3+ Hepatitis B 98.3 0.3 98.1 1.5 96.8 1.9 96.7 2.6 99.4 1.2 98.4 1.7 94.6 3.6 2+ MMR 98.3 0.3 97.8 1.6 95.6 2.2 96.1 2.8 97.5 2.5 97.9 2.0 92.6 4.2 2+ Varicella 97.2 0.4 96.5 2.0 94.1 2.5 94.4 3.4 96.2 3.0 97.9 2.0 89.2 5.0 1 Tdap 96.6 0.5 96.5 2.0 93.3 2.7 93.3 3.6 95.5 3.2 94.8 3.1 91.2 4.6 1 MCV4 96.4 0.5 96.8 1.9 93.5 2.6 93.9 3.5 95.5 3.2 94.8 3.1 91.9 4.4 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 96.8 1.9 37.1 5.3 12.4 3.6 94.4 2.4 37.8 5.2 17.3 4.0 94.4 3.4 37.8 7.1 16.1 5.4 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 96.8 2.8 38.9 7.6 19.1 6.2 97.4 2.2 45.6 7.0 20.7 5.7 90.5 4.7 27.7 7.2 12.8 5.4 District 5-1 21 The 2017 GAIS sampled 367 seventh grade adolescents in District 5-1 (Table 51-A). Of the students sampled, 50.4% were male, 49.3% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 92.4% of the sample; 7.6% were enrolled in private schools. A total of 14 schools were sampled (12 public, 2 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 5-1, the 2017 UTD immunization rate for 7th graders was 97.3%, lower than the 2016 rate (97.7%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 5-1-B). The 2017 District 5-1 coverage rates for all vaccines were similar to the 2016 rates. Compared to the 2017 State coverage rates, the rates for UTD and Varicella were significantly higher in District 5-1, but the rates for HPV (1-dose and series completion) were significantly lower. The 2017 District 5-1 coverage rates did not vary by gender, but the coverage rate for 1-dose of HPV was significantly higher in children attending public vs. private schools (Table 5-1-B). Table 5-1-A: Gender, school type, waiver and exemptions among District 5-1 adolescents, 2017 (n = 367). Gender Male Female Unknown # of Percent of students sample (%) 185 50.4 181 49.3 1 0.3 School type Public (12) 339 92.4 Private (2) 28 7.6 Within waiver period? Yes No 0 0 367 100 Exemptions Religious 2 0.5 Medical 0 0 No exemption 365 99.5 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. None of the students in the District 5-1 sample were found to be in the school waiver period (Table 5-1-A). None of the students in the District 5-1 sample had a medical exemption for one or more vaccines; 2 (0.5%) students had a religious exemption on file (Table 5-1-A). Table 5-1-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 5-1, 2017 2017, Year, Gender, 2017, School type, 2017, State District 5-1 District 5-1 District 5-1 Overall n = 6,191 (%) 2016 n = 304 (%) 2017 n = 367 (%) Male n = 185 (%) Female n = 181 (%) Public n = 339 (%) Private n = 28 (%) UTD rate* 94.4 0.6 97.7 1.7 97.3 1.7 97.8 2.1 96.7 2.6 97.1 1.8 100.0 0.0 3+ Hepatitis B 98.3 0.3 99.0 1.1 99.7 0.5 99.5 1.1 100.0 0.0 99.7 0.6 100.0 0.0 2+ MMR 98.3 0.3 99.0 1.1 99.7 0.5 99.5 1.1 100.0 0.0 99.7 0.6 100.0 0.0 2+ Varicella 97.2 0.4 98.4 1.4 99.2 0.9 99.5 1.1 98.9 1.5 99.1 1.0 100.0 0.0 1 Tdap 96.6 0.5 98.4 1.4 98.1 1.4 98.4 1.8 97.8 2.1 97.9 1.5 100.0 0.0 1 MCV4 96.4 0.5 98.0 1.6 97.8 1.5 97.8 2.1 97.8 2.1 97.6 1.6 100.0 0.0 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 98.7 1.3 34.5 5.4 12.2 3.7 99.2 0.9 40.3 5.0 16.6 3.8 99.5 1.1 38.9 7.0 14.6 5.1 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.9 1.5 41.4 7.2 18.8 5.7 99.1 1.0 41.9 5.3 17.1 4.0 100.0 0.0 21.4 15.2 10.7 11.5 District 5-2 22 The 2017 GAIS sampled 381 seventh grade adolescents in District 5-2 (Table 52-A). Of the students sampled, 51.7% were male, 47.5% were female, and 0.8% had missing gender information. Students enrolled in public schools accounted for 57.5% of the sample; 42.5% were enrolled in private schools. A total of 30 