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 5H23IP000744-05-02 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 [vaccination 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 vaccination 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. The objectives of the Georgia adolescent immunization study are: 1. To generate annual state and District-level vaccination coverage estimates for school-required and HPV vaccinations for 7th grade Georgia students. 2. Determine if coverage levels are different from the previous year, between genders or any other domain of interest (as data allows). 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 adolescents in the state of Georgia. Vaccination history for 7th grade students from 18 Health Districts were analyzed to calculate rates. Identifying information and vaccination history data were obtained from school 3231 files and the Georgia Registry of Immunization Transactions and Services (GRITS). Vaccination rates for Tdap, Polio, MMR, MCV4 (meningococcal), Hepatitis B, Varicella and HPV vaccines were calculated. Data collection for the 2018 GAIS study began January 22 and lasted for three months until April, 20, 2018. A twostage cluster-sampling scheme was developed to randomly select the study sample. Stage one of the cluster sampling scheme involved randomly selecting up to 30 middle schools (public or private) from each of the 18 Health Districts. If a District had fewer than 30 middle schools, then all middle 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, with the goal of having similar sized samples for each District. The following formula was used to determine the sample size for each District, taking into account a finite population correction: Where: Ni= 7th grade population in District i c.i. halfwidth < 0.05 (half of the confidence interval) critical value = 1.96 (for a 95% confidence interval) p = 0.5 (expected proportion, 0.5 is the most conservative value) ni= sample size for District i The final sample size for the study is the addition of all the District samples. Once we know the sample size for the District, we determine the number of students to sample from each school by dividing the sample ni by the number of schools in the sample. Target and Sample Populations The target population of the 2018 GAIS included all 7th grade adolescents in the State of Georgia during the 20172018 school year. A sample of 7,057 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 vaccination 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, which may overlap Health District boundaries. The IRCs participated in a 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 middle schools in their respective Districts and assigned a required number of students per school to be sampled. Once at a school, IRCs obtained a roster of all currently enrolled 7th graders in that school and using a random-number generator, selected the required number of students. Step #2: Collect immunization forms at public and private schools Once the school-specific sample was selected, IRCs checked the sample's 3231 forms (the official vaccination history) on file at the school. A comparison of the GRITS record and the 3231 form was conducted for the sample 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 adolescents into the GAIS website A record was created by the IRC for each sampled student in the GAIS website. Information collected included first and last name, date of birth, county, school, exemptions (medical or religious), waiver status and immunity history. This data was used to link the sampled student with GRITS in order to download their vaccination history. A 7 blank vaccination record was also available in the GAIS website as a backup incase linking failed, this way the IRC could record the vaccination history. 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. Data Analysis The data cleaning and analysis for the 2018 GAIS were performed using R (ver. 3.4.2) software. Vaccination history 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 vaccination 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, 2018. Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. Vaccination rates are calculated regardless of the student's waiver, exemption or immunity status. Margins of error are provided for all vaccination 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%. Vaccination 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: 2018 State rates vs individual 2018 District rates Individual District rates for 2017 vs 2018 2018 coverage rates for male vs. female students 2018 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 2018 Male (52.6%) and female students (65.5%) in District X in 2018 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 2018 2017 (12.4%) and 2018 (20.2%) for District X Public (24.9%) and private schools (14.2%) 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 2018, State n = 7,057 (%) 50.1 1.2 28.0 1.1 Year, District X 2017 n = 363 (%) 2018 n = 370 (%) 52.7 5.1 58.6 5.2 12.4 3.6 20.2 4.3 Gender, 2018, 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, 2018, 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, 2018 Georgia Adolescent Immunization Study Fabio R. Machado, MPH Immunization Study Epidemiologist Principal Investigator, Primary Author Ebony S. Thomas, MPH Vaccine-Preventable Disease Epidemiologist Primary Editor Figure 1: Georgia Health Districts Metro Atlanta Districts State of Georgia 10 The 2018 Georgia Adolescent Immunization Study (GAIS) sampled 7,057 seventh grade adolescents from 503 middle schools (322 public, 181 private) (Table 1). Of the students sampled, 50.2% were male, 49.2% were female, and 0.6% had missing gender information. Students enrolled in public schools accounted for 70.6% of the sample; 29.4% were enrolled in private schools. 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, 2018. Statewide, the 2018 UTD vaccination rate for 7th graders was 93.9%, lower than the 2017 rate (94.4%). Vaccination 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 2018 vaccination rate for 1 HPV was significantly higher than the 2017 rate, whereas the vaccination rates for Tdap and MCV4 were significantly lower. The statewide vaccination rates for 1 HPV was significantly higher for female students than male students. Statewide coverage rates for all vaccines were significantly higher for students enrolled in public schools than students enrolled in private schools (Table 2). Only fifteen (0.2%) of the students in the 2018 sample were found to be in the school waiver period. Eight (0.1%) of the students in the sample had a medical exemption for one more vaccines and 191 (2.7%) had a religious exemption on file (Table 1). Table 1: Gender, school type, waiver and exemptions among Georgia adolescents, 2018 (n = 7,057). Gender Male Female Unknown # of Percent of students sample (%) 3541 50.2 3474 49.2 42 0.6 School type Public (322) 4981 70.6 Private (181) 2076 29.4 Within waiver period? Yes No 15 0.2 7042 99.8 Exemptions Religious 191 2.7 Medical 8 0.1 No exemption 6859 97.2 Fifteen adolescents had documentation of serologic immunity in lieu of vaccination: 11 had varicella immunity, 3 had measles, mumps, rubella (MMR) immunity, and 1 had hepatitis B immunity. Twenty-seven (27) students had either documentation of physiciandiagnosed or a history of varicella (not shown). Statewide vaccination rate determinations were calculated based only on receipt of vaccine, therefore these students were not excluded from the