GEORGIA IMMUNIZATION STUDY 2002 Final Report A collaboration between: Georgia Department of Human Resources Division of Public Health, Epidemiology Branch and Immunization Program, Georgia Public Health Districts, and Private Medical Providers throughout Georgia. Prepared by Carol A. Hoban, M.S., M.P.H. Principal Investigator and Project Coordinator Contributors Mike Chaney, Georgia Immunization Program Manager Susan Lance-Parker, D.V.M., Ph.D., Notifiable Disease Section Chief Acknowledgments The Division of Public Health, Georgia Department of Human Resources thanks the public health representatives that participated in this study for all of their hard work, support and dedication. We are grateful to the private providers in Georgia for their support and cooperation throughout this study. Over seventy percent of all immunizations in this year's study were received at a physician's office. This study would not have been possible without their cooperation and support. We appreciate the Rollins School of Public Health at Emory University for providing us with the study materials. Their generosity allowed us to repeat the assessment for a sixth year and compare our efforts with theirs. We acknowledge the support of the Georgia Chapter of the American Academy of Pediatrics, the Georgia Academy of Family Physicians and the Medical Association of Georgia for their support with this and many other public health activities. A special note of thanks to Mr. Mike Chaney, Georgia Immunization Program Manager, for his support and leadership during this study. Executive Summary The private sector administered 72 percent of all childhood immunizations, the County Health Departments administered 20 percent, and unknown sources provided the remaining 8 percent. The rate of fully vaccinated children in Georgia has increased steadily since 1997. Immunization against varicella (chicken pox) showed the greatest increase in the past two years from 64 to 89 percent. By twelve months of age 93 percent of Georgia infants had received two doses for hepatitis B immunization. At twenty-four months, 91 percent of children had been given the recommended three doses. Ninety percent of Georgia's two-year-olds were immunized against H. influenzae, hepatitis B, mumps, measles, rubella and polio. In Georgia, 88 percent of children twelve months of age were appropriately immunized against diphtheria, tetanus and pertussis. Seventy-nine percent of Georgia's two-year-olds were adequately immunized against ten vaccine-preventable childhood diseases, namely diphtheria, tetanus, pertussis, hepatitis B, H. influenzae type B, mumps, measles, rubella, polio and varicella. A disparity of fully immunized two-year-olds was seen among the 19 health districts, ranging from 69 to 93 percent. Four of the state's public health districts had a rate of 85 percent or greater for immunization against the ten vaccine-preventable childhood diseases. Six of the public health districts had a rate less than 75 percent. Maternal race was not a significant factor in the immunization status of the children studied. The children of college-educated mothers were shown to have the highest immunization rates. The children of mothers who were Medicaid recipients were slightly less likely to be adequately immunized. Table of Contents List of Tables ........................................................................................................iii List of Figures ....................................................................................................... x List of Appendices ............................................................................................... xi SECTION I: PROJECT OVERVIEW .............................................................................. 1 Project Activity Timeline ............................................................................ 3 SECTION II: METHODOLOGY .................................................................................... 5 Research Design ...................................................................................... 6 Target and Sample Populations ................................................................ 6 Preparation for Data Collection ................................................................ 7 Data Form Development ........................................................................... 7 Data Collection Protocol ........................................................................... 9 Data Entry ............................................................................................... 10 Analysis Plan .......................................................................................... 11 SECTION III: RESULTS OF STATEWIDE ANALYSES .................................................... 12 Sampling ................................................................................................. 13 Response Rates ..................................................................................... 15 Parent Refusals by District....................................................................... 18 Statewide Immunization Results .............................................................. 19 Statewide Comparisons of Maternal Demographics of Adequately Immunized Children ................................................................................. 33 Summary of Statewide Analyses ............................................................ 36 SECTION IV: RESULTS OF DISTRICT LEVEL ANALYSES.............................................. 37 Overview of District Rates........................................................................ 38 Individual Health District Reports of Rates and Crosstabulations ............ 39 District 1-1 Northwest Health District ....................................................... 39 District 1-2 North Georgia Health District ................................................. 45 District 2-0 North Health District............................................................... 51 District 3-1 Cobb/Douglas Health District ................................................. 57 District 3-2 Fulton Health District.............................................................. 63 District 3-3 Clayton County Health District ............................................... 69 District 3-4 East Metro Health District ...................................................... 75 District 3-5 Dekalb Health District ............................................................ 81 District 4-0 LaGrange Health District........................................................ 87 District 5-1 South Central Health District.................................................. 93 District 5-2 North Central Health District .................................................. 99 District 6-0 East Central Health District.................................................. 105 District 7-0 West Central Health District................................................. 111 District 8-1 South Health District ............................................................ 117 i District 8-2 Southwest Health District..................................................... 123 District 9-1 East Health District .............................................................. 129 District 9-2 Southeast Health District ..................................................... 135 District 9-3 Coastal Health District ......................................................... 141 District 10-0 Northeast Health District .................................................... 147 SECTION V: DISCUSSION OF RESULTS .................................................................. 153 Summary................................................................................................ 154 Conclusions ........................................................................................... 156 Strengths................................................................................................ 156 Limitations.............................................................................................. 157 APPENDICES................................................................................................... 159 ii List of Tables Page 1. Project Activity Timeline ............................................................................. 3 2. Sample Description ................................................................................... 14 3. 2002 Eligible Sample, Number Located, and Response Rate by District.. 16 4. Parent Refusals by Health District for the 2002 Study .............................. 18 5. 4:3:1+3 State Immunization Coverage by Study Year .............................. 20 6. 4:3:1 State Immunization Coverage by Study Year................................... 20 7. 3:3:1 State Immunization Coverage by Study Year................................... 22 8. State Immunization Status by Vaccine Series by Study Year ................... 23 9. Statewide Immunization Status by Individual Vaccines at 12 Months of Age............................................................................................................ 24 10. 4:3:1 District and State Coverage Rates by Study Year............................ 26 11. State and District Immunization Rates for DTP/DTaP by Study Year ....... 27 12. State and District Immunization Rates for OPV/IPV by Study Year .......... 28 13. State and District Immunization Rates for MMR by Study Year ................ 29 14. State and District Immunization Rates for Hib by Study Year ................... 30 15. State and District Immunization Rates for Hep B by Study Year............... 31 16. State and District Immunization Rates for Varicella by Study Year ........... 32 17. Statewide Cross tabulations of Maternal Race and Child Immunization Status by Study Year ................................................................................ 34 18. Statewide Cross tabulations of Maternal Educational Attainment and Child Immunization Status by Study Year .......................................................... 35 19. Statewide Cross tabulations of Maternal Medicaid Status and Child Immunization Status.................................................................................. 36 20. District Immunization Rates for Health District 1-1 by Study Year............. 40 21. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 1-1 ......................................................................... 41 22. Cross tabulations of Maternal Race and Child Immunization Status for Health District 1-1 by Study Year .............................................................. 42 23. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 1-1 by Study Year.............................................. 43 iii 24. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 1-1 ..................................................................... 44 25. District Immunization Rates for Health District 1-2 by Study Year............. 46 26. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 1-2 ......................................................................... 47 27. Cross tabulations of Maternal Race and Child Immunization Status for Health District 1-2 by Study Year .............................................................. 48 28. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 1-2 by Study Year.............................................. 49 29. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 1-2 ..................................................................... 50 30. District Immunization Rates for Health District 2-0 by Study Year............. 52 31. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 2-0 ......................................................................... 53 32. Cross tabulations of Maternal Race and Child Immunization Status for Health District 2-0 by Study Year .............................................................. 54 33. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 2-0 by Study Year.............................................. 55 34. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 2-0 ..................................................................... 56 35. District Immunization Rates for Health District 3-1 by Study Year............. 58 36. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 3-1 ......................................................................... 59 37. Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-1 by Study Year .............................................................. 60 38. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-1 by Study Year .............................................. 61 39. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-1...................................................................... 62 40. District Immunization Rates for Health District 3-2 by Study Year............. 64 iv 41. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 3-2 ......................................................................... 65 42. Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-2 by Study Year .............................................................. 66 43. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-2 by Study Year .............................................. 67 44. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-2...................................................................... 68 45. District Immunization Rates for Health District 3-3 by Study Year............. 70 46. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 3-3 ......................................................................... 71 47. Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-3 by Study Year .............................................................. 72 48. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-3 by Study Year .............................................. 73 49. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-3...................................................................... 74 50. District Immunization Rates for Health District 3-4 by Study Year............. 76 51. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 3-4 .......................................................................... 77 52. Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-4 by Study Year .............................................................. 78 53. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-4 by Study Year .............................................. 79 54. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-4...................................................................... 80 55. District Immunization Rates for Health District 3-5 by Study Year............. 82 56. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 3-5 ......................................................................... 83 57. Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-5 by Study Year .............................................................. 84 v 58. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-5 by Study Year .............................................. 85 59. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-5 ..................................................................... 86 60. District Immunization Rates for Health District 4-0 by Study Year............. 88 61. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 4-0 ......................................................................... 89 62. Cross tabulations of Maternal Race and Child Immunization Status for Health District 4-0 by Study Year .............................................................. 90 63. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 4-0 by Study Year .............................................. 91 64. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 4-0 ..................................................................... 92 65. District Immunization Rates for Health District 5-1 by Study Year............. 94 66. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 5-1 ......................................................................... 95 67. Cross tabulations of Maternal Race and Child Immunization Status for Health District 5-1 by Study Year .............................................................. 96 68. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 5-1 by Study Year .............................................. 97 69. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 5-1 ..................................................................... 98 70. District Immunization Rates for Health District 5-2 by Study Year........... 100 71. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 5-2 ....................................................................... 101 72. Cross tabulations of Maternal Race and Child Immunization Status for Health District 5-2 by Study Year ............................................................ 102 73. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 5-2 by Study Year ............................................ 103 74. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 5-2 ................................................................... 104 vi 75. District Immunization Rates for Health District 6-0 by Study Year........... 106 76. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 6-0 ....................................................................... 107 77. Cross tabulations of Maternal Race and Child Immunization Status for Health District 6-0 by Study Year ............................................................ 108 78. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 6-0 by Study Year ............................................ 109 79. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 6-0 ................................................................... 110 80. District Immunization Rates for Health District 7-0 by Study Year........... 112 81. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 7-0 ....................................................................... 113 82. Cross tabulations of Maternal Race and Child Immunization Status for Health District 7-0 by Study Year ............................................................ 114 83. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 7-0 by Study Year ............................................ 115 84. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 7-0 ................................................................... 116 85. District Immunization Rates for Health District 8-1 by Study Year........... 118 86. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 8-1 ....................................................................... 119 87. Cross tabulations of Maternal Race and Child Immunization Status for Health District 8-1 by Study Year ............................................................ 120 88. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 8-1 by Study Year ............................................ 121 89. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 8-1 ................................................................... 122 90. District Immunization Rates for Health District 8-2 by Study Year........... 124 91. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 8-2 ....................................................................... 125 92. Cross tabulations of Maternal Race and Child Immunization Status for vii Health District 8-2 by Study Year ............................................................ 126 93. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 8-2 by Study Year ............................................ 127 94. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 8-2 ................................................................... 128 95. District Immunization Rates for Health District 9-1 by Study Year........... 130 96. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 9-1 ....................................................................... 131 97. Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-1 by Study Year ............................................................ 132 98. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 9-1 by Study Year ............................................ 133 99. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 9-1 ................................................................... 134 100. District Immunization Rates for Health District 9-2 by Study Year........... 136 101. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 9-2 ....................................................................... 137 102. Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-2 by Study Year ............................................................ 138 103. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 9-2 by Study Year ............................................ 139 104. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 9-2 ................................................................... 