schools were sampled (17 public, 13 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 5-2, the 2017 UTD immunization rate for 7th graders was 94.8%, lower than the 2016 rate (96.6%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 5-2-B). The 2017 District 5-2 coverage rates varied only slightly from the 2016 rates except for HPV series completion which showed a significant increase. No observable significant differences were found between the 2017 State and District 5-2 coverage rates. The 2017 District 5-2 coverage rate for 1-dose of HPV was lower for male vs. female adolescents. The coverage rate for HPV (1-dose and series completion) was significantly higher in children attending public vs. private schools in District 5-2 (Table 5-2-B). Table 5-2-A: Gender, school type, waiver and exemptions among District 5-2 adolescents, 2017 (n = 381). Gender Male Female Unknown # of Percent of students sample (%) 197 51.7 181 47.5 3 0.8 School type Public (17) 219 57.5 Private (13) 162 42.5 Within waiver period? Yes No 0 0 381 100 Exemptions Religious 9 2.4 Medical 2 0.5 No exemption 370 97.1 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. None of the students in the District 5-2 sample were found to be in the school waiver period (Table 5-2-A). Two (0.5%) of the students in the District 5-2 sample had a medical exemption for one or more vaccines; 9 (2.4%) students had a religious exemption on file (Table 5-2-A). Table 5-2-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 5-2, 2017 2017, Year, Gender, 2017, School type, 2017, State District 5-2 District 5-2 District 5-2 Overall n = 6,191 (%) 2016 n = 388 (%) 2017 n = 381 (%) Male n = 197 (%) Female n = 181 (%) Public n = 219 (%) Private n = 162 (%) UTD rate* 94.4 0.6 96.6 1.8 94.8 2.2 97.0 2.4 92.8 3.8 94.5 3.0 95.1 3.3 3+ Hepatitis B 98.3 0.3 98.5 1.2 99.2 0.9 100.0 0.0 98.9 1.5 99.1 1.3 99.4 1.2 2+ MMR 98.3 0.3 97.9 1.4 99.0 1.0 99.5 1.0 98.9 1.5 99.1 1.3 98.8 1.7 2+ Varicella 97.2 0.4 97.9 1.4 98.4 1.3 99.5 1.0 97.8 2.1 98.2 1.8 98.8 1.7 1 Tdap 96.6 0.5 96.9 1.7 95.5 2.1 97.5 2.2 93.9 3.5 95.9 2.6 95.1 3.3 1 MCV4 96.4 0.5 96.6 1.8 95.5 2.1 97.0 2.4 94.5 3.3 95.4 2.8 95.7 3.1 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 97.4 1.6 42.8 4.9 16.8 3.7 98.7 1.1 46.7 5.0 23.9 4.3 99.5 1.0 41.6 6.9 21.8 5.8 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.3 1.9 53.0 7.3 26.5 6.4 99.1 1.3 52.1 6.6 27.9 5.9 98.1 2.1 39.5 7.5 18.5 6.0 District 6-0 23 The 2017 GAIS sampled 356 seventh grade adolescents in District 6-0 (Table 60-A). Of the students sampled, 49.7% were male, 48.9% were female, and 1.4% had missing gender information. Students enrolled in public schools accounted for 77.5% of the sample; 22.5% were enrolled in private schools. A total of 30 schools were sampled (21 public, 9 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 6, the 2017 UTD immunization rate for 7th graders was 95.8%, lower than the 2016 rate (97%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 6-0-B). The 2017 District 6-0 coverage rates varied only slightly from the 2016 rates except for HPV series completion which showed a significant increase. No observable significant differences were found between the 2017 State and District 6-0 coverage rates. The 2017 District 6-0 coverage rates for HPV (1-dose and series completion) was lower for male vs. female adolescents. The coverage rate for 1-dose of HPV was significantly higher in children attending public vs. private schools in District 6-0 (Table 6-0-B). Table 6-0-A: Gender, school type, waiver and exemptions among District 6-0 adolescents, 2017 (n = 356). Gender Male