coverage rate calculations. Table 2: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, 2018 Year Gender, 2018 School type, 2018 2017 n = 6,191 (%) 2018 n = 7,057 (%) Male n = 3,541 (%) Female n = 3,474 (%) Public n = 4,981 (%) Private n = 2,076 (%) UTD rate* 94.4 0.6 93.9 0.6 94.4 0.8 94.4 0.8 94.7 0.6 92.1 1.2 3+ Hepatitis B 98.3 0.3 98.2 0.3 98.6 0.4 98.6 0.4 98.8 0.3 96.9 0.7 2+ MMR 98.3 0.3 97.9 0.3 98.3 0.4 98.4 0.4 98.5 0.3 96.5 0.8 2+ Varicella 97.2 0.4 97.0 0.4 97.5 0.5 97.4 0.5 97.6 0.4 95.7 0.9 1 Tdap 96.6 0.5 95.7 0.5 96.1 0.6 96.2 0.6 96.3 0.5 94.0 1.0 1 MCV4 96.4 0.5 95.5 0.5 95.8 0.7 96.0 0.6 96.1 0.5 93.9 1.0 4+ Polio 1 HPV Complete HPV series 97.6 0.4 47.9 1.2 23.3 1.1 97.3 0.4 50.6 1.2 23.4 1.0 97.8 0.5 48.9 1.6 22.8 1.4 97.7 0.5 52.8 1.7 24.2 1.4 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 97.9 0.4 55.0 1.4 25.0 1.2 96.1 0.8 39.8 2.1 19.5 1.7 Section III: Health District Immunization Reports11 Immunization Study Data Collection Team by Health District, Georgia Adolescent Immunization Study, 2018 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 Toni Jackson Jamie Henley Toni Jackson Farrah Machida Toni Jackson Saron Ephraim Kelly Seegmueller Saron Ephraim Kelly Seegmueller Dionne Hansey Kelly Seegmueller Latonya Thomas Tina Dempsey Kelly Seegmueller Kelly Duke Kelly Seegmueller Kelly Duke Shelia Fultz Kelly Seegmueller Lisa Jenkins Lisa Jenkins Kelly Seegmueller John Sheahan Kelly Duke Shelia Fultz Kelly Duke John Sheahan Lisa Jenkins Angie Webster Lisa Jenkins Dionne Hansey District 1-1 (Rome) 12 The 2018 GAIS sampled 393 seventh grade adolescents in District 1-1 from 29 middle schools (23 public, 6 private) (Table 1-1-A). Of the students sampled, 47.8% were male, 51.7% were female, and 0.5% were missing gender information. Students enrolled in public schools accounted for 81.9% of the sample; 18.1% were enrolled in private schools. 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, 2018. In District 1-1, the 2018 UTD vaccination rate for 7th graders was 95.7%, higher than the 2017 rate (94.3%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 1-1 vaccination rates for MCV4 and Polio were significantly higher than the state rates, whereas the rates for HPV (1-dose and complete) were significantly lower. The 2018 vaccination estimates did not differ from 2017, between genders or school type (Table 1-1-B). Table 1-1-A: Gender, school type, waiver and exemptions among District 1-1 adolescents, 2018 (n = 393). Gender Male Female Unknown # of Percent of students sample (%) 188 47.8 203 51.7 2 0.5 School type Public (23) 322 81.9 Private (6) 71 18.1 Within waiver period? Yes No 0 0.0 393 100.0 Exemptions Religious 9 2.3 Medical 1 0.3 No exemption 383 97.5 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. None of the students in the District 1-1 sample were found to be in the school "waiver" period (Table 1-1-A). One (0.3%) of the students in the District 1-1 sample had a medical exemption for one more vaccines; 9 (2.3%) students had a religious exemption on file (Table 1-1-A). Table 1-1-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 1-1, 2018 2018, Year, Gender, 2018, School type, 2018, State District 1-1 District 1-1 District 1-1 Overall n = 7,057 (%) 2017 n = 370 (%) 2018 n = 393 (%) Male n = 188 (%) Female n = 203 (%) Public n = 322 (%) Private n = 71 (%) UTD rate* 93.9 0.6 94.3 2.4 95.7 2.0 97.9 2.1 94.6 3.1 95.0 2.4 98.6 2.7 3+ Hepatitis B 98.2 0.3 97.3 1.7 99.0 1.0 99.5 1.0 99.0 1.4 98.8 1.2 100.0 0.0 2+ MMR 97.9 0.3 97.6 1.6 98.7 1.1 99.5 1.0 98.5 1.7 98.4 1.4 100.0 0.0 2+ Varicella 97.0 0.4 97.3 1.7 98.0 1.4 98.9 1.5 97.5 2.1 97.8 1.6 98.6 2.7 1 Tdap 95.7 0.5 95.9 2.0 97.2 1.6 98.4 1.8 97.0 2.3 96.6 2.0 100.0 0.0 1 MCV4 95.5 0.5 94.9 2.3 97.2 1.6 98.4 1.8 97.0 2.3 96.6 2.0 100.0 0.0 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 97.3 1.7 47.6 5.1 21.9 4.2 98.7 1.1 44.8 4.9 18.3 3.8 98.9 1.5 48.4 7.1 17.0 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 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg 7). 99.0 1.4 41.9 6.8 19.7 5.5 98.8 1.2 45.7 5.4 17.1 4.1 98.6 2.7 40.8 11.4 23.9 9.9 District 1-2 (Dalton) 13 The 2018 GAIS sampled 391 seventh grade adolescents in District 1-2 from 30 middle schools (19 public, 11 private) (Table 1-2-A). Of the students sampled, 50.1% were male, 48.6% were female, and 1.3% were missing gender information. Students enrolled in public schools accounted for 73.7% of the sample; 26.3% were enrolled in private schools. 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, 2018. In District 1-2, the 2018 UTD vaccination rate for 7th graders was 89.5%, lower than the 2017 rate (92%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 1-2 vaccination rates for UTD, MMR, Tdap and MCV4 were significantly lower than the state rates, whereas the rates for HPV (1-dose and complete) were significantly higher. The 2018 District 1-2 vaccination rates for HPV (1-dose and completion) were significantly higher than the 2017 rates. The 2018 vaccination rates for UTD, Tdap, MCV4, and HPV (1-dose and complete) were significantly higher for public school students than private school students (Table 1-2-B). Table 1-2-A: Gender, school type, waiver and exemptions among District 1-2 adolescents, 2018 (n = 391). Gender Male Female Unknown # of Percent of students sample (%) 196 50.1 190 48.6 5 1.3 School type Public (19) 288 73.7 Private (11) 103 26.3 Within waiver period? Yes No 0 0.0 391 100.0 Exemptions Religious 30 7.7 Medical 0 0.0 No exemption 361 92.3 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination 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 more vaccines; 30 (7.7%) students had a religious exemption on file (Table 1-2-A) . Table 1-2-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 1-2, 2018 2018, Year, Gender, 2018, School type, 2018, State District 1-2 District 1-2 District 1-2 Overall n = 7,057 (%) 2017 n = 314 (%) 2018 n = 391 (%) Male n = 196 (%) Female n = 190 (%) Public n = 288 (%) Private n = 103 (%) UTD rate* 93.9 0.6 92.0 3.0 89.5 3.0 89.8 4.2 91.6 4.0 92.7 3.0 80.6 7.6 3+ Hepatitis B 98.2 0.3 97.5 1.7 96.9 1.7 98.5 1.7 97.4 2.3 98.3 1.5 93.2 4.9 2+ MMR 97.9 0.3 95.2 2.4 95.4 2.1 95.4 2.9 97.4 2.3 96.5 2.1 92.2 5.2 2+ Varicella 97.0 0.4 94.6 2.5 95.4 2.1 95.9 2.8 96.8 2.5 96.5 2.1 92.2 5.2 1 Tdap 95.7 0.5 93.9 2.6 91.3 2.8 92.9 3.6 92.1 3.8 94.8 2.6 81.6 7.5 1 MCV4 95.5 0.5 93.3 2.8 91.0 2.8 92.3 3.7 92.1 3.8 93.8 2.8 83.5 7.2 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 94.6 2.5 40.8 5.4 20.4 4.5 95.4 2.1 50.1 5.0 28.6 4.5 95.9 2.8 49.5 7.0 32.1 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 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 96.8 2.5 52.1 7.1 25.8 6.2 96.5 2.1 56.2 5.7 32.6 5.4 92.2 5.2 33.0 9.1 17.5 7.3 District 2-0 (Gainesville) 14 The 2018 GAIS sampled 389 seventh grade adolescents in District 2-0 from 30 middle schools (15 public, 15 private) (Table 2-0-A). Of the students sampled, 47.3% were male and 52.7% were female. Students enrolled in public schools accounted for 62.0% of the sample; 38.0% were enrolled in private schools. 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, 2018. In District 2-0, the 2018 UTD vaccination rate for 7th graders was 94.6%, higher than the 2017 rate (92.9%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 2-0 vaccination rates for HPV (1-shot and complete series) were significantly lower than the state rates. The 2018 vaccination rates did not differ from 2017 or between genders. The 2018 vaccination rates for MCV4 and HPV (1-shot and complete series) were significantly higher for public school students than private school students (Table 2-0-B). Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements (Table 2-0-A). Table 2-0-A: Gender, school type, waiver and exemptions among District 2-0 adolescents, 2018 (n = 389). Gender Male Female Unknown # of Percent of students sample (%) 184 47.3 205 52.7 0 0.0 School type Public (15) 241 62.0 Private (15) 148 38.0 Within waiver period? Yes No 1 0.3 388 99.7 Exemptions Religious 10 2.6 Medical 0 0.0 No exemption 379 97.4 Only one (0.3%) of the students in the District 2-0 sample was found to be in the school waiver period (Table 2-0-A). None of the students in the District 2-0 sample had a medical exemption for one more vaccines; 10 (2.6%) students had a religious exemption on file (Table 2-0-A). Table 2-0-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 2-0, 2018 2018, Year, Gender, 2018, School type, 2018, State District 2-0 District 2-0 District 2-0 Overall n = 7,057 (%) 2017 n = 323 (%) 2018 n = 389 (%) Male n = 184 (%) Female n = 205 (%) Public n = 241 (%) Private n = 148 (%) UTD rate* 93.9 0.6 92.9 2.8 94.6 2.2 96.2 2.8 93.2 3.5 96.3 2.4 91.9 4.4 3+ Hepatitis B 98.2 0.3 99.4 0.9 98.5 1.2 98.9 1.5 98.0 1.9 99.2 1.1 97.3 2.6 2+ MMR 97.9 0.3 99.1 1.0 98.5 1.2 98.9 1.5 98.0 1.9 99.6 0.8 96.6 2.9 2+ Varicella 97.0 0.4 96.9 1.9 96.7 1.8 97.3 2.4 96.1 2.7 97.5 2.0 95.3 3.4 1 Tdap 95.7 0.5 95.4 2.3 96.9 1.7 97.3 2.4 96.6 2.5 98.3 1.6 94.6 3.6 1 MCV4 95.5 0.5 95.7 2.2 96.7 1.8 97.3 2.4 96.1 2.7 98.3 1.6 93.9 3.9 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 97.8 1.6 37.2 5.3 17.3 4.1 97.9 1.4 38.6 4.8 18.0 3.8 98.4 1.8 37.0 7.0 15.8 5.3 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 97.6 2.1 40.0 6.7 20.0 5.5 98.8 1.4 46.1 6.3 22.8 5.3 96.6 2.9 26.4 7.1 10.1 4.9 District 3-1 (Cobb/Douglas) 15 The 2018 GAIS sampled 394 seventh grade adolescents in District 3-1 from 30 middle schools (12 public, 18 private) (Table 3-1-A). Of the students sampled, 48.0% were male, 51.8% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 43.4% of the sample; 56.6% were enrolled in private schools. 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, 2018. In District 3-1, the 2018 UTD vaccination rate for 7th graders was 93.1%, lower than the 2017 rate (93.3%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 3-1 vaccination rates for HPV (1-shot and complete series) were significantly lower than the state rates. The 2018 vaccination estimates did not differ from 2017, between genders or school type (Table 3-1-B). Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination 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, 2018 (n = 394). Gender Male Female Unknown # of Percent of students sample (%) 189 48.0 204 51.8 1 0.3 School type Public (12) 171 43.4 Private (18) 223 56.6 Within waiver period? Yes No 0 0.0 394 100.0 Exemptions Religious 15 3.8 Medical 0 0.0 No exemption 379 96.2 None of the students in the District 3-1 sample had a medical exemption for one more vaccines; 15 (3.8%) students had a religious exemption on file (Table 3-1-A). exemption on file (Table 3-1-A). Table 3-1-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 3-1, 2018 2018, Year, Gender, 2018, School type, 2018, State District 3-1 District 3-1 District 3-1 Overall n = 7,057 (%) 2017 n = 267 (%) 2018 n = 394 (%) Male n = 189 (%) Female n = 204 (%) Public n = 171 (%) Private n = 223 (%) UTD rate* 93.9 0.6 93.3 3.0 93.1 2.5 93.7 3.5 93.1 3.5 92.4 4.0 93.7 3.2 3+ Hepatitis B 98.2 0.3 98.1 1.6 97.5 1.6 97.4 2.3 98.0 1.9 97.1 2.5 97.8 1.9 2+ MMR 97.9 0.3 98.9 1.3 98.0 1.4 98.4 1.8 98.0 1.9 97.7 2.3 98.2 1.7 2+ Varicella 97.0 0.4 97.4 1.9 95.7 2.0 96.3 2.7 95.6 2.8 94.7 3.3 96.4 2.4 1 Tdap 95.7 0.5 96.6 2.2 95.9 2.0 96.8 2.5 95.6 2.8 95.9 3.0 96.0 2.6 1 MCV4 95.5 0.5 95.9 2.4 95.4 2.1 95.8 2.9 95.6 2.8 95.3 3.2 95.5 2.7 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 97.0 2.0 43.1 5.9 21.0 4.9 97.0 1.7 41.4 4.9 19.3 3.9 97.4 2.3 38.6 6.9 17.5 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 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 97.1 2.3 44.1 6.8 21.1 5.6 95.3 3.2 43.9 7.4 17.0 5.6 98.2 1.7 39.5 6.4 21.1 5.4 District 3-2 (Fulton) 16 The 2018 GAIS sampled 382 seventh grade adolescents in District 3-2 from 29 middle schools (20 public, 9 private) (Table 3-2-A). Of the students sampled, 57.9% were male, 41.4% were female, and 0.8% had missing gender information. Students enrolled in public schools accounted for 72.5% of the sample; 27.5% were enrolled in private schools. 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, 2018. In District 3-2, the 2018 UTD vaccination rate for 7th graders was 93.5%, lower than the 2017 rate (94.7%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 3-2 vaccination rates did not differ from the state, 2017, between genders or school type (Table 3-2B). Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. Only two (0.5%) of the students in the District 3-2 sample were found to be in the school waiver period (Table 3-2-A). Table 3-2-A: Gender, school type, waiver and exemptions among District 3-2 adolescents, 2018 (n = 382). Gender Male Female Unknown # of Percent of students sample (%) 221 57.9 158 41.4 3 0.8 School type Public (20) 277 72.5 Private (9) 105 27.5 Within waiver period? Yes No 2 0.5 380 99.5 Exemptions Religious 10 2.6 Medical 0 0.0 No exemption 372 97.4 None of the students in the District 3-2 sample had a medical exemption for one more vaccines; 10 (2.6%) students had a religious exemption on file (Table 3-2-A). Table 3-2-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 3-2, 2018 2018, Year, Gender, 2018, School type, 2018, State District 3-2 District 3-2 District 3-2 Overall n = 7,057 (%) 2017 n = 378 (%) 2018 n = 382 (%) Male n = 221 (%) Female n = 158 (%) Public n = 277 (%) Private n = 105 (%) UTD rate* 93.9 0.6 94.7 2.3 93.5 2.5 93.7 3.2 93.7 3.8 92.8 3.1 95.2 4.1 3+ Hepatitis B 98.2 0.3 98.9 1.0 99.0 1.0 99.5 0.9 98.1 2.1 99.3 1.0 98.1 2.6 2+ MMR 97.9 0.3 98.4 1.3 97.9 1.4 98.2 1.8 97.5 2.5 98.2 1.6 97.1 3.2 2+ Varicella 97.0 0.4 97.1 1.7 97.1 1.7 98.2 1.8 95.6 3.2 97.8 1.7 95.2 4.1 1 Tdap 95.7 0.5 97.9 1.5 96.1 1.9 95.9 2.6 96.8 2.7 95.7 2.4 97.1 3.2 1 MCV4 95.5 0.5 97.1 1.7 95.8 2.0 94.6 3.0 97.5 2.5 95.3 2.5 97.1 3.2 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 98.4 1.3 51.6 5.0 25.1 4.4 97.6 1.5 47.6 5.0 20.4 4.0 97.7 2.0 47.1 6.6 22.6 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 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 97.5 2.5 49.4 7.8 17.7 6.0 97.8 1.7 48.4 5.9 19.5 4.7 97.1 3.2 45.7 9.5 22.9 8.0 District 3-3 (Clayton) 17 The 2018 GAIS sampled 390 seventh grade adolescents in District 3-3 from 19 middle schools (18 public, 1 private) (Table 3-3-A). Of the students sampled, 49.5% were male, 50.0% were female, and 0.5% had missing gender information. Students enrolled in public schools accounted for 99.5% of the sample; only 0.5% were enrolled in private schools. 