GEORGIA IMMUNIZATION STUDY 2003 Final Report Georgia Department of Human Resources Division of Public Health Epidemiology Branch Prevention Branch, Immunization Program Nineteen Public Health Districts Prepared by Carol A. Hoban, M.S., M.P.H. Principal Investigator and Project Coordinator Contributors Mike Chaney, Georgia Immunization Program Manager Acknowledgments The Georgia Department of Human Resources, Division of Public Health, Epidemiology Branch and the Immunization Program would like to thank the public health representatives that participated in this study for all of their hard work, support and dedication. This study could not have been completed successfully without the cooperation of health district staff throughout Georgia. A profound thank you and sincere appreciation is also given to the private and non-public health providers and the Vaccines for Children providers that participated in this collaborative effort. Their cooperation and assistance throughout the study is greatly appreciated. We would also like to thank the Rollins School of Public Health at Emory University for providing us with the study materials. Their generosity allowed us to continue repeated assessments each year and compare our efforts with theirs. A special note of thanks to Mr. Mike Chaney, Georgia Immunization Program Manager, for his support and leadership during this study. 2003 Executive Summary The 2003 Immunization Study was conducted by the Georgia Department of Human Resources, Division of Public Health, Epidemiology Branch, Immunization Program and Public Health Districts. However, this study could not have been conducted without the assistance of the private providers, non-public health providers and the Vaccines for Children providers that contributed in this collaborative effort. Their cooperation and assistance throughout the study is greatly appreciated. The Immunization Study employs a non-experimental retrospective cohort research design in order to ascertain the immunization coverage rate for children born in the State of Georgia. This study design allows for the calculation of immunization rates for children who turned two in January 2003. Identifying information about the children and their parents was collected from birth certificates. The Immunization Study showed that during 2003 most childhood immunizations (75 percent) were administered in the private sector, while County Health Departments immunized 16 percent, and the sources for 9 percent are unknown. The proportion of children in Georgia who have received all of the recommended vaccinations increased steadily from 16 percent in 1997 to 79 percent in 2002, with a slight decline in 2003 to 74 percent. Acute infection with Hepatitis B causes severe disease in only a small proportion of those infected, but it can lead to chronic infection, cirrhosis, and cancer of the liver. In Georgia in 2003, 91 percent of infants had received two doses of hepatitis B vaccine by 12 months of age, and, at 24 months, 88 percent of children had received the recommended three doses. Vaccines have largely controlled diphtheria, measles, pertussis, and other scourges of the past. In 1923, with a population of less than three million, Georgia recorded 274 deaths from diphtheria, 347 deaths from measles, and 254 deaths from pertussis, while in 2003, just 80 years later, and with a population that has almost tripled, Georgia had no reported cases of tetanus or diphtheria, and just 36 cases of pertussis. In 2003, 85 percent of children 12 months of age were appropriately immunized against diphtheria, tetanus and pertussis, and 74 percent of Georgia's two-year-olds were adequately immunized against ten vaccine-preventable childhood diseases (diphtheria, tetanus, pertussis, hepatitis B, H. influenzae type B, mumps, measles, rubella, polio and varicella). There was considerable variation from district to district in the proportion of two-yearolds reported to be fully immunized, ranging from 59 percent in the DeKalb district to 92 percent in the North (Gainesville) district. Three of the state's public health districts (Gainesville, Valdosta and Athens) succeeded in immunizing at least 85 percent of their two-year-olds against the 10 vaccine-preventable childhood diseases. Nine of the public health districts (Rome, Cobb-Douglas, Fulton, DeKalb, Columbus, Albany, Savannah, Waycross and Brunswick) had a rate less than 75 percent. Within Metropolitan Atlanta, the immunization rates varied from 59 percent in DeKalb to 83 percent in Gwinnett. In Georgia outside Metropolitan Atlanta, the immunization rates ranged from 61 percent in Savannah to 92 percent in the Gainesville district (see Map below). There was minor variation in immunization status of children by the race and education of their mothers, and by whether their mothers were Medicaid recipients. Among children of white women, 78 percent were adequately immunized, while among children of black women, 70 percent were adequately immunized. Children of college-educated mothers had slightly higher immunization rates (79 percent) than children of mothers with less than high school education (76 percent). The children of mothers who did not receive Medicaid were more likely to be adequately immunized (79 percent) than were children of mothers who did receive Medicaid (72 percent). Map 2. Georgia Vaccination Rates (4:3:1:3:3:1) by Public Health District, 2003 Health Districts Counties Vaccination Rate Dade Catoosa Walker Whitfield Murray Chattooga 1-1 Floyd Gordon Bartow Fannin Union Gilmer 1-2 Pickens Lumpkin Dawson Cherokee Forsyth Towns Rabun White Habersham 2 Stephens Banks Franklin Hall Jackson Madison Hart Elbert 58.7 - 68.0 72.4 - 79.1 81.7 - 91.5 Polk Haralson Carroll Paulding 3-1 Cobb Gwinnett 3-4 Barrow Clarke Oconee Douglas 3-2 DeKalb Fulton 3-5 Rockdale Walton 3-3 Clayton Newton Morgan Oglethorpe 10 Wilkes Greene Taliaferro Lincoln Columbia McDuffie Fayette Henry Warren Richmond Heard Coweta Troup 4 Meriwether Spalding Butts Jasper Putnam Hancock Glascock Pike Lamar Monroe Jones 5-2 Baldwin Washington Jefferson 6 Burke 1-1 Northwest (Rome) 1-2 North Georgia (Dalton) 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton (Morrow) 3-4 East Metro (Lawrenceville) 3-5 DeKalb 4 LaGrange 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 East (Savannah) 9-2 Southeast (Waycross) 9-3 Coastal (Brunswick) 10 Northeast (Athens) Note: The State Vaccination Rate (4:3:1) is 74.3 Upson Bibb Wilkinson Jenkins Screven Harris Talbot Crawford Twiggs Johnson Emanuel Muscogee 7 Chattahoochee Marion Taylor Peach Houston Macon Bleckley Laurens 5-1 Treutlen Candler Bulloch Effingham 9-1 Schley Stewart Webster Sumter Quitman Randolph Terrell Lee Dooly Pulaski Crisp Wilcox Turner Dodge Montgomery Wheeler Toombs Evans Tattnall Bryan Telfair Ben Hill Jeff Davis Appling Long Liberty Chatham Clay Calhoun Dougherty Early Miller Baker Mitchell 8-2 Seminole Decatur Grady Worth Irwin Tift Coffee Colquitt Berrien 8-1 Cook Atkinson Lanier Thomas Brooks Lowndes Clinch Echols Bacon Wayne 9-2 Pierce Brantley Ware Charlton McIntosh 9-3 Glynn Camden 0 510 20 30 40 Miles Georgia Department of Human Resources Division of Public Health Office of Health Information & Policy Created: April, 2004 Source: Georgia Division of Public Health Projection: UTM 1983, Zone 16 Classification: Natural Breaks Map originally in color. 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................................................................................................... 