Female Unknown # of Percent of students sample (%) 177 49.7 174 48.9 5 1.4 School type Public (21) 276 77.5 Private (9) 80 22.5 Within waiver period? Yes No 1 0.3 355 99.7 Exemptions Religious 0 0 Medical 0 0 No exemption 356 100 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Only one (0.3%) of the students in the District 6 sample was found to be in the school waiver period (Table 6-0-A). None of the students in the District 6-0 sample had a medical exemption for one or more vaccines or a religious exemption on file (Table 6-0-A). Table 6-0-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 6-0, 2017 2017, Year, Gender, 2017, School type, 2017, State District 6-0 District 6-0 District 6-0 Overall n = 6,191 (%) 2016 n = 336 (%) 2017 n = 356 (%) Male n = 177 (%) Female n = 174 (%) Public n = 276 (%) Private n = 80 (%) UTD rate* 94.4 0.6 97.0 1.8 95.8 2.1 95.5 3.1 96.0 2.9 95.7 2.4 96.2 4.2 3+ Hepatitis B 98.3 0.3 98.8 1.2 100.0 0.0 100.0 0.0 100.0 0.0 100.0 0.0 100.0 0.0 2+ MMR 98.3 0.3 98.8 1.2 100.0 0.0 100.0 0.0 100.0 0.0 100.0 0.0 100.0 0.0 2+ Varicella 97.2 0.4 97.6 1.6 98.0 1.4 97.7 2.2 98.3 1.9 98.6 1.4 96.2 4.2 1 Tdap 96.6 0.5 98.8 1.2 97.8 1.5 98.3 1.9 97.1 2.5 97.1 2.0 100.0 0.0 1 MCV4 96.4 0.5 98.8 1.2 97.2 1.7 97.7 2.2 96.6 2.7 96.4 2.2 100.0 0.0 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 98.2 1.4 49.1 5.4 14.0 3.7 99.2 1.0 50.8 5.2 25.8 4.6 99.4 1.1 43.5 7.3 20.9 6.0 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.9 1.6 58.6 7.3 31.0 6.9 98.9 1.2 54.0 5.9 25.7 5.2 100.0 0.0 40.0 10.8 26.2 9.7 District 7-0 24 The 2017 GAIS sampled 329 seventh grade adolescents in District 7-0 (Table 70-A). Of the students sampled, 48.6% were male, 49.8% were female, and 1.5% had missing gender information. Students enrolled in public schools accounted for 79.3% of the sample; 20.7% were enrolled in private schools. A total of 18 schools were sampled (12 public, 6 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 7, the 2017 UTD immunization rate for 7th graders was 94.5%, higher than the 2016 rate (89.6%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 7-0-B). The 2017 District 7-0 coverage rates varied only slightly from the 2016 rates except for the UTD and HPV (1-dose and series completion) rates which showed significant increases. Compared to the 2017 State coverage rates, the rates for HPV (1-dose and series completion) were higher in District 7-0. The 2017 District 7-0 coverage rates did not vary by gender, but the rate for 1-dose of HPV was significantly higher in children attending public vs. private schools (Table 7-0-B). Table 7-0-A: Gender, school type, waiver and exemptions among District 7-0 adolescents, 2017 (n = 329). Gender Male Female Unknown # of Percent of students sample (%) 160 48.6 164 49.8 5 1.5 School type Public (12) 261 79.3 Private (6) 68 20.7 Within waiver period? Yes No 1 0.3 328 99.7 Exemptions Religious 9 2.7 Medical 1 0.3 No exemption 319 97.0 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Only one (0.3%) of the students in the District 7-0 sample was found to be in the school waiver period (Table 7-0-A). One (0.3%) of the students in the District 7-0 sample had a medical exemption for one or more vaccines; 9 (2.7%) students had a religious exemption on file (Table 7-0-A). Table 7-0-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 7-0, 2017 2017, Year, Gender, 2017, School type, 2017, State District 7-0 District 7-0 District 7-0 Overall n = 6,191 (%) 2016 n = 318 (%) 2017 n = 329 (%) Male n = 160 (%) Female n = 164 (%) Public n = 261 (%) Private n = 68 (%) UTD rate* 94.4 0.6 89.6 3.4 94.5 2.5 93.8 3.8 