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, 2018. In District 3-3, the 2018 UTD vaccination rate for 7th graders was 96.2%, higher than the 2017 rate (95.9%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 3-3 vaccination rates for UTD, HepB, MMR, Varicella, Tdap, MCV4 and 1 HPV were significantly higher than the state rates. The 2018 District 3-3 vaccination rates for 1 HPV was significantly higher than the 2017 rates. The 2018 District 3-3 vaccination rates for Tdap and MCV4 were significantly higher for female students than male students (Table 3-3-B). Table 3-3-A: Gender, school type, waiver and exemptions among District 3-3 adolescents, 2018 (n = 390). Gender Male Female Unknown # of Percent of students sample (%) 193 49.5 195 50.0 2 0.5 School type Public (18) 388 99.5 Private (1) 2 0.5 Within waiver period? Yes No 0 0.0 390 100.0 Exemptions Religious 5 1.3 Medical 0 0.0 No exemption 385 98.7 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination 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 more vaccines; 5 (1.3%) students had a religious exemption on file (Table 3-3-A). Table 3-3-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 3-3, 2018 2018, Year, Gender, 2018, School type, 2018, State District 3-3 District 3-3 District 3-3 Overall n = 7,057 (%) 2017 n = 294 (%) 2018 n = 390 (%) Male n = 193 (%) Female n = 195 (%) Public n = 388 (%) Private n=2 (%) UTD rate* 93.9 0.6 95.9 2.3 96.2 1.9 95.3 3.0 97.4 2.2 96.1 1.9 3+ Hepatitis B 98.2 0.3 98.3 1.5 99.5 0.7 100.0 0.0 99.5 1.0 99.5 0.7 2+ MMR 2+ Varicella 1 Tdap 1 MCV4 4+ Polio 1 HPV 97.9 0.3 97.0 0.4 95.7 0.5 95.5 0.5 99.7 0.7 98.3 1.5 98.0 1.6 97.6 1.7 99.7 0.5 98.5 1.2 97.4 1.6 97.7 1.5 97.3 0.4 50.6 1.2 98.6 1.3 58.5 5.6 97.9 1.4 65.9 4.7 100.0 0.0 99.5 1.0 95.9 2.8 96.4 2.6 100.0 0.0 97.9 2.0 99.5 1.0 99.5 1.0 98.4 1.7 62.7 6.8 97.9 2.0 69.2 6.5 99.7 0.5 98.5 1.2 97.4 1.6 97.7 1.5 97.9 1.4 65.7 4.7 Sample size is too small to generate meaningful estimates or comparisons Complete HPV series 23.4 1.0 23.1 4.8 26.9 4.4 22.8 5.9 30.8 6.5 26.8 4.4 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). District 3-4 (Gwinnett/ Newton/ Rockdale) 18 The 2018 GAIS sampled 398 seventh grade adolescents in District 3-4 from 30 middle schools (17 public, 13 private) (Table 3-4-A). Of the students sampled, 51.3% were male, 48.0% were female, and 0.8% had missing gender information. Students enrolled in public schools accounted for 59.8% of the sample; 40.2% were enrolled in private schools. Adolescents were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by 1/1/18. In District 3-4, the 2018 UTD vaccination rate for 7th graders was 93.2%, higher than the 2017 rate (91.4%) and lower than the state average for 2018 (93.9%). Vaccination 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 2018 District 3-4 vaccination rates were similar to the state averages and 2017 rates. The 2018 District 3-4 vaccination rate for 1 HPV was significantly higher for female students than male students. The vaccination rates for HPV (1-shot and complete series) were significantly higher for public school students than private school students (Table 3-4-B). Table 3-4-A: Gender, school type, waiver and exemptions among District 3-4 adolescents, 2018 (n = 398). Gender Male Female Unknown # of Percent of students sample (%) 204 51.3 191 48.0 3 0.8 School type Public (17) 238 59.8 Private (13) 160 40.2 Within waiver period? Yes No 0 0.0 398 100.0 Exemptions Religious 14 3.5 Medical 0 0.0 No exemption 384 96.5 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination 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 more vaccines; 14 (3.5%) students had a religious exemption on file (Table 3-4-A). Table 3-4-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 3-4, 2018 2018, Year, Gender, 2018, School type, 2018, State District 3-4 District 3-4 District 3-4 Overall n = 7,057 (%) 2017 n = 362 (%) 2018 n = 398 (%) Male n = 204 (%) Female n = 191 (%) Public n = 238 (%) Private n = 160 (%) UTD rate* 93.9 0.6 91.4 2.9 93.2 2.5 93.1 3.5 94.8 3.2 92.9 3.3 93.8 3.8 3+ Hepatitis B 98.2 0.3 97.0 1.8 98.2 1.3 98.5 1.7 99.5 1.0 98.7 1.4 97.5 2.4 2+ MMR 97.9 0.3 97.8 1.5 98.2 1.3 98.5 1.7 99.5 1.0 98.7 1.4 97.5 2.4 2+ Varicella 97.0 0.4 95.0 2.2 97.0 1.7 97.5 2.1 97.9 2.0 97.1 2.1 96.9 2.7 1 Tdap 95.7 0.5 96.4 1.9 95.2 2.1 95.6 2.8 96.3 2.7 95.8 2.6 94.4 3.6 1 MCV4 95.5 0.5 97.0 1.8 94.7 2.2 95.1 3.0 95.8 2.8 95.0 2.8 94.4 3.6 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 97.0 1.8 45.9 5.1 24.3 4.4 97.5 1.5 49.7 4.9 19.6 3.9 98.5 1.7 45.1 6.8 18.6 5.3 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 97.9 2.0 55.5 7.1 20.9 5.8 97.9 1.8 58.0 6.3 23.9 5.4 96.9 2.7 37.5 7.5 13.1 5.2 District 3-5 (DeKalb) 19 The 2018 GAIS sampled 402 seventh grade adolescents in District 3-5 from 30 middle schools (17 public, 13 private) (Table 3-5-A). Of the students sampled, 50.2% were male, 47.8% were female, and 2.0% had missing gender information. Students enrolled in public schools accounted for 57.0% of the sample; 43.0% were enrolled in private schools. Adolescents were considered up-to-date (UTD) if they received 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4 vaccines by 1/1/2018. In District 3-5, the 2018 UTD vaccination rate for 7th graders was 91.5%, higher than the 2017 rate (87.2%) and lower than the state average for 2018 (93.9%). Vaccination 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 2018 District 3-5 vaccination rates for HPV (1-shot and complete series) were significantly higher than the state rates, whereas the vaccination rate for HepB, MMR, Varicella and Polio were significantly lower. The 2018 District 3-5 vaccination rates did not differ significantly from 2017 rates or between genders. The vaccination rates for UTD, HepB, MMR and Varicella were significantly higher for public school students than private school students, whereas the vaccination rates for completing the HPV series was significantly lower (Table 3-5-B). Table 3-5-A: Gender, school type, waiver and exemptions among District 3-5 adolescents, 2018 (n = 402). Gender Male Female Unknown # of Percent of students sample (%) 202 50.2 192 47.8 8 2.0 School type Public (17) 229 57.0 Private (13) 173 43.0 Within waiver period? Yes No 2 0.5 400 99.5 Exemptions Religious 15 3.7 Medical 1 0.2 No exemption 386 96.0 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. Only two (0.5%) of the students in the District 3-5 sample were found to be in the school waiver period (Table 3-5-A). One (0.2%) of the students in the District 3-5 sample had a medical exemption for one more vaccines; 15 (3.7%) students had a religious exemption on file (Table 3-5-A). Table 3-5-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 3-5, 2018 2018, Year, Gender, 2018, School type, 2018, State District 3-5 District 3-5 District 3-5 Overall n = 7,057 (%) 2017 n = 345 (%) 2018 n = 402 (%) Male n = 202 (%) Female n = 192 (%) Public n = 229 (%) Private n = 173 (%) UTD rate* 93.9 0.6 87.2 3.5 91.5 2.7 92.6 3.6 93.8 3.4 94.8 2.9 87.3 5.0 3+ Hepatitis B 98.2 0.3 93.6 2.6 94.8 2.2 96.5 2.5 96.4 2.7 97.8 1.9 90.8 4.3 2+ MMR 97.9 0.3 96.2 2.0 95.3 2.1 96.5 2.5 97.4 2.3 97.4 2.1 92.5 3.9 2+ Varicella 97.0 0.4 93.3 2.6 94.5 2.2 95.5 2.8 96.9 2.5 96.9 2.2 91.3 4.2 1 Tdap 95.7 0.5 93.9 2.5 93.8 2.4 95.0 3.0 95.8 2.8 95.6 2.6 91.3 4.2 1 MCV4 95.5 0.5 93.6 2.6 93.3 2.4 95.0 3.0 94.8 3.1 95.2 2.8 90.8 4.3 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 94.2 2.5 54.2 5.3 25.8 4.6 94.0 2.3 60.0 4.8 31.6 4.5 96.0 2.7 59.4 6.8 34.2 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 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 95.3 3.0 63.0 6.8 30.2 6.5 96.1 2.5 60.7 6.3 26.6 5.7 91.3 4.2 59.0 7.3 38.2 7.2 District 4-0 (LaGrange) 20 The 2018 GAIS sampled 386 seventh grade adolescents in District 4-0 from 30 middle schools (21 public, 9 private) (Table 4-0-A). Of the students sampled, 54.1% were male, 45.6% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 76.4% of the sample; 23.6% were enrolled in private schools. 