158 ii List of Tables Page 1. Project Activity Timeline ............................................................................. 3 2. Sample Description ................................................................................... 14 3. 2003 Eligible Sample, Number Located, and Response Rate by District.. 16 4. Parent Refusals by Health District for the 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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. 2003 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 2003 Study ...................... 161 116. 2003 Varicella Rates and Cases of Chicken Pox by District ................... 170 117. Statewide Percentage of Shots by Provider: 1998-99, 1999-00, 2001, 2002 and 2003 ........................................................................................ 173 118. District Specific Percentage of Shots by Provider 2003 .......................... 174 119. Location of Immunizations by District -Four Year Comparison 1999-00, 2001, 2002 and 2003 .............................................................................. 176 120. Margins of Error for 2003 Statewide and District 4:3:1+3 Rates ............. 180 121. Margins of Error for 2003 Statewide and District 4:3:1 Rates ................. 181 122. Margins of Error for 2003 Statewide and District 3:3:1 Rates ................. 182 ix List of Figures Page 1. Sampling Procedure.................................................................................... 13 2. 2003 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 2003 Study ................................................................................................ 162 24. 2003 State Varicella Coverage Rates and Percentage of Sample with Chicken Pox Disease ................................................................................ 171 x List of Appendices Page Appendix A: Description of Sampling Plan and Statistical Note.............. ......... 158 Appendix B: List of 2003 Public Health Representatives ......................... ........ 163 Appendix C: Data Collection Form........................................................... ........ 165 Appendix D: Varicella Vaccine and Chicken Pox Data ............................ ........ 168 Appendix E: Provider of Immunizations ................................................... ........ 172 Appendix F: Margins of Error for Immunization Coverage Rates............. ........ 178 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 2003 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. The sixth year, 2002 examined immunization rates for children born in 2000. This year, immunization rates for children born in January 2001 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 2002. During December 2002, 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 2003. 2 During January, a training session for the public health representatives was held via conference call. Data were collected from February 2003 through August 2003. (Data collection continued on some difficult to obtain records through the end of September 2003). 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, 2002 Initial notification of public health community Immunization Coordinators December, 2002 Health Directors Initial notification of private health January, 2003 community One day training for public health January, 2003 representatives Data collection period February August, 2003 Data entry period February November, 2003 Double data entry of 5% of data forms December, 2003 Final data cleaning and analysis of data December-January, 2003 Final Report January, 2004 Throughout this report, we refer to study years one, two, three, four, and five as 1998-99, 1999-00, 2001, 2002, and 2003 respectively. The results from these five study years refer to rates for 1996, 1997, 1999, 2000, and 2001 respectively. 3 Data collection was extended beyond August 2003 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 seventh 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 2001. 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 2003. Identifying information about the children and their parents was collected from birth certificates. Target and Sample Populations The target population of the seventh year of the Georgia Immunization Study included all two-year-old children born in the State of Georgia in 2001. A sample size of 3,813 children born in the month of January 2001 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 2001. 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 sex 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 via a conference call during January 2003. 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 has been revised and updated by the staff at the Georgia Division of Public Health for use in each subsequent study year. 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. 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 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 9 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 United States (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 year four 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 2003. 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 98.0% 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 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 2003 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. The sixth year, 2002 examined immunization rates for children born in 2000. This year, immunization rates for children born in January 2001 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 2002. During December 2002, 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 2003. 2 During January, a training session for the public health representatives was held via conference call. Data were collected from February 2003 through August 2003. (Data collection continued on some difficult to obtain records through the end of September 2003). 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, 2002 Initial notification of public health community Immunization Coordinators December, 2002 Health Directors Initial notification of private health January, 2003 community One day training for public health January, 2003 representatives Data collection period February August, 2003 Data entry period February November, 2003 Double data entry of 5% of data forms December, 2003 Final data cleaning and analysis of data December-January, 2003 Final Report January, 2004 Throughout this report, we refer to study years one, two, three, four, and five as 1998-99, 1999-00, 2001, 2002, and 2003 respectively. The results from these five study years refer to rates for 1996, 1997, 1999, 2000, and 2001 respectively. 3 Data collection was extended beyond August 2003 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 seventh 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 2001. 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 2003. Identifying information about the children and their parents was collected from birth certificates. Target and Sample Populations The target population of the seventh year of the Georgia Immunization Study included all two-year-old children born in the State of Georgia in 2001. A sample size of 3,813 children born in the month of January 2001 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 2001. 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 sex 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 via a conference call during January 2003. 