140 105. District Immunization Rates for Health District 9-3 by Study Year........... 142 106. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 9-3 ....................................................................... 143 107. Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-3 by Study Year ............................................................ 144 108. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 9-3 by Study Year ............................................ 145 109. Cross tabulations of Maternal Medicaid Status and Child Immunization viii Status for Health District 9-3 ................................................................... 146 110. District Immunization Rates for Health District 10-0 by Study Year......... 148 111. 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 10-0 ..................................................................... 149 112. Cross tabulations of Maternal Race and Child Immunization Status for Health District 10-0 by Study Year .......................................................... 150 113. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 10-0 by Study Year .......................................... 151 114. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 10-0 ................................................................. 152 115. Data Used for Sample Size Estimates for the 2002 Study ...................... 162 116. 2002 Varicella Rates and Cases of Chicken Pox by District ................... 171 117. Statewide Percentage of Shots by Provider: 1998-99, 1999-00, 2001, and 2002 ........................................................................ 174 118. District Specific Percentage of Shots by Provider 2002 .......................... 175 119. Location of Immunizations by District -Four Year Comparison 1998-99, 1999-00, 2001, 2002 ............................................................................... 177 120. Margins of Error for 2002 Statewide and District 4:3:1+3 Rates ............. 181 121. Margins of Error for 2002 Statewide and District 4:3:1 Rates ................. 182 122. Margins of Error for 2002 Statewide and District 3:3:1 Rates ................. 183 ix List of Figures Page 1. Sampling Procedure.................................................................................... 13 2. 2002 Response Rates by District ................................................................ 17 3. Statewide Coverage 4:3:1 and 4:3:1+3 ....................................................... 21 4. 4:3:1 Coverage for State and District 1-1 .................................................... 39 5. 4:3:1 Coverage for State and District 1-2 .................................................... 45 6. 4:3:1 Coverage for State and District 2-0 .................................................... 51 7. 4:3:1 Coverage for State and District 3-1 .................................................... 57 8. 4:3:1 Coverage for State and District 3-2 .................................................... 63 9. 4:3:1 Coverage for State and District 3-3 .................................................... 69 10. 4:3:1 Coverage for State and District 3-4 .................................................... 75 11. 4:3:1 Coverage for State and District 3-5 .................................................... 81 12. 4:3:1 Coverage for State and District 4-0 .................................................... 87 13. 4:3:1 Coverage for State and District 5-1 .................................................... 93 14. 4:3:1 Coverage for State and District 5-2 .................................................... 99 15. 4:3:1 Coverage for State and District 6-0 .................................................. 105 16. 4:3:1 Coverage for State and District 7-0 .................................................. 111 17. 4:3:1 Coverage for State and District 8-1 .................................................. 117 18. 4:3:1 Coverage for State and District 8-2 .................................................. 123 19. 4:3:1 Coverage for State and District 9-1 .................................................. 129 20. 4:3:1 Coverage for State and District 9-2 .................................................. 135 21. 4:3:1 Coverage for State and District 9-3 .................................................. 141 22. 4:3:1 Coverage for State and District 10-0 ................................................ 147 23. Explanations of Table 115 Data Used for Sample Size Estimates for the 2002 Study ................................................................................................ 163 24. 2002 State Varicella Coverage Rates and Percentage of Sample with Chicken Pox Disease ................................................................................ 172 x List of Appendices Page Appendix A: Description of Sampling Plan and Statistical Note.............. ......... 159 Appendix B: List of 2002 Public Health Representatives ......................... ........ 164 Appendix C: Data Collection Form........................................................... ........ 166 Appendix D: Varicella Vaccine and Chicken Pox Data ............................ ........ 169 Appendix E: Provider of Immunizations ................................................... ........ 173 Appendix F: Margins of Error for Immunization Coverage Rates............. ........ 179 xi SECTION I: PROJECT OVERVIEW 1 SECTION I: PROJECT OVERVIEW AND INTRODUCTION The Division of Public Health, Epidemiology Branch, Immunization Program and Health Districts collaborated on the 2002 Georgia Immunization Study. The purpose of the study was to assess the immunization coverage rates of two-year-old children in Georgia statewide and for each of the nineteen health districts. The Rollins School of Public Health, Emory University did the first three years of the study. Immunization rates for the first year of the study evaluated rates for children born in 1994. The second year of the study estimated rates for children born in 1995. The third year examined rates for children born in 1996. The fourth year, 1999-00 looked at immunization rates for infants born in 1997. The fifth year, 2001 examined immunization rates for children born in 1999. This year, immunization rates for children born in January 2000 were assessed. The current rates are compared throughout this report with data from the previous four years of the study. Public health representatives in each of the nineteen health districts collected immunization data from both public and private health care providers. The Principal Investigator and Project Coordinator was Carol A. Hoban, MS, MPH. Ms. Hoban performed data entry and analysis. Staff at the Georgia Division of Public Health began work on the Georgia Immunization Project in November 2001. During December 2001, the sampling procedure was completed, and revisions were made to the data collection form and training manual. Letters were sent to each district health director informing them about the study. Each Vaccines For Children provider in Georgia (approximately 700) received a letter and supporting information about the study during the month of January 2002. Throughout this report, we refer to study years one, two, three, four, and five as 1997-98, 1998-99, 199900, 2001, and 2002 respectively. The results from these five study years refer to rates for 1995, 1996, 1997, 1999, and 2000 respectively. 2 During January, a training session for the public health representatives was held in Forsyth, Georgia. Data were collected from February 2002 through August 2002. (Data collection continued on some difficult to obtain records through the end of September 2002). The Project Coordinator served as the contact person for the public health representatives during the data collection period. Conference calls were held monthly with the public health representatives to answer questions and address concerns regarding data collection. Table 1 describes project activities that took place throughout the project timeline. Table 1: Project Activity Timeline Project Activity Date Original, stratified sample drawn December, 2001 Initial notification of public health community Immunization Coordinators December, 2001 Health Directors Initial notification of private health January, 2002 community One day training for public health January, 2002 representatives Data collection period February August, 2002 Data entry period February November, 2002 Double data entry of 5% of data forms November, 2002 Final data cleaning and analysis of data December, 2002 Final Report January, 2003 3 Data collection was extended beyond August 2002 in to allow for follow-up of records for which the public health representatives had some information but needed more time to complete. This Final Report includes both statewide and health district level immunization analyses. It contains an overview of data collection, sampling methodology, and a discussion of the study findings. Additional reports on related topics are discussed in Appendices D, E, and F. Findings specific to Varicella are discussed in Appendix D. A report on the immunization site (public or private provider) is included in Appendix E. Margins of error for immunization coverage rates are included in Appendix F. 4 SECTION II: METHODOLOGY 5 SECTION II: METHODOLOGY Research Design The sixth year of the Georgia Immunization Study employed a non- experimental retrospective cohort research design in order to ascertain the immunization coverage rate for children born in the State of Georgia in January 2000. In this retrospective study, all of the immunizations should have occurred prior to the initiation of the project. However, during the data collection time period children that were not up-to-date on all immunizations were allowed to receive their shots. The study design allowed for the calculation of immunization rates for children who turned two in January 2002. Identifying information about the children and their parents was collected from birth certificates. Target and Sample Populations The target population of the sixth year of the Georgia Immunization Study included all two-year-old children born in the State of Georgia in 2000. A sample size of 4,387 children born in the month of January 2000 was selected for the study. The sample design allowed for independent estimates for each of the 19 health districts in the state. (See Appendix A for a description of the sampling plan.) The final estimate for the state is based on weighted data to account for differential probabilities of selection for each health district. Dr. John Carter, Epidemiologist and Assistant Professor at the Rollins School of Public Health, drew a stratified random sample (by health district) from the total births in the state for January 2000. Information for each child, including all birth certificate variables available, was downloaded into an ASCII file. Examples of the type of birth certificate information obtained for each child include: Health district of birth County of birth Infant's first, middle, and last name Infant's gender 6 Infant's date of birth Infant's address Medicaid status of mother at birth of child Mother's first, middle, and last name Father's first, middle, and last name (if available) Mother's race Mother's level of education Preparation for Data Collection Public health representatives in each health district completed the data collection procedures. Division of Public Health staff trained the representatives in Forsyth, Georgia on January 16th, 2002. During this training, the public health representatives: received an overview of childhood immunizations learned the data collection process and locating methods were taught information on recording data on the data collection form were instructed in confidentiality and professional etiquette This information as well as other pertinent details were defined in the Public Health Representative Training Manual presented to each representative at the training. This manual was developed by the staff at the Rollins School of Public Health in 1996-97, and was revised by the staff at the Georgia Division of Public Health for use in year five. Data Form Development The Georgia Division of Public Health, Epidemiology Branch, revised the standardized data collection form developed by the staff at the Rollins School of Public Health. (See Appendix C for a copy of the data collection form.) The form followed the recommended schedule of childhood immunizations jointly approved by the Advisory Committee on Immunization Practices (ACIP), the American 7 Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). The data collection form contained four distinct sections to be completed by the public health representatives, and included identifying information from the child's birth certificate. The section titled "Part A: Identifying Information" included the identifying information for each child as well as a code number to further identify each record. This section also included an area for the representatives to record any changes to identifying information (i.e., change of address). The immunization dates for each particular vaccination were recorded in the section labeled "Part B: Immunization History." There were spaces available for five Diphtheria, Tetanus, Pertussis (DTP/DTaP) vaccines, four Polio (OPV/IPV) vaccines, two Measles, Mumps, Rubella (MMR) vaccines, five Haemophilus Influenza type B (Hib) vaccines, four Hepatitis B (Hep B) vaccines, and two Varicella vaccines. The data collection form provided one extra space for each vaccine to accommodate instances where a child was over-immunized. In this section the representative also noted the location where each individual vaccine was given (Health Department, Private Physician, or Unknown). See Appendix E for a report of the "Provider of Immunizations" information. The next section, "Part C: Tracking Log", provided space for representatives to chronicle all activities performed for each record. This section aided the representatives in their work by documenting where they were in the abstraction process at any point in time. The section also enabled the State staff to understand the steps necessary to find each child's immunization history and to clarify notations made by the representative in Part D of the form. "Part D: Data Collection" is designed to track where the data were collected and the reason data abstraction ended for each individual record. This information was used to understand why the representative returned the record to the State and to determine if any evidence of the child was found. 8 Data Collection Protocol Step #1: Search for immunization records at local health departments. In this step, representatives reviewed computerized files or immunization cards for shot dates. Representatives also used these files to find updated contact information for families. Representatives were instructed to check with Women, Infants, and Children (WIC) offices, for updated contact information as well. Step #2: Search for immunization records through the parent(s). In this step, representatives used the contact information from the birth certificate or any updated contact information found at the health department to contact the parent. Representatives also used sources such as city phone directories, directory assistance, and the Internet to find current contact information for parents. Parents were then contacted by phone and letter and asked to provide an immunization history or the location of immunization information (i.e., the name of the doctor or clinic office). Representatives also sent consent forms to parents. Although immunization data are in the public domain, and law does not require consent forms, many private physicians refused to provide information without a signed consent from the parent. Note about Field Visits: In some cases, representatives made home visits to collect data. This practice was encouraged if the representative was comfortable with it. Step #3: Search for immunization records through private physician(s). In this step, representatives contacted private physicians and requested the child's immunization history. Most physicians provided the information by phone or fax, once a copy of the 9 parent's consent form was received. Some provided the information with a verbal parental consent. Others cooperated by checking a list of children from the sample against their patient list. Some physicians preferred that representatives visit their offices in person to collect the data. Representatives were instructed to collect the information by the method (e.g., phone, fax, personal visit) most convenient to the doctor's office. In most cases, nurses, office managers, and records clerks were the main contacts for representatives collecting data in private physician offices. Representatives returned completed data collection forms to the Georgia Immunization Program on a weekly basis via U.S. mail. The returned forms were reviewed by staff for correctness and completeness. ("Completeness" here refers not to immunization status, but to completion of the abstraction process, i.e., that a representative did all he or she could do to document a child's entire immunization record.) If a form was incorrectly filled out or incomplete, the public health representative was contacted for clarification. The immunization dates and location for each record were then entered into an Epi Info Version 6.04 data file. This program was developed specifically for this study in Year Two, revised in Year Three by Ms. Alperin, Co-Principal Investigator and again in year six by Ms. Hoban. Data Entry The principal investigator reviewed each record prior to entry into the Epi Info database. Attempts were made to resolve any unclear information with the public health representative before data entry. Data cleaning and double data entry were done in the month of December 2002. Five percent of the data were re-entered and correlated with the original forms to look for data entry errors and estimate the error rate for the final sample. A data reliability rate of approximately 99.0% was found. 10 Analysis Plan The plan for the analysis was very similar to that used in the previous years. Additionally, trends from the previous five years of the study are shown in this Final Report. Epi Info was the main software program used to assess immunization coverage rates, and provide a measure of where the immunizations were given. The analyses include univariate, bivariate, and multivariate analyses to produce a clear description of the immunization status of two-year-old children in the State of Georgia. 11 SECTION III: RESULTS OF STATEWIDE ANALYSES 12 SECTION III: RESULTS OF STATEWIDE ANALYSES Sampling The sample of 4,387 children was drawn from 10,994 children born in Georgia in January 2000. A total of 132,286 children were born in Georgia during 2000. Children who were ineligible for participation in the study were extracted from the original sample, leaving an eligible sample of 4,147. (Ineligible children were those who were deceased, adopted, moved out of state, or were known to be part of a military family.) Figure 1 below depicts the stages of the sampling procedure. Figure 1: Sampling Procedure All children born in Georgia in 2000 (N = 132,286) All children born in Georgia in January 2000 (N = 10,994) Original sample of 4,387 children Eligible sample of 4,147 children Final sample of 2,721 children Of the 4,147 children in the eligible sample, 2,721 children were located, 1,426 children never were located and 125 parental refusals were removed. The resulting final sample consisted of 2,721 children. The final sample represents the children for whom parental consent was given to have their child's 13 immunization record included in this study. The children who were never located were those for whom no evidence beyond the birth certificate could be found to confirm that the child existed. The final sample of 2,721 children represented 65.6 percent of the eligible sample. Table 2: Sample Description Sampling Step Original Sample Deceased Adopted Moved out of state Military Number 4,387 4 12 167 57 Percent of Sample 100.0% 0.1% 0.3% 3.8% 1.3% Eligible Sample 4,147 94.5% Eligible Sample Records Not Located /Eligibility Unknown * 4,147 1,426 100.0% 34.4% Final Sample (Located Records**) 2,721 65.6% * Records Not Located / Eligibility Unknown - This category refers to records where no evidence of a child's existence was found beyond birth certificate data (including those records where only one Hepatitis B shot was given at birth [n=8] or if a parent refused to participate in the study). ** Located Records This category refers to all records where evidence of a child's existence was found, regardless of the child's immunization status. The supposition here, is that, if evidence of a child's existence was found, it is possible to also find documentation of that child's immunization status. This category includes records where: a) a provider refused to participate in the study; b) no immunization record was available due to documented religious objection; c) a provider could not be found (this implies contact with a parent, who would have provided evidence of the child's existence); d) no immunization record was available due to documented medical exemption; e) a parent could not be found, but shot dates were found elsewhere 14 Response Rates Table 3 and Figure 2 depict the district and state response rates for the 2002 study. The response rates are the number of records located divided by the total number of records in the sample. Response rates provide some indication of the ease or difficulty of accessing records of the children in the study as well as the quality of data collection. As noted in the last column of Table 3, response rates are reported - using the eligible sample as the total. In reviewing the response rates based on the eligible sample, the district response rates range from a low of 30.7 percent to a high of 98.8 percent, with a statewide average response rate of 68.6 percent. 