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, 2018. In District 4-0, the 2018 UTD vaccination rate for 7th graders was 88.3%, lower than the 2017 rate (90.3%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 4-0 vaccination rates for UTD, MMR, Varicella, Tdap, MCV4 and HPV (1-shot and complete series) were significantly lower than the state rates. The 2018 District 4-0 vaccination rates did not differ significantly from 2017 rates or between genders. The vaccination rates for Tdap and HPV (1-shot and complete series) were significantly higher for public school students than private school students (Table 4-0-B). Table 4-0-A: Gender, school type, waiver and exemptions among District 4-0 adolescents, 2018 (n = 386). Gender Male Female Unknown # of Percent of students sample (%) 209 54.1 176 45.6 1 0.3 School type Public (21) 295 76.4 Private (9) 91 23.6 Within waiver period? Yes No 0 0.0 386 100.0 Exemptions Religious 26 6.7 Medical 1 0.3 No exemption 359 93.0 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. None of the students in the District 4-0 sample were found to be in the school "waiver" period (Table 4-0-A). One (0.3%) of the students in the District 4-0 sample had a medical exemption for one more vaccines; 26 (6.7%) students had a religious exemption on file (Table 4-0-A). Table 4-0-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 4-0, 2018 2018, Year, Gender, 2018, School type, 2018, State District 4-0 District 4-0 District 4-0 Overall n = 7,057 (%) 2017 n = 341 (%) 2018 n = 386 (%) Male n = 209 (%) Female n = 176 (%) Public n = 295 (%) Private n = 91 (%) UTD rate* 93.9 0.6 90.3 3.1 88.3 3.2 89.5 4.2 87.5 4.9 90.2 3.4 82.4 7.8 3+ Hepatitis B 98.2 0.3 96.8 1.9 96.9 1.7 97.1 2.3 97.2 2.5 96.9 2.0 96.7 3.7 2+ MMR 97.9 0.3 95.6 2.2 95.3 2.1 96.7 2.4 94.3 3.4 96.3 2.2 92.3 5.5 2+ Varicella 97.0 0.4 94.1 2.5 94.8 2.2 96.7 2.4 93.2 3.7 95.9 2.3 91.2 5.8 1 Tdap 95.7 0.5 93.3 2.7 90.4 2.9 90.0 4.1 91.5 4.1 92.5 3.0 83.5 7.6 1 MCV4 95.5 0.5 93.5 2.6 90.2 3.0 90.0 4.1 90.9 4.3 91.9 3.1 84.6 7.4 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 94.4 2.4 37.8 5.2 17.3 4.0 95.9 2.0 44.6 5.0 18.4 3.9 96.7 2.4 46.9 6.8 20.1 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 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 95.5 3.1 42.0 7.3 16.5 5.5 96.9 2.0 48.8 5.7 20.3 4.6 92.3 5.5 30.8 9.5 12.1 6.7 District 5-1 (Dublin) 21 The 2018 GAIS sampled 391 seventh grade adolescents in District 5-1 from 14 middle schools (12 public, 2 private) (Table 5-1-A). Of the students sampled, 52.2% were male, 47.6% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 91.3% of the sample; 8.7% were enrolled in private schools. 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, 2018. In District 5-1, the 2018 UTD vaccination rate for 7th graders was 91.8%, lower than the 2017 rate (97.3%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 5-1 vaccination rates for HepB, MMR and Polio were significantly higher than the state rates, whereas the rates for MCV4 and 1 HPV were significantly lower. The 2018 District 5-1 vaccination rates for UTD, Tdap and MCV4 were significantly lower than the 2017 rates. The 2018 vaccination estimates for male and female students did not differ significantly. The vaccination rates for HPV (1-shot and complete series) were significantly higher for public school students than private school students (Table 5-1-B). Table 5-1-A: Gender, school type, waiver and exemptions among District 5-1 adolescents, 2018 (n = 391). Gender Male Female Unknown # of Percent of students sample (%) 204 52.2 186 47.6 1 0.3 School type Public (12) 357 91.3 Private (2) 34 8.7 Within waiver period? Yes No 0 0.0 391 100.0 Exemptions Religious 5 1.3 Medical 1 0.3 No exemption 385 98.5 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. None of the students in the District 5-1 sample were found to be in the school "waiver" period (Table 5-1-A). One (0.3%) of the students in the District 5-1 sample had a medical exemption for one more vaccines; 5 (1.3%) students had a religious exemption on file (Table 5-1-A). Table 5-1-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 5-1, 2018 2018, Year, Gender, 2018, School type, 2018, State District 5-1 District 5-1 District 5-1 Overall n = 7,057 (%) 2017 n = 367 (%) 2018 n = 391 (%) Male n = 204 (%) Female n = 186 (%) Public n = 357 (%) Private n = 34 (%) UTD rate* 93.9 0.6 97.3 1.7 91.8 2.7 91.7 3.8 92.5 3.8 91.3 2.9 97.1 5.7 3+ Hepatitis B 98.2 0.3 99.7 0.5 99.2 0.9 99.0 1.4 100.0 0.0 99.4 0.8 97.1 5.7 2+ MMR 97.9 0.3 99.7 0.5 99.0 1.0 99.0 1.4 99.5 1.1 98.9 1.1 100.0 0.0 2+ Varicella 97.0 0.4 99.2 0.9 98.0 1.4 97.5 2.1 98.9 1.5 97.8 1.5 100.0 0.0 1 Tdap 95.7 0.5 98.1 1.4 93.4 2.5 94.1 3.2 93.0 3.7 92.7 2.7 100.0 0.0 1 MCV4 95.5 0.5 97.8 1.5 92.8 2.6 93.6 3.4 92.5 3.8 92.2 2.8 100.0 0.0 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 99.2 0.9 40.3 5.0 16.6 3.8 98.7 1.1 43.0 4.9 19.9 4.0 98.5 1.7 41.7 6.8 19.1 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 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 99.5 1.1 44.6 7.1 21.0 5.9 98.9 1.1 45.1 5.2 21.6 4.3 97.1 5.7 20.6 13.6 2.9 5.7 District 5-2 (Macon) 22 The 2018 GAIS sampled 412 seventh grade adolescents in District 5-2 from 30 middle schools (17 public, 13 private) (Table 5-2-A). Of the students sampled, 47.8% were male, 51.9% were female, and 0.2% had missing gender information. Students enrolled in public schools accounted for 58.7% of the sample; 41.3% were enrolled in private schools. 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, 2018. In District 5-2, the 2018 UTD vaccination rate for 7th graders was 93%, lower than the 2017 rate (94.8%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 5-2 vaccination rates for HepB, MMR, Varicella and Polio were significantly lower than the state rates. The 2018 District 5-2 vaccination rates for HepB, MMR, Varicella and Polio were significantly lower than the 2017 rates. The 2018 District 5-2 vaccination rate for completing the HPV series was significantly higher for female students than male students. The vaccination rates for HPV (1-shot and complete series) were significantly higher for public school students than private school students (Table 5-2-B). Table 5-2-A: Gender, school type, waiver and exemptions among District 5-2 adolescents, 2018 (n = 412). Gender Male Female Unknown # of Percent of students sample (%) 197 47.8 214 51.9 1 0.2 School type Public (17) 242 58.7 Private (13) 170 41.3 Within waiver period? Yes No 0 0.0 412 100.0 Exemptions Religious 20 4.9 Medical 0 0.0 No exemption 392 95.1 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. None of the students in the District 5-2 sample were found to be in the school "waiver" period (Table 5-2-A). None of the students in the District 5-2 sample had a medical exemption for one more vaccines; 20 (4.9%) students had a religious exemption on file (Table 5-2-A). Table 5-2-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 5-2, 2018 2018, Year, Gender, 2018, School type, 2018, State District 5-2 District 5-2 District 5-2 Overall n = 7,057 (%) 2017 n = 381 (%) 2018 n = 412 (%) Male n = 197 (%) Female n = 214 (%) Public n = 242 (%) Private n = 170 (%) UTD rate* 93.9 0.6 94.8 2.2 93.0 2.5 90.9 4.0 95.3 2.8 93.0 3.2 92.9 3.9 3+ Hepatitis B 98.2 0.3 99.2 0.9 96.1 1.9 95.4 2.9 97.2 2.2 96.7 2.3 95.3 3.2 2+ MMR 97.9 0.3 99.0 1.0 95.9 1.9 94.9 3.1 97.2 2.2 96.7 2.3 94.7 3.4 2+ Varicella 97.0 0.4 98.4 1.3 94.7 2.2 92.9 3.6 96.7 2.4 95.0 2.7 94.1 3.5 1 Tdap 95.7 0.5 95.5 2.1 94.7 2.2 93.9 3.3 95.8 2.7 94.6 2.8 94.7 3.4 1 MCV4 95.5 0.5 95.5 2.1 94.4 2.2 93.4 3.5 95.8 2.7 94.6 2.8 94.1 3.5 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 98.7 1.1 46.7 5.0 23.9 4.3 95.4 2.0 47.1 4.8 21.4 4.0 94.4 3.2 44.2 6.9 16.8 5.2 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 96.7 2.4 50.0 6.7 25.7 5.9 96.3 2.4 53.7 6.3 27.3 5.6 94.1 3.5 37.6 7.3 12.9 5.0 District 6-0 (Augusta) 23 The 2018 GAIS sampled 404 seventh grade adolescents in District 6-0 from 30 middle schools (20 public, 10 private) (Table 6-0-A). Of the students sampled, 54.7% were male, 45.3% were female. Students enrolled in public schools accounted for 70.0% of the sample; 30.0% were enrolled in private schools. 