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 has been revised and updated by the staff at the Georgia Division of Public Health for use in each subsequent study year. 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. 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 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 9 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 United States (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 year four 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 2003. 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 98.0% 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 3,813 children was drawn from 11,188 children born in Georgia in January 2001. A total of 133,468 children were born in Georgia during 2001. Children who were ineligible for participation in the study were extracted from the original sample, leaving an eligible sample of 3,613. (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 2001 (N = 133,468) All children born in Georgia in January 2001 (N = 11,188) Original sample of 3,813 children Eligible sample of 3,613 children Final sample of 2,567 children Of the 3,613 children in the eligible sample, 2,567 children were located, 932 children never were located and 114 parental refusals were removed. The resulting final sample consisted of 2,567 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 2,567 children represented 71 percent of the eligible sample. Table 2: Sample Description Sampling Step Original Sample Deceased Adopted Moved out of state Military Number 3,813 2 6 125 67 Percent of Sample 100.0% 0.1% 0.2% 3.2% 1.7% Eligible Sample 3,613 94.8% Eligible Sample Records Not Located /Eligibility Unknown * 3,613 1,046 100.0% 29.0% Final Sample (Located Records**) 2,567 71.0% * 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 2003 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 36.1 percent to a high of 98.9 percent, with a statewide average response rate of 74.2 percent. 15 Table 3: 2003 Eligible Sample, Number Located and Response Rates by District Health Eligible Number Response District Sample Located* (Number) Rate ** (% of Eligible Sample located) 1-1 198 155 78.3% 1-2 172 165 95.9% 2-0 109 103 94.5% 3-1 221 152 68.8% 3-2 487 176 36.1% 3-3 344 271 78.8% 3-4 89 65 73.0% 3-5 270 152 56.3% 4-0 180 119 66.1% 5-1 92 91 98.9% 5-2 175 138 78.9% 6-0 135 125 92.6% 7-0 236 140 59.3% 8-1 129 124 96.1% 8-2 166 151 91.0% 9-1 167 150 89.8% 9-2 147 140 95.2% 9-3 110 94 85.5% 10-0 185 169 91.4% State 3,613 2,681 74.2% *sample includes parental refusals **number located / eligible sample 16 Figure 2 2003 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 2003 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 155 165 103 152 176 271 65 152 119 91 138 125 140 124 151 150 140 94 169 2,681 Parent Refusals Number 4 12 9 7 38 3 5 2 9 1 12 2 0 0 1 0 2 0 7 114 Percent 2.6 7.3 8.7 4.6 21.6 1.1 7.7 1.3 7.6 1.1 8.7 1.6 0.0 0.0 0.7 0.0 1.4 0.0 4.1 4.3 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 2,567 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 2,567 children who were located in 2003, 74.3 percent were adequately immunized at the 4:3:1+3 level. This percent of adequately immunized children decreased from 78.9 percent in 2002. 19 Table 5: 4:3:1+3 State Immunization Coverage by Study Year Status Adequately Immunized Number Percent 1998-99 1,360 41.9 1999-00 1,573 56.3 2001 1,837 66.7 2002 2,146 78.9 2003 1,906 74.3 Note: State rates based on data weighted by health district. Inadequately Immunized Number Percent 2,100 58.1 1,220 43.7 918 33.3 575 21.1 661 25.7 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 73.3 percent in 1998-99 to 78.8 percent in 1999-00, but decreased slightly to 75.1 percent in the 2001 assessment. The 2002 assessment had the highest percentage recorded since this study began with the number of adequately immunized children at 83.9 percent. During the 2003 assessment, the number of adequately immunized children decreased to 80.8 percent. Status Table 6: 4:3:1 State Immunization Coverage by Study Year Adequately Immunized Inadequately Immunized Number Percent Number Percent 1998-99 2,511 73.3 949 26.7 1999-00 2,202 78.8 591 21.2 2001 2,068 75.1 687 24.9 2002 2,284 83.9 437 16.1 2003 2,075 80.8 492 19.2 Note: State rates based on data weighted by health district. 20 Figure 3: Statewide Coverage 4:3:1 and 4:3:1+3 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 4:3:1 4:3:1+3 Figure 3 reveals the statewide 4:3:1 coverage rates for the 1998-99, 1999-00, 2001, 2002 and 2003 studies. The figure also shows statewide 4:3:1+3 vaccination coverage for the 1998-99, 1999-00, 2001, 2002 and 2003 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 increased during the 1998-99 and 1999-00 studies (78.4 and 82.0 respectively) and decreased slightly in the 2001 study to 78.9 percent. In the 2002 study the 3:3:1 rate increased to 88.8 percent, but has decreased slightly in 2003 to 85.9 percent. 21 Table 7: 3:3:1 State Immunization Coverage by Study Year Status Adequately Immunized Number Percent 1998-99 2,685 78.4 1999-00 2,290 82.0 2001 2,175 78.9 2002 2,417 88.8 2003 2,205 85.9 Note: State rates based on data weighted by health district. Inadequately Immunized Number Percent 775 21.6 503 18.0 580 21.1 304 11.2 362 14.1 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 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. In 2003, coverage rates decreased slightly, but still showed over 90 percent coverage for 3 DTP/DTap vaccine series. The coverage rate for the Varicella vaccine dramatically increased from 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. The coverage rate for the Varicella vaccine decreased slightly in 2003 to 81.8 percent. (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 1998-99 1999-00 2001 Number Percent Number Percent Number Percent 2,912 84.9 2,491 89.2 2,392 86.8 4 DTP/DTaP 2,545 74.2 2,233 79.9 2,093 76.0 3 OPV/IPV 2,864 83.6 2,358 84.4 2,226 80.8 1 MMR 2,752 80.2 2,363 84.6 2,258 82.0 3 Hib 2,866 83.6 2,441 87.4 2,322 84.3 3 Hep B 2,839 82.9 2,422 86.7 2,308 83.8 1 Varicella 1,620 47.1 1,795 64.3 2,147 77.9 Note: State rates based on data weighted by health district. 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 2003 Number Percent 2,340 91.2 2,096 81.7 2,251 87.7 2,266 88.3 2,242 87.3 2,255 87.8 2,101 81.8 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 1998-99, 1999-00, 2001, 2002 and 2003 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 98-99 98-99 99-00 99-00 2001 2001 2002 2002 2003 2003 DTP/DTaP1 3,071 88.8% 2,588 92.7% 2,507 91.0% 2,667 98.0% 2,447 95.3% DTP/DTaP2 2,976 86.0% 2,507 89.8% 2,426 88.1% 2,592 95.3% 2,367 92.2% DTP/DTaP3 2,712 78.4% 2,327 83.3% 2,214 80.4% 2,394 88.0% 2,176 84.8% DTP/DTaP4 81 2.3% 25 0.9% 12 0.4% 23 0.8% 8 0.3% DTP/DTaP5 0 0.0% 1 0.0% 0 0.0% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 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% 2,442 2,350 1,004 3 95.1% 91.5% 39.1% 0.1% MMR1** MMR2 206 6.0% 117 4.2% 87 3.2% 34 1.2% 92 3.6% 1 0.0% 1 0.0% 0 0.0% 1 0.0% 1 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 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% 2,436 2,345 1,110 16 0 94.9% 91.4% 43.2% 0.6% 0.0% HEPB1 HEPB2 HEPB3 HEPB4 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% 2,440 2,346 1,264 19 95.1% 91.4% 49.2% 0.7% VAR1** 160 4.6% 150 5.4% 118 4.3% 44 1.6% 125 4.9% VAR2 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 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 1998-99 study = 3,460; 1999-00 study = 2,793; 2001 study = 2,755; 2002 study = 2,721; 2003 study = 2,567. 