15 Table 3: 2002 Eligible Sample, Number Located and Response Rates by District Health Eligible Number Response District Sample Located* (Number) Rate ** (% of Eligible Sample located) 1-1 237 209 88.2% 1-2 187 167 89.3% 2-0 105 76 72.4% 3-1 434 293 67.5% 3-2 469 172 36.7% 3-3 361 111 30.7% 3-4 250 212 84.8% 3-5 347 201 57.9% 4-0 206 164 79.6% 5-1 80 79 98.8% 5-2 319 252 79.0% 6-0 121 102 84.3% 7-0 205 117 57.1% 8-1 137 129 94.2% 8-2 88 77 87.5% 9-1 186 152 81.7% 9-2 101 90 89.1% 9-3 157 119 75.8% 10-0 157 124 79.0% State 4,147 2,846 68.6 % *sample includes parental refusals **number located / eligible sample 16 Figure 2 2002 Response Rates by District 100 80 60 40 20 0 '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 '9-3 '10 Georgia Health Districts 17 Parent Refusals by District: Table 4 shows the number of parents who refused to participate in the study. Table 4: Parent Refusals by Health District for the 2002 Study 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 9-3 10-0 Total Number of Records Found 209 167 76 293 172 111 212 201 164 79 252 102 117 129 77 152 90 119 124 2,846 Parent Refusals Number 8 9 0 9 28 0 37 6 17 1 4 0 1 0 0 0 1 1 3 125 Percent 3.8 5.4 0.0 3.1 16.3 0.0 17.5 3.0 10.4 1.3 1.6 0.0 0.9 0.0 0.0 0.0 1.1 0.8 2.4 4.4 Parent refusals are defined as situations where the parent told the public health representative that he/she did not want to participate in the study. 18 Statewide Immunization Results The immunization rates that were calculated for this report involved only the final sample of 2,721 children (children located). All reported immunization rates include information from both public and private providers. Since "adequate immunization status" is defined differently by different authorities, the Georgia Immunization Study has evaluated immunization status in several different ways: "4:3:1+3" status a child has received four DTP/DaTP, three OPV/IPV, one MMR, three Hib, three Hep B and one Varicella at anytime "4:3:1" status: used most frequently throughout the study, referring to the more traditional standard of immunization status -- a child who has received four DTP/DTaP, three OPV/IPV, and one MMR vaccination "3:3:1" status: used infrequently in this study - refers to a child who has received three DTP/DTaP, three OPV/IPV, and one MMR vaccination Table 5 illustrates the percent of the children in the final samples in the last four years of this study who were adequately immunized with the 4:3:1+3 series compared to the children in the final sample who were not adequately immunized with this series. Of the 2,721 children who were located in 2002, 78.9 percent were adequately immunized at the 4:3:1+3 level. This percent of adequately immunized children increased from 66.7 percent in 2001. 19 Table 5: 4:3:1+3 State Immunization Coverage by Study Year Status Adequately Immunized Number Percent 1997-98 474 16.0 1998-99 1,360 41.9 1999-00 1,573 56.3 2001 1,837 66.7 2002 2,146 78.9 Note: State rates based on data weighted by health district. Inadequately Immunized Number Percent 2,078 84.0 2,100 58.1 1,220 43.7 918 33.3 575 21.1 Table 6 illustrates the percent of the children in the final sample who were adequately immunized with the 4:3:1 series compared to the children in the final sample who were not adequately immunized with this series. The number of adequately immunized children increased from 71.3 percent in 1997-98 to 73.3 percent in 1998-99 and to 78.8 percent in the 1999-00 study, but decreased slightly to 75.1 percent in the 2001 assessment. During the 2002 assessment, the number of adequately immunized children increased to 83.9 percent which is the highest percentage recorded since this study began. Table 6: 4:3:1 State Immunization Coverage by Study Year Status Adequately Immunized Number Percent 1997-98 1,821 71.3 1998-99 2,511 73.3 1999-00 2,202 78.8 2001 2,068 75.1 2002 2,284 83.9 Note: State rates based on data weighted by health district. 20 Inadequately Immunized Number Percent 731 28.7 949 26.7 591 21.2 687 24.9 437 16.1 Figure 3: Statewide Coverage 4:3:1 and 4:3:1+3 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 4:3:1 4:3:1+3 Figure 3 reveals the statewide 4:3:1 coverage rates for the 1997-98, 1998-99, 1999-00, 2001 and 2002 studies. The figure also shows statewide 4:3:1+3 vaccination coverage for the 1997-98, 1998-99, 1999-00, 2001 and 2002 studies. The 3:3:1 immunization coverage rates allow for three DTP/DTaP instead of four DTP/DTaP. The number of OPV/IPV and MMR vaccinations remain the same. Table 7 indicates the 3:3:1 immunization coverage rate for the state remained consisted during the 1997-98 and 1998-99 studies (78.1 and 78.4 respectively) while increasing in the 1999-00 study to 82.0 percent. In the 2001 study the 3:3:1 rate decreased to 78.9 percent, but increased to 88.8 percent during the 2002 assessment. 21 Table 7: 3:3:1 State Immunization Coverage by Study Year Status Adequately Immunized Number Percent 1997-98 2,005 78.1 1998-99 2,685 78.4 1999-00 2,290 82.0 2001 2,175 78.9 2002 2,417 88.8 Note: State rates based on data weighted by health district. Inadequately Immunized Number Percent 547 21.9 775 21.6 503 18.0 580 21.1 304 11.2 The statewide immunization status for each individual vaccine series is located in Table 8. This table illustrates the number and percent of children who were adequately immunized with each of the recommended vaccines. Vaccines which are part of the 4:3:1+3 shot series are shown here. In 1997-98, 1998-99, 1999-00, and 2001 none of the immunization rates met the state goal of 90 percent coverage; however, during the 2002 assessment nearly all vaccines were at or above the state goal of 90 percent coverage. The coverage rate for the Varicella vaccine dramatically increased from 19.0 percent in 1997-98 to 47.1 percent in 1998-99, to 64.3 percent in 1999-00, to 77.9 percent in 2001 and to 88.5 percent in 2002. (Note: The Hib vaccine status can be considered adequate with three or four shots, depending on the manufacturer of the vaccine. For this study, adequate immunization status for the Hib vaccines was calculated considering three Hib shots as "adequate"). 22 Table 8: State Immunization Status by Vaccine Series by Study Year Vaccine 3 DTP/DTaP 1997-98 1998-99 1999-00 Number Percent Number Percent Number Percent 2,227 87.3 2,912 84.9 2,491 89.2 4 DTP/DTaP 1,861 72.9 2,545 74.2 2,233 79.9 3 OPV/IPV 2,186 85.4 2,864 83.6 2,358 84.4 1 MMR 2,063 80.8 2,752 80.2 2,363 84.6 3 Hib 2,141 83.6 2,866 83.6 2,441 87.4 3 Hep B 2,133 83.2 2,839 82.9 2,422 86.7 1 Varicella 555 19.0 1,620 47.1 1,795 64.3 Note: State rates based on data weighted by health district. 2001 Number Percent 2,392 86.8 2,093 76.0 2,226 80.8 2,258 82.0 2,322 84.3 2,308 83.8 2,147 77.9 2002 Number Percent 2,561 94.1 2,303 84.6 2,466 90.6 2,474 90.9 2,474 90.9 2,471 90.8 2,407 88.5 In addition to looking at the immunization status of the children in the sample at two years of age, the study also reviewed data on the immunization status of the children at one year of age. Table 9 provides an overview of the immunization status of the children in the final sample of the 1997-98, 1998-99, 1999-00, 2001, and 2002 studies at one year of age, looking at coverage status by individual doses of vaccine. 23 Table 9: Statewide Immunization Status by Individual Vaccines at 12 Months of Age Number Percent* Number Percent* Number Percent* Number Percent* Number Percent* Vaccine 97-98 97-98 98-99 98-99 99-00 99-00 2001 2001 2002 2002 DTP/DTaP1 2,404 94.2% 3,071 88.8% 2,588 92.7% 2,507 91.0% 2,667 98.0% DTP/DTaP2 2,282 89.4% 2,976 86.0% 2,507 89.8% 2,426 88.1% 2,592 95.3% DTP/DTaP3 2,049 80.3% 2,712 78.4% 2,327 83.3% 2,214 80.4% 2,394 88.0% DTP/DTaP4 61 2.4% 81 2.3% 25 0.9% 12 0.4% 23 0.8% DTP/DTaP5 0 0.0% 0 0.0% 1 0.0% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 2,389 2,268 1,850 9 93.6% 88.9% 72.5% 0.4% 3,063 2,965 2,411 8 88.5% 85.7% 69.7% 0.2% 2,586 2,493 742 7 92.6% 89.3% 26.6% 00.3% 2,504 2,412 601 1 90.9% 87.5% 21.8% 0.0% 2,662 2,581 948 2 97.8% 94.9% 34.8% 0.1% MMR1** MMR2 83 3.3% 206 6.0% 117 4.2% 87 3.2% 34 1.2% 4 0.2% 1 0.0% 1 0.0% 0 0.0% 1 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 2,324 2,190 1,935 48 0 91.1% 85.8% 75.8% 1.9% 0.0% 3,024 2,925 2,612 99 0 87.4% 84.5% 75.5% 2.9% 0.0% 2,569 2,482 2,220 61 1 92.0% 88.9% 79.5% 2.2% 0.0% 2,492 2,398 1,720 27 1 90.5% 87.0% 62.4% 1.0% 0.0% 2,651 2,569 1,267 15 0 97.4% 94.4% 46.6% 0.6% 0.0% HEPB1 HEPB2 HEPB3 HEPB4 2,404 2,283 1,825 21 94.2% 89.5% 71.5% 0.8% 3,068 2,961 2,419 15 88.7% 85.7% 69.9% 0.4% 2,616 2,527 2,087 23 93.7% 90.5% 74.7% 0.8% 2,508 2,449 1,803 14 91.0% 88.9% 65.4% 0.5% 2,649 2,542 1,116 17 97.4% 93.4% 41.0% 0.6% VAR1** 37 1.5% 160 4.6% 150 5.4% 118 4.3% 44 1.6% VAR2 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% *Percents are calculated as (number immunized/sample size). **The Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday. Sample Size for 1997-98 study = 2,552; 1998-99 study = 3,460; 1999-00 study = 2,793; 2001 study = 2,755, 2002 study = 2,721. 24 Table 10 shows the1997-98, 1998-99, 1999-00, 2001, and 2002 4:3:1 immunization coverage rates and percents for each of the 19 health districts in the state. (For more detailed information on immunization rates specific to health districts, see Section IV: Results of District Level Analyses) The margin of error indicates the confidence limits surrounding the immunization rates. The 2002 margin of error for each health district ranges from +/- 3.4 percent to +/- 8.7 percent. The District level 2002 4:3:1 immunization rates range from 73.9 percent to 94.3 percent. Of the 19 health districts, two had an immunization coverage rate over 90 percent and fifteen districts had 2002 coverage rates between 80 and 90 percent. The following summary highlights the changes in 4:3:1 coverage rates between 2001 and 2002: Coverage increased between 0 and 5 percent in four districts (District 1-1, 1-2, 4-0 and 6-0) Coverage increased between 5 and 20 percent in nine districts (Districts 3-1, 3-3, 3-4, 3-5, 5-2, 7-0, 8-1, 9-1and 9-3) Coverage increased 40.2 percent in District 3-2 Coverage fell between 0 and 5 percent in three districts (Districts 2-0, 5-1 and 10-0) Coverage fell between 5 and 15 percent in two districts (Districts 8-2 and 9-2) 25 Table 10: 4:3:1 District and State Coverage Rates by Study Year Dist 1997-98 1998-99 1999-00 2001 2002 % Margin % Margin % of Error of Error Margin % Margin % Margin of Error of Error of Error 1-1 81.5 +/- 6.6 78.2 +/- 6.8 67.5 +/- 7.1 1-2 71.7 +/- 8.3 74.9 +/- 6.4 75.3 +/-7.0 2-0 78.9 +/- 9.2 66.7 +/- 6.8 88.5 +/-5.5 3-1 75.3 +/- 5.6 58.1 +/- 6.5 75.6 +/-6.1 3-2 49.7 +/- 7.1 53.8 +/- 5.4 69.6 +/-6.5 3-3 85.5 +/- 5.4 76.3 +/- 7.1 60.7 +/-10.4 3-4 57.4 +/- 9.6 65.0 +/- 5.6 94.5 +/-2.3 3-5 58.3 +/- 7.6 63.0 +/- 5.5 64.9 +/-6.3 4-0 58.7 +/- 9.5 67.5 +/- 5.6 79.7 +/-5.7 5-1 78.3 +/- 7.8 87.1 +/- 7.1 91.3 +/-6.2 5-2 71.8 +/- 7.2 94.5 +/- 2.8 83.6 +/-9.8 6-0 76.6 +/- 7.1 96.1 +/- 2.8 72.3 +/-12.8 7-0 71.8 +/- 5.8 67.9 +/- 7.8 77.1 +/-6.3 8-1 88.4 +/- 6.8 80.4 +/- 8.1 86.0 +/-6.6 8-2 81.4 +/- 9.1 83.8 +/- 6.1 83.7 +/-5.9 9-1 66.4 +/- 7.8 80.4 +/- 6.5 78.5 +/-7.1 9-2 80.5 +/- 8.6 83.5 +/- 6.6 85.0 +/-6.1 9-3 68.6 +/- 7.7 60.6 +/- 9.2 82.2 +/-8.8 10-0 73.6 +/- 7.6 78.9 +/- 6.1 73.4 +/-7.0 State 71.3 +/- 1.8 73.3 +/- 1.5 78.8 +/-1.5 Note: State rates based on data weighted by health district. 78.9 78.1 94.8 70.7 42.4 57.6 75.9 75.5 83.5 85.0 69.1 88.9 73.1 76.7 93.2 69.1 90.8 71.6 84.4 75.1 +/-6.2 +/-6.7 +/-3.7 +/-6.8 +/-5.6 +/-8.9 +/-9.4 +/-6.0 +/-5.1 +/-9.0 +/-8.6 +/-4.8 +/-6.7 +/-8.2 +/-4.3 +/-8.2 +/-4.9 +/-9.1 +/-5.7 +/-1.5 80.6 79.1 93.4 84.5 82.6 73.9 94.3 84.6 87.1 80.8 84.7 89.2 82.8 82.2 83.1 80.9 85.4 85.6 80.2 83.9 +/-5.5 +/-6.3 +/-5.6 +/-4.2 +/-6.2 +/-8.2 +/-3.4 +/-5.1 +/-5.4 +/-8.7 +/-4.5 +/-6.0 +/-6.9 +/-6.6 +/-8.4 +/-6.2 +/-7.3 +/-6.3 +/-7.1 +/-1.6 Additional information regarding 3:3:1 and 4:3:1+3 coverage rates and margins of error by district can be found in Appendix F: Margins of Error for Immunization Coverage Rates. Tables 11-16 present the state and district rates for each individual vaccine during the 1997-98, 1998-99, 1999-00, 2001, and 2002 data collection periods. 26 As shown in Table 11, 2002 district immunization rates for the DTP/DTaP vaccines ranged from 73.9 percent to 94.9 percent, with a statewide rate of 84.6 percent receiving all four doses. The 2002 statewide DTP/DTaP rate increased from the 1997-98, 1998-999, 1999-00, and 2001 study years. Table 11: State and District Immunization Rates for DTP/DTaP by Study Year 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 9-3 10-0 State 1997-98 Rates 4 DTP/DTaP 83.0% 72.6% 80.3% 77.9% 51.8% 86.1% 59.4% 61.3% 61.5% 79.2% 72.5% 76.6% 73.1% 88.4% 81.4% 67.1% 84.1% 72.1% 74.4% 72.9% 1998-99 Rates 4 DTP/DTaP 78.2% 75.4% 67.7% 59.0% 55.1% 76.3% 66.4% 64.4% 69.0% 87.1% 96.5% 96.1% 69.3% 81.5% 84.5% 80.4% 83.5% 64.2% 78.9% 74.2% 1999-00 Rates 4 DTP/DTaP 67.5% 77.4% 89.3% 77.7% 71.1% 63.1% 94.8% 66.2% 79.7% 91.3% 83.6% 74.5% 77.1% 86.9% 85.6% 80.8% 88.0% 82.2% 74.7% 79.9% Note: State rates based on data weighted by health district. 2001 Rates 4 DTP/DTaP 79.5% 79.5% 94.8% 70.7% 42.4% 61.0% 75.9% 77.0% 83.5% 86.7% 72.7% 89.5% 74.3% 77.7% 94.7% 69.9% 92.4% 71.6% 85.1% 76.0% 2002 Rates 4 DTP/DTaP 81.1% 82.3% 94.7% 84.9% 84.0% 73.9% 94.9% 84.6% 87.8% 80.8% 85.5% 89.2% 83.6% 82.2% 85.7% 81.6% 86.5% 85.6% 80.2% 84.6% 27 Table 12 shows the 1997-98, 1998-99, 1999-00, 2001, and 2002 state and district rates for the OPV/IPV vaccines. The 2002 district coverage rates for these vaccines varied between 82.9 percent and 97.4 percent. The 2002 statewide immunization rate for OPV/IPV was 90.6 percent, which is higher than the previous year's study rates. Table 12: State and District Immunization Rates for OPV/IPV by Study Year District 1997-98 Rates 3 OPV/IPV 1998-99 Rates 3 OPV/IPV 1999-00 Rates 3 OPV/IPV 2001 Rates 3 OPV/IPV 1-1 88.1% 90.8% 72.3% 1-2 88.5% 86.9% 82.2% 2-0 93.4% 73.7% 88.5% 3-1 84.4% 72.5% 79.3% 3-2 75.4% 64.9% 76.8% 3-3 88.5% 93.5% 71.4% 3-4 64.4% 72.9% 96.4% 3-5 77.9% 76.4% 75.7% 4-0 83.7% 80.2% 85.9% 5-1 90.6% 92.9% 93.8% 5-2 85.9% 98.0% 87.3% 6-0 91.2% 98.3% 85.1% 7-0 93.2% 83.2% 85.9% 8-1 94.2% 94.6% 87.9% 8-2 88.6% 90.1% 90.8% 9-1 80.7% 87.4% 88.5% 9-2 92.7% 93.4% 90.2% 9-3 10-0 State 84.3% 89.1% 85.4% 77.1% 86.5% 83.6% 86.3% 76.0% 84.4% Note: State rates based on data weighted by health district. 88.6% 86.3% 97.0% 75.3% 45.5% 69.5% 77.2% 83.7% 86.4% 93.3% 81.8% 93.2% 78.4% 84.5% 96.2% 79.7% 92.4% 76.8% 88.3% 80.8% 2002 Rates 3 OPV/IPV 90.0% 85.4% 97.4% 90.8% 84.7% 82.9% 96.0% 88.7% 92.5% 96.2% 94.0% 95.1% 90.5% 91.5% 90.9% 90.1% 92.1% 89.8% 86.0% 90.6% 28 Table 13 shows the 1997-98, 1998-99, 1999-00, 2001, and 2002 state and district rates for MMR. The 2002 district rates for MMR ranged from a low of 84.7 percent to a high of 97.4 percent, with a statewide rate of 90.9 percent coverage. This statewide rate for the MMR vaccine increased from the 2001 rate of 82.0 percent. Table 13: State and District Immunization Rates for MMR by Study Year District 1-1 1997-98 Rates 1 MMR 90.4% 1998-99 Rates 1 MMR 86.6% 1999-00 Rates 1 MMR 73.5% 1-2 85.8% 84.6% 83.6% 2-0 85.5% 72.0% 90.1% 3-1 78.4% 64.0% 81.9% 3-2 71.2% 65.8% 77.8% 3-3 88.5% 84.9% 70.2% 3-4 63.4% 69.7% 96.4% 3-5 68.1% 73.3% 71.6% 4-0 69.2% 73.1% 84.9% 5-1 84.0% 91.8% 96.3% 5-2 80.5% 95.7% 90.9% 6-0 84.7% 98.3% 87.2% 7-0 92.3% 83.2% 85.3% 8-1 95.3% 89.1% 90.7% 8-2 85.7% 91.5% 88.9% 9-1 72.1% 86.7% 85.4% 9-2 87.8% 85.1% 91.0% 9-3 76.4% 67.9% 87.7% 10-0 State 82.2% 80.4% 84.8% 80.2% 77.3% 84.6% Note: State rates based on data weighted by health district. 2001 Rates 1 MMR 89.2% 85.6% 97.0% 77.0% 45.1% 74.6% 83.5% 87.8% 86.4% 91.7% 82.7% 95.1% 80.2% 82.5% 97.0% 79.7% 93.1% 80.0% 89.6% 82.0% 2002 Rates 1 MMR 90.5% 87.3% 96.1% 90.1% 84.7% 84.7% 97.1% 86.7% 93.2% 97.4% 92.3% 96.1% 92.2% 93.8% 90.9% 89.5% 94.4% 87.3% 90.1% 90.9% 29 As shown in Table 14, 2002 district immunization rates for the Hib vaccine varied between 80.2 and 97.4 percent. The statewide Hib coverage rate in 2002 was 90.9 percent, an increase from the 2001 statewide rate of 84.3 percent. Table 14: State and District Immunization Rates for Hib by Study Year District 1-1 1-2 2-0 1997-98 Rates 3 Hib 88.9% 89.4% 88.2% 1998-99 Rates 3 Hib 90.8% 88.0% 73.1% 1999-00 Rates 3 Hib 76.5% 86.3% 88.5% 3-1 83.5% 71.6% 85.0% 3-2 69.1% 65.2% 79.9% 3-3 87.9% 93.5% 79.8% 3-4 59.4% 70.4% 97.5% 3-5 74.8% 76.7% 77.0% 4-0 79.8% 81.0% 88.5% 5-1 89.6% 94.1% 96.3% 5-2 81.2% 98.0% 96.4% 6-0 92.0% 98.3% 87.2% 7-0 88.5% 85.4% 85.3% 8-1 96.5% 94.6% 92.5% 8-2 87.1% 90.8% 92.8% 9-1 81.4% 86.0% 91.5% 9-2 93.9% 93.4% 95.5% 9-3 10-0 State 85.7% 88.4% 83.6% 78.0% 87.7% 83.6% 89.0% 79.9% 87.4% Note: State rates based on data weighted by health district. 2001 Rates 3 Hib 89.2% 95.2% 96.3% 83.9% 45.5% 81.4% 92.4% 89.3% 88.3% 91.7% 84.5% 97.5% 82.6% 81.6% 92.5% 81.3% 95.4% 81.1% 94.2% 84.3% 2002 Rates 3 Hib 91.5% 86.1% 96.1% 91.2% 85.4% 80.2% 96.6% 86.2% 93.2% 97.4% 92.7% 97.1% 89.7% 94.6% 92.2% 90.8% 93.3% 91.5% 86.8% 90.9% 30 Table 15 reports the statewide and district immunization coverage rates for the Hepatitis B vaccine. In 2002, the district coverage rates varied from a low of 80.2 percent to 97.4 percent. The 2002 statewide rate of 90.8 percent for the Hepatitis B vaccine was higher than the 2001 statewide rate of 83.8 percent. Table 15: State and District Immunization Rates for Hep B by Study Year District 1-1 1997-98 Rates 3 Hep B 92.6% 1998-99 Rates 3 Hep B 88.0% 1999-00 Rates 3 Hep B 76.5% 1-2 85.8% 86.3% 86.3% 2-0 88.2% 73.1% 89.3% 3-1 82.3% 72.1% 85.5% 3-2 74.3% 62.8% 79.4% 3-3 84.8% 92.8% 76.2% 3-4 62.4% 72.2% 97.5% 3-5 75.5% 73.6% 77.9% 4-0 78.8% 81.0% 85.9% 5-1 88.7% 89.4% 96.3% 5-2 78.5% 97.7% 89.1% 6-0 82.5% 98.9% 85.1% 7-0 93.6% 84.7% 87.6% 8-1 89.5% 91.3% 92.5% 8-2 85.7% 90.8% 90.2% 9-1 9-2 9-3 10-0 State 82.1% 95.1% 85.7% 86.0% 83.2% 84.6% 91.7% 81.7% 87.7% 82.9% 89.2% 91.7% 87.7% 79.9% 86.7% Note: State rates based on data weighted by health district. 2001 Rates 3 Hep B 92.8% 93.2% 95.6% 82.8% 44.4% 81.4% 86.1% 88.8% 88.8% 93.3% 83.6% 93.2% 85.0% 84.5% 95.5% 76.4% 95.4% 81.1% 91.6% 83.8% 2002 Rates 3 Hep B 91.0% 87.3% 97.4% 92.6% 84.7% 80.2% 94.9% 85.6% 92.5% 96.2% 93.1% 96.1% 90.5% 94.6% 92.2% 90.1% 92.1% 89.0% 88.4% 90.8% 31 Table 16 reports Varicella coverage rates among the 19 health districts and statewide by study year. Children reported to have had Varicella disease are not considered in the results below. For a more detailed description of Varicella rates including prior history of disease, see Appendix D. The district coverage rates ranged from 81.9 percent to 97.1 percent, with a statewide coverage rate of 88.5 percent for the Varicella vaccine. This is an increase from the 2001 Varicella rate of 77.9 percent. Table 16: State and District Immunization Rates for Varicella by Study Year 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 1997-98 Rates 1 Varicella 5.2% 14.2% 21.1% 50.2% 17.3% 71.5% 9.9% 29.4% 6.7% 12.3% 15.4% 19.0% 21.4% 16.3% 1998-99 Rates 1 Varicella 41.5% 48.0% 48.4% 43.2% 43.1% 80.6% 54.2% 51.0% 31.7% 21.2% 63.7% 75.3% 24.1% 30.4% 1999-00 Rates 1 Varicella 45.2% 58.2% 81.7% 66.3% 67.5% 52.4% 89.5% 57.2% 65.6% 61.3% 61.8% 61.7% 53.5% 61.7% 2001 Rates 1 Varicella 83.7% 82.9% 94.8% 72.4% 44.4% 69.5% 86.1% 81.1% 83.0% 86.7% 80.0% 88.3% 74.9% 78.6% 8-2 9-1 9-2 9-3 10-0 State 18.6% 14.3% 3.7% 5.0% 11.6% 19.0% 71.8% 18.9% 27.3% 25.7% 52.0% 47.1% 66.0% 51.5% 58.6% 57.5% 58.4% 64.3% 96.2% 71.5% 88.5% 69.5% 87.0% 77.9% Notes: State rates based on data weighted by health district. 2002 Rates 1 Varicella 89.1% 86.1% 96.1% 88.4% 81.9% 82.9% 96.0% 83.6% 92.5% 84.6% 90.3% 97.1% 88.8% 93.0% 90.9% 83.6% 87.6% 83.9% 86.8% 88.5% 32 Statewide Comparisons of Maternal Demographics of Adequately Immunized Children Cross-tabulations were performed at the state level in order to describe the relationship between maternal characteristics and the immunization status of two-year-old children. Tables 17-19 provide some of the characteristics of mothers of children who were up-to-date on their 4:3:1 series. Analyses include cross-tabulations of 4:3:1 complete children and total children in each group with the following three variables: maternal race, maternal education, and maternal Medicaid status. Differences between groups are significant if the p-value is less than 0.05. 