97.0 2.6 95.0 2.6 92.6 6.2 3+ Hepatitis B 98.3 0.3 94.7 2.5 97.3 1.8 96.2 2.9 100.0 0.0 97.7 1.8 95.6 4.9 2+ MMR 98.3 0.3 94.3 2.5 97.3 1.8 96.9 2.7 99.4 1.2 98.1 1.7 94.1 5.6 2+ Varicella 97.2 0.4 94.3 2.5 97.0 1.9 96.9 2.7 98.8 1.7 97.7 1.8 94.1 5.6 1 Tdap 96.6 0.5 94.0 2.6 95.7 2.2 95.6 3.2 97.6 2.4 96.2 2.3 94.1 5.6 1 MCV4 96.4 0.5 93.7 2.7 95.1 2.3 94.4 3.6 97.6 2.4 95.8 2.4 92.6 6.2 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 93.7 2.7 39.0 5.4 12.9 3.7 97.0 1.9 64.7 5.2 34.3 5.1 96.2 2.9 60.6 7.6 31.2 7.2 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 99.4 1.2 69.5 7.1 37.2 7.4 97.7 1.8 68.6 5.6 36.4 5.8 94.1 5.6 50.0 11.9 26.5 10.5 District 8-1 25 The 2017 GAIS sampled 343 seventh grade adolescents in District 8-1 (Table 81-A). Of the students sampled, 47.8% were male, 49.6% were female, and 2.6% had missing gender information. Students enrolled in public schools accounted for 70.0% of the sample; 30.0% were enrolled in private schools. A total of 25 schools were sampled (15 public, 10 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 8-1, the 2017 UTD immunization rate for 7th graders was 98.8%, higher than the 2016 rate (97.7%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 8-1 -B). The 2017 District 8-1 coverage rates for all vaccines were similar to the 2016 rates. Compared to the 2017 State coverage rates, the rates for UTD, Varicella, Tdap and MCV4 were higher in District 8-1. The 2017 District 8-1 coverage rates did not vary by gender, but the rate for 1dose of HPV was significantly higher in children attending public vs. private schools (Table 8-1-B). Table 8-1-A: Gender, school type, waiver and exemptions among District 8-1 adolescents, 2017 (n = 343). Gender Male Female Unknown # of Percent of students sample (%) 164 47.8 170 49.6 9 2.6 School type Public (15) 240 70.0 Private (10) 103 30.0 Within waiver period? Yes No 1 0.3 342 99.7 Exemptions Religious 1 0.3 Medical 0 0 No exemption 342 99.7 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Only one (0.3%) of the students in the District 8-1 sample was found to be in the school waiver period (Table 8-1-A). None of the students in the District 8-1 sample had a medical exemption for one or more vaccines; 1 (0.3%) student had a religious exemption on file (Table 8-1-A). Table 8-1-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 8-1, 2017 2017, Year, Gender, 2017, School type, 2017, State District 8-1 District 8-1 District 8-1 Overall n = 6,191 (%) 2016 n = 347 (%) 2017 n = 343 (%) Male n = 164 (%) Female n = 170 (%) Public n = 240 (%) Private n = 103 (%) UTD rate* 94.4 0.6 97.7 1.6 98.8 1.1 98.8 1.7 98.8 1.6 98.7 1.4 99.0 1.9 3+ Hepatitis B 98.3 0.3 98.8 1.1 100.0 0.0 100.0 0.0 100.0 0.0 100.0 0.0 100.0 0.0 2+ MMR 98.3 0.3 98.6 1.3 100.0 0.0 100.0 0.0 100.0 0.0 100.0 0.0 100.0 0.0 2+ Varicella 97.2 0.4 98.0 1.5 99.1 1.0 99.4 1.2 98.8 1.6 99.2 1.2 99.0 1.9 1 Tdap 96.6 0.5 98.6 1.3 99.7 0.6 99.4 1.2 100.0 0.0 99.6 0.8 100.0 0.0 1 MCV4 96.4 0.5 98.6 1.3 99.7 0.6 99.4 1.2 100.0 0.0 99.6 0.8 100.0 0.0 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 96.0 2.1 43.2 5.2 18.4 4.1 100.0 0.0 46.6 5.3 23.3 4.5 100.0 0.0 46.3 7.6 23.8 6.5 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 100.0 0.0 48.8 7.5 24.1 6.4 100.0 0.0 53.3 6.3 23.3 5.4 100.0 0.0 31.1 9.0 23.3 8.2 District 8-2 26 The 2017 GAIS sampled 361 seventh grade adolescents in District 8-2 (Table 82-A). Of the students sampled, 54.3% were male, 45.4% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 74.8% of the sample; 25.2% were enrolled in private schools. A total of 30 schools were sampled (22 public, 8 