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, 2018. In District 6-0, the 2018 UTD vaccination rate for 7th graders was 94.6%, lower than the 2017 rate (95.8%) and higher than the state average for 2018 (93.9%). Vaccination 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 2018 District 6-0 vaccination rates for HepB, MMR and Polio were significantly higher than the state rates. The 2018 District 6-0 vaccination rate for MMR was significantly lower than the 2017 rate. The 2018 District 60 vaccination rate for 1 HPV was significantly higher for female students than male students. The vaccination rate for 1 HPV was significantly higher for public school students than private school students, whereas the vaccination rates for UTD were significantly lower (Table 6-0-B). Table 6-0-A: Gender, school type, waiver and exemptions among District 6-0 adolescents, 2018 (n = 404). Gender Male Female Unknown # of Percent of students sample (%) 221 54.7 183 45.3 0 0.0 School type Public (20) 283 70.0 Private (10) 121 30.0 Within waiver period? Yes No 0 0.0 404 100.0 Exemptions Religious 3 0.7 Medical 0 0.0 No exemption 401 99.3 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. None of the students in the District 6-0 sample were 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 more vaccines; 3 (0.7%) students had a religious exemption on file (Table 6-0-A). Table 6-0-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 6-0, 2018 2018, Year, Gender, 2018, School type, 2018, State District 6-0 District 6-0 District 6-0 Overall n = 7,057 (%) 2017 n = 356 (%) 2018 n = 404 (%) Male n = 221 (%) Female n = 183 (%) Public n = 283 (%) Private n = 121 (%) UTD rate* 93.9 0.6 95.8 2.1 94.6 2.2 95.0 2.9 94.0 3.4 93.3 2.9 97.5 2.8 3+ Hepatitis B 98.2 0.3 100.0 0.0 99.3 0.8 99.1 1.2 99.5 1.1 99.3 1.0 99.2 1.6 2+ MMR 97.9 0.3 100.0 0.0 99.0 1.0 98.6 1.5 99.5 1.1 98.9 1.2 99.2 1.6 2+ Varicella 97.0 0.4 98.0 1.4 97.5 1.5 97.3 2.1 97.8 2.1 96.8 2.0 99.2 1.6 1 Tdap 95.7 0.5 97.8 1.5 96.3 1.8 96.8 2.3 95.6 3.0 95.8 2.3 97.5 2.8 1 MCV4 95.5 0.5 97.2 1.7 96.5 1.8 96.8 2.3 96.2 2.8 96.1 2.3 97.5 2.8 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 99.2 1.0 50.8 5.2 25.8 4.6 98.5 1.2 48.3 4.9 23.3 4.1 98.2 1.8 43.0 6.5 22.2 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 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.9 1.5 54.6 7.2 24.6 6.2 98.2 1.5 51.6 5.8 25.4 5.1 99.2 1.6 40.5 8.8 18.2 6.9 District 7-0 (Columbus) 24 The 2018 GAIS sampled 377 seventh grade adolescents in District 7-0 from 30 middle schools (18 public, 12 private) (Table 7-0-A). Of the students sampled, 45.6% were male, 54.1% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 71.4% of the sample; 28.6% were enrolled in private schools. 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, 2018. In District 7-0, the 2018 UTD vaccination rate for 7th graders was 93.6%, lower than the 2017 rate (94.5%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 7-0 vaccination rates for HPV (1-shot and complete series) were significantly higher than the state rates. The 2018 District 7-0 vaccination rates did not differ significantly from 2017 rates or between genders. The vaccination rates for UTD and HPV (1-shot and complete series) were significantly higher for public school students than private school students (Table 7-0-B). Table 7-0-A: Gender, school type, waiver and exemptions among District 7-0 adolescents, 2018 (n = 377). Gender Male Female Unknown # of Percent of students sample (%) 172 45.6 204 54.1 1 0.3 School type Public (18) 269 71.4 Private (12) 108 28.6 Within waiver period? Yes No 2 0.5 375 99.5 Exemptions Religious 6 1.6 Medical 1 0.3 No exemption 371 98.4 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. Only two (0.5%) of the students in the District 7-0 sample were 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 more vaccines; 6 (1.6%) students had a religious exemption on file (Table 7-0-A). Table 7-0-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 7-0, 2018 2018, Year, Gender, 2018, School type, 2018, State District 7-0 District 7-0 District 7-0 Overall n = 7,057 (%) 2017 n = 329 (%) 2018 n = 377 (%) Male n = 172 (%) Female n = 204 (%) Public n = 269 (%) Private n = 108 (%) UTD rate* 93.9 0.6 94.5 2.5 93.6 2.5 95.3 3.1 92.2 3.7 95.5 2.5 88.9 5.9 3+ Hepatitis B 98.2 0.3 97.3 1.8 98.1 1.4 98.3 2.0 98.0 1.9 98.9 1.3 96.3 3.6 2+ MMR 97.9 0.3 97.3 1.8 97.9 1.5 98.8 1.6 97.1 2.3 98.9 1.3 95.4 4.0 2+ Varicella 97.0 0.4 97.0 1.9 97.6 1.5 98.3 2.0 97.1 2.3 98.5 1.4 95.4 4.0 1 Tdap 95.7 0.5 95.7 2.2 95.0 2.2 97.1 2.5 93.1 3.5 96.3 2.3 91.7 5.2 1 MCV4 95.5 0.5 95.1 2.3 95.2 2.2 97.1 2.5 93.6 3.4 96.7 2.2 91.7 5.2 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 97.0 1.9 64.7 5.2 34.3 5.1 96.3 1.9 61.3 4.9 31.6 4.7 97.1 2.5 60.5 7.3 32.0 7.0 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 95.6 2.8 61.8 6.7 30.9 6.3 97.4 1.9 69.5 5.5 36.1 5.7 93.5 4.6 40.7 9.3 20.4 7.6 District 8-1 (Valdosta) 25 The 2018 GAIS sampled 394 seventh grade adolescents in District 8-1 from 25 middle schools (16 public, 9 private) (Table 8-1-A). Of the students sampled, 45.2% were male, 54.6% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 74.4% of the sample; 25.6% were enrolled in private schools. 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, 2018. In District 8-1, the 2018 UTD vaccination rate for 7th graders was 97.5%, lower than the 2017 rate (98.8%) and higher than the state average for 2018 (93.9%). Vaccination 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 2018 District 8-1 vaccination rates for every vaccination was significantly higher than the state rates. The 2018 District 8-1 vaccination rate for 1 HPV was significantly higher than the 2017 rates. The 2018 vaccination estimates for male and female students did not differ significantly. The vaccination rates for 1 HPV were significantly higher for public school students than private school students (Table 8-1-B). Table 8-1-A: Gender, school type, waiver and exemptions among District 8-1 adolescents, 2018 (n = 394). Gender Male Female Unknown # of Percent of students sample (%) 178 45.2 215 54.6 1 0.3 School type Public (16) 293 74.4 Private (9) 101 25.6 Within waiver period? Yes No 0 0.0 394 100.0 Exemptions Religious 3 0.8 Medical 1 0.3 No exemption 390 99.0 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. None of the students in the District 8-1 sample were found to be in the school "waiver" period (Table 8-1-A). One (0.3%) of the students in the District 8-1 sample had a medical exemption for one more vaccines; 3 (0.8%) students had a religious exemption on file (Table 8-1-A). Table 8-1-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 8-1, 2018 2018, Year, Gender, 2018, School type, 2018, State District 8-1 District 8-1 District 8-1 Overall n = 7,057 (%) 2017 n = 343 (%) 2018 n = 394 (%) Male n = 178 (%) Female n = 215 (%) Public n = 293 (%) Private n = 101 (%) UTD rate* 93.9 0.6 98.8 1.1 97.5 1.6 97.8 2.2 97.7 2.0 98.6 1.3 94.1 4.6 3+ Hepatitis B 98.2 0.3 100.0 0.0 99.5 0.7 99.4 1.1 99.5 0.9 99.3 0.9 100.0 0.0 2+ MMR 97.9 0.3 100.0 0.0 99.2 0.9 99.4 1.1 99.1 1.3 99.3 0.9 99.0 1.9 2+ Varicella 97.0 0.4 99.1 1.0 98.5 1.2 98.3 1.9 98.6 1.6 99.0 1.2 97.0 3.3 1 Tdap 95.7 0.5 99.7 0.6 98.7 1.1 98.9 1.5 99.1 1.3 99.0 1.2 98.0 2.7 1 MCV4 95.5 0.5 99.7 0.6 98.5 1.2 98.3 1.9 99.1 1.3 99.0 1.2 97.0 3.3 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 100.0 0.0 46.6 5.3 23.3 4.5 99.0 1.0 56.1 4.9 27.9 4.4 99.4 1.1 51.7 7.3 25.3 6.4 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.6 1.6 60.0 6.6 30.2 6.1 99.0 1.2 63.5 5.5 30.0 5.3 99.0 1.9 34.7 9.3 21.8 8.1 District 8-2 (Albany) 26 The 2018 GAIS sampled 387 seventh grade adolescents in District 8-2 from 30 middle schools (21 public, 9 private) (Table 8-2-A). Of the students sampled, 49.9% were male, 49.9% were female, and 0.3% had missing gender information. Students enrolled in public schools accounted for 73.1% of the sample; 26.9% were enrolled in private schools. 