33 Table 17 contains statewide cross-tabulations of maternal race and children's immunization status. The numbers in the top row of each cell represent the total number of individuals who fall into each category by race and adequacy of immunization. The bottom row represents the percent of each race that falls into that specific category. The table shows that, for all years, the immunization rates of children born to black and white mothers were virtually the same. Maternal race was not a significant factor in the immunization status of two-year-old children in Georgia. Table 17: Statewide Cross tabulations of Maternal Race and Child Immunization Status by Study Year Maternal Race White Black Other 4:3:1 Total 1997-98 4:3:1 Adequate #/Total (percent) 1,134/1,572 (72.1) 658/936 (70.3) 29/44 (65.9) 71.3% 1998-99 4:3:1 Adequate #/Total (percent) 1654/2265 (73.0) 806/1122 (71.8) 51/73 (69.9) 73.3% 2001 4:3:1 Adequate #/Total (percent) 1265/1661 (76.2) 765/1045 (73.2) 38/49 (77.6) 75.1% 2002 4:3:1 Adequate #/Total (percent) 1410/1664 (84.7) 806/978 (82.4) 64/79 (81.0) 83.9% Notes: Total rates based on data weighted by health district. 1998-99 Chi-square=2.61, p=0.45; 1997-98 Chi-square =1.95, p=0.58; 199900 Analysis not done; 2001 Chi-square=3.15, p=0.21; 2002 Chi-square=3.81, p=0.28. 34 Table 18 shows the statewide cross-tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group according to the immunization status of their children. The bottom row represents the percent of the total number in that category. In 2002, maternal educational attainment was associated with child immunization status (Chi-square=31.97, p=0.000006). As the mother's education level increased, the child's immunization rate increased as well. Table 18: Statewide Cross tabulations of Maternal Educational Attainment and Child Immunization Status by Study Year Education Less than high school Some high school High school Some college College or higher 4:3:1 Total 1997-98 4:3:1 Adequate #/Total (percent) 93/123 (75.6) 401/569 (70.5) 643/916 (70.2) 326/465 (70.1) 358/479 (74.7) 71.3% 1998-99 4:3:1 Adequate #/Total (percent) 135/176 (76.7) 472/662 (71.3) 866/1,189 (72.8) 493/679 (72.6) 545/754 (72.3) 73.3% 2001 4:3:1 Adequate #/Total (percent) 161/221 (72.9) 456/595 (76.6) 724/960 (75.4) 364/485 (75.1) 363/494 (73.5) 75.1% 2002 4:3:1 Adequate #/Total (percent) 124/157 (79.0) 455/561 (81.1) 752/914 (82.3) 415/498 (83.3) 538/591 (91.0) 83.9% Notes: Total rates based on data weighted by health district. In 1996-97, 28 records did not include Information on educational attainment on the birth certificate. 1997-98 Chi-square = 4.94, p = 0.29; 1998-99 Chi-square=2.12, p=0.71; 1999-00 Analysis not done; 2001 Chi-square=2.09, p=0.7; 2002 Chi-square=31.97, p<0.05. 35 Table 19 shows the statewide cross-tabulation of maternal Medicaid status and 4:3:1 immunization status for 2001 and 2002 study years. The 4:3:1 rates are shown for Medicaid recipients and non-Medicaid recipients. In 2002, statewide immunization rates are higher for Non-Medicaid recipients (Chi-square=15.34, p=0.00009). Table 19: 2002 Statewide Cross tabulations of Maternal Medicaid Status and Child Immunization Status Medicaid Status Medicaid NonMedicaid 4:3:1 Total 2001 4:3:1 Adequate #/Total (percent) 1,024/1,357 (75.5) 1,044/1,398 (74.7) 75.1% 2001 4:3:1 Inadequate #/Total (percent) 333/1,357 (24.5) 354/1,398 (25.3) 24.9% 2002 4:3:1 Adequate #/Total (percent) 1,054/1,300 (81.1) 1,230/1,421 (86.6) 83.9% 2002 4:3:1 Inadequate #/Total (percent) 246/1,300 (18.9) 191/1,421 (13.4) 16.1% Notes: 4:3:1 total rates based on data weighted by health district. 2001 Chi-square = 0.23, p = 0.64; 2002 Chi-square = 15.13, p<0.05. Summary of Statewide Analyses The statewide analyses reviewed both the study's process of measuring immunization rates and the rates themselves. In measuring immunization rates, the study assessed rates at three levels: 4:3:1+3 coverage, 4:3:1 coverage, and 3:3:1 coverage. In reviewing rates at the most commonly used level of coverage, 4:3:1 coverage, immunization rates increased in 2002 statewide compared to the same rates as measured by this study in 2001. 36 SECTION IV: RESULTS OF DISTRICT LEVEL ANALYSES 37 Section IV: Results of District Level Analyses Overview of District Rates The immunization rates for this sixth year report were calculated based on final samples. The final sample sizes in each health district varied by district. The number of children in the final sample in each district is reported in each Individual Health District Report in this section, as well as in Table 3: Response Rates for the 2002 Georgia Immunization Study. The rates reported are based on information collected from both public and private providers. Summaries of all district rates are included in Section III: Statewide Rates, specifically Tables 1016. The Individual District Reports include immunization rates for each recommended vaccine and 4:3:1 rates. Although statistical analyses would be informative for each of the districts, sub-category sample sizes in the cross tabulation tables were too small for such analyses to be interpreted and generalized to the target population. 38 Individual Health District Report: District 1-1 The eligible sample from this district included 237 children born in January 2000. From the 237 children, 209 records were located (Response Rate=88.2%). Of the 209 located records, there were 8 parental refusals leaving a final sample of 201 records. The 4:3:1 immunization coverage estimate is 80.6 percent (162/201). This rate is lower than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 4: 4:3:1 Coverage for State and District 1-1 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 1-1 The 4:3:1+3 immunization coverage estimate is 75.1 percent (151/201). This rate is lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 39 Table 20: District Immunization Rates for Health District 1-1 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 83.0% 88.1% 90.4% 88.9% 92.6% 5.2% 1998-99 Adequate Rates 78.2% 90.8% 86.6% 90.8% 88.0% 41.5% 1999-00 Adequate Rates 67.5% 82.2% 73.5% 76.5% 76.5% 45.2% 2001 Adequate Rates 79.5% 88.6% 89.2% 89.2% 92.8% 83.7% 2002 Adequate Rates 81.1% 90.0% 90.5% 91.5% 91.0% 89.1% Table 20 reveals the coverage rates of each vaccine series. Coverage rates ranged from 81.1 to 91.5 percent for the 2002 study data. Table 21 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 40 Table 21: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 1-1 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 201 100.0% 189 94.0% 168 83.6% 5 2.5% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 201 100.0% 188 93.5% 67 33.3% 0 0.0% MMR1 MMR2 5 2.5% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 201 100.0% 188 93.5% 64 31.8% 1 0.5% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 200 99.5% 184 91.5% 49 24.4% 1 0.5% VAR1 5 VAR2 0 *Percent = number immunized / sample size sample size = 201 2.5% 0.0% 41 Table 22: Cross tabulations of Maternal Race and Child Immunization Status for Health District 1-1 by Study Year* 1997-98 4:3:1 Adequate Maternal Race #/Total (percent) White 96/120 (80.0) Black 11/12 (91.7) Other 3/3 (100.0) Total 110/135 (81.5) * Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 99/129 (76.7) 11/12 (91.7) 1/1 (100.0) 111/142 (78.2) 2001 4:3:1 Adequate #/Total (percent) 123/154 (79.9) 8/12 (66.7) ---- 131/166 (78.9) 2002 4:3:1: Adequate #/Total (percent) 140/174 (80.5) 19/23 (82.6) 3/3 (100.0) 162/200 (81.0) Table 22 contains a cross tabulation of maternal race and children's immunization status. The numbers in the top row of each cell represent the total number of individuals in each category. The bottom row in each cell represents the percent in that immunization status category. Table 22 shows that in 1997-98, 1998-99, and 2002 the 4:3:1 immunization rate of children born to black mothers was higher than that of children born to white mothers in the district. However, in 2001 the immunization rate of children born to white mothers was higher than that of black mothers. 42 Table 23: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 1-1 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 8/11 (72.7) 25/31 (80.6) 42/54 (77.8) 22/25 (88.0) 13/14 (92.9) --- Total 110/135 (81.5) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 9/13 (69.2) 23/34 (67.6) 43/52 (82.7) 23/28 (82.1) 13/15 (86.7) --- 111/142 (78.2) 2001 4:3:1 Adequate #/Total (percent) 14/15 (93.3) 29/41 (70.7) 41/52 (78.8) 27/35 (77.1) 20/23 (87.0) --- 131/166 (78.9) 2002 4:3:1 Adequate #/Total (percent) 9/14 (64.3) 36/50 (72.0) 66/79 (83.5) 29/35 (82.9) 19/20 (95.0) 3/3 (100.0) 162/200 (81.0) Table 23 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status in District 1-1. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). For the 2002 study, immunization rates increased with educational attainment. 43 Table 24: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 1-1 Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 62/80 (77.5) 69/86 (80.2) 131/166 (78.9) 2002 4:3:1 Adequate #/Total (percent) 79/99 (79.8) 83/102 (81.4) 162/200 (81.0) Table 24 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For Health District 1-1, children born to non-Medicaid women had a slightly higher immunization rate than children born to women using Medicaid. 44 Individual Health District Report: District 1-2 The eligible sample from this district included 187 children born in January 2000. From these children, 167 records were located (Response Rate=89.3%). Of the 167 located records, there were 9 parental refusals leaving a final sample of 158 records. 4:3:1 immunization coverage estimate is 79.1 percent (125/158). This rate is lower than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 5: 4:3:1 Coverage for State and District 1-2 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 1-2 4:3:1+3 immunization coverage estimate 72.8 percent (115/158). This rate is lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 45 Table 25: District Immunization Rates for Health District 1-2 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 72.6% 88.5% 85.8% 89.4% 85.8% 14.2% 1998-99 Adequate Rates 75.4% 86.9% 84.6% 88.0% 86.3% 48.0% 1999-00 Adequate Rates 77.4% 82.2% 83.6% 86.3% 86.3% 58.2% 2001 Adequate Rates 79.5% 86.3% 85.6% 95.2% 93.2% 82.9% 2002 Adequate Rates 82.3% 85.4% 87.3% 86.1% 87.3% 86.1% Table 25 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 82.3 to 87.3 percent for the 2002 study data. Table 26 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 46 Table 26: 2002 District Immunization Rates by Individual Vaccine at 12 months of age for Health District 1-2 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 155 98.1% 150 94.9% 141 89.2% 2 1.3% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 155 98.1% 148 93.7% 62 39.2% 0 0.0% MMR1 MMR2 2 1.3% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 153 96.8% 148 93.7% 72 45.6% 1 0.6% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 154 97.5% 147 93.0% 54 34.2% 0 0.0% VAR1 2 VAR2 0 *Percent = number immunized / sample size Sample size = 158 1.3% 0.0% 47 Table 27: Cross tabulations of Maternal Race and Child Immunization Status for Health District 1-2 by Study Year* Maternal Race White Black Other Unknown 1997-98 4:3:1 Adequate #/Total (percent) 79/110 (71.8) 1/2 (50.0) 1/1 (100.0) --- Total 81/113 (71.7) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 125/167 (74.9) 4/6 (66.7) 2/2 (100.0) --- 131/175 (74.9) 2001 4:3:1 Adequate #/Total (percent) 112/142 (78.9) 2/4 (50.0) --- --- 114/146 (78.1) 2002 4:3:1 Adequate #/Total (percent) 118/149 (79.2) 2/3 (66.7) 2/2 (100.0) 3/4 (75.0) 125/158 (79.1) Table 27 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The sample of non-white mothers in the district was too small to make generalizations from these numbers. 48 Table 28: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 1-2 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 8/10 (80.0) 20/27 (74.1) 31/46 (67.4) 14/20 (70.0) 8/10 (80.0) --- Total 81/113 (71.7) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 12/14 (85.7) 29/39 (74.4) 49/65 (75.4) 18/25 (72.0) 23/32 (71.9) ---- 131/175 (74.9) 2001 4:3:1 Adequate #/Total (percent) 14/20 (70.0) 32/37 (86.5) 30/45 (66.7) 21/23 (91.3) 17/21 (81.0) --- 114/146 (78.1) 2002 4:3:1 Adequate #/Total (percent) 10/10 (100.0) 28/37 (75.7) 25/36 (69.4) 31/37 (83.8) 29/34 (85.3) 2/4 (50.0) 125/158 (79.1) Table 28 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Immunization rates varied from year to year in relation to education of the mother. 49 Table 29: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 1-2 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 52/62 (83.9) 62/84 (73.8) 114/146 (78.1) 2002 4:3:1 Adequate #/Total (percent) 44/60 (73.3) 81/98 (82.7) 125/158 (79.1) Table 29 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For Health District 1-2, children born to non-Medicaid women had a higher immunization rate than children born to women not using Medicaid. 50 Individual Health District Report: District 2-0 The eligible sample from this district included 105 children born in January 2000. From the 105 children, 76 records were located (Response rate = 72.4%). Of the 76 located records, there were no parental refusals leaving a final sample of 76 records. 4:3:1 immunization coverage estimate is 93.4 percent (71/76). This rate is much higher than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 6: 4:3:1 Coverage for State and District 2-0 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 2-0 4:3:1+3 immunization coverage estimate is 93.4 percent (71/76). This rate is also much higher than the statewide 4:3:1+3 immunization rate of 78.9 percent. 51 Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella Table 30: District Immunization Rates for Health District 2-0 by Study Year 1997-98 1998-99 1999-00 2001 2002 Adequate Adequate Adequate Adequate Adequate Rates Rates Rates Rates Rates 80.3% 67.7% 89.3% 94.8% 94.7% 93.4% 73.7% 88.5% 97.0% 97.4% 85.5% 72.0% 90.1% 97.0% 96.1% 88.2% 73.1% 88.5% 96.3% 96.1% 88.2% 73.1% 89.3% 95.6% 97.4% 21.1% 48.4% 81.7% 94.8% 96.1% Table 30 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 94.7 to 97.4 percent for the 2002 study data. Table 31 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 52 Table 31: 2002 District Immunization Rates by Individual Vaccine at 12 months of age for Health District 2-0 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 76 100.0% 76 100.0% 71 93.4% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 76 100.0% 76 100.0% 51 67.1% 0 0.0% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 75 98.7% 75 98.7% 49 64.5% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 76 100.0% 76 100.0% 42 55.3% 0 0.0% VAR1 9 VAR2 0 *Percent = number immunized / sample size Sample size = 76 6.7% 0.0% 53 Table 32: Cross tabulations of Maternal Race and Child Immunization Status for Health District 2-0 by Study Year* 1997-98 4:3:1 Adequate Maternal Race #/Total (percent) White 53/69 (76.8) Black 6/6 (100.0) Other 1/1 (100.0) Total 60/76 (78.9) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 114/169 (67.5) 9/13 (69.2) 1/4 (25.0) 124/186 (66.7) 2001 4:3:1 Adequate #/Total (percent) 121/127 (95.3) 5/6 (83.3) 2/2 (100.0) 128/135 (94.8) 2002 4:3:1 Adequate #/Total (percent) 65/70 (92.9) 4/4 (100.0) 2/2 (100.0) 71/76 (93.4) Table 32 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 32 shows that the number of white mothers was over 10 times the number of black mothers in each year of the study for District 2-0. The sample size of black mothers was too small to make definitive generalizations on racial differences in immunization rates. 54 Table 33: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 2-0 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 5/5 (100.0) 12/17 (70.6) 25/32 (78.1) 10/11 (90.9) 8/11 (72.7) --- Total 60/76 (78.9) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 17/22 (77.3) 24/41 (58.5) 38/58 (65.5) 21/30 (70.0) 24/35 (68.6) --- 124/186 (66.7) 2001 4:3:1 Adequate #/Total (percent) 23/25 (92.0) 24/24 (100.0) 38/42 (90.5) 15/16 (93.8) 28/28 (100.0) --- 128/135 (94.8) 2002 4:3:1 Adequate #/Total (percent) 9/9 (100.0) 15/18 (83.3) 20/21 (95.2) 7/8 (87.5) 17/17 (100.0) 3/3 (100.0) 71/76 (93.4) Table 33 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in District 2-0 varied with maternal educational attainment, with no clear trend or correlation emerging. 55 Table 34: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 2-0 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 48/51 (94.1) 80/84 (95.2) 128/135 (94.8) 2002 4:3:1 Adequate #/Total (percent) 24/28 (85.7) 47/48 (97.9) 71/76 (93.4) Table 34 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For Health District 2-0, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. 56 Individual Health District Report: District 3-1 The eligible sample from this district included 434 children born in January 2000. From the 434 children, 293 records were located (Response Rate=67.5%). Of the 293 located records, there were 9 parental refusals leaving a final sample of 284 records. The 4:3:1 immunization coverage estimate is 84.5 percent (240/284). This rate is higher than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 7: 4:3:1 Coverage for State and District 3-1 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 3-1 The 4:3:1+3 immunization coverage estimate is 81.3 percent (231/284). This rate is higher than the statewide 4:3:1+3 immunization rate of 78.9 percent. 57 Table 35: District Immunization Rates for Health District 3-1 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 77.9% 84.4% 78.4% 83.5% 82.3% 50.2% 1998-99 Adequate Rates 59.0% 72.5% 64.0% 71.6% 72.1% 43.2% 1999-00 Adequate Rates 77.7% 79.3% 81.9% 85.0% 85.5% 66.3% 2001 Adequate Rates 70.7% 75.3% 77.0% 83.9% 82.8% 72.4% 2002 Adequate Rates 84.9% 90.8% 90.1% 91.2% 92.6% 88.4% Table 35 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 84.9 to 92.6 percent for the 2002 study data. Table 36 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 58 Table 36: 2002 District Immunization Rates by Individual Vaccine at 12 months of age for Health District 3-1 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 278 97.9% 270 95.1% 257 90.5% 1 0.4% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 277 97.5% 271 95.4% 66 23.2% 0 0.0% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 275 96.8% 269 94.7% 123 43.3% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 276 97.2% 269 94.7% 111 39.1% 5 1.8% VAR1 4 VAR2 0 *Percent = number immunized / sample size Sample size = 284 1.4% 0.0% 59 Table 37: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-1 by Study Year* Maternal Race White Black Other Unknown 1997-98 4:3:1 Adequate #/Total (percent) 135/183 (73.8) 36/45 (80.0) 2/2 (100.0) --- 1998-99 4:3:1 Adequate #/Total (percent) 101/172 (58.7) 25/45 (55.6) 3/5 (60.0) --- Total 174/231 (75.3) *Excludes 1999-00 study year. 129/222 (58.1) 2001 4:3:1 Adequate #/Total (percent) 95/128 (74.2) 22/40 (55.0) 6/6 (100.0) --- 123/174 (70.7) 2002 4:3:1 Adequate #/Total (percent) 179/207 (86.5) 51/66 (77.3) 8/9 (88.9) 2/2 (100.0) 240/284 (84.5) Table 37 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 37 shows that the number of white mothers in the District 3-1 sample was substantially higher than the number of black mothers in each year of the study. The table also shows no clear relationship between race and immunization status in this district. 60 Table 38: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-1 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 6/9 (66.7) 12/18 (66.7) 46/64 (71.9) 38/51 (74.5) 72/89 (80.9) --- Total 174/231 (75.3) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 7/10 (70.0) 10/22 (45.5) 32/68 (47.1) 26/47 (55.3) 54/75 (72.0) --- 129/222 (58.1) 2001 4:3:1 Adequate #/Total (percent) 7/16 (43.8) 17/23 (73.9) 41/53 (77.4) 22/34 (64.7) 36/48 (75.0) --- 123/174 (70.7) 2002 4:3:1 Adequate #/Total (percent) 17/26 (65.4) 21/28 (75.0) 60/74 (81.1) 38/46 (82.6) 99/105 (94.3) 5/5 (100.0) 240/284 (84.5) Table 38 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers. In the 2002 study year, immunization status of children in District 3-1 varied significantly (p-value = 0.002) with maternal educational attainment. Immunization status increased as maternal education increased. 61 Table 39: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-1 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 39/61 (63.9) 84/113 (74.3) 123/174 (70.7) 2002 4:3:1 Adequate #/Total (percent) 58/79 (73.4) 182/205 (88.8) 240/284 (84.5) Table 39 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For Health District 3-1, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. 