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 8-2, the 2017 UTD immunization rate for 7th graders was 97.8%, lower than the 2016 rate (99.1%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 8-2-B). The 2017 District 8-2 coverage rates varied only slightly from the 2016 rates except for HPV series completion which showed a significant increase. Compared to the 2017 State coverage rates, the rates for UTD, Varicella and HPV (1-dose and series completion) were higher in District 8-2. The 2017 District 8-2 coverage rates did not vary by gender, but the rates for HPV (1-dose and series completion) were significantly higher in children attending public vs. private schools (Table 8-2-B). Table 8-2-A: Gender, school type, waiver and exemptions among District 8-2 adolescents, 2017 (n = 361). Gender Male Female Unknown # of Percent of students sample (%) 196 54.3 164 45.4 1 0.3 School type Public (22) 270 74.8 Private (8) 91 25.2 Within waiver period? Yes No 1 0.3 360 99.7 Exemptions Religious 3 0.8 Medical 0 0 No exemption 358 99.2 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Only one (0.3%) of the students in the District 8-2 sample was found to be in the school waiver period (Table 8-2-A). None of the students in the District 8-2 sample had a medical exemption for one or more vaccines; 3 (0.8%) students had a religious exemption on file (Table 8-2-A). Table 8-2-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 8-2, 2017 2017, Year, Gender, 2017, School type, 2017, State District 8-2 District 8-2 District 8-2 Overall n = 6,191 (%) 2016 n = 341 (%) 2017 n = 361 (%) Male n = 196 (%) Female n = 164 (%) Public n = 270 (%) Private n = 91 (%) UTD rate* 94.4 0.6 99.1 1.0 97.8 1.5 98.0 2.0 98.2 2.1 98.1 1.6 96.7 3.7 3+ Hepatitis B 98.3 0.3 100 0.0 99.4 0.8 100.0 0.0 99.4 1.2 99.6 0.7 98.9 2.1 2+ MMR 98.3 0.3 100 0.0 99.4 0.8 100.0 0.0 99.4 1.2 99.6 0.7 98.9 2.1 2+ Varicella 97.2 0.4 99.4 0.8 99.2 0.9 100.0 0.0 98.8 1.7 99.3 1.0 98.9 2.1 1 Tdap 96.6 0.5 99.7 0.6 98.1 1.4 98.0 2.0 98.8 1.7 98.5 1.4 96.7 3.7 1 MCV4 96.4 0.5 100 0.0 98.1 1.4 98.0 2.0 98.8 1.7 98.5 1.4 96.7 3.7 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 100 0.0 55.1 5.3 17.3 4.0 99.2 0.9 53.5 5.2 30.7 4.8 100.0 0.0 52.0 7.0 31.6 6.5 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.8 1.7 55.5 7.6 29.9 7.0 99.3 1.0 60.0 5.9 34.4 5.7 98.9 2.1 34.1 9.8 19.8 8.2 District 9-1 27 The 2017 GAIS sampled 489 seventh grade adolescents in District 9-1 (Table 91-A). Of the students sampled, 47.6% were male, 51.7% were female, and 0.6% had missing gender information. Students enrolled in public schools accounted for 71.2% of the sample; 28.8% were enrolled in private schools. A total of 38 schools were sampled (26 public, 12 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 9-1, the 2017 UTD immunization rate for 7th graders was 97.8%, higher than the 2016 rate (94.8%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 9-1 -B). The 2017 District 9-1 coverage rates significantly increased from the 2016 rates except for MMR and Tdap. Compared to the 2017 State coverage rates, the rates for UTD, Hepatitis B, Varicella, MCV4 and HPV series completion were higher in District 9-1. The 2017 District 9 -1 coverage rates did not vary by gender, but he coverage rate for 1-dose of HPV was significantly higher in children attending public vs. private schools (Table 9-1B). Table 9-1-A: Gender, school type, waiver and exemptions among District 9-1 adolescents, 2017 (n = 489). Gender Male Female Unknown # of Percent of students sample (%) 233 47.6 253 51.7 3 0.6 School type Public (26) 348 71.2 Private (12) 