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, 2018. In District 8-2, the 2018 UTD vaccination rate for 7th graders was 99%, higher than the 2017 rate (97.8%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 8-2 vaccination rates for UTD, HepB, MMR, Varicella, Tdap, MCV4 and HPV (1-shot and complete series) were significantly higher than the state rates. The 2018 District 8-2 vaccination rates did not differ significantly from 2017 rates or between genders. The vaccination rates for Polio and HPV (1-shot and complete series) were significantly higher for public school students than private school students (Table 8-2-B). Table 8-2-A: Gender, school type, waiver and exemptions among District 8-2 adolescents, 2018 (n = 387). Gender Male Female Unknown # of Percent of students sample (%) 193 49.9 193 49.9 1 0.3 School type Public (21) 283 73.1 Private (9) 104 26.9 Within waiver period? Yes No 0 0.0 387 100.0 Exemptions Religious 1 0.3 Medical 0 0.0 No exemption 386 99.7 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. None of the students in the District 8-2 sample were 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 more vaccines; 1 (0.3%) students had a religious exemption on file (Table 8-2-A). Table 8-2-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 8-2, 2018 2018, Year, Gender, 2018, School type, 2018, State District 8-2 District 8-2 District 8-2 Overall n = 7,057 (%) 2017 n = 361 (%) 2018 n = 387 (%) Male n = 193 (%) Female n = 193 (%) Public n = 283 (%) Private n = 104 (%) UTD rate* 93.9 0.6 97.8 1.5 99.0 1.0 99.5 1.0 99.0 1.4 98.9 1.2 99.0 1.9 3+ Hepatitis B 98.2 0.3 99.4 0.8 99.2 0.9 100.0 0.0 99.0 1.4 99.3 1.0 99.0 1.9 2+ MMR 97.9 0.3 99.4 0.8 99.5 0.7 100.0 0.0 99.5 1.0 99.6 0.7 99.0 1.9 2+ Varicella 97.0 0.4 99.2 0.9 99.5 0.7 100.0 0.0 99.5 1.0 99.6 0.7 99.0 1.9 1 Tdap 95.7 0.5 98.1 1.4 99.5 0.7 99.5 1.0 100.0 0.0 99.6 0.7 99.0 1.9 1 MCV4 95.5 0.5 98.1 1.4 99.5 0.7 99.5 1.0 100.0 0.0 99.6 0.7 99.0 1.9 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 99.2 0.9 53.5 5.1 30.7 4.8 98.4 1.2 58.1 4.9 29.7 4.6 99.5 1.0 57.0 7.0 33.2 6.6 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 97.9 2.0 59.6 6.9 26.4 6.2 99.6 0.7 62.5 5.6 33.2 5.5 95.2 4.1 46.2 9.6 20.2 7.7 District 9-1 (Coastal) 27 The 2018 GAIS sampled 360 seventh grade adolescents in District 9-1 from 28 middle schools (17 public, 11 private) (Table 9-1-A). Of the students sampled, 51.9% were male, 46.7% were female, and 1.4% had missing gender information. Students enrolled in public schools accounted for 66.1% of the sample; 33.9% were enrolled in private schools. 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, 2018. In District 9-1, the 2018 UTD vaccination rate for 7th graders was 95.3%, lower than the 2017 rate (97.8%) and higher than the state average for 2018 (93.9%). Vaccination 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 2018 District 9-1 vaccination rate for 1 HPV was significantly higher than the state rate. The 2018 District 91 vaccination rate for 1 HPV was significantly higher than the 2017 rate, whereas the vaccination rate for Varicella was significantly lower. The 2018 vaccination estimates for male and female students did not differ significantly. The vaccination rates for completing the HPV series was significantly lower for public school students than private school students (Table 9-1-B). Table 9-1-A: Gender, school type, waiver and exemptions among District 9-1 adolescents, 2018 (n = 360). Gender Male Female Unknown # of Percent of students sample (%) 187 51.9 168 46.7 5 1.4 School type Public (17) 238 66.1 Private (11) 122 33.9 Within waiver period? Yes No 5 1.4 355 98.6 Exemptions Religious 7 1.9 Medical 0 0.0 No exemption 353 98.1 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. Only five (1.4%) of the students in the District 9-1 sample were 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 more vaccines; 7 (1.9%) students had a religious exemption on file (Table 9-1-A). Table 9-1-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 9-1, 2018 2018, Year, Gender, 2018, School type, 2018, State District 9-1 District 9-1 District 9-1 Overall n = 7,057 (%) 2017 n = 489 (%) 2018 n = 360 (%) Male n = 187 (%) Female n = 168 (%) Public n = 238 (%) Private n = 122 (%) UTD rate* 93.9 0.6 97.8 1.3 95.3 2.2 95.7 2.9 97.6 2.3 95.0 2.8 95.9 3.5 3+ Hepatitis B 98.2 0.3 99.6 0.6 98.6 1.2 98.9 1.5 99.4 1.2 99.2 1.2 97.5 2.7 2+ MMR 97.9 0.3 99.2 0.8 98.3 1.3 98.4 1.8 99.4 1.2 98.7 1.4 97.5 2.7 2+ Varicella 97.0 0.4 99.4 0.7 97.5 1.6 97.9 2.1 98.2 2.0 97.5 2.0 97.5 2.7 1 Tdap 95.7 0.5 98.2 1.2 97.2 1.7 97.3 2.3 99.4 1.2 97.9 1.8 95.9 3.5 1 MCV4 95.5 0.5 98.2 1.2 96.9 1.8 97.3 2.3 98.8 1.6 97.5 2.0 95.9 3.5 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 98.6 1.1 52.6 4.4 27.8 4.0 97.8 1.5 61.4 5.0 26.9 4.6 98.4 1.8 58.8 7.1 26.2 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 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 98.2 2.0 66.1 7.2 28.6 6.8 97.9 1.8 62.6 6.2 23.5 5.4 97.5 2.7 59.0 8.7 33.6 8.4 District 9-2 (Waycross) 28 The 2018 GAIS sampled 405 seventh grade adolescents in District 9-2 from 30 middle schools (21 public, 9 private) (Table 9-2-A). Of the students sampled, 50.1% were male, 48.4% were female, and 1.5% had missing gender information. Students enrolled in public schools accounted for 73.6% of the sample; 26.4% were enrolled in private schools. 