62 Individual Health District Report: District 3-2 The eligible sample from this district included 469 children born in January 2000. From the 469 children, 172 records were located (Response Rate=36.7%). Of the 172 located records, there were 28 parental refusals leaving a final sample of 144 records. The 4:3:1 immunization coverage estimate is 82.6 percent (119/144). This rate is lower than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 8: 4:3:1 Coverage for State and District 3-2 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 3-2 The 4:3:1+3 immunization coverage estimate is 77.8 percent (112/144). This rate is lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 63 Table 40: District Immunization Rates for Health District 3-2 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 51.8% 75.4% 71.2% 69.1% 74.3% 17.3% 1998-99 Adequate Rates 55.1% 64.9% 65.8% 65.2% 62.8% 43.1% 1999-00 Adequate Rates 71.1% 76.8% 77.8% 79.9% 79.4% 67.5% 2001 Adequate Rates 42.4% 45.5% 45.1% 45.5% 44.4% 44.4% 2002 Adequate Rates 84.0% 84.7% 84.7% 85.4% 84.7% 81.9% Table 40 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 81.9 to 85.4 percent for the 2002 study data. Table 41 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 64 Table 41: 2002 District Immunization Rates by Individual Vaccine at 12 months of age for Health District 3-2 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 134 93.1% 130 90.3% 123 85.4% 1 0.7% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 133 92.4% 128 88.9% 59 41.0% 0 0.0% MMR1 MMR2 3 2.1% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 132 91.7% 127 88.2% 96 66.7% 4 2.8% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 135 93.8% 127 88.2% 66 45.8% 2 1.4% VAR1 6 VAR2 0 *Percent = number immunized / sample size Sample size = 144 4.2% 0.0% 65 Table 42: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-2 by Study Year* 1997-98 4:3:1 Adequate Maternal Race #/Total (percent) White 50/78 (64.1) Black 44/111 (39.6) Other 1/2 (50.0) Total 95/191 (49.7) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 95/153 (62.1) 77/161 (47.8) 3/11 (27.3) 175/325 (53.8) 2001 4:3:1 Adequate #/Total (percent) 66/148 (44.6) 58/143 (40.6) 2/6 (33.3) 126/297 (42.4) 2002 4:3:1 Adequate #/Total (percent) 69/79 (87.3) 48/61 (78.7) 2/3 (66.7) 119/144 (82.6) Table 42 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). In all years of the study, the immunization rate of children born to white mothers was higher than that of black mothers. 66 Table 43: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-2 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 4/14 (28.6) 19/45 (42.2) 28/64 (43.8) 11/22 (50.0) 33/46 (71.7) --- Total 95/191 (49.7) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 10/22 (45.5) 23/53 (43.4) 41/77 (53.2) 32/51 (62.7) 69/122 (56.6) --- 175/325 (53.8) 2001 4:3:1 Adequate #/Total (percent) 16/30 (53.3) 24/47 (51.1) 25/69 (36.2) 15/37 (40.5) 46/114 (40.4) --- 126/297 (42.4) 2002 4:3:1 Adequate #/Total (percent) 7/9 (77.8) 15/20 (75.0) 20/26 (76.9) 22/28 (78.6) 50/55 (90.9) 5/6 (83.3) 119/144 (82.6) Table 43 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in the sample in District 3-2 varied with maternal educational attainment. 67 Table 44: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-2 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 41/93 (44.1) 85/204 (41.7) 126/297 (42.4) 2002 4:3:1 Adequate #/Total (percent) 37/48 (77.1) 82/96 (85.4) 119/144 (82.6) Table 44 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For Health District 3-2, children born to Medicaid women had a slightly higher immunization rate than children born to women not using Medicaid in the 2001 study, but were lower than non-Medicaid women in the 2002 study. 68 Individual Health District Report: District 3-3 The eligible sample from this district included 361 children born in January 2000. From the 361 children, 111 records were located (Response Rate=30.7%). Of the 111 located records, there were no parental refusals leaving a final sample of 111 records. The 4:3:1 immunization coverage estimate is 73.9 percent (82/111). This rate is lower than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 9: 4:3:1 Coverage for State and District 3-3 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 3-3 The 4:3:1+3 immunization coverage estimate is 69.4 percent (77/111). This rate is lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 69 Table 45: District Immunization Rates for Health District 3-3 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 86.1% 88.5% 88.5% 87.9% 84.8% 71.5% 1998-99 Adequate Rates 76.3% 93.5% 84.9% 93.5% 92.8% 80.6% 1999-00 Adequate Rates 63.1% 71.4% 70.2% 79.8% 76.2% 52.4% 2001 Adequate Rates 61.0% 69.5% 74.6% 81.4% 81.4% 69.5% 2002 Adequate Rates 73.9% 82.9% 84.7% 80.2% 80.2% 82.9% Table 45 reveals the coverage rates of each vaccine series. Coverage rates ranged from 73.9 to 84.7 percent. Table 46 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 70 Table 46: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 3-3 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 106 95.5% 98 88.3% 88 79.3% 4 3.6% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 106 95.5% 98 88.3% 44 39.6% 0 0.0% MMR1 MMR2 1 0.9% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 106 95.5% 97 87.4% 51 45.9% 2 1.8% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 103 92.8% 95 85.6% 37 33.3% 0 0.0% VAR1 2 VAR2 0 *Percent = number immunized / sample size Sample size = 111 1.8% 0.0% 71 Table 47: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-3 by Study Year* Maternal Race White Black Other Unknown 1997-98 4:3:1 Adequate #/Total (percent) 70/81 (86.4) 64/77 (83.1) 7/7 (100.0) --- Total 141/165 (85.5) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 52/71 (73.2) 49/62 (79.0) 5/6 (83.3) --- 106/139 (76.3) 2001 4:3:1 Adequate #/Total (percent) 27/49 (55.1) 39/67 (58.2) 2/2 (100.0) --- 68/118 (57.6) 2002 4:3:1 Adequate #/Total (percent) 40/52 (76.9) 38/54 (70.4) 3/4 (75.0) 1/1 (100.0) 82/111 (73.9) Table 47 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in the sample in District 3-3 varied with maternal race. 72 Table 48: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-3 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 4/5 (80.0) 22/30 (73.3) 53/61 (86.9) 36/41 (87.8) 26/28 (92.9) --- Total 141/165 (85.5) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 4/4 (100.0) 21/27 (77.8) 36/51 (70.6) 27/35 (77.1) 18/22 (81.8) --- 106/139 (76.3) 2001 4:3:1 Adequate #/Total (percent) 1/4 (25.0) 17/31 (54.8) 31/48 (64.6) 15/26 (57.7) 4/9 (44.4) --- 68/118 (57.6) 2002 4:3:1 Adequate #/Total (percent) 12/13 (92.3) 10/18 (55.6) 25/36 (69.4) 17/21 (81.0) 16/20 (80.0) 2/3 (66.7) 82/111 (73.8) Table 48 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in the sample in District 3-3 does not appear to change with educational attainment. 73 Table 49: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-3 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 42/71 (59.2) 26/47 (55.3) 68/118 (57.6) 2002 4:3:1 Adequate #/Total (percent) 41/58 (70.7) 41/53 (77.4) 82/111 (73.9) Table 49 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For Health District 3-3, children born to Medicaid women had a slightly higher immunization rate than children born to women not using Medicaid for the 2001 study. However, in the 2002 study children born to non-Medicaid women had a higher immunization rate than children born to women not using Medicaid. 74 Individual Health District Report: District 3-4 The eligible sample from this district included 250 children born in January 2000. From the 250 children, 212 records were located (Response Rate=84.8%). Of the 212 located records, there were 37 parental refusals leaving a final sample of 175 records. The 4:3:1 immunization coverage estimate is 94.3 percent (165/175). This rate is higher than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 10: 4:3:1 Coverage for State and District 3-4 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 3-4 The 4:3:1+3 immunization coverage estimate is 86.9 percent (152/175). This rate is higher than the statewide 4:3:1+3 immunization rate of 78.9 percent. 75 Table 50: District Immunization Rates for Health District 3-4 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 59.4% 64.4% 63.4% 59.4% 62.4% 9.9% 1998-99 Adequate Rates 66.4% 72.9% 69.7% 70.4% 72.2% 54.2% 1999-00 Adequate Rates 94.8% 96.4% 96.4% 97.5% 97.5% 89.5% 2001 Adequate Rates 75.9% 77.2% 83.5% 92.4% 86.1% 86.1% 2002 Adequate Rates 94.9% 96.0% 97.1% 96.6% 94.9% 96.0% Table 50 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 94.9 to 97.1 percent for the 2002 study data. Table 51 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 76 Table 51: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 3-4 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 172 98.3% 169 96.6% 160 91.4% 2 1.1% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 171 97.7% 169 96.6% 59 33.7% 1 0.6% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 172 98.3% 169 96.6% 89 50.9% 2 1.1% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 168 96.0% 166 94.9% 77 44.0% 1 0.6% VAR1 1 VAR2 0 *Percent = number immunized / sample size Sample size = 175 0.6% 0.0% 77 Table 52: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-4 by Study Year* Maternal Race White Black Other Unknown 1997-98 4:3:1 Adequate #/Total (percent) 45/81 (55.6) 11/16 (68.8) 2/4 (50.0) --- 1998-99 4:3:1 Adequate #/Total (percent) 155/241 (64.3) 14/24 (58.3) 11/12 (91.7) --- Total 58/101 (57.4) *Excludes 1999-00 study year. 180/277 (65.0) 2001 4:3:1 Adequate #/Total (percent) 43/56 (76.8) 12/17 (70.6) 5/6 (83.3) --- 60/79 (75.9) 2002 4:3:1 Adequate #/Total (percent) 122/127 (96.1) 30/35 (85.7) 11/11 (100.0) 2/2 (100.0) 165/175 (94.3) Table 52 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 52 shows that in the 1997-98 study year, the immunization rates of children born to white mothers was less than that of black mothers, but in the 1998-99, 2001, and 2002 study years data this trend was reversed. 78 Table 53: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-4 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (Percent) 2/3 (66.7) 7/12 (58.3) 20/34 (58.8) 13/18 (72.2) 16/34 (47.1) --- Total 58/101 (57.4) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (Percent) 5/6 (83.3) 16/22 (72.7) 47/71 (66.2) 45/74 (60.8) 67/104 (64.4) --- 180/277 (65.0) 2001 4:3:1 Adequate #/Total (Percent) 2/3 (66.7) 7/11 (63.6) 16/25 (64.0) 8/10 (80.0) 27/30 (90.0) --- 60/79 (75.9) 2002 4:3:1 Adequate #/Total (Percent) 4/5 (80.0) 15/18 (83.3) 58/61 (95.1) 27/29 (93.1) 55/56 (98.2) 6/6 (100.0) 165/175 (94.3) Table 53 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). In the 2001 and 2002 studies, the immunization status of the children in the sample in District 3-4 appears to increase with educational attainment of the mother. 79 Table 54: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-4 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 13/24 (54.2) 47/55 (85.5) 60/79 (75.9) 2002 4:3:1 Adequate #/Total (percent) 41/46 (89.1) 124/129 (96.1) 165/175 (94.3) Table 54 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For Health District 3-4, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. 80 Individual Health District Report: District 3-5 The eligible sample from this district included 347 children born in January 2000. From the 347 children, 201 records were located (Response Rate=57.9%). Of the 201 located records, there were 6 parental refusals leaving a final sample of 195 records. The 4:3:1 immunization coverage estimate is 84.6 percent (165/195). This rate is slightly higher than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 11: 4:3:1 Coverage for State and District 3-5 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 3-5 The 4:3:1+3 immunization coverage estimate is 77.9 percent (152/195). This rate is slightly lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 81 Table 55: District Immunization Rates for Health District 3-5 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 61.3% 77.9% 68.1% 74.8% 75.5% 29.4% 1998-99 Adequate Rates 64.4% 76.4% 73.3% 76.7% 73.6% 51.0% 1999-00 Adequate Rates 66.2% 75.7% 71.6% 77.0% 77.9% 57.2% 2001 Adequate Rates 77.0% 83.7% 87.8% 89.3% 88.8% 81.1% 2002 Adequate Rates 84.6% 88.7% 86.7% 86.2% 85.6% 83.6% Table 55 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 83.6 to 88.7 percent for the 2002 study data. Table 56 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 82 Table 56: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 3-5 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3DTaP3 DTP4/DTaP4 DTP5/DTaP5 186 95.4% 182 93.3% 173 88.7% 1 0.5% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 186 95.4% 182 93.3% 60 30.8% 0 0.0% MMR1 MMR2 4 2.1% 1 0.5% HIB1 HIB2 HIB3 HIB4 HIB5 182 93.3% 177 90.8% 75 38.5% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 181 92.8% 175 89.7% 67 34.4% 0 0.0% VAR1 10 VAR2 0 *Percent = number immunized / sample size Sample size = 195 5.1% 0.0% 83 Table 57: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-5 by Study Year* Maternal Race White Black Other Unknown 1997-98 4:3:1 Adequate #/Total (Percent) 42/54 (77.8) 51/101 (50.5) 0/4 (0.0) --- Total 93/159 (58.5) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (Percent) 78/111 (70.3) 94/166 (56.6) 12/15 (80.0) --- 184/292 (63.0) 2001 4:3:1 Adequate #/Total (Percent) 38/52 (73.1) 100/130 (76.9) 10/14 (71.4) --- 148/196 (75.5) 2002 4:3:1 Adequate #/Total (Percent) 51/63 (81.0) 101/117 (86.3) 9/10 (90.0) 4/5 (80.0) 165/195 (84.6) Table 57 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 57 shows that the number of white mothers was less than that of black mothers in each year. The immunization rates of children born to white mothers was greater than that of black mothers for the 1997-98 and 1998-99 study years, but in the 2001 and 2002 studies, the immunization rates of children born to black mothers was higher than that of children born to white mothers. 84 Table 58: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 3-5 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 6/7 (85.7) 15/26 (57.7) 26/50 (52.0) 16/37 (43.2) 32/43 (74.4) --- Total 95/163 (58.3) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 8/11 (72.7) 19/36 (52.8) 47/84 (56.0) 30/56 (53.6) 80/105 (76.2) --- 184/292 (63.0) 2001 4:3:1 Adequate #/Total (percent) 12/17 (70.6) 17/25 (68.0) 43/59 (72.9) 33/46 (71.7) 43/49 (87.8) --- 148/196 (75.5) 2002 4:3:1 Adequate #/Total (percent) 11/15 (73.3) 19/22 (86.4) 40/48 (83.3) 38/49 (77.6) 51/54 (94.4) 6/7 (85.7) 165/195 (84.6) Table 58 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). In the 1998-99, 2001, and 2002 study years, the immunization status of the children in District 3-5 was greatest with the highest level of maternal educational attainment. 85 Table 59: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 3-5 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 69/98 (70.4) 79/98 (80.6) 148/196 (75.5) 2001 4:3:1 Adequate #/Total (percent) 66/82 (80.5) 99/113 (87.6) 165/195 (84.6) Table 59 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For Health District 3-5, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. 86 Individual Health District Report: District 4-0 The eligible sample from this district included 206 children born in January 2000. From the 206 children, 164 records were located (Response Rate=79.6%). Of the 164 located records, there were 17 parental refusals leaving a final sample of 147 records. The 4:3:1 immunization coverage estimate is 87.1 percent (128/147). This rate is higher than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 12: 4:3:1 Coverage for State and District 4-0 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 4-0 The 4:3:1+3 immunization coverage estimate is 85.0 percent (125/147). This rate is higher than the statewide 4:3:1+3 immunization rate of 78.9 percent. 87 Table 60: District Immunization Rates for Health District 4-0 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 61.5% 83.7% 69.2% 79.8% 78.8% 6.7% 1998-99 Adequate Rates 69.0% 80.2% 73.1% 81.0% 81.0% 31.7% 1999-00 Adequate Rates 79.7% 85.9% 84.9% 88.5% 85.9% 65.6% 2001 Adequate Rates 83.5% 86.4% 86.4% 88.3% 88.8% 83.0% 2002 Adequate Rates 87.8% 92.5% 93.2% 93.2% 92.5% 92.5% Table 60 reveals the coverage rates of each vaccine series. Coverage rates ranged from 87.8 to 93.2 percent for the 2002 study data. Table 61 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 88 Table 61: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 4-0 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 144 98.0% 143 97.3% 127 86.4% 1 0.7% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 144 98.0% 142 96.6% 51 34.7% 0 0.0% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 143 97.3% 141 95.9% 73 49.7% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 144 98.0% 142 96.6% 65 44.2% 0 0.0% VAR1 0 VAR2 0 *Percent = number immunized / sample size Sample size = 147 0.0% 0.0% 89 Table 62: Cross tabulations of Maternal Race and Child Immunization Status for Health District 4-0 by Study Year* 1997-98 4:3:1 Adequate Maternal Race #/Total (percent) White 36/70 (51.4) Black 24/33 (72.7) Other 1/1 (100.0) Total 61/104 (58.7) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 132/203 (65.0) 47/63 (74.6) 2/2 (100) 181/268 (67.5) 2001 4:3:1 Adequate #/Total (percent) 115/138 (83.3) 54/65 (83.1) 3/3 (100.0) 172/206 (83.5) 2002 4:3:1 Adequate #/Total (percent) 89/99 (89.9) 39/47 (83.0) 0/1 (0.0) 128/147 (87.1) Table 62 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 62 shows that in 2002, the immunization rate of children born to white mothers was higher than that of children born to black mothers. 90 Table 63: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 4-0 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 5/5 (100.0) 13/25 (52.0) 23/42 (54.8) 8/14 (57.1) 12/18 (66.7) --- 1998-99 4:3:1 Adequate #/Total (percent) 5/8 (62.5) 37/52 (71.2) 75/108 (69.4) 43/62 (69.4) 21/38 (55.2) --- 2001 4:3:1 Adequate #/Total (percent) 4/5 (80.0) 43/49 (87.8) 69/84 (82.1) 32/41 (78.0) 24/27 (88.9) --- 2002 4:3:1 Adequate #/Total (percent) 2/2 (100.0) 37/44 (84.1) 44/52 (84.6) 24/26 (92.3) 21/23 (91.3) --- Total 61/104 (58.7) *Excludes 1999-00 study year. 181/268 (67.5) 172/206 (83.5) 128/147 (87.1) Table 63 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in the sample in District 4-0 appears to vary with educational attainment. 91 Table 64: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 4-0 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 85/102 (83.3) 87/104 (83.7) 172/206 (83.5) 2002 4:3:1 Adequate #/Total (percent) 62/71 (87.3) 66/76 (86.8) 128/147 (87.1) Table 64 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For the 2001 study, the immunization rate of children born to non-Medicaid women was essentially the same as children born to women using Medicaid. However, in the 2002 study children born to women using Medicaid had a slightly higher immunization rate than children born to women not using Medicaid. 92 Individual Health District Report: District 5-1 The eligible sample from this district included 80 children born in January 2000. From the 80 children, 79 records were located (Response Rate=98.8%). Of the 79 located records, there was 1 parental refusal leaving a final sample of 78 records. The 4:3:1 immunization coverage estimate is 80.8 percent (63/78). This rate is lower than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 13: 4:3:1 Coverage for State and District 5-1 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 5-1 The 4:3:1+3 immunization coverage estimate 70.5 percent (55/78). This rate is lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 93 Table 65: District Immunization Rates for Health District 5-1 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1996-97 Adequate Rates 79.2% 90.6% 84.0% 89.6% 88.7% 12.3% 1997-98 Adequate Rates 87.1% 92.9% 91.8% 94.1% 89.4% 21.2% 1998-99 Adequate Rates 91.3% 93.8% 96.3% 96.3% 96.3% 61.3% 1999-00 Adequate Rates 86.7% 93.3% 91.7% 91.7% 93.3% 86.7% 2001 Adequate Rates 80.8% 96.2% 97.4% 97.4% 96.2% 84.6% Table 65 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 80.8 to 97.4 percent for the 2002 study data. Table 66 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 94 Table 66: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 5-1 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 76 97.4% 76 97.4% 71 91.0% 3 3.8% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 76 97.4% 76 97.4% 32 41.0% 1 1.3% MMR1 MMR2 3 3.8% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 76 97.4% 76 97.4% 43 55.1% 1 1.3% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 77 98.7% 76 97.4% 41 52.6% 1 1.3% VAR1 2 VAR2 0 *Percent = number immunized / sample size Sample size = 78 2.6% 0.0% 95 Table 67: Cross tabulations of Maternal Race and Child Immunization Status for Health District 5-1 by Study Year* Maternal Race White Black Other 1997-98 4:3:1 Adequate #/Total (percent) 55/67 (82.1) 28/39 (71.8) --- Total 83/106 (78.3) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 39/45 (86.7) 34/39 (87.2) 1/1 (100) 74/85 (87.1) 2001 4:3:1 Adequate #/Total (percent) 32/36 (88.9) 19/24 (79.2) --- 51/60 (85.0) 2002 4:3:1 Adequate #/Total (percent) 34/44 (77.3) 29/34 (85.3) --- 63/78 (80.8) Table 67 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 67 shows that the number of white mothers was greater than that of black mothers. The table also shows that the immunization rates for the 2002 study are higher for black mothers than for white mothers. 