141 28.8 Within waiver period? Yes No 0 0 489 100 Exemptions Religious 8 1.6 Medical 0 0 No exemption 481 98.4 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Only one (0.3%) of the students in the District 9-1 sample was found to be in the school waiver period (Table 9-1-A). None of the students in the District 9-1 sample had a medical exemption for one or more vaccines; 8 (1.6%) students had a religious exemption on file (Table 9-1-A). Table 9-1-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 9-1, 2017 2017, Year, Gender, 2017, School type, 2017, State District 9-1 District 9-1 District 9-1 Overall n = 6,191 (%) 2016 n = 344 (%) 2017 n = 489 (%) Male n = 233 (%) Female n = 253 (%) Public n = 348 (%) Private n = 141 (%) UTD rate* 94.4 0.6 94.8 2.4 97.8 1.3 97.9 1.9 97.6 1.9 98.6 1.3 95.7 3.3 3+ Hepatitis B 98.3 0.3 97.7 1.6 99.6 0.6 100.0 0.0 99.2 1.1 99.4 0.8 100.0 0.0 2+ MMR 98.3 0.3 97.7 1.6 99.2 0.8 99.1 1.2 99.2 1.1 99.7 0.6 97.9 2.4 2+ Varicella 97.2 0.4 95.1 2.3 99.4 0.7 99.6 0.8 99.2 1.1 99.7 0.6 98.6 2.0 1 Tdap 96.6 0.5 95.9 2.1 98.2 1.2 97.9 1.9 98.4 1.5 98.6 1.3 97.2 2.7 1 MCV4 96.4 0.5 95.3 2.2 98.2 1.2 97.9 1.9 98.4 1.5 98.6 1.3 97.2 2.7 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 95.3 2.2 43.6 5.2 14.5 3.7 98.6 1.1 52.6 4.4 27.8 4.0 98.7 1.4 52.8 6.4 27.0 5.7 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.4 1.5 53.0 6.2 28.9 5.6 98.6 1.3 55.7 5.2 29.0 4.8 98.6 2.0 44.7 8.2 24.8 7.1 District 9-2 28 The 2017 GAIS sampled 224 seventh grade adolescents in District 9-2 (Table 92-A). Of the students sampled, 51.8% were male, 47.8% were female, and 0.4% had missing gender information. Students enrolled in public schools accounted for 81.2% of the sample; 18.8% were enrolled in private schools. A total of 14 schools were sampled (11 public, 3 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 9-2, the 2017 UTD immunization rate for 7th graders was 95.5%, lower than the 2016 rate (96.9%) and higher than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 9-2-B). The 2017 District 9-2 coverage rates for all vaccines were similar to the 2016 rates and the 2017 State rates. Rates also did not vary for District 9-2 based on student gender or school type (Table 9-2-B). Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. None of the students in the District 9-2 sample were found to be in the school waiver period (Table 9-2-A). Table 9-2-A: Gender, school type, waiver and exemptions among District 9-2 adolescents, 2017 (n = 224). Gender Male Female Unknown # of Percent of students sample (%) 116 51.8 107 47.8 1 0.4 School type Public (11) 182 81.2 Private (3) 42 18.8 Within waiver period? Yes No 0 0 224 100 Exemptions Religious 6 2.7 Medical 0 0 No exemption 218 97.3 None of the students in the District 9-2 sample had a medical exemption for one or more vaccines; 6 (2.7%) students had a religious exemption on file (Table 9-2-A). Table 9-2-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 9-2, 2017 2017, Year, Gender, 2017, School type, 2017, State District 9-2 District 9-2 District 9-2 Overall n = 6,191 (%) 2016 n = 355 (%) 2017 n = 224 (%) Male n = 116 (%) Female n = 107 (%) Public n = 182 (%) Private n = 42 (%) UTD rate* 94.4 0.6 96.9 1.8 95.5 2.7 96.6 3.3 95.3 4.0 95.6 3.0 95.2 6.5 3+ Hepatitis B 98.3 0.3 98.6 1.2 99.1 1.2 99.1 1.7 100.0 0.0 98.9 1.5 100.0 0.0 2+ MMR 98.3 0.3 99.2 1.0 99.1 1.2 99.1 1.7 100.0 0.0 98.9 1.5 100.0 0.0 2+ Varicella 97.2 0.4 98.3 1.3 98.2 1.7 98.3 2.4 99.1 1.8 97.8 2.1 100.0 0.0 1 Tdap 96.6 0.5 97.5 1.6 96.4 2.4 97.4 2.9 96.3 3.6 96.7 2.6 95.2 6.5 1 MCV4 96.4 0.5 98.0 1.4 96.9 2.3 98.3 2.4 96.3 3.6 97.3 