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, 2018. In District 9-2, the 2018 UTD vaccination rate for 7th graders was 93.3%, lower than the 2017 rate (95.5%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 9-2 vaccination rate for completing the HPV series was significantly lower than the state rate. The 2018 District 9-2 vaccination rates did not differ significantly from 2017 rates or between genders. The vaccination rates for UTD, Tdap, MCV4 and HPV (1-shot and complete series) were significantly higher for public school students than private school students (Table 9-2-B). Table 9-2-A: Gender, school type, waiver and exemptions among District 9-2 adolescents, 2018 (n = 405). Gender Male Female Unknown # of Percent of students sample (%) 203 50.1 196 48.4 6 1.5 School type Public (21) 298 73.6 Private (9) 107 26.4 Within waiver period? Yes No 3 0.7 402 99.3 Exemptions Religious 6 1.5 Medical 1 0.2 No exemption 398 98.3 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. Only three (0.7%) of the students in the District 9-2 sample were found to be in the school waiver period (Table 9-2-A). One (0.2%) of the students in the District 9-2 sample had a medical exemption for one more vaccines; 6 (1.5%) students had a religious exemption on file (Table 9-2-A). Table 9-2-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 9-2, 2018 2018, Year, Gender, 2018, School type, 2018, State District 9-2 District 9-2 District 9-2 Overall n = 7,057 (%) 2017 n = 224 (%) 2018 n = 405 (%) Male n = 203 (%) Female n = 196 (%) Public n = 298 (%) Private n = 107 (%) UTD rate* 93.9 0.6 95.5 2.7 93.3 2.4 94.6 3.1 94.9 3.1 96.3 2.1 85.0 6.8 3+ Hepatitis B 98.2 0.3 99.1 1.2 98.3 1.3 99.5 1.0 99.0 1.4 99.0 1.1 96.3 3.6 2+ MMR 97.9 0.3 99.1 1.2 97.5 1.5 98.5 1.7 99.5 1.0 98.7 1.3 94.4 4.4 2+ Varicella 97.0 0.4 98.2 1.7 97.3 1.6 97.5 2.1 99.5 1.0 98.3 1.5 94.4 4.4 1 Tdap 95.7 0.5 96.4 2.4 95.1 2.1 96.6 2.5 95.9 2.8 97.3 1.8 88.8 6.0 1 MCV4 95.5 0.5 96.9 2.3 94.8 2.2 96.6 2.5 95.4 2.9 97.0 1.9 88.8 6.0 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 97.8 1.9 48.7 6.6 18.3 5.1 97.3 1.6 46.2 4.9 18.3 3.8 98.0 1.9 44.8 6.8 15.3 5.0 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 99.0 1.4 49.0 7.0 21.9 5.8 97.7 1.7 52.7 5.7 21.1 4.6 96.3 3.6 28.0 8.5 10.3 5.8 District 10-0 (Athens) 29 The 2018 GAIS sampled 402 seventh grade adolescents in District 10-0 from 29 middle schools (18 public, 11 private) (Table 10-0-A). Of the students sampled, 49.8% were male, 50.0% were female, and 0.2% had missing gender information. Students enrolled in public schools accounted for 66.9% of the sample; 33.1% were enrolled in private schools. 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, 2018. In District 10-0, the 2018 UTD vaccination rate for 7th graders was 97.3%, higher than the 2017 rate (93.9%) and the state average for 2018 (93.9%). Vaccination 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 2018 District 10-0 vaccination rates for UTD, HepB, MMR, Varicella, Tdap, MCV4 and Polio were significantly higher than the state rates. The 2018 District 10-0 vaccination rates for UTD, HepB, Varicella and Polio were significantly higher than the 2017 rates. The 2018 vaccination estimates for male and female students did not differ significantly. The vaccination rate for 1 HPV was significantly higher for public school students than private school students (Table 10-0-B). Table 10-0-A: Gender, school type, waiver and exemptions among District 10-0 adolescents, 2018 (n = 402). Gender Male Female Unknown # of Percent of students sample (%) 200 49.8 201 50.0 1 0.2 School type Public (18) 269 66.9 Private (11) 133 33.1 Within waiver period? Yes No 0 0.0 402 100.0 Exemptions Religious 6 1.5 Medical 1 0.2 No exemption 395 98.3 Transfer students with incomplete vaccination records have a 30-day waiver period to meet vaccination requirements. None of the students in the District 10-0 sample were found to be in the school "waiver" period (Table 10-0-A). One (0.2%) of the students in the District 10-0 sample had a medical exemption for one more vaccines; 6 (1.5%) students had a religious exemption on file (Table 10-0-A). Table 10-0-B: Georgia adolescent vaccination coverage rates by vaccine antigen, gender and school type, District 10-0, 2018 2018, Year, Gender, 2018, School type, 2018, State District 10-0 District 10-0 District 10-0 Overall n = 7,057 (%) 2017 n = 347 (%) 2018 n = 402 (%) Male n = 200 (%) Female n = 201 (%) Public n = 269 (%) Private n = 133 (%) UTD rate* 93.9 0.6 93.9 2.5 97.3 1.6 98.5 1.7 96.5 2.5 98.5 1.4 94.7 3.8 3+ Hepatitis B 98.2 0.3 97.4 1.7 99.5 0.7 99.5 1.0 99.5 1.0 100.0 0.0 98.5 2.1 2+ MMR 97.9 0.3 97.7 1.6 99.3 0.8 99.5 1.0 99.0 1.4 99.6 0.7 98.5 2.1 2+ Varicella 97.0 0.4 96.0 2.1 98.5 1.2 99.0 1.4 98.0 1.9 99.3 1.0 97.0 2.9 1 Tdap 95.7 0.5 96.8 1.8 98.0 1.4 99.0 1.4 97.5 2.2 98.9 1.3 96.2 3.2 1 MCV4 95.5 0.5 96.5 1.9 98.0 1.4 99.0 1.4 97.5 2.2 98.9 1.3 96.2 3.2 4+ Polio 1 HPV Complete HPV series 97.3 0.4 50.6 1.2 23.4 1.0 96.5 1.9 40.6 5.2 17.9 4.0 98.8 1.1 47.5 4.9 21.1 4.0 98.5 1.7 46.0 6.9 20.5 5.6 * UTD if adolescent has 3 Hepatitis B, 2 MMR, 2 Varicella, 1 Tdap and 1 MCV4. Red font indicates a rate decrease since 2017 Bolded and italicized font indicates a significant difference (p<0.05) from the comparison group (see methods, pg. 7). 99.0 1.4 49.3 6.9 21.9 5.7 98.9 1.3 53.2 6.0 23.0 5.0 98.5 2.1 36.1 8.2 17.3 6.4 Appendices i Appendix A: Vaccination Coverage Measures Appendix Table A: Vaccine antigen-specific vaccination coverage by District, GAIS, 2018 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 (%) (%) (%) (%) (%) (%) (%) (%) (%) 95.7 99.0 98.7 98.0 97.2 97.2 98.7 44.8 18.3 1-2 North Georgia (Dalton) 89.5 96.9 95.4 95.4 91.3 91.0 95.4 50.1 28.6 2-0 North (Gainesville) 94.6 98.5 98.5 96.7 96.9 96.7 97.9 38.6 18.0 3-1 Cobb-Douglas 93.1 97.5 98.0 95.7 95.9 95.4 97.0 41.4 19.3 3-2 Fulton 93.5 99.0 97.9 97.1 96.1 95.8 97.6 47.6 20.4 3-3 Clayton 96.2 99.5 99.7 98.5 97.4 97.7 97.9 65.9 26.9 3-4 East Metro (Lawrenceville) 93.2 98.2 98.2 97.0 95.2 94.7 97.5 49.7 19.6 3-5 DeKalb 91.5 94.8 95.3 94.5 93.8 93.3 94.0 60.0 31.6 4-0 LaGrange 88.3 96.9 95.3 94.8 90.4 90.2 95.9 44.6 18.4 5-1 South Central (Dublin) 91.8 99.2 99.0 98.0 93.4 92.8 98.7 43.0 19.9 5-2 North Central (Macon) 93.0 96.1 95.9 94.7 94.7 94.4 95.4 47.1 21.4 6-0 East Central (Augusta) 94.6 99.3 99.0 97.5 96.3 96.5 98.5 48.3 23.3 7-0 West Central (Columbus) 93.6 98.1 97.9 97.6 95.0 95.2 96.3 61.3 31.6 8-1 South (Valdosta) 97.5 99.5 99.2 98.5 98.7 98.5 99.0 56.1 27.9 8-2 Southwest (Albany) 99.0 99.2 99.5 99.5 99.5 99.5 98.4 58.1 29.7 9-1 Coastal (Savannah) 95.3 98.6 98.3 97.5 97.2 96.9 97.8 61.4 26.9 9-2 Southeast (Waycross) 93.3 98.3 97.5 97.3 95.1 94.8 97.3 46.2 18.3 10 Northeast (Athens) 97.3 99.5 99.3 98.5 98.0 98.0 98.8 47.5 21.1 Georgia 93.9 98.2 97.9 97.0 95.7 95.5 97.3 50.6 23.4 ii Appendix B: Frequency of exemptions Appendix Table B: Frequency of exemptions and school waiver status by Health District, GAIS, 2018 District Sample size Within school waiver period Religious exemption Medical exemption 1-1 Northwest (Rome) 393 0 9 1 1-2 North Georgia (Dalton) 391 2-0 North (Gainesville) 389 3-1 Cobb-Douglas 394 3-2 Fulton 382 3-3 Clayton 390 0 30 0 1 10 0 0 15 0 2 10 0 0 5 0 3-4 East Metro (Lawrenceville) 398 3-5 DeKalb 402 4-0 LaGrange 386 5-1 South Central (Dublin) 391 5-2 North Central (Macon) 412 0 14 0 2 15 1 0 26 1 0 5 1 0 20 0 6-0 East Central (Augusta) 404 0 3 0 7-0 West Central (Columbus) 377 2 6 1 8-1 South (Valdosta) 394 0 3 1 8-2 Southwest (Albany) 387 0 1 0 9-1 Coastal (Savannah) 360 5 7 0 9-2 Southeast (Waycross) 10 Northeast (Athens) 405 3 6 1 402 0 6 1 Georgia 7,057 15 191 8 Total 10 30 11 15 12 5 14 18 27 6 20 3 9 4 1 12 10 7 214 iii Appendix C: Reasons for incomplete vaccination Appendix Table C: Reasons for incomplete vaccination by antigen, Georgia Adolescent Immunization Study, 2018 Reason Exempt certificate on file 3+ Hepatitis B 83 2+ MMR 105 2+ Varicella 109 1 Tdap 171 1 MCV4 174 4+ Polio 105 1 dose HPV 191 Complete HPV series 195 Serology+ or history of disease 1 3 38 0 0 0 0 0 School waiver on file 2 2 2 4 5 2 5 6 Late (given after 1/1/2018) Incomplete series (as of 5/30/18) Never initiated series (as of 5/30/18) UTD 7 2 19 18 14 17 6,931 6,910 9 24 28 6,847 55 64 0 0 76 76 6,751 6,738 9 137 58 0 14 3156 6,869 3,568 357 114 4736 1,649 Total (sample size) Vaccine gap (admitted to school without completing series or having an exemption, as of 1/1/18) 7,057 7,057 7,057 7,057 7,057 7,057 7,057 40 37 61 131 140 81 3,293 7,057 5,207 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