96 Table 68: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 5-1* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 5/6 (83.3) 23/29 (79.3) 33/44 (75.0) 12/16 (75.0) 10/11 (90.9) --- 1998-99 4:3:1 Adequate #/Total (percent) 2/2 (100.0) 19/22 (86.4) 36/42 (85.7) 8/9 (88.9) 9/10 (90.0) --- 2001 4:3:1 Adequate #/Total (percent) 2/2 (100.0) 13/19 (68.4) 19/21 (90.5) 11/12 (91.7) 6/6 (100.0) --- 2002 4:3:1 Adequate #/Total (percent) 1/2 (50.0) 23/26 (88.5) 28/36 (77.8) 3/3 (100.0) 8/11 (72.7) --- Total 83/106 (78.3) *Excludes 1999-00 study year. 74/85 (87.1) 51/60 (85.0) 63/78 (80.8) Table 68 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The educational categories were based on those used in previous years of the study, to allow comparisons between the three years. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in the sample in District 5-1 varies with educational attainment. 97 Table 69: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 5-1 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 29/35 (82.9) 22/25 (88.0) 51/60 (85.0) 2002 4:3:1 Adequate #/Total (percent) 35/43 (81.4) 28/35 (80.0) 63/78 (80.8) Table 69 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For the 2001 study, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid, but in the 2002 study children born to women using Medicaid had a slightly higher immunization rate than children born to non-Medicaid women. 98 Individual Health District Report: District 5-2 The eligible sample from this district included 319 children born in January 2000. From the 319 children, 252 records were located (Response Rate=79.0%). Of the 252 located records, there were 4 parental refusals leaving a final sample of 248 records. The 4:3:1 immunization coverage estimate is 84.7 percent (210/248). This rate is higher than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 14: 4:3:1 Coverage for State and District 5-2 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 5-2 The 4:3:1+3 immunization coverage estimate is 80.2 percent (199/248). This rate is higher than the statewide 4:3:1+3 immunization rate of 78.9 percent. 99 Table 70: District Immunization Rates for Health District 5-2 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 72.5% 85.9% 80.5% 81.2% 78.5% 15.4% 1998-99 Adequate Rates 96.5% 98.0% 95.7% 98.0% 97.7% 63.7% 1999-00 Adequate Rates 83.6% 87.3% 90.9% 96.4% 89.1% 61.8% 2001 Adequate Rates 72.7% 81.8% 82.7% 84.5% 83.6% 80.0% 2002 Adequate Rates 85.5% 94.0% 92.3% 92.7% 93.1% 90.3% Table 70 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 85.5 to 94.0 percent for the 2002 study data. Table 71 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. The Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 100 Table 71: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 5-2 Vaccine Dose Number Immunized DTP1/DTaP1 246 DTP2/DTaP2 240 DTP3/DTaP3 217 DTP4/DTaP4 0 DTP5/DTaP5 0 OPV/IPV1 244 OPV/IPV2 238 OPV/IPV3 94 OPV/IPV4 0 MMR1 2 MMR2 0 HIB1 245 HIB2 238 HIB3 109 HIB4 0 HIB5 0 HEPB1 244 HEPB2 238 HEPB3 127 HEPB4 1 VAR1 1 VAR2 0 *Percent = number immunized / sample size Sample size = 248 Percent* 99.2% 96.8% 87.5% 0.0% 0.0% 98.4% 96.0% 37.9% 0.0% 0.8% 0.0% 98.8% 96.0% 44.0% 0.0% 0.0% 98.4% 96.0% 51.2% 0.4% 0.4% 0.0% 101 Table 72: Cross tabulations of Maternal Race and Child Immunization Status for Health District 5-2 by Study Year* Maternal Race White Black Other Unknown 1997-98 4:3:1 Adequate #/Total (percent) 45/69 (65.2) 61/78 (78.2) 1/2 (50.0) --- Total 107/149 (71.8) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 143/151 (94.7) 97/103 (94.2) 2/2 (100.0) --- 242/256 (94.5) 2001 4:3:1 Adequate #/Total (percent) 33/52 (63.5) 43/58 (74.1) --- ---- 76/110 (69.1) 2002 4:3:1 Adequate #/Total (percent) 109/123 (88.6) 96/120 (80.0) 4/4 (100.0) 1/1 (100.0) 210/248 (84.7) Table 72 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The table shows that the immunization rate of children born to white mothers was less than that of black mothers in the 1997-98 and 2001 study data, but not in the 1998-99 and 2002 study years. 102 Table 73: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 5-2 by Study Year* 1997-98 4:3:1 Adequate Maternal #/Total Educational Level (percent) Less than high 6/6 school (100.0) Some high 31/48 school (64.6) High school 38/50 graduate (76.0) Some college 16/22 (72.7) College or more 16/23 (69.6) Total 107/149 (71.8) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 9/10 (90.0) 48/51 (94.1) 93/99 (93.9) 47/50 (94.0) 45/46 (97.8) 242/256 (94.5) 2001 4:3:1 Adequate #/Total (percent) 1/4 (25.0) 13/17 (76.5) 41/53 (77.4) 12/23 (52.2) 9/13 (69.2) 76/110 (69.1) 2002 4:3:1 Adequate #/Total (percent) 6/6 (100.0) 45/54 (83.3) 85/104 (81.7) 44/52 (84.6) 30/32 (93.8) 210/248 (84.7) Table 73 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in District 5-2 varied with maternal educational attainment. 103 Table 74: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 5-2 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 44/63 (69.8) 32/47 (68.1) 76/110 (69.1) . 2002 4:3:1 Adequate #/Total (percent) 103/131 (78.6) 107/117 (91.5) 210/248 (84.7) Table 74 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For the 2001 study, children born to Medicaid women had a slightly higher immunization rate than children born to women not using Medicaid. In the 2002 study, children born to women not using Medicaid had a higher immunization rate than children born to Medicaid women. 104 Individual Health District Report: District 6-0 The eligible sample from this district included 121 children born in January 2000. From the 121 children, 102 records were located (Response Rate=84.3%). Of the 102 located records, there were no parental refusals leaving a final sample of 102 records. The 4:3:1 immunization coverage estimate is 89.2 percent (91/102). This rate is higher than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 15: 4:3:1 Coverage for State and District 6-0 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 6-0 The 4:3:1+3 immunization coverage estimate is 86.3 percent (88/102). This rate is higher than the statewide 4:3:1+3 immunization rate of 78.9 percent. 105 Table 75: District Immunization Rates for Health District 6-0 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 76.6% 91.2% 84.7% 92.0% 82.5% 19.0% 1998-99 Adequate Rates 96.1% 98.3% 98.3% 98.3% 98.9% 75.3% 1999-00 Adequate Rates 74.5% 85.1% 87.2% 87.2% 85.1% 61.7% 2001 Adequate Rates 89.5% 93.2% 95.1% 97.5% 93.2% 88.3% 2002 Adequate Rates 89.2% 95.1% 96.1% 97.1% 96.1% 97.1% Table 75 reveals the coverage rates of each vaccine series. Coverage rates ranged from 89.2 to 97.1 percent for the 2002 study data. Table 76 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 106 Table 76: 2002 District Immunization Rates by Individual Vaccine at 12 months of age for Health District 6-0 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 100 98.0% 98 96.1% 88 86.3% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 100 98.0% 98 96.1% 35 34.3% 0 0.0% MMR1 MMR2 2 2.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 100 98.0% 98 96.1% 65 63.7% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 100 98.0% 96 94.1% 51 50.0% 1 1.0% VAR1 1 VAR2 0 *Percent = number immunized / sample size Sample size = 102 1.0% 0.0% 107 Table 77: Cross tabulations of Maternal Race and Child Immunization Status for Health District 6-0 by Study Year* 1997-98 4:3:1 Adequate Maternal Race #/Total (percent) White 53/70 (75.7) Black 51/66 (77.3) Other 1/1 (100.0) Total 105/137 (76.6) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 98/102 (96.0) 71/74 (95.9) 2/2 (100.0) 171/178 (96.1) 2001 4:3:1 Adequate #/Total (percent) 57/65 (87.7) 86/96 (89.6) 1/1 (100.0) 144/162 (88.9) 2002 4:3:1 Adequate #/Total (percent) 39/42 (92.9) 52/60 (86.7) --- 91/102 (89.2) Table 77 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 77 shows that the immunization rates of children born to white mothers were similar to that of black mothers in the 1997-98, 1998-99 and 2001 study years, but higher for white mothers in the 2002 study. 108 Table 78: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 6-0 by Study Year* 1997-98 4:3:1 Adequate Maternal #/Total Educational Level (percent) Less than high 4/4 school (100.0) Some high 28/38 school (73.7) High school 37/43 graduate (86.0) Some college 19/30 (63.3) College or more 17/22 (77.3) Total 105/137 (76.6) *Excludes 1999-00 study years. 1998-99 4:3:1 Adequate #/Total (percent) 4/4 (100.0) 36/37 (97.3) 65/69 (94.2) 43/44 (97.7) 23/24 (95.8) 171/178 (96.1) 2001 4:3:1 Adequate #/Total (percent) 10/12 (83.3) 32/38 (84.2) 47/52 (90.4) 34/35 (97.1) 21/25 (84.0) 144/162 (88.9) 2002 4:3:1 Adequate #/Total (percent) 3/3 (100.0) 18/21 (85.7) 37/42 (88.1) 18/19 (94.7) 15/17 (88.2) 91/102 (89.2) Table 78 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The educational categories were based on those used in previous years, to allow comparisons between the three years. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in District 6-0 varies with educational attainment. 109 Table 79: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 6-0 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 83/93 (89.2) 61/69 (88.4) 144/162 (88.9) 2002 4:3:1 Adequate #/Total (percent) 53/61 (86.9) 38/41 (92.7) 91/102 (89.2) Table 79 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For the 2001 study, children born to Medicaid women had a slightly higher immunization rate than children born to women not using Medicaid. In the 2002 study, children born to women not using Medicaid had a higher immunization rate than children born to Medicaid women. 110 Individual Health District Report: District 7-0 The eligible sample from this district included 205 children born in January 2000. From the 205 children, 117 records were located (Response Rate=57.1%). Of the 117 located records, there was 1 parental refusal leaving a final sample of 116 records. The 4:3:1 immunization coverage estimate is 82.8 percent (96/116). This rate is slightly lower than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 16: 4:3:1 Coverage for State and District 7-0 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 7-0 The 4:3:1+3 immunization coverage estimate is 74.1 percent (86/116). This rate is lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 111 Table 80: District Immunization Rates for Health District 7-0 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 73.1% 93.2% 92.3% 88.5% 93.6% 21.4% 1998-99 Adequate Rates 69.3% 83.2% 83.2% 85.4% 84.7% 24.1% 1999-00 Adequate Rates 77.1% 85.9% 85.3% 85.3% 87.6% 53.5% 2001 Adequate Rates 74.3% 78.4% 80.2% 82.6% 85.0% 74.9% 2002 Adequate Rates 83.6% 90.5% 92.2% 89.7% 90.5% 88.8% Table 80 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 83.6 to 92.2 percent for the 2002 study data. Table 81 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 112 Table 81: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 7-0 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 116 100.0% 114 98.3% 107 92.2% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 116 100.0% 113 97.4% 33 28.4% 0 0.0% MMR1 MMR2 2 1.7% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 115 99.1% 112 96.6% 62 53.4% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 115 99.1% 110 94.8% 57 49.1% 1 0.9% VAR1 1 VAR2 0 *Percent = number immunized / sample size Sample size = 116 0.9% 0.0% 113 Table 82: Cross tabulations of Maternal Race and Child Immunization Status for Health District 7-0 by Study Year* 1997-98 4:3:1 Adequate Maternal Race #/Total (percent) White 81/109 (74.3) Black 85/120 (70.8) Other 2/5 (40.0) Total 168/234 (71.8) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 46/61 (75.4) 45/73 (61.6) 2/3 (66.7) 93/137 (67.9) 2001 4:3:1 Adequate #/Total (percent) 43/64 (67.2) 78/101 (77.2) 1/2 (50.0) 122/167 (73.1) 2002 4:3:1 Adequate #/Total (percent) 36/44 (81.8) 60/72 (83.3) --- 96/116 (82.8) Table 82 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 82 shows that the immunization rate of children born to black mothers was greater than white mothers in the 2001 and 2002 study years. 114 Table 83: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 7-0 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 5/7 (71.4) 39/56 (69.6) 69/90 (76.7) 25/43 (58.1) 30/38 (78.9) --- Total 168/234 (71.8) *Excludes 1999-00 study data. 1998-99 4:3:1 Adequate #/Total (percent) 8/10 (80.0) 14/24 (58.3) 36/58 (62.1) 21/29 (72.4) 14/16 (87.5) --- 93/137 (67.9) 2001 4:3:1 Adequate #/Total (percent) 4/6 (66.7) 41/53 (77.4) 55/72 (76.4) 10/13 (76.9) 12/23 (52.2) --- 122/167 (73.1) 2002 4:3:1 Adequate #/Total (percent) 3/3 (100.0) 34/40 (85.0) 35/42 (83.3) 18/23 (78.3) 6/7 (85.7) 0/1 (0.0) 96/116 (82.8) Table 83 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The educational categories were based on those used in previous years, to allow comparisons between the three years. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). In the 2002 study year, the immunization status of the children in District 7-0 varies with maternal educational attainment. 115 Table 84: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 7-0 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 79/104 (76.0) 43/63 (68.3) 122/167 (73.1) 2002 4:3:1 Adequate #/Total (percent) 70/83 (84.3) 26/33 (78.8) 96/116 (82.8) Table 84 shows immunization status of children born to women stratified by Medicaid status for the 2001 and the 2002 study years. For Health District 7-0, children born to Medicaid women had a higher immunization rate than children born to women not using Medicaid for both study years. 116 Individual Health District Report: District 8-1 The eligible sample from this district included 137 children born in January 2000. From the 137 children, 129 records were located (Response Rate=94.2%). Of the 129 located records, there were no parental refusals leaving a final sample of 129 records. The 4:3:1 immunization coverage estimate is 82.2 percent (106/129). This rate is slightly lower than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 17: 4:3:1 Coverage for State and District 8-1 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 8-1 The 4:3:1+3 immunization coverage estimate is 77.5 percent (100/129). This rate is lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 117 Table 85: District Immunization Rates for Health District 8-1 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 88.4% 94.2% 95.3% 96.5% 89.5% 16.3% 1998-99 Adequate Rates 81.5% 94.6% 89.1% 94.6% 91.3% 30.4% 1999-00 Adequate Rates 86.9% 87.9% 90.7% 92.5% 92.5% 61.7% 2001 Adequate Rates 77.7% 84.5% 82.5% 81.6% 84.5% 78.6% 2002 Adequate Rates 82.2% 91.5% 93.8% 94.6% 94.6% 93.0% Table 85 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 82.2 to 94.6 percent for the 2002 study data. Table 86 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 118 Table 86: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 8-1 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 129 100.0% 125 96.9% 116 89.9% 1 0.8% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 129 100.0% 125 96.9% 33 25.6% 0 0.0% MMR1 MMR2 2 1.6% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 129 100.0% 125 96.9% 63 48.8% 1 0.8% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 128 99.2% 120 93.0% 48 37.2% 1 0.8% VAR1 0 VAR2 0 *Percent = number immunized / sample size Sample size = 129 0.0% 0.0% 119 Table 87: Cross tabulations of Maternal Race and Child Immunization Status for Health District 8-1 by Study Year* 1997-98 4:3:1 Adequate Maternal Race #/Total (percent) White 41/49 (83.7) Black 34/36 (94.4) Other 1/1 (100.0) Total 76/86 (88.4) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 46/56 (82.1) 28/35 (80.0) 0/1 (0.0) 74/92 (80.4) 2001 4:3:1 Adequate #/Total (percent) 42/60 (70.0) 36/42 (85.7) 1/1 (100.0) 79/103 (76.7) 2002 4:3:1 Adequate #/Total (percent) 67/80 (83.8) 38/48 (79.2) 1/1 (100.0) 106/129 (82.2) Table 87 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 87 shows that the number of white mothers was more than that of black mothers. The table also shows that the immunization rate of children born to white mothers was less than that of children born to black mothers in the 2001 and 2002 study years. 120 Table 88: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 8-1 by Study Year* 1997-98 4:3:1 Adequate Maternal #/Total Educational Level (percent) Less than high 2/2 school (100.0) Some high 23/27 school (85.2) High school 26/28 graduate (92.9) Some college 13/16 (81.3) College or more 12/13 (92.3) Total 76/86 (88.4) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 7/8 (87.5) 21/31 (67.7) 24/27 (88.9) 12/15 (80.0) 10/11 (90.9) 74/92 (80.4) 2001 4:3:1 Adequate #/Total (percent) 9/13 (69.2) 19/26 (73.1) 27/34 (79.4) 17/22 (77.3) 7/8 (87.5) 79/103 (76.7) 2002 4:3:1 Adequate #/Total (percent) 6/9 (66.7) 29/35 (82.9) 34/40 (85.0) 22/27 (81.5) 15/18 (83.3) 106/129 (82.2) Table 88 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The educational categories were based on those used in previous years, to allow comparisons between the three years. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in the sample in District 8-1 varies with educational attainment. 121 Table 89: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 8-1 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 50/68 (73.5) 29/35 (82.9) 79/103 (76.7) 2002 4:3:1 Adequate #/Total (percent) 64/74 (86.5) 42/55 (76.4) 106/129 (82.2) Table 89 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For the 2001 study, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. In the 2002 study, children born to women using Medicaid had a higher immunization rate than children born to nonMedicaid women. 122 Individual Health District Report: District 8-2 The eligible sample from this district included 88 children born in January 2000. From the 88 children, 77 records were located (Response Rate=87.5%). Of the 77 located records, there were no parental refusals leaving a final sample of 77 records. The 4:3:1 immunization coverage estimate is 83.1 percent (64/77). This rate is essentially the same as the statewide 4:3:1 immunization rate of 83.9 percent. Figure 18: 4:3:1 Coverage for State and District 8-2 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 8-2 The 4:3:1+3 immunization coverage estimate rate is 81.8 percent (63/77). This rate is higher than the statewide 4:3:1+3 immunization rate of 78.9 percent. 123 Table 90: District Immunization Rates for Health District 8-2 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 81.4% 88.6% 85.7% 87.1% 85.7% 18.6% 1998-99 Adequate Rates 84.5% 90.1% 91.5% 90.8% 90.8% 71.8% 1999-00 Adequate Rates 85.6% 90.8% 88.9% 92.8% 90.2% 66.0% 2001 Adequate Rates 94.7% 96.2% 97.0% 92.5% 95.5% 96.2% 2002 Adequate Rates 85.7% 90.9% 92.2% 92.2% 92.2% 90.9% Table 90 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 85.7 to 92.2 percent for the 2002 study data. Table 91 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 124 Table 91: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 8-2 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 77 100.0% 75 97.4% 71 92.2% 1 1.3% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 77 100.0% 75 97.4% 25 32.5% 0 0.0% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 77 100.0% 74 96.1% 32 41.6% 1 1.3% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 77 100.0% 72 93.5% 28 36.4% 0 0.0% VAR1 0 VAR2 0 *Percent = number immunized / sample size Sample size = 77 0.0% 0.0% 125 Table 92: Cross tabulations of Maternal Race and Child Immunization Status for Health District 8-2 by Study Year* Maternal Race White Black Other 1997-98 4:3:1 Adequate #/Total (percent) 31/40 (77.5) 26/30 (86.7) --- Unknown --- Total 57/70 (81.4) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 56/71 (78.9) 62/70 (88.6) 1/1 (100.0) --- 119/142 (83.8) 2001 4:3:1 Adequate #/Total (percent) 55/58 (94.8) 67/73 (91.8) 2/2 (100.0) --- 124/133 (93.2) 2002 4:3:1 Adequate #/Total (percent) 21/28 (75.0) 40/46 (87.0) 1/1 (100.0) 2/2 (100.0) 64/77 (83.1) Table 92 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 92 shows that the immunization rates of children in District 8-2 varies with maternal race. 126 Table 93: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 8-2 by Study Year* 1996-97 4:3:1 Adequate Maternal #/Total Educational Level (percent) Less than high 7/9 school (77.8) Some high 17/19 school (89.5) High school 18/25 graduate (72.0) Some college 10/10 (100.0) College or more 5/7 (71.4) Total 57/70 (81.4) *Excludes 1999-00 study year. 1997-98 4:3:1 Adequate #/Total (percent) 9/11 (81.8) 41/48 (85.4) 41/47 (87.2) 18/23 (78.2) 10/13 (76.9) 119/142 (83.8) 1998-99 4:3:1 Adequate #/Total (percent) 9/9 (100.0) 39/44 (88.6) 44/48 (91.7) 22/22 (100.0) 10/10 (100.0) 124/133 (93.2) 2001 4:3:1 Adequate #/Total (percent) 7/10 (70.0) 21/24 (87.5) 19/25 (76.0) 11/12 (91.7) 6/6 (100.0) 64/77 (83.1) Table 93 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The educational categories were based on those used in previous years, to allow comparisons between the three years. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in District 8-2 varies with educational attainment. 127 Table 94: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 8-2 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 82/90 (91.1) 42/43 (97.7) 124/133 (93.2) 2002 4:3:1 Adequate #/Total (percent) 43/54 (79.6) 21/23 (91.3) 64/77 (83.1) Table 94 shows immunization status of children born to women stratified by Medicaid status for the 2001 and the 2002 study years. For Health District 8-2, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid for both study years. 128 Individual Health District Report: District 9-1 The eligible sample from this district included 186 children born in January 2000. From the 186 children, 152 records were located (Response Rate=81.7%). Of the 152 located records, there were no parental refusals leaving a final sample of 152 records. The 4:3:1 immunization coverage estimate is 80.9 percent (123/152). This rate is lower to the statewide 4:3:1 immunization rate of 83.9 percent. Figure 19: 4:3:1 Coverage for State and District 9-1 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 9-1 The 4:3:1+3 immunization coverage estimate is 74.3 percent (113/152). This rate is lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 129 Table 95: District Immunization Rates for Health District 9-1 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 67.1% 80.7% 72.1% 81.4% 82.1% 14.3% 1998-99 Adequate Rates 80.4% 87.4% 86.7% 86.0% 84.6% 18.8% 1999-00 Adequate Rates 80.8% 88.5% 85.4% 91.5% 89.2% 51.5% 2001 Adequate Rates 69.9% 79.7% 79.7% 81.3% 76.4% 71.5% 2002 Adequate Rates 81.6% 90.1% 89.5% 90.8% 90.1% 83.6% Table 95 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 81.6 to 90.8 percent for the 2002 study data. Table 96 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 130 Table 96: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 9-1 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 150 98.7% 145 95.4% 126 82.9% 1 0.7% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 150 98.7% 143 94.1% 71 46.7% 0 0.0% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 149 98.0% 144 94.7% 81 53.3% 2 1.3% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 150 98.7% 143 94.1% 91 59.9% 2 1.3% VAR1 1 VAR2 0 *Percent = number immunized / sample size Sample size = 152 0.7% 0.0% 131 Table 97: Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-1 by Study Year* Maternal Race White Black Other Unknown 1997-98 4:3:1 Adequate #/Total (percent) 38/70 (54.3) 53/66 (80.3) 2/4 (50.0) --- Total 93/140 (66.4) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 47/66 (71.2) 68/77 (88.3) --- --- 115/143 (80.4) 2001 4:3:1 Adequate #/Total (percent) 36/55 (65.5) 47/66 (71.2) 2/2 (100.0) --- 85/123 (69.1) 2002 4:3:1 Adequate #/Total (percent) 51/65 (78.5) 70/83 (84.3) 0/1 (0.0) 2/3 (66.7) 123/152 (80.9) Table 97 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 97 shows that the immunization rate of children born to white mothers was less than that of black mothers in each of the years of the study. 132 Table 98: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 9-1 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 4/5 (80.0) 28/37 (75.7) 28/45 (62.2) 22/30 (73.3) 11/23 (47.8) --- Total 93/140 (66.4) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 8/8 (100.0) 31/37 (83.8) 40/49 (81.6) 19/26 (73.1) 17/23 (73.9) --- 115/143 (80.4) 2001 4:3:1 Adequate #/Total (percent) 0/2 (0.0) 18/22 (81.8) 38/58 (65.5) 11/22 (50.0) 18/19 (94.7) --- 85/123 (69.1) 2002 4:3:1 Adequate #/Total (percent) 2/2 (100.0) 21/29 (72.4) 50/60 (83.3) 19/27 (70.4) 30/33 (90.9) 1/1 (100.0) 123/152 (80.9) Table 98 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in the sample in District 9-1 seems to vary with educational attainment. 133 Table 99: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 9-1 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 43/64 (67.2) 42/59 (71.2) 85/123 (69.1) 2002 4:3:1 Adequate #/Total (percent) 69/89 (77.5) 54/63 (85.7) 123/152 (80.9) Table 99 shows immunization status of children born to women stratified by Medicaid status for the 2001 and the 2002 study years. For Health District 9-1, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid for both study years. 134 Individual Health District Report: District 9-2 The eligible sample from this district included 101 children born in January 2000. From the 101 children, 90 records were located (Response Rate=89.1%). Of the 90 located records, there was 1 parental refusal leaving a final sample of 89 records. The 4:3:1 immunization coverage estimate is 85.4 percent (76/89). This rate is higher than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 20: 4:3:1 Coverage for State and District 9-2 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 9-2 The 4:3:1+3 immunization coverage estimate is 79.8 percent (71/89). This rate is higher than the statewide 4:3:1+3 immunization rate of 78.9 percent. 135 Table 100: District Immunization Rates for Health District 9-2 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 84.1% 92.7% 87.8% 93.9% 95.1% 3.7% 1998-99 Adequate Rates 83.5% 93.4% 85.1% 93.4% 91.7% 27.3% 1999-00 Adequate Rates 88.0% 90.2% 91.0% 95.5% 91.7% 58.6% 2001 Adequate Rates 92.4% 92.4% 93.1% 95.4% 95.4% 88.5% 2002 Adequate Rates 86.5% 92.1% 94.4% 93.3% 92.1% 87.6% Table 100 reveals the coverage rates of each vaccine series. Coverage rates ranged from 86.5 to 94.4 percent for the 2002 study data. Table 101 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 136 Table 101: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 9-2 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 89 100.0% 86 96.6% 82 92.1% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 89 100.0% 86 96.6% 9 10.1% 0 0.0% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 89 100.0% 86 96.6% 12 13.5% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 89 100.0% 85 95.5% 15 16.9% 0 0.0% VAR1 0 VAR2 0 *Percent = number immunized / sample size Sample size = 89 0.0% 0.0% 137 Table 102: Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-2 by Study Year* Maternal Race White Black Other 1997-98 4:3:1 Adequate #/Total (percent) 53/65 (81.5) 13/17 (76.5) --- Unknown --- Total 66/82 (80.5) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 81/96 (84.4) 20/25 (80.0) --- --- 101/121 (83.5) 2001 4:3:1 Adequate #/Total (percent 82/92 (89.1) 36/38 (94.7) 1/1 (100.0) --- 119/131 (90.8) 2002 4:3:1 Adequate #/Total (percent 50/59 (84.7) 24/28 (85.7) --- 2/2 (100.0) 76/89 (85.4) Table 102 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 102 shows that the number of white mothers was more than the number of black mothers. The table also shows that the immunization rate of children born to white mothers was similar to that of black mothers. 138 Table 103: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 9-2 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 4/5 (80.0) 15/19 (78.9) 32/37 (86.5) 8/14 (57.1) 7/7 (100.0) --- Total 66/82 (80.5) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 7/8 (87.5) 18/23 (78.3) 44/51 (86.3) 15/17 (88.2) 17/22 (77.3) --- 101/121 (83.5) 2001 4:3:1 Adequate #/Total (percent) 12/12 (100.0) 28/33 (84.8) 48/55 (87.3) 21/21 (100.0) 10/10 (100.0) --- 119/131 (90.8) 2002 4:3:1 Adequate #/Total (percent) 7/9 (77.8) 17/19 (89.5) 33/37 (89.2) 13/18 (72.2) 5/5 (100.0) 1/1 (100.0) 76/89 (85.4) Table 103 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in District 9-2 varied with educational attainment. 139 Table 104: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 9-2 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 68/76 (89.5) 51/55 (92.7) 119/131 (90.8) 2002 4:3:1 Adequate #/Total (percent) 54/62 (87.1) 22/27 (81.5) 76/89 (85.4) Table 104 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For the 2001 study, children born to non-Medicaid women had a slightly higher immunization rate than children born to women using Medicaid. In the 2002 study, children born to women using Medicaid had a higher immunization rate than children born to nonMedicaid women. 140 Individual Health District Report: District 9-3 The eligible sample from this district included 157 children born in January 2000. From the 157 children, 119 records were located (Response Rate=75.8%). Of the 119 located records, there was 1 parental refusal leaving a final sample of 118 records. The 4:3:1 immunization coverage estimate is 85.6 percent (101/118). This rate is higher than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 21: 4:3:1 Coverage for State and District 9-3 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 9-3 The 4:3:1+3 immunization coverage estimate is 80.5 percent (95/118). This rate is higher than the statewide 4:3:1+3 immunization rate of 78.9 percent. 141 Table 105: District Immunization Rates for Health District 9-3 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 72.1% 94.3% 76.4% 85.7% 85.7% 5.0% 1998-99 Adequate Rates 64.2% 77.1% 67.9% 78.0% 81.7% 25.7% 1999-00 Adequate Rates 82.2% 86.3% 87.7% 89.0% 87.7% 57.5% 2001 Adequate Rates 71.6% 76.8% 80.0% 81.1% 81.1% 69.5% 2002 Adequate Rates 85.6% 89.8% 87.3% 91.5% 89.0% 83.9% Table 105 reveals the coverage rates of each vaccine series. Coverage rates ranged from 83.9 to 91.5 percent for the 2002 study data. Table 106 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. As shown in the following table, the percentage of children vaccinated for DTP/DTaP decreases by dose. Similarly, the Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 142 Table 106: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 9-3 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 113 95.8% 110 93.2% 103 87.3% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 113 95.8% 110 93.2% 68 57.6% 0 0.0% MMR1 MMR2 7 5.9% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 113 95.8% 110 93.2% 79 66.9% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 113 95.8% 108 91.5% 61 51.7% 1 0.8% VAR1 7 VAR2 0 *Percent = number immunized / sample size Sample size = 118 5.9% 0.0% 143 Table 107: Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-3 by Study Year* Maternal Race White Black Other 1997-98 4:3:1 Adequate #/Total (percent) 58/89 (65.2) 38/51 (74.5) --- Unknown --- Total 96/140 (68.6) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 38/60 (63.3) 26/46 (56.5) 2/3 (66.7) --- 66/109 (60.6) 2001 4:3:1 Adequate #/Total (percent) 47/67 (70.1) 21/28 (75.0) --- --- 68/95 (71.6) 2002 4:3:1 Adequate #/Total (percent) 61/70 (87.1) 39/46 (84.8) 1/1 (100.0) 0/1 (0.0) 101/118 (85.6) Table 107 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 107 shows that the number of white mothers was more than the number of black mothers. The table also shows that the immunization rate of children born to white mothers was higher than that of black mothers for the 1998-99 and 2002 study years. 144 Table 108: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 9-3 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 1/2 (50.0) 26/32 (81.3) 34/58 (58.6) 20/26 (76.9) 15/22 (68.2) --- Total 96/140 (68.6) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 2/2 (100.0) 17/30 (56.7) 29/47 (61.7) 12/19 (63.1) 6/11 (54.5) --- 66/109 (60.6) 2001 4:3:1 Adequate #/Total (percent) 7/8 (87.5) 15/23 (65.2) 23/31 (74.2) 15/21 (71.4) 8/12 (66.7) --- 68/95 (71.6) 2002 4:3:1 Adequate #/Total (percent) 3/3 (100.0) 26/29 (89.7) 38/48 (79.2) 22/24 (91.7) 9/11 (81.8) 3/3 (100.0) 101/118 (85.6) Table 108 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in the sample in District 9-3 varies with educational attainment. 145 Table 109: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 9-3 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 38/53 (71.7) 30/42 (71.4) 68/95 (71.6) 2002 4:3:1 Adequate #/Total (percent) 64/73 (87.7) 37/45 (82.2) 101/118 (85.6) Table 109 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For the 2001 study, children born to non-Medicaid women had essentially the same immunization rate as children born to women using Medicaid. In the 2002 study, children born to women using Medicaid had a higher immunization rate than children born to non-Medicaid women. 146 Individual Health District Report: District 10-0 The eligible sample from this district included 157 children born in January 2000. From the 157 children, 124 records were located (Response Rate=79.0%). Of the 124 located records, there were 3 parental refusals leaving a final sample of 121 records. The 4:3:1 immunization coverage estimate is 80.2 percent (97/121). This rate is lower than the statewide 4:3:1 immunization rate of 83.9 percent. Figure 22: 4:3:1 Coverage for State and District 10-0 100 90 80 70 60 50 40 30 20 10 0 97-98 98-99 99-00 2001 2002 State Dist 10-0 The 4:3:1+3 immunization coverage estimate is 74.4 percent (90/121). This rate is lower than the statewide 4:3:1+3 immunization rate of 78.9 percent. 147 Table 110: District Immunization Rates for Health District 10-0 by Study Year Vaccine 4 DTP/DTaP 3 OPV/IPV 1 MMR 3 Hib 3 HepB 1 Varicella 1997-98 Adequate Rates 74.4% 89.1% 82.2% 88.4% 86.0% 11.6% 1998-99 Adequate Rates 78.9% 86.5% 84.8% 87.7% 87.7% 52.0% 1999-00 Adequate Rates 74.7% 76.0% 77.3% 79.9% 79.9% 55.8% 2001 Adequate Rates 85.1% 88.3% 89.6% 94.2% 91.6% 87.0% 2002 Adequate Rates 80.2% 86.0% 90.1% 86.8% 88.4% 86.8% Table 110 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 80.2 to 90.1 percent for the 2002 study data. Table 111 shows the immunization rates for each individual vaccine at twelve months of age. Not all shots are recommended prior to the first birthday; therefore, certain immunization rates within each series are expected to be low. For example, the DTP/DTaP vaccine series includes 4 doses before the second birthday; however, only three of the four shots are recommended within the first year of life. The Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday, so these rates should be close to 0% at 12 months. 148 Table 111: 2002 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 10-0 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 DTP2/DTaP2 DTP3/DTaP3 DTP4/DTaP4 DTP5/DTaP5 119 98.3% 116 95.9% 105 86.8% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 119 98.3% 115 95.0% 29 24.0% 0 0.0% MMR1 MMR2 1 0.8% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 119 98.3% 115 95.0% 29 24.0% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 119 98.3% 113 93.4% 29 24.0% 0 0.0% VAR1 1 VAR2 0 *Percent = number immunized / sample size Sample size = 121 0.8% 0.0% 149 Table 112: Cross tabulations of Maternal Race and Child Immunization Status for Health District 10-0 by Study Year* Maternal Race White Black Other Unknown 1997-98 4:3:1 Adequate #/Total (percent) 73/98 (74.5) 21/30 (70.0) 1/1 (100.0) --- Total 95/129 (73.6) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 109/141 (77.3) 25/28 (89.2) 1 /2 (50.0) --- 135/171 (78.9) 2001 4:3:1 Adequate #/Total (percent) 98/118 (83.1) 32/35 (91.4) 0/1 (0.0) --- 130/154 (84.4) 2002 4:3:1 Adequate #/Total (percent) 69/88 (78.4) 26/31 (83.9) 1/1 (100.0) 1/1 (100.0) 97/121 (80.2) Table 112 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 112 shows that the number of white mothers was more than the number of black mothers. The table also shows that the immunization rates of children born to white mothers were lower than that of black mothers in the 1998-99, 2001, and 2002 study years. 150 Table 113: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 10-0 by Study Year* Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Unknown 1997-98 4:3:1 Adequate #/Total (percent) 7/8 (87.5) 26/33 (78.8) 34/49 (69.4) 13/19 (68.4) 15/20 (75.0) --- Total 95/129 (73.6) *Excludes 1999-00 study year. 1998-99 4:3:1 Adequate #/Total (percent) 2/3 (66.7) 25/33 (75.8) 50/66 (75.8) 33/39 (84.6) 25/30 (83.3) --- 135/171 (78.9) 2001 4:3:1 Adequate #/Total (percent) 14/18 (77.8) 28/32 (87.5) 48/59 (81.4) 23/26 (88.5) 17/19 (89.5) --- 130/154 (84.4) 2002 4:3:1 Adequate #/Total (percent) 5/7 (71.4) 25/29 (86.2) 35/47 (74.5) 12/14 (85.7) 20/23 (87.0) 0/1 (0.0) 97/121 (80.2) Table 113 shows the cross tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). The immunization status of the children in District 10-0 varies with educational attainment. 151 Table 114: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 10-0 Maternal Medicaid Status Medicaid Non-Medicaid Total 2001 4:3:1 Adequate #/Total (percent) 57/69 (82.6) 73/85 (85.9) 130/154 (84.4) 2002 4:3:1 Adequate #/Total (percent) 47/59 (79.7) 50/62 (80.6) 97/121 (80.2) Table 114 shows immunization status of children born to women stratified by Medicaid status for the 2001 and 2002 study years. For Health District 10-0, children born to non-Medicaid women had a slightly higher immunization rate than children born to women using Medicaid. 152 Section V: Discussion of Results 153 Section V: Discussion Summary The purpose of the sixth year of the Georgia Immunization Study (GIS) was to assess the statewide and district-specific immunization coverage rates of two-year-old children who received immunizations from both public and private providers in Georgia in 2001-02. To assess these rates, the study drew an original sample of 4,387 children born in January 2000. The final sample of returned immunization records totaled 4,387. After removal of ineligible children (those deceased, adopted, moved out of state, born in military hospitals) the eligible sample was 4,147. Of these, 2,721 were located and make up the final sample. The sixth year of the GIS, 2002, measured immunization coverage for children born in 1999 at three levels: 4:3:1+3 coverage, defined as 4 DTP, 3 OPV/IPV, 1 MMR, 3 Hib, 3 Hep B, and 1 Varicella 4:3:1 coverage, defined as 4 DTP, 3 OPV/IPV, and 1 MMR 3:3:1 coverage, defined as 3 DTP, 3 OPV/IPV, and 1 MMR Of these three coverage levels, 4:3:1+3 coverage rates were lowest and 3:3:1 rates the highest. The 4:3:1 measure was used most frequently throughout the study. Although complete 4:3:1 coverage is not considered adequate by the childhood immunization schedule currently recommended, coverage rates have traditionally been calculated using the 4:3:1 measure. Continuing to use this measure for most of the analyses allowed for comparison of data collected in 1997-98,1998-99, 1999-00, 2001, and 2002. The newer 4:3:1+3 measure of *It must be remembered that the 2002 study is estimating 2000 rates. The 2001 study is estimating 1999 rates, 1999-00 study estimated 1997 rates, 1998-99 study estimated 1996 rates, and the 1997-98 study estimated rates for 1995. 154 coverage was added in 1997-98. Therefore, 4:3:1+3 rates can be compared using study data from 1997-98, 1998-99,1999-00, 2001 and 2002. The 2002 results reflect immunization rates for children born in 2000. The results of the study indicate that, of the 2,721 children whose immunization records were located during 2002 data collection: 78.9 percent of children born in January of 2000 in Georgia were adequately immunized with the 4:3:1+3 vaccine series, compared to 66.7 percent in those who were born in January of 1999. 83.9 percent of children born in January of 2000 in Georgia were adequately immunized with the 4:3:1 vaccine series, compared to 75.1 percent of children born in January of 1999, 78.8 percent of children born in November of 1997, 73.3 percent of children born in April of 1996, and 71.3 percent of those born in April of 1995. 4:3:1 immunization rates in the individual health districts ranged from 73.9 percent to 94.3 percent in the 2002 study 42.4 percent to 94.8 percent in the 2001 study 60.7 percent to 94.5 percent in the 1999-00 study 53.8 percent to 96.1 percent in the 1998-99 study 49.7 percent to 88.4 percent in the 1997-98 study The study investigated where the immunizations are being administered in Georgia (See Appendix E). In the sixth study year, 71.9 percent of the shots found were given by private providers. Furthermore, the findings may serve to guide future immunization assessments, as well as to highlight areas for additional research. 