2.4 95.2 6.5 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 97.7 1.5 44.5 5.2 14.6 3.7 97.8 1.9 48.7 6.6 18.3 5.1 97.4 2.9 46.6 9.1 16.4 6.7 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 99.1 1.8 51.4 9.5 20.6 7.7 97.3 2.4 51.1 7.3 17.6 5.5 100.0 0.0 38.1 14.7 21.4 12.4 District 10-0 29 The 2017 GAIS sampled 347 seventh grade adolescents in District 10-0 (Table 10-0-A). Of the students sampled, 50.4% were male, 49.3% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 65.1% of the sample; 34.9% were enrolled in private schools. A total of 29 schools were sampled (18 public, 11 private). Adolescent were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by January 1, 2017. In District 10-0, the 2017 UTD immunization rate for 7th graders was 93.9%, lower than the 2016 rate (95.7%) and lower than the State rate for 2017 (94.4%). Immunization rates that decreased from the previous year are shown in red; rates that were significantly different (p<0.05) between comparison categories are bolded and italicized (Table 10-0-B). The 2017 District 10-0 coverage rates for all vaccines were similar to the 2016 rates. Similarly, the 2017 District 10-0 coverage rates did not vary by gender. Compared to the 2017 State coverage rates, the rates for HPV (1-dose and series completion) were higher in District 10-0. The coverage rates for MMR and Polio were significantly higher for students attending public vs. private schools in District 10-0 (Table 10-0-B). Table 10-0-A: Gender, school type, waiver and exemptions among District 10-0 adolescents, 2017 (n = 347). Gender Male Female Unknown # of Percent of students sample (%) 175 50.4 171 49.3 1 0.3 School type Public (18) 226 65.1 Private (11) 121 34.9 Within waiver period? Yes No 2 0.6 345 99.4 Exemptions Religious 7 2.0 Medical 1 0.3 No exemption 339 97.7 Transfer students with incomplete immunization records have a 30-day waiver period to meet immunization requirements. Only two (0.6%) of the students in the District 10-0 sample were found to be in the school waiver period (Table 10-0-A). One (0.3%) of the students in the District 10-0 sample had a medical exemption for one or more vaccines; 7 (2.0%) students had a religious exemption on file (Table 10-0-A). Table 10-0-B: Georgia adolescent immunization coverage rates by vaccine antigen, gender and school type, District 10-0, 2017 2017, Year, Gender, 2017, School type, 2017, State District 10-0 District 10-0 District 10-0 Overall n = 6,191 (%) 2016 n = 370 (%) 2017 n = 347 (%) Male n = 175 (%) Female n = 171 (%) Public n = 226 (%) Private n = 121 (%) UTD rate* 94.4 0.6 95.7 2.1 93.9 2.5 93.1 3.7 95.3 3.2 94.7 2.9 92.6 4.7 3+ Hepatitis B 98.3 0.3 98.4 1.3 97.4 1.7 97.7 2.2 97.7 2.3 98.7 1.5 95.0 3.9 2+ MMR 98.3 0.3 98.1 1.4 97.7 1.6 97.1 2.5 98.8 1.6 99.1 1.2 95.0 3.9 2+ Varicella 97.2 0.4 95.7 2.1 96.0 2.1 94.9 3.3 97.7 2.3 97.3 2.1 93.4 4.4 1 Tdap 96.6 0.5 96.8 1.8 96.8 1.8 96.0 2.9 98.2 2.0 97.3 2.1 95.9 3.6 1 MCV4 96.4 0.5 96.2 1.9 96.5 1.9 96.0 2.9 97.7 2.3 97.3 2.1 95.0 3.9 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.0 96.8 1.8 39.5 5.0 14.1 3.5 96.5 1.9 40.6 5.2 17.9 4.0 96.6 2.7 38.9 7.2 16.6 5.5 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2016 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 97.1 2.5 42.7 7.4 19.3 5.9 98.2 1.7 41.6 6.4 19.9 5.2 93.4 4.4 38.8 8.7 14.0 6.2 Appendices i Appendix A: Immunization Coverage Measures Appendix Table A: Vaccine antigen-specific immunization coverage by District, GAIS, 2017 Highest rate District 1-1 Northwest (Rome) 3+ 2+ 2+ 1 1 4+ 1 dose Complete UTD Hepatitis B MMR Varicella Tdap MCV4 Polio HPV