24 Table 10 shows the 1998-99, 1999-00, 2001, 2002 and 2003 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 2003 margin of error for each health district ranges from +/- 4.5 percent to +/- 7.8 percent. The District level 2003 4:3:1 immunization rates range from 66.0 percent to 94.7 percent. Of the 19 health districts, five had an immunization coverage rate over 90 percent and seven districts had 2003 coverage rates between 80 and 90 percent. The following summary highlights the changes in 4:3:1 coverage rates between 2002 and 2003: Coverage increased between 0 and 5 percent in three districts (District 2-0, 3-1 and 3-3) Coverage increased between 5 and 20 percent in four districts (Districts 1-2, 5-1, 8-1and 10-0) Coverage fell between 0 and 5 percent in eight districts (Districts 1-1, 3-4, 4-0, 5-2, 6-0, 9-1, 9-2 and 9-3) Coverage fell between 5 and 20 percent in four districts (Districts 3-2, 3-5, 7-0 and 8-2) 25 Table 10: 4:3:1 District and State Coverage Rates by Study Year Dist 1998-99 1999-00 2001 2002 2003 % Margin % Margin % Margin of % Margin % Margin of Error of Error Error of Error of Error 1-1 78.2 +/- 6.8 67.5 +/- 7.1 78.9 +/-6.2 1-2 74.9 +/- 6.4 75.3 +/-7.0 78.1 +/-6.7 2-0 66.7 +/- 6.8 88.5 +/-5.5 94.8 +/-3.7 3-1 58.1 +/- 6.5 75.6 +/-6.1 70.7 +/-6.8 3-2 53.8 +/- 5.4 69.6 +/-6.5 42.4 +/-5.6 3-3 76.3 +/- 7.1 60.7 +/-10.4 57.6 +/-8.9 3-4 65.0 +/- 5.6 94.5 +/-2.3 75.9 +/-9.4 3-5 63.0 +/- 5.5 64.9 +/-6.3 75.5 +/-6.0 4-0 67.5 +/- 5.6 79.7 +/-5.7 83.5 +/-5.1 5-1 87.1 +/- 7.1 91.3 +/-6.2 85.0 +/-9.0 5-2 94.5 +/- 2.8 83.6 +/-9.8 69.1 +/-8.6 6-0 96.1 +/- 2.8 72.3 +/-12.8 88.9 +/-4.8 7-0 67.9 +/- 7.8 77.1 +/-6.3 73.1 +/-6.7 8-1 80.4 +/- 8.1 86.0 +/-6.6 76.7 +/-8.2 8-2 83.8 +/- 6.1 83.7 +/-5.9 93.2 +/-4.3 9-1 80.4 +/- 6.5 78.5 +/-7.1 69.1 +/-8.2 9-2 83.5 +/- 6.6 85.0 +/-6.1 90.8 +/-4.9 9-3 60.6 +/- 9.2 82.2 +/-8.8 71.6 +/-9.1 10-0 78.9 +/- 6.1 73.4 +/-7.0 84.4 +/-5.7 State 73.3 +/- 1.5 78.8 +/-1.5 75.1 +/-1.5 Note: State rates based on data weighted by health district. 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 77.5 85.6 94.7 75.2 68.1 78.4 90.0 66.0 83.6 93.3 83.3 86.2 76.4 91.9 74.0 77.3 81.2 81.9 90.7 80.8 +/-6.7 +/-5.6 +/-4.5 +/-7.0 +/-7.8 +/-4.9 +/-7.6 +/-7.6 +/-6.9 +/-5.2 +/-6.5 +/-6.1 +/-7.0 +/-4.8 +/-7.0 +/-6.7 +/-6.5 +/-7.8 +/-4.5 +/-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 1998-99, 1999-00, 2001, 2002 and 2003 data collection periods. 26 As shown in Table 11, 2003 district immunization rates for the DTP/DTaP vaccines ranged from 66.0 percent to 95.7 percent, with a statewide rate of 81.7 percent receiving all four doses. The 2003 statewide DTP/DTaP rate decreased slightly from the 2002 study year. 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 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% 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% Note: State rates based on data weighted by health district. 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% 2003 Rates 4 DTP/DTaP 77.5% 86.3% 95.7% 76.6% 68.1% 79.1% 90.0% 66.0% 84.5% 93.3% 84.9% 87.8% 77.1% 91.9% 75.3% 77.3% 82.6% 83.0% 93.2% 81.7% 27 Table 12 shows the 1998-99, 1999-00, 2001, 2002 and 2003 state and district rates for the OPV/IPV vaccines. The 2003 district coverage rates for these vaccines varied between 71.7 percent and 97.8 percent. The 2003 statewide immunization rate for OPV/IPV was 87.7 percent, which is slightly lower than the previous year's study rate. Table 12: State and District Immunization Rates for OPV/IPV by Study Year District 1998-99 Rates 3 OPV/IPV 1999-00 Rates 3 OPV/IPV 2001 Rates 3 OPV/IPV 2002 Rates 3 OPV/IPV 1-1 90.8% 72.3% 88.6% 1-2 86.9% 82.2% 86.3% 2-0 73.7% 88.5% 97.0% 3-1 72.5% 79.3% 75.3% 3-2 64.9% 76.8% 45.5% 3-3 93.5% 71.4% 69.5% 3-4 72.9% 96.4% 77.2% 3-5 76.4% 75.7% 83.7% 4-0 80.2% 85.9% 86.4% 5-1 92.9% 93.8% 93.3% 5-2 98.0% 87.3% 81.8% 6-0 98.3% 85.1% 93.2% 7-0 83.2% 85.9% 78.4% 8-1 94.6% 87.9% 84.5% 8-2 90.1% 90.8% 96.2% 9-1 87.4% 88.5% 79.7% 9-2 93.4% 90.2% 92.4% 9-3 10-0 State 77.1% 86.5% 83.6% 86.3% 76.0% 84.4% 76.8% 88.3% 80.8% Note: State rates based on data weighted by health district. 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% 2003 Rates 3 OPV/IPV 84.8% 88.9% 94.7% 83.4% 71.7% 85.8% 90.0% 82.0% 92.7% 97.8% 93.7% 91.9% 85.0% 96.0% 80.7% 88.7% 88.4% 89.4% 93.2% 87.7% 28 Table 13 shows the 1998-99, 1999-00, 2001, 2002 and 2003 state and district rates for MMR. The 2003 district rates for MMR ranged from a low of 71.0 percent to a high of 97.8 percent, with a statewide rate of 88.3 percent coverage. This statewide rate for the MMR vaccine decreased from the 2002 rate of 90.9 percent. Table 13: State and District Immunization Rates for MMR by Study Year District 1-1 1998-99 Rates 1 MMR 86.6% 1999-00 Rates 1 MMR 73.5% 2001 Rates 1 MMR 89.2% 1-2 84.6% 83.6% 85.6% 2-0 72.0% 90.1% 97.0% 3-1 64.0% 81.9% 77.0% 3-2 65.8% 77.8% 45.1% 3-3 84.9% 70.2% 74.6% 3-4 69.7% 96.4% 83.5% 3-5 73.3% 71.6% 87.8% 4-0 73.1% 84.9% 86.4% 5-1 91.8% 96.3% 91.7% 5-2 95.7% 90.9% 82.7% 6-0 98.3% 87.2% 95.1% 7-0 83.2% 85.3% 80.2% 8-1 89.1% 90.7% 82.5% 8-2 91.5% 88.9% 97.0% 9-1 86.7% 85.4% 79.7% 9-2 85.1% 91.0% 93.1% 9-3 67.9% 87.7% 80.0% 10-0 State 84.8% 80.2% 77.3% 84.6% 89.6% 82.0% Note: State rates based on data weighted by health district. 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% 2003 Rates 1 MMR 88.1% 90.8% 96.8% 80.7% 71.0% 85.1% 90.0% 80.7% 92.7% 97.8% 96.8% 91.9% 87.9% 95.2% 81.3% 90.0% 90.6% 89.4% 93.8% 88.3% 29 As shown in Table 14, 2003 district immunization rates for the Hib vaccine varied between 72.5 and 97.8 percent. The statewide Hib coverage rate in 2003 was 87.3 percent, a decrease from the 2002 statewide rate of 90.9 percent. Table 14: State and District Immunization Rates for Hib by Study Year District 1-1 1-2 2-0 1998-99 Rates 3 Hib 90.8% 88.0% 73.1% 1999-00 Rates 3 Hib 76.5% 86.3% 88.5% 2001 Rates 3 Hib 89.2% 95.2% 96.3% 3-1 71.6% 85.0% 83.9% 3-2 65.2% 79.9% 45.5% 3-3 93.5% 79.8% 81.4% 3-4 70.4% 97.5% 92.4% 3-5 76.7% 77.0% 89.3% 4-0 81.0% 88.5% 88.3% 5-1 94.1% 96.3% 91.7% 5-2 98.0% 96.4% 84.5% 6-0 98.3% 87.2% 97.5% 7-0 85.4% 85.3% 82.6% 8-1 94.6% 92.5% 81.6% 8-2 90.8% 92.8% 92.5% 9-1 86.0% 91.5% 81.3% 9-2 93.4% 95.5% 95.4% 9-3 10-0 State 78.0% 87.7% 83.6% 89.0% 79.9% 87.4% 81.1% 94.2% 84.3% Note: State rates based on data weighted by health district. 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% 2003 Rates 3 Hib 84.1% 90.8% 93.6% 82.1% 72.5% 88.4% 90.0% 76.0% 87.3% 97.8% 91.3% 93.5% 85.7% 95.2% 81.3% 87.3% 86.2% 89.4% 95.7% 87.3% 30 Table 15 reports the statewide and district immunization coverage rates for the Hepatitis B vaccine. In 2003, the district coverage rates varied from a low of 74.6 percent to 96.7 percent. The 2003 statewide rate of 87.8 percent for the Hepatitis B vaccine was lower than the 2002 statewide rate of 90.8 percent. Table 15: State and District Immunization Rates for Hep B by Study Year District 1-1 1998-99 Rates 3 Hep B 88.0% 1999-00 Rates 3 Hep B 76.5% 2001 Rates 3 Hep B 92.8% 1-2 86.3% 86.3% 93.2% 2-0 73.1% 89.3% 95.6% 3-1 72.1% 85.5% 82.8% 3-2 62.8% 79.4% 44.4% 3-3 92.8% 76.2% 81.4% 3-4 72.2% 97.5% 86.1% 3-5 73.6% 77.9% 88.8% 4-0 81.0% 85.9% 88.8% 5-1 89.4% 96.3% 93.3% 5-2 97.7% 89.1% 83.6% 6-0 98.9% 85.1% 93.2% 7-0 84.7% 87.6% 85.0% 8-1 91.3% 92.5% 84.5% 8-2 90.8% 90.2% 95.5% 9-1 9-2 9-3 10-0 State 84.6% 91.7% 81.7% 87.7% 82.9% 89.2% 91.7% 87.7% 79.9% 86.7% 76.4% 95.4% 81.1% 91.6% 83.8% Note: State rates based on data weighted by health district. 