155 Conclusions The greatest increase in rates from the 2001 study to the 2002 study was observed in the 4:3:1+3 vaccine series (66.7% to 78.9%). These rates are lower, because they represent an immunization schedule that was introduced in the last few years. In fact, the most recent addition to the series, the Varicella vaccine, was only recommended for use in 1995 and was first available statewide in January 1997. The 2002 Georgia Immunization Study (GIS) measured Varicella rates for the fifth year. From one perspective, the rates represent a success for the Georgia Immunization Program and the health districts. Measurement of rates for a new vaccine series has to begin at some time. The collection of data on 4:3:1+3 rates from the first point at which these rates became available (i.e. the 1997-98 Georgia Immunization Study) will allow public health staff to survey trends and monitor rates. In reviewing the 4:3:1 vaccine series, rates increased statewide from the 2001 study (75.1 percent) to 83.9 percent in 2002. The results of the previous four years of the GIS study (1997-98, 1998-99, 1999-00, and 2001) show that immunization-specific coverage rates for the state remained relatively similar during the years when all shots were given, 19971998, 1996-97 and 1995-96, respectively. Strengths 1. This study represents Georgia's sixth successful statewide, population-based assessment of immunization coverage rates. The sampling methodology for the study, was originally developed by Dr. Joan Herold, Demographer/Survey Specialist at Emory University. The sample sizes fulfill the power and accuracy requirements for the data analyses. 2. The stratification of the sample by health district, allows for the calculation of district level immunization rates. 3. In the absence of a statewide registry, the study represents the current "state of the art" in this research area. The methodology allowed for analysis of these useful data: 156 Determination of where the shots are given, either public or private provider. (See Appendix E: Provider of Immunizations). Former immunization audits in Georgia have looked at rates of public providers alone. Assessment of immunization status based on the most recent recommended 4:3:1+3 vaccine series. Comparison of rates for children born in 1995, 1996, 1997, 1999, and 2000 in Georgia. 4. As a measure of reliability for the data entry process, double data entry was conducted on 5 percent of all records entered. The data entry error rate is approximately 1 percent for the 2002 study. Limitations The following sections describe important limitations of the study that should be considered when interpreting study results. 1. There were three limitations related to sampling. First, although the study included a random sample of children born in January 2000 and, thus, represented a generalizable estimate of coverage rates for all two-year-olds born in 2000, it could not account for variations that may routinely occur in other months of the year. Second, limiting the sample to children born in one month does not form the basis of a surveillance system capable of detecting changes in the health care system. Third, there may be children in the eligible sample who were erroneously included in the eligible sample and listed as not located. Examples of this type of error would be cases where a child died, was adopted, or was part of a military family, but the child's ineligibility related to these circumstances never became known to the study participants because the child could not be found. Although public health representatives were trained to follow the same protocol, each worked independently with limited supervision and may have deviated from the stated protocol in order to obtain all of the information. 157 2. Each year of the study fewer records were found in the public health system and consequently more parents had to be located. Parents in the Metro Atlanta area more often refused to participate (District 3-2, 3-4, and 3-5). Response rates tended to be lower in the Metro area (District 3-1, 3-2, 3-3, and 3-5). 158 APPENDIX A: DESCRIPTION OF SAMPLING PLAN AND STATISTICAL NOTE 159 APPENDIX A: DESCRIPTION OF SAMPLING PLAN AND STATISTICAL NOTE The target population for this study was children born in the state of Georgia in 2000 who were residing in the state in 2002. Children who were born in Georgia to mothers who were not Georgia residents were excluded, since Georgia was not responsible for the health care of these children. Children born on military bases were excluded because they fall under their own health care system and their immunization records were not obtainable. Those who died or moved out of state before their second birthday were also excluded because Georgia was no longer responsible for their immunization status. Adopted children were excluded because they were untraceable. The sampling frame for the study was all infants born in January 2000 in the state of Georgia who were born to Georgia residents, not in military hospitals, and who survived until their first birthday. This choice of sampling frame assumes no seasonality in birth coverage or exposure to immunizations in the state in 2000. From this sampling frame, independent random samples of birth certificate data were drawn for each health district in Georgia, in accordance with the required sample sizes. At the time of sample selection, children born in military hospitals and children known to have died within the first year of life were eliminated from the sampling frame. However, it was impossible to eliminate from the sampling frame children born to military families who were not born in a military hospital, children who were adopted, and children who died after the first year of life or who moved out of state during 2002. Thus, these exclusions were made after sample selection. It can be assumed that the elimination of these records after sample selection did not have a significant effect on the random nature of the sampling because of the very small percentage they represented of the total population. For a description of sample sizes, see Table 115: Data Used for Sample Size Estimates for the 2002 Study. Response rates and immunization coverage levels from the 2001 study were used in the sample size calculation for the 2002 study. The sample sizes were adjusted for small population size. The desired 160 sample size was then increased by a factor equivalent to the non-response rate (non-locatable immunization records) for each district from the 2001 study. The final calculated sample size is shown in the last column (Column H) of Table 115. This is the number of birth records statewide and per health district used as a result of this calculation for the study. At the end of the study, response rates (located immunization records) varied from a low of 30.7 percent to a high of 98.9 percent, with the average response rate for the state at 68.6 percent. The state level data are based on a sample stratified by health district, with differing probabilities of selection. Therefore, the district data were weighted in order to provide more accurate, weighted estimates for the state level coverage rates. 161 Table 115: Data Used for Sample Size Estimates for the 2002 Study A Health 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 9-3 10-0 State B Jan 2000 Total Births C D Jan 2001 2000 4:3:1 Eligible Immunization Births Rates 653 603 0.789 E 2002 First Sample Estimate 255.818 F G H 2002 Return 2002 Second Rate based Adjusted Sample on 2001 Sample Estimate Eligible Size Sample 179.617 0.734 245 448 437 0.781 262.825 164.119 0.767 214 654 609 0.948 75.750 67.370 0.683 99 936 912 0.707 318.317 235.959 0.456 517 1,234 1,193 0.424 375.284 285.480 0.607 470 374 365 0.576 375.284 185.035 0.418 365 978 961 0.759 281.081 217.473 0.810 268 905 881 0.755 284.240 214.905 0.597 360 729 695 0.835 211.711 162.278 0.786 206 139 135 0.85 195.922 79.927 0.896 89 536 522 0.691 328.102 201.469 0.590 341 551 530 0.889 151.634 117.902 0.900 131 477 387 0.731 302.163 169.680 0.810 209 310 297 0.767 274.614 142.684 0.912 156 467 431 0.932 97.386 79.437 0.893 89 349 324 0.691 328.102 163.019 0.855 191 456 380 0.908 128.365 95.952 0.970 99 338 238 0.716 312.467 135.098 0.744 182 447 439 0.844 202.320 138.493 0.887 156 10,981 10,339 0.751 0.698 4,387 162 Figure 23: Explanations of Table 115 Data Used for Sample Size Estimates For the 2002 Study Column A: Health District Column B: January 2000 Total Births Column C: January 2000 Eligible Births Column D: 2001 4:3:1 Immunization Rates Column E: First Sample Estimate 2002 Study Column F: Second Sample Estimate 2002 Study Column G: Estimated Return Rate (Based on 2001 Study) Column H: Adjusted Sample Size 2002 Study District number. Given. Source: DHR Vital Statistics Office. Given. Source: Georgia Birth Cohort Follow-up Study (1999-00). Formula Used: 3.8416 x (D) (1 D) / .0025 Adjustment for small size district populations. Formula Used: E / (1 + E/C). Given. Source: Georgia Birth Cohort Follow-up Study (1999-00). Formula Used: (Column F) / (Column G) 163 APPENDIX B: LIST OF 2002 PUBLIC HEALTH REPRESENTATIVES FOR THE GEORGIA IMMUNIZATION STUDY 164 APPENDIX B: LIST OF 2002 PUBLIC HEALTH REPRESENTATIVES FOR THE GEORGIA IMMUNIZATION STUDY Health 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 9-3 10-0 Public Health Representative Rosemarie Newman Ann Vossen, R.N. Annette Harkins, R.N. Joy Stymest Georgia Goseer, R.N. Likesar McCray Lisa Germany Freda Sheppard Kathy Heidish, R.N. Gloria Melvin Eunice Rose Stuart Brown, MD Mike Bynum Michelle Heard, R.N., B.S.N. Amy Fenn, RN Susan Beckham, R.N. Debbie Adams, R.N. Shelly Tye, R.N. Melba McNorril, R.N. Darlene Morris, R.N. Beverly Roberson, R.N., B.S.N. Kirsten Wright, M.P.H Yugonda Thomas Dorene Wilson Rhonda L. Schell Susan Malone, R.N. Lisa Boyett Hollard Phillips, M.S. Doris Wilbon, B.S. Stacy Giles, R.N. JoAnn Deas, R.N. Pat Thomas, R.N. Linda Sornson, R.N. Robert Hamilton Noelle Broadnax Barbie Bushey, R.N., C.P.N., M.P.H. 165 APPENDIX C: DATA COLLECTION FORM 166 167 168 APPENDIX D: VARICELLA VACCINE AND CHICKEN POX DATA 169 APPENDIX D: Varicella Vaccine and Chicken Pox Data Table 116 elaborates on the information found on the Varicella vaccine as well as information with regard to chicken pox. The results of this study have considered a child immunized for Varicella if the vaccine was administered anytime before or during the data collection period. The table below demonstrates the utilization of the Varicella vaccine results in two ways. The first column describes the Varicella results had the twoyear cut off been applicable. The second column depicts the Varicella results without the two-year restriction. The Varicella vaccination rates that report vaccination within the first two years of a child's life are lower than the Varicella vaccination rates that report vaccination at any point in time during the data collection period. These rates have not been adjusted for children who had natural Varicella immunity due to the chicken pox. The final column describes the frequency of cases of chicken pox by district. A child's chicken pox status was provided by health department records, parents, or physicians. The percent column is equal to the number of children who had chicken pox divided by the district's final sample size. 170 Table 116: 2002 Varicella Rates and Cases of Chicken Pox by District Health District Varicella shot by age 2 Varicella shot Had chicken pox at anytime (by end of anytime (by end of data collection) data collection) 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 9-3 10-0 Statewide Number Percent 168 83.6 130 82.3 73 96.1 248 87.3 118 81.9 89 80.2 159 90.9 160 82.1 134 91.2 61 78.2 214 86.3 95 93.1 96 82.8 115 89.1 70 90.9 121 79.6 74 83.1 96 81.4 101 83.5 2,322 85.3 Number Percent 179 89.1 136 86.1 73 96.1 251 88.4 118 81.9 92 82.9 168 96.0 163 83.6 136 92.5 66 84.6 224 90.3 99 97.1 103 88.8 120 93.0 70 90.9 127 83.6 78 87.6 99 83.9 105 86.8 2,407 88.5 Number Percent 3 1.5 2 1.3 0 0.0 2 0.7 2 1.4 0 0.0 2 1.1 1 0.5 1 0.7 3 3.8 1 0.4 1 1.0 2 1.7 1 0.8 0 0.0 5 0.7 2 2.2 1 0.8 0 0.0 29 1.1 171 Figure 24: 2002 State Varicella Coverage Rates and Percentage of Sample with Chicken Pox Disease 80 70 60 50 40 30 20 10 0 STATE Vaccine By Two Vaccine Anytime With disease Figure 24 depicts the Varicella rate by the age of two years and the Varicella rate without the two year cut-off (received Varicella shot at any time during the data collection period). The last bar indicates the percentage of children with documented chicken pox disease at any point in time. 172 Appendix E: Provider of Immunizations 173 Appendix E: Provider of Immunizations Information about the provider of the immunizations was collected by noting where the shots were given (Public Health, Private Health, or Both) and who provided the information (Health Department, Private Provider, or Parent). If there was no indication of who gave the individual shot, the location for that shot was classified as unknown. The total number and percentage of shots given at each of the provider categories is shown in Table 117. Table 117: Statewide Percentage of Shots by Provider: 1998-99, 1999-00, 2001, and 2002 Provider Public Health Dept Private Physician Unknown 1998-99 Total Percent # 20,222 45.1% 22,686 50.6% 1,934 4.3% 1999-00 Total Percent # 11,248 29.1% 2001 Total Percent # 9,472 25.5% 23,984 61.9% 25,797 69.5% 3,503 9.0% 1,866 5.0% 2002 Total Percent # 8,085 20.3% 28,667 71.9% 3,112 7.8% Total 44,842 100.0% 38,735 100.0% 37,135 100.0% 39,864 100.0% As shown in Table 117, in 2002, over 70% of the shots recorded for the sampled children were given by a private provider. 174 Location of Immunizations by District Table 118 illustrates the distribution of immunizations among public and private providers for each health district. These data were generated by counting the total number of shots given in each health district by provider location. Table 118: District Specific Percentage of Shots by Provider 2002 District Public Health Department Private Physician Unknown Total Shots Given 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 9-3 10-0 State # Shots Given 591 308 284 791 480 402 195 318 437 349 979 378 390 390 259 440 474 280 340 Percent 20.3 13.7 24.3 19.1 24.0 26.6 7.4 11.7 19.9 29.9 26.7 24.1 22.8 20.5 22.8 17.5 36.4 16.9 19.9 # Shots Given 2,129 1,505 875 2,253 1,130 892 2,322 2,337 1,678 806 2,426 1,171 1,321 1,501 841 1,974 777 1,362 1,367 8,085 20.3 28,667 Percent 73.2 66.9 75.0 54.4 56.5 59.1 87.9 86.4 76.5 69.0 66.2 74.6 77.1 78.7 73.9 78.2 59.7 82.2 80.1 # Shots Given 189 437 8 1,097 389 216 124 51 79 13 260 20 2 15 38 109 51 14 0 Percent 6.5 19.4 0.7 26.5 19.5 14.3 4.7 1.9 3.6 1.1 7.1 1.3 0.1 0.8 3.3 4.3 3.9 0.9 0.0 71.9 3,112 7.8 2,909 2,250 1,167 4,141 1,999 1,510 2,641 2,706 2,194 1,168 3,665 1,569 1,713 1,906 1,138 2,523 1,302 1,656 1,707 39,864 175 In Year Six: In all nineteen health districts, more than 50% of the shots were given in the Private sector. Results by region: North (Districts 1-1, 1-2, 2-0, and 10-0) In all of these districts private physicians gave the majority of the immunizations. Metro Atlanta (Districts 3-1, 3-2, 3-3, 3-4, and 3-5) In the metro-Atlanta area more of the immunizations were administered in the private sector than in the public sector. District 3-1, Cobb County had the highest number of unknown shot locations (26.5 percent). Central (Districts 4-0, 5-1, 5-2, 6-0, 7-0) Children in all of the central districts received the majority of their shots at a private provider. South (Districts 8-1, 8-2, 9-1, 9-2, 9-3) Private providers provided the majority of vaccinations in all health districts. 176 Four Year Comparison of Provider Information The following table shows a comparison of results from the current year and the three previous years of the study. The comparisons reflect a movement of immunization services into the private sector in Georgia. Table 119: Location of Immunizations by District Four Year Comparison 1998-99, 1999-00, 2001, 2002 District Public Health Department 98-99 99-00 2001 2002 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 9-3 10-0 55.9 51.7 34.5 24.9 60.5 35.5 41.9 18.8 24.9 30.6 34.8 19.1 17.5 8.9 24.4 25.9 62.4 35.8 44.5 51.8 60.1 46.3 30.0 34.9 60.5 36.1 60.9 23.1 70.3 26.5 41.9 14.4 81.3 57.9 52.0 31.0 40.7 34.1 State 45.1 29.0 Totals 26.5 16.0 20.3 18.9 28.7 20.2 3.1 22.0 25.4 43.7 44.9 14.5 36.1 30.6 29.6 16.7 53.9 23.6 19.7 25.5 20.3 13.7 24.3 19.1 24.0 26.6 7.4 11.7 19.9 29.9 26.7 24.1 22.8 20.5 22.8 17.5 36.4 16.9 19.9 20.3 Private Physician 98-99 99-00 2001 2002 44.1 44.2 65.7 73.2 63.6 72.6 81.3 66.9 39.3 48.3 75.9 75.0 56.0 57.5 55.3 54.4 59.3 60.2 48.9 56.5 39.6 53.4 66.2 59.1 80.2 77.1 96.9 87.9 65.7 65.9 75.7 86.4 36.3 61.0 74.2 76.5 55.3 43.2 52.5 69.0 38.8 53.6 51.4 66.2 70.0 59.8 84.9 74.6 37.1 55.6 63.8 77.1 35.1 76.3 69.3 78.7 29.7 59.8 70.4 73.9 52.8 81.7 81.1 78.2 17.1 39.7 45.5 59.7 47.4 61.2 75.7 82.2 57.9 65.8 80.1 80.1 50.6 61.9 69.5 71.9 177 Four-Year Comparison: Summary of Table 119 In 1998-99 45.1% of the shots were given in the public health department 50.6% of the shots were given in the private sector 4.3% of the shot locations were unknown In 1999-00 29.0% of the shots were received at the public health department 61.9% of the shots were given in the private sector 9.0% of the shot locations were unknown In 2001 25.5% of the shots were received at the public health department 69.5% of the shots were given in the private sector 5.0% of the shot locations were unknown In 2002 20.3% of the shots were received at the public health department 71.9% of the shots were given in the private sector 7.8% of the shot locations were unknown 178 APPENDIX F: MARGINS OF ERROR FOR IMMUNIZATION COVERAGE RATES 179 APPENDIX I: MARGINS OF ERROR FOR IMMUNIZATION COVERAGE RATES Margins of error were calculated for all statewide and district immunization coverage rates, including 4:3:1+3 rates, 4:3:1 rates, and 3:3:1 rates. These margins of error can be found in Tables 120-122. The formula used to calculate the margins of error in these tables was: Margin of error = square root of: (3.8416)(imm rate)(1 - imm rate) Final sample size Confidence intervals can be calculated using the margins of error. The constant 3.8416 is the chi-square value representing an error probability of less than 5%. Using the above formula for margin of error yields a 95% confidence interval for immunization rates. The interpretation of the 95% confidence interval for the state 4:3:1 immunization rate is as follows: With 95% confidence, the true statewide 4:3:1 immunization rate for infants born in 2000 is between 82.3 and 85.5 percent. Due to the extensive analyses conducted for this report and the large number of rates reported, margins of error for specific rates were only calculated for the following: Statewide 4:3:1+3 immunization coverage rates Statewide 4:3:1 immunization coverage rates Statewide 3:3:1 immunization coverage rates District 4:3:1+3 immunization coverage rates District 4:3:1 immunization coverage rates District 3:3:1 immunization coverage rates These margins of error and confidence intervals are noted in this appendix. 180 Table 120: Margins of Error for 2002 Statewide and District 4:3:1+3 Rates Health District Sizes of Final Sample (Records Located) 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 9-3 10-0 Statewide Rate (weighted) 201 158 76 284 144 111 175 195 147 78 248 102 116 129 77 152 89 118 121 2,721 4:3:1+3 Immunization Coverage Rates (percent) 75.1 72.8 93.4 81.3 77.8 69.4 86.9 77.9 85.0 70.5 80.2 86.3 74.1 77.5 81.8 74.3 79.8 80.5 74.4 Margins of Error (percent) +/- 6.0 +/- 6.9 +/- 5.6 +/- 4.5 +/- 6.8 +/- 8.6 +/- 5.0 +/- 5.8 +/- 5.8 +/- 10.1 +/- 5.0 +/- 6.7 +/- 8.0 +/- 7.2 +/- 8.6 +/- 6.9 +/- 8.3 +/- 7.1 +/- 7.8 95% Confidence Intervals (percent) 69.1 81.1 65.9 79.7 87.8 99.0 76.8 85.8 71.0 84.6 60.8 78.0 81.9 91.9 72.1 83.7 79.2 90.8 60.4 80.6 75.2 85.2 79.6 93.0 66.1 82.1 70.3 84.7 73.2 90.4 67.4 81.2 71.5 88.1 73.4 87.6 66.6 82.2 78.9 +/- 1.5 77.4 80.4 181 Table 121: Margins of Error for 2002 Statewide and District 4:3:1 Rates Health 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 9-3 10-0 Sizes of Final Sample (Records Located) 201 158 76 284 144 111 175 195 147 78 248 102 116 129 77 152 89 118 121 4:3:1 Immunization Coverage Rates (percent) 80.6 79.1 93.4 84.5 82.6 73.9 94.3 84.6 87.1 80.8 84.7 89.2 82.8 82.2 83.1 80.9 85.4 85.6 80.2 Margins of Error (percent) +/- 5.5 +/- 6.3 +/- 5.6 +/- 4.2 +/- 6.2 +/- 8.2 +/- 3.4 +/- 5.1 +/- 5.4 +/- 8.7 +/- 4.5 +/- 6.0 +/- 6.9 +/- 6.6 +/- 8.4 +/- 6.2 +/- 7.3 +/- 6.3 +/- 7.1 95% Confidence Intervals (percent) 75.1 86.1 72.8 85.4 87.8 99.0 80.3 88.7 76.4 88.8 65.7 82.1 90.9 97.7 79.5 89.7 81.7 92.5 72.1 89.5 80.2 89.2 83.2 95.2 75.9 89.7 75.6 88.8 74.7 91.5 74.7 87.1 78.1 92.7 79.3 91.9 73.1 87.3 Statewide Rate (weighted) 2,721 83.9 +/- 1.6 82.3 85.5 182 Table 122: Margins of Error for 2002 Statewide and District 3:3:1 Rates Sizes of Final Health Sample District (Records Located) 1-1 201 1-2 158 2-0 76 3-1 284 3-2 144 3-3 111 3-4 175 3-5 195 4-0 147 5-1 78 5-2 248 6-0 102 7-0 116 8-1 129 8-2 77 9-1 152 9-2 89 9-3 118 10-0 121 Statewide Rate 2,721 (weighted) 3:3:1 Immunization Coverage Rates (percent) 87.6 82.9 96.1 89.1 83.3 81.1 96.0 86.2 91.8 96.2 90.7 94.1 88.8 89.9 88.3 86.8 91.0 87.3 86.0 88.8 Margins of Error (percent) +/- 4.6 +/- 5.9 +/- 4.4 +/- 3.6 +/- 6.1 +/- 7.3 +/- 2.9 +/- 4.8 +/- 4.4 +/- 4.2 +/- 3.6 +/- 4.6 +/- 5.7 +/- 5.2 +/- 7.2 +/- 5.4 +/- 5.9 +/- 6.0 +/- 6.2 95% Confidence Intervals (percent) 83.0 92.2 77.0 88.8 91.7 100.5 85.5 92.7 77.2 89.4 73.8 88.4 93.1 98.9 81.4 91.0 87.4 96.2 92.0 100.4 87.1 94.3 89.5 98.7 83.1 94.5 84.7 95.1 81.1 95.5 81.4 92.2 85.1 96.9 81.3 93.3 79.8 92.2 +/- 1.2 87.6 90.0 183