HPV series (%) (%) (%) (%) (%) (%) (%) (%) (%) 94.3 97.3 97.6 97.3 95.9 94.9 97.3 47.6 21.9 1-2 North Georgia (Dalton) 92.0 97.5 95.2 94.6 93.9 93.3 94.6 40.8 20.4 2-0 North (Gainesville) 92.9 99.4 99.1 96.9 95.4 95.7 97.8 37.2 17.3 3-1 Cobb-Douglas 93.3 98.1 98.9 97.4 96.6 95.9 97.0 43.1 21.0 3-2 Fulton 94.7 98.9 98.4 97.1 97.9 97.1 98.4 51.6 25.1 3-3 Clayton 95.9 98.3 99.7 98.3 98.0 97.6 98.6 58.5 23.1 3-4 East Metro (Lawrenceville) 91.4 97.0 97.8 95.0 96.4 97.0 97.0 45.9 24.3 3-5 DeKalb 87.2 93.6 96.2 93.3 93.9 93.6 94.2 54.2 25.8 4-0 LaGrange 90.3 96.8 95.6 94.1 93.3 93.5 94.4 37.8 17.3 5-1 South Central (Dublin) 97.3 99.7 99.7 99.2 98.1 97.8 99.2 40.3 16.6 5-2 North Central (Macon) 94.8 99.2 99.0 98.4 95.5 95.5 98.7 46.7 23.9 6-0 East Central (Augusta) 95.8 100.0 100.0 98.0 97.8 97.2 99.2 50.8 25.8 7-0 West Central (Columbus) 94.5 97.3 97.3 97.0 95.7 95.1 97.0 64.7 34.3 8-1 South (Valdosta) 98.8 100.0 100.0 99.1 99.7 99.7 100.0 46.6 23.3 8-2 Southwest (Albany) 97.8 99.4 99.4 99.2 98.1 98.1 99.2 53.5 30.7 9-1 Coastal (Savannah) 97.8 99.6 99.2 99.4 98.2 98.2 98.6 52.6 27.8 9-2 Southeast (Waycross) 95.5 99.1 99.1 98.2 96.4 96.9 97.8 48.7 18.3 10 Northeast (Athens) 93.9 97.4 97.7 96.0 96.8 96.5 96.5 40.6 17.9 Georgia 94.4 98.3 98.3 97.2 96.6 96.4 97.6 47.9 23.3 ii Appendix B: Frequency of exemptions Appendix Table B: Frequency of exemptions and school waiver status by District, GAIS, 2017 District Sample size Within school waiver period Religious exemption Medical exemption 1-1 Northwest (Rome) 370 1 9 0 1-2 North Georgia (Dalton) 2-0 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton 314 0 19 0 323 0 8 0 267 0 5 0 378 0 6 1 294 0 3 0 3-4 East Metro (Lawrenceville) 362 0 13 0 3-5 DeKalb 345 2 14 0 4-0 LaGrange 341 1 13 1 5-1 South Central (Dublin) 367 0 2 0 5-2 North Central (Macon) 381 0 9 2 6-0 East Central (Augusta) 356 1 7-0 West Central (Columbus) 329 1 8-1 South (Valdosta) 343 1 8-2 Southwest (Albany) 361 1 9-1 Coastal (Savannah) 489 0 0 0 9 1 1 0 3 0 8 0 9-2 Southeast (Waycross) 10 Northeast (Athens) 224 0 347 2 6 0 7 1 Georgia 6,191 10 135 6 Total 10 19 8 5 7 3 13 16 15 2 11 1 11 2 4 8 6 10 151 iii Appendix C: Reasons for incomplete vaccination Appendix Table C: Reasons for incomplete vaccination by antigen, Georgia Adolescent Immunization Study, 2017 Reason In conflict with another vaccine 3+ Hepatitis B 0 2+ MMR 0 2+ Varicella 3 1 1 4+ 1 dose Tdap MCV4 Polio HPV 0 0 0 0 Complete HPV series 0 School waiver on file 1 0 0 4 4 2 4 7 Serology+ or history of disease 5 1 39 0 0 0 0 0 Exempt certificate on file 63 79 81 116 121 79 138 139 Incomplete series 17 8 26 0 1 32 0 5 Late (given after 1/1/2017) 12 7 17 47 58 14 365 598 Vaccine not received 8 8 8 44 41 23 2,716 3,999 UTD 6,085 6,088 6,017 5,980 5,966 6,041 2,968 1,443 Total (sample size) 6,191 6,191 6,191 6,191 6,191 6,191 6,191 6,191 Additional Resources iv For more information about the Georgia Department of Public Health Immunization Program, please visit the following website: http://dph.georgia.gov/immunization-section For past Georgia Immunization Study Final Reports, please visit the following website: http://dph.georgia.gov/immunization-publications For more information about the Georgia Department of Public Health Acute Disease Epidemiology Unit, please visit the following website: http://dph.georgia.gov/acute-disease-epidemiology To access current vaccine schedules, vaccine information sheets and other immunization materials, please visit the Immunization Action Coalition website: http://www.immunize.org For questions relating to this document, please email the author at Fabio.Machado@dph.ga.gov