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% 2003 Rates 3 Hep B 83.4% 90.8% 93.6% 86.2% 74.6% 88.8% 90.0% 78.0% 92.7% 96.7% 93.7% 95.1% 87.9% 96.0% 82.0% 79.3% 87.7% 86.2% 95.1% 87.8% 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 71.7 percent to 96.8 percent, with a statewide coverage rate of 86.7 percent for the Varicella vaccine. This is a decrease from the 2002 Varicella rate of 88.5 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 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% 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% 8-2 9-1 9-2 9-3 10-0 State 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% 90.9% 83.6% 87.6% 83.9% 86.8% 88.5% Notes: State rates based on data weighted by health district. 2003 Rates 1 Varicella 86.8% 90.2% 96.8% 80.7% 71.7% 84.7% 90.0% 74.0% 92.7% 95.6% 92.9% 90.2% 85.7% 94.4% 78.0% 83.3% 91.3% 86.2% 95.7% 86.7% 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 the 1998-99, 2001 and 2002 study years the immunization rates of children born to black and white mothers were virtually the same. However, in the 2003 study maternal race was 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 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% 2003 4:3:1 Adequate #/Total (percent) 1221/1560 (78.3) 661/940 (70.3) 53/67 (79.1) 80.8% Notes: Total rates based on data weighted by health district. 1998-99 Chi-square=2.61, p=0.45; 1999-00 Analysis not done; 2001 Chisquare=3.15, p=0.21; 2002 Chi-square=3.81, p=0.28; 2003 Chi-square=20.49, p<.05. 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 and 2003, maternal educational attainment was associated with child immunization status. 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 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% 2003 4:3:1 Adequate #/Total (percent) 25/33 (75.8) 297/408 (72.8) 619/856 (72.1) 380/495 (76.8) 614/775 (79.2) 80.8% Notes: Total rates based on data weighted by health district. 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; 2003 Chi square=12.50, p<.05. 35 Table 19 shows the statewide cross-tabulation of maternal Medicaid status and 4:3:1 immunization status for 2001, 2002 and 2003 study years. The 4:3:1 rates are shown for Medicaid recipients and non-Medicaid recipients. During the 2002 and 2003 study years, statewide immunization rates were significantly higher for Non-Medicaid recipients (Chi-square=15.34, p=0.00009 and Chi-square=17.45, p < .05, respectively). Table 19: 2003 Statewide Cross tabulations of Maternal Medicaid Status and Child Immunization Status Medicaid Status Medicaid Non-Medicaid 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% 2002 4:3:1 Adequate #/Total (percent) 1,054/1,300 (81.1) 1,230/1,421 (86.6) 83.9% 2003 4:3:1 Adequate #/Total (percent) 991/1,375 (72.1) 944/1,192 (79.2) 80.8% 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; 2003 Chi-square = 17.45, p <.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 decreased slightly in 2003 statewide compared to the same rates as measured by this study in 2002. 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 198 children born in January 2001. From the 198 children, 155 records were located (Response Rate=78.3%). Of the 155 located records, there were 4 parental refusals leaving a final sample of 151 records. The 4:3:1 immunization coverage estimate is 77.5 percent (117/151). This rate is lower than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 4: 4:3:1 Coverage for State and District 1-1 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 1-1 The 4:3:1+3 immunization coverage estimate is 66.9 percent (101/151). This rate is lower than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 77.5% 84.8% 88.1% 84.1% 83.4% 86.8% Table 20 reveals the coverage rates of each vaccine series. Coverage rates ranged from 77.5 to 88.1 percent for the 2003 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: 2003 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 146 96.7% 137 90.7% 121 80.1% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 144 95.4% 136 90.1% 59 39.1% 0 0.0% MMR1 MMR2 4 2.6% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 145 96.0% 137 90.7% 52 34.4% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 145 96.0% 138 91.4% 53 35.1% 1 0.7% VAR1 7 VAR2 0 *Percent = number immunized / sample size sample size = 151 4.6% 0.0% 41 Table 22: Cross tabulations of Maternal Race and Child Immunization Status for Health District 1-1 by Study Year* 1998-99 4:3:1 Adequate Maternal Race #/Total (percent) White 99/129 (76.7) Black 11/12 (91.7) Other 1/1 (100.0) Total 111/142 (78.2) * Excludes 1999-00 study year. 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) 2003 4:3:1: Adequate #/Total (percent) 96/135 (71.1) 9/16 (56.3) ---- 105/151 (69.5) 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 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 and 2003 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 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) --- Total 111/142 (78.2) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 2/2 (100.0) 18/25 (72.0) 25/43 (58.1) 24/31 (77.4) 36/50 (72.0) --- 105/151 (69.5) 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 2003 study, immunization rates varied 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) 2003 4:3:1 Adequate #/Total (percent) 49/78 (62.8) 56/73 (76.7) 105/151 (69.5) Table 24 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. For Health District 1-1, children born to non-Medicaid women had a 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 172 children born in January 2001. From these children, 165 records were located (Response Rate=95.9%). Of the 165 located records, there were 12 parental refusals leaving a final sample of 153 records. 4:3:1 immunization coverage estimate is 85.6 percent (131/153). This rate is higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 5: 4:3:1 Coverage for State and District 1-2 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 1-2 4:3:1+3 immunization coverage estimate 81.7 percent (125/153). This rate is higher than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 86.3% 88.9% 90.8% 90.8% 90.8% 90.2% Table 25 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 86.3 to 90.8 percent for the 2003 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: 2003 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 149 97.4% 147 96.1% 134 87.6% 1 0.7% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 148 96.7% 144 94.1% 64 41.8% 0 0.0% MMR1 MMR2 4 2.6% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 149 97.4% 146 95.4% 57 37.3% 1 0.7% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 149 97.4% 145 94.8% 68 44.4% 0 0.0% VAR1 14 VAR2 0 *Percent = number immunized / sample size Sample size = 153 9.2% 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 1998-99 4:3:1 Adequate #/Total (percent) 125/167 (74.9) 4/6 (66.7) 2/2 (100.0) --- Total 131/175 (74.9) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 118/145 (81.4) 1/2 (50.0) 4/6 (66.7) --- 123/153 (80.4) 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 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) ---- Total 131/175 (74.9) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 3/3 (100.0) 16/22 (72.7) 36/44 (81.8) 24/30 (80.0) 44/54 (81.5) ---- 123/153 (80.4) 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) 2003 4:3:1 Adequate #/Total (percent) 43/62 (69.4) 80/91 (87.9) 123/153 (80.4) Table 29 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. For Health District 1-2, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. 50 Individual Health District Report: District 2-0 The eligible sample from this district included 109 children born in January 2001. From the 109 children, 103 records were located (Response rate = 94.5%). Of the 103 located records, there were 9 parental refusals leaving a final sample of 94 records. 4:3:1 immunization coverage estimate is 94.7 percent (89/94). This rate is much higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 6: 4:3:1 Coverage for State and District 2-0 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 2-0 4:3:1+3 immunization coverage estimate is 91.5 percent (86/94). This rate is also much higher than the statewide 4:3:1+3 immunization rate of 74.3 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 1998-99 1999-00 2001 2002 2003 Adequate Adequate Adequate Adequate Adequate Rates Rates Rates Rates Rates 67.7% 89.3% 94.8% 94.7% 95.7% 73.7% 88.5% 97.0% 97.4% 94.7% 72.0% 90.1% 97.0% 96.1% 96.8% 73.1% 88.5% 96.3% 96.1% 93.6% 73.1% 89.3% 95.6% 97.4% 93.6% 48.4% 81.7% 94.8% 96.1% 96.8% Table 30 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 93.6 to 96.8 percent for the 2003 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: 2003 District Immunization Rates by Individual Vaccine at 12 months of age for Health District 2-0 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 91 96.8% DTP2/DTaP2 90 95.7% DTP3/DTaP3 87 92.6% DTP4/DTaP4 0 0.0% DTP5/DTaP5 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 91 96.8% 90 95.7% 57 60.6% 0 0.0% MMR1 MMR2 9 9.6% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 91 96.8% 89 94.7% 48 51.1% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 91 96.8% 90 95.7% 58 61.7% 0 0.0% VAR1 7 VAR2 0 *Percent = number immunized / sample size Sample size = 94 7.4% 0.0% 53 Table 32: Cross tabulations of Maternal Race and Child Immunization Status for Health District 2-0 by Study Year* 1998-99 4:3:1 Adequate Maternal Race #/Total (percent) White 114/169 (67.5) Black 9/13 (69.2) Other 1/4 (25.0) Total 124/186 (66.7) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 82/91 (90.1) 3/3 (100.0) --- 85/94 (90.4) 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 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) --- Total 124/186 (66.7) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 1/1 (100.0) 11/12 (91.7) 38/41 (92.7) 5/7 (71.4) 30/33 (90.9) --- 85/94 (90.4) 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) 2003 4:3:1 Adequate #/Total (percent) 49/52 (94.2) 36/42 (85.7) 85/94 (90.4) Table 34 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. During the 2001 and 2002 study years, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. However, in 2003 children born to Medicaid women had a higher immunization rate than children born to non-Medicaid women. 56 Individual Health District Report: District 3-1 The eligible sample from this district included 221 children born in January 2001. From the 221 children, 152 records were located (Response Rate=68.8%). Of the 152 located records, there were 7 parental refusals leaving a final sample of 145 records. The 4:3:1 immunization coverage estimate is 75.2 percent (109/145). This rate is lower than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 7: 4:3:1 Coverage for State and District 3-1 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 3-1 The 4:3:1+3 immunization coverage estimate is 72.4 percent (105/145). This rate is lower than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 76.6% 83.4% 80.7% 82.1% 86.2% 80.7% Table 35 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 76.6 to 86.2 percent for the 2003 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: 2003 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 133 91.7% 127 87.6% 120 82.8% 1 0.7% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 133 91.7% 127 87.6% 54 37.2% 1 0.7% MMR1 MMR2 10 6.9% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 132 91.0% 126 86.9% 62 42.8% 1 0.7% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 133 91.7% 130 89.7% 79 54.5% 0 0.0% VAR1 14 VAR2 0 *Percent = number immunized / sample size Sample size = 145 9.7% 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 1998-99 4:3:1 Adequate #/Total (percent) 101/172 (58.7) 25/45 (55.6) 3/5 (60.0) --- 2001 4:3:1 Adequate #/Total (percent) 95/128 (74.2) 22/40 (55.0) 6/6 (100.0) --- Total 129/222 (58.1) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 84/108 (77.8) 21/35 (60.0) 1/2 (50.0) --- 106/145 (73.1) 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 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) --- Total 129/222 (58.1) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 3/3 (100.0) 7/10 (70.0) 25/38 (65.8) 14/23 (60.9) 57/71 (80.3) --- 106/145 (73.1) 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. The other study years showed no correlation between educational attainment and immunization rate. 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) 2003 4:3:1 Adequate #/Total (percent) 21/35 (60.0) 85/110 (77.3) 106/145 (73.1) Table 39 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 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 487 children born in January 2001. From the 487 children, 176 records were located (Response Rate=36.1%). Of the 176 located records, there were 38 parental refusals leaving a final sample of 138 records. The 4:3:1 immunization coverage estimate is 68.1 percent (94/138). This rate is much lower than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 8: 4:3:1 Coverage for State and District 3-2 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 3-2 The 4:3:1+3 immunization coverage estimate is 65.9 percent (91/138). This rate is also much lower than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 68.1% 71.7% 71.0% 72.5% 74.6% 71.7% Table 40 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 68.1 to 74.6 percent for the 2003 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: 2003 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 115 83.3% 109 79.0% 98 71.0% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 115 83.3% 109 79.0% 58 42.0% 0 0.0% MMR1 MMR2 4 2.9% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 115 83.3% 108 78.3% 67 48.6% 1 0.7% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 116 84.1% 113 81.9% 69 50.0% 0 0.0% VAR1 10 VAR2 0 *Percent = number immunized / sample size Sample size = 138 7.2% 0.0% 65 Table 42: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-2 by Study Year* 1998-99 4:3:1 Adequate Maternal Race #/Total (percent) White 95/153 (62.1) Black 77/161 (47.8) Other 3/11 (27.3) Total 175/325 (53.8) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 50/76 (65.8) 31/59 (52.5) 3/3 (100.0) 84/138 (60.9) 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 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) --- Total 175/325 (53.8) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 3/3 (100.0) 7/14 (50.0) 16/27 (59.3) 7/21 (33.3) 51/73 (69.9) --- 84/138 (60.9) 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) 2003 4:3:1 Adequate #/Total (percent) 32/67 (47.8) 52/71 (73.2) 84/138 (60.9) Table 44 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. For Health District 3-2, immunization status of the children in the sample varied with maternal Medicaid status. 68 Individual Health District Report: District 3-3 The eligible sample from this district included 344 children born in January 2001. From the 344 children, 272 records were located (Response Rate=78.8%). Of the 272 located records, there were 3 parental refusals leaving a final sample of 269 records. The 4:3:1 immunization coverage estimate is 78.4 percent (211/269). This rate is lower than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 9: 4:3:1 Coverage for State and District 3-3 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 3-3 The 4:3:1+3 immunization coverage estimate is 74.6 percent (201/269). This rate is almost the same as the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 79.1% 85.8% 85.1% 88.4% 88.8% 84.7% Table 45 reveals the coverage rates of each vaccine series. Coverage rates ranged from 79.1 to 88.8 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: 2003 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 262 97.8% 250 93.3% 229 85.4% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 262 97.8% 245 91.4% 108 40.3% 0 0.0% MMR1 MMR2 12 4.5% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 261 97.4% 250 93.3% 171 63.8% 2 0.7% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 261 97.4% 251 93.7% 181 67.5% 2 0.7% VAR1 12 VAR2 0 *Percent = number immunized / sample size Sample size = 268 4.5% 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 1998-99 4:3:1 Adequate #/Total (percent) 52/71 (73.2) 49/62 (79.0) 5/6 (83.3) --- Total 106/139 (76.3) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 75/104 (72.1) 103/142 (72.5) 20/23 (87.0) --- 198/269 (73.6) 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 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) --- Total 106/139 (76.3) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 4/6 (66.7) 28/40 (70.0) 57/85 (67.1) 52/62 (83.9) 57/76 (75.0) --- 198/269 (73.6) 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) 2003 4:3:1 Adequate #/Total (percent) 92/127 (72.4) 106/142 (74.6) 198/269 (73.6) Table 49 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. For Health District 3-3, immunization status of the children in the sample varied with maternal Medicaid status. 74 Individual Health District Report: District 3-4 The eligible sample from this district included 89 children born in January 2001. From the 89 children, 65 records were located (Response Rate=73.0%). Of the 65 located records, there were 5 parental refusals leaving a final sample of 60 records. The 4:3:1 immunization coverage estimate is 90.0 percent (54/60). This rate is higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 10: 4:3:1 Coverage for State and District 3-4 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 3-4 The 4:3:1+3 immunization coverage estimate is 83.3 percent (50/60). This rate is higher than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% Table 50 reveals the coverage rates of each vaccine series. Vaccine coverage rates were 90.0 percent for the 2003 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: 2003 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 54 90.0% 54 90.0% 53 88.3% 1 1.7% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 54 90.0% 54 90.0% 21 35.0% 0 0.0% MMR1 MMR2 2 3.3% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 54 90.0% 54 90.0% 29 48.3% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 54 90.0% 53 88.3% 25 41.7% 1 1.7% VAR1 2 VAR2 0 *Percent = number immunized / sample size Sample size = 60 3.3% 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 1998-99 4:3:1 Adequate #/Total (percent) 155/241 (64.3) 14/24 (58.3) 11/12 (91.7) --- 2001 4:3:1 Adequate #/Total (percent) 43/56 (76.8) 12/17 (70.6) 5/6 (83.3) --- Total 180/277 (65.0) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 37/42 (88.1) 10/12 (83.3) 5/6 (83.3) --- 52/60 (86.7) 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 all study years represented, the immunization rates of children born to white mothers was greater than that of black mothers. 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 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) --- Total 180/277 (65.0) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (Percent) 1/1 (100.0) 3/3 (100.0) 17/21 (81.0) 9/10 (90.0) 22/25 (88.0) --- 52/60 (86.7) 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). The immunization status of the children in District 3-4 appears to vary 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) 2003 4:3:1 Adequate #/Total (percent) 17/19 (89.5) 35/41 (85.4) 52/60 (86.7) Table 54 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. In the 2003 study, children born to Medicaid women had a higher immunization rate than children born to women using non-Medicaid. 80 Individual Health District Report: District 3-5 The eligible sample from this district included 270 children born in January 2001. From the 270 children, 152 records were located (Response Rate=56.3%). Of the 152 located records, there were 2 parental refusals leaving a final sample of 150 records. The 4:3:1 immunization coverage estimate is 66.0 percent (99/150). This rate is much lower than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 11: 4:3:1 Coverage for State and District 3-5 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 3-5 The 4:3:1+3 immunization coverage estimate is 58.7 percent (88/150). This rate is also much lower than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 66.0% 82.0% 80.7% 76.0% 78.0% 74.0% Table 55 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 66.0 to 82.0 percent for the 2003 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: 2003 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 134 89.3% 130 86.7% 123 82.0% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 134 89.3% 128 85.3% 58 38.7% 0 0.0% MMR1 MMR2 4 2.7% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 132 88.0% 124 82.7% 58 38.7% 1 0.7% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 135 90.0% 128 85.3% 57 38.0% 1 0.7% VAR1 7 VAR2 0 *Percent = number immunized / sample size Sample size = 150 4.7% 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 1998-99 4:3:1 Adequate #/Total (Percent) 78/111 (70.3) 94/166 (56.6) 12/15 (80.0) --- Total 184/292 (63.0) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (Percent) 36/45 (80.0) 53/100 (53.0) 2/5 (40.0) --- 91/150 (60.7) 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 in District 3-5 varied with maternal race with no clear trend emerging. 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 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) --- Total 184/292 (63.0) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 2/5 (40.0) 9/13 (69.2) 22/42 (52.4) 21/39 (53.8) 37/51 (72.5) --- 91/150 (60.7) 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 all 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) 2002 4:3:1 Adequate #/Total (percent) 66/82 (80.5) 99/113 (87.6) 165/195 (84.6) 2003 4:3:1 Adequate #/Total (percent) 36/72 (50.0) 55/78 (70.5) 91/150 (60.7) Table 59 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 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 180 children born in January 2001. From the 180 children, 119 records were located (Response Rate=66.1%). Of the 119 located records, there were 9 parental refusals leaving a final sample of 110 records. The 4:3:1 immunization coverage estimate is 83.6 percent (92/110). This rate is higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 12: 4:3:1 Coverage for State and District 4-0 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 4-0 The 4:3:1+3 immunization coverage estimate is 79.1 percent (87/110). This rate is higher than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 84.5% 92.7% 92.7% 87.3% 92.7% 92.7% Table 60 reveals the coverage rates of each vaccine series. Coverage rates ranged from 84.5 to 92.7 percent for the 2003 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: 2003 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 107 97.3% 103 93.6% 94 85.5% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 107 97.3% 103 93.6% 45 40.9% 0 0.0% MMR1 MMR2 3 2.7% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 105 95.5% 102 92.7% 53 48.2% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 107 97.3% 106 96.4% 64 58.2% 1 0.9% VAR1 3 VAR2 0 *Percent = number immunized / sample size Sample size = 110 2.7% 0.0% 89 Table 62: Cross tabulations of Maternal Race and Child Immunization Status for Health District 4-0 by Study Year* 1998-99 4:3:1 Adequate Maternal Race #/Total (percent) White 132/203 (65.0) Black 47/63 (74.6) Other 2/2 (100) Total 181/268 (67.5) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 57/68 (83.8) 29/42 (69.0) --- 86/110 (78.2) 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 and 2003, 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 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) --- 2003 4:3:1 Adequate #/Total (percent) 4/4 (100.0) 21/29 (72.4) 28/33 (84.8) 15/20 (75.0) 18/24 (75.0) --- Total 181/268 (67.5) *Excludes 1999-00 study year. 172/206 (83.5) 128/147 (87.1) 86/110 (78.2) 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) 2003 4:3:1 Adequate #/Total (percent) 53/69 (76.8) 33/41 (80.5) 86/110 (78.2) Table 64 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. The immunization rate of children born to non-Medicaid women did not vary significantly from the immunization rate of children born to women using Medicaid. 92 Individual Health District Report: District 5-1 The eligible sample from this district included 92 children born in January 2001. From the 92 children, 91 records were located (Response Rate=98.9%). Of the 91 located records, there was 1 parental refusal leaving a final sample of 90 records. The 4:3:1 immunization coverage estimate is 93.3 percent (84/90). This rate is much higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 13: 4:3:1 Coverage for State and District 5-1 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 5-1 The 4:3:1+3 immunization coverage estimate 83.3 percent (75/90). This rate is much higher than the statewide 4:3:1+3 immunization rate of 74.3 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 1998-99 Adequate Rates 87.1% 92.9% 91.8% 94.1% 89.4% 21.2% 1999-00 Adequate Rates 91.3% 93.8% 96.3% 96.3% 96.3% 61.3% 2001 Adequate Rates 86.7% 93.3% 91.7% 91.7% 93.3% 86.7% 2002 Adequate Rates 80.8% 96.2% 97.4% 97.4% 96.2% 84.6% 2003 Adequate Rates 93.3% 97.8% 97.8% 97.8% 96.7% 95.6% Table 65 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 93.3 to 97.8 percent for the 2003 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: 2003 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 90 100.0% 89 98.9% 81 90.0% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 90 100.0% 89 98.9% 39 43.3% 0 0.0% MMR1 MMR2 3 3.3% 1 1.1% HIB1 HIB2 HIB3 HIB4 HIB5 89 98.9% 88 97.8% 51 56.7% 1 1.1% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 89 98.9% 71 78.9% 44 48.9% 0 0.0% VAR1 2 VAR2 0 *Percent = number immunized / sample size Sample size = 90 2.2% 0.0% 95 Table 67: Cross tabulations of Maternal Race and Child Immunization Status for Health District 5-1 by Study Year* 1998-99 4:3:1 Adequate Maternal Race #/Total (percent) White 39/45 (86.7) Black 34/39 (87.2) Other 1/1 (100) Total 74/85 (87.1) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 56/64 (87.5) 19/25 (76.0) 1/1 (100.0) 76/90 (84.4) 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 immunization rates for District 5-1 vary with maternal race with no clear trend emerging. 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 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) --- 2003 4:3:1 Adequate #/Total (percent) --- 13/16 (81.3) 30/36 (83.3) 10/12 (83.3) 23/26 (88.5) --- Total 74/85 (87.1) *Excludes 1999-00 study year. 51/60 (85.0) 63/78 (80.8) 76/90 (84.4) 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) 2002 4:3:1 Adequate #/Total (percent) 37/48 (77.1) 39/42 (92.9) 76/90 (84.4) Table 69 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. The immunization rates for District 5-1 vary with maternal Medicaid status. 98 Individual Health District Report: District 5-2 The eligible sample from this district included 175 children born in January 2001. From the 175 children, 138 records were located (Response Rate=78.9%). Of the 138 located records, there were 12 parental refusals leaving a final sample of 126 records. The 4:3:1 immunization coverage estimate is 83.3 percent (105/126). This rate is higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 14: 4:3:1 Coverage for State and District 5-2 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 5-2 The 4:3:1+3 immunization coverage estimate is 74.6 percent (94/126). This rate is nearly equal to the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 84.9% 93.7% 96.8% 91.3% 93.7% 92.9% Table 70 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 84.9 to 96.8 percent for the 2003 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: 2003 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 5-2 Vaccine Dose Number Immunized DTP1/DTaP1 121 DTP2/DTaP2 117 DTP3/DTaP3 108 DTP4/DTaP4 0 DTP5/DTaP5 0 OPV/IPV1 121 OPV/IPV2 117 OPV/IPV3 55 OPV/IPV4 0 MMR1 6 MMR2 0 HIB1 121 HIB2 117 HIB3 41 HIB4 1 HIB5 0 HEPB1 120 HEPB2 116 HEPB3 72 HEPB4 0 VAR1 5 VAR2 0 *Percent = number immunized / sample size Sample size = 126 Percent* 96.0% 92.9% 85.7% 0.0% 0.0% 96.0% 92.9% 43.7% 0.0% 4.8% 0.0% 96.0% 92.9% 32.5% 0.8% 0.0% 95.2% 92.1% 57.1% 0.0% 4.0% 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 1998-99 4:3:1 Adequate #/Total (percent) 143/151 (94.7) 97/103 (94.2) 2/2 (100.0) --- Total 242/256 (94.5) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 55/68 (80.9) 41/56 (73.2) 2/2 (100.0) --- 98/126 (77.8) 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 immunization rates for District 5-2 vary with maternal race with no clear trend emerging. 102 Table 73: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 5-2 by Study Year* 1998-99 4:3:1 Adequate Maternal #/Total Educational Level (percent) Less than high 9/10 school (90.0) Some high 48/51 school (94.1) High school 93/99 graduate (93.9) Some college 47/50 (94.0) College or more 45/46 (97.8) Total 242/256 (94.5) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) --- 18/23 (78.3) 30/42 (71.4) 26/33 (78.8) 24/28 (85.7) 98/126 (77.8) 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 2002 4:3:1 Adequate 4:3:1 Adequate #/Total #/Total (percent) (percent) 44/63 103/131 (69.8) (78.6) 32/47 107/117 (68.1) (91.5) 76/110 210/248 (69.1) (84.7) . 2003 4:3:1 Adequate #/Total (percent) 48/70 (68.6) 50/56 (89.3) 98/126 (77.8) Table 74 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. In the 2002 and 2003 study years, 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 135 children born in January 2001. From the 135 children, 125 records were located (Response Rate=92.6%). Of the 125 located records, there were 2 parental refusals leaving a final sample of 123 records. The 4:3:1 immunization coverage estimate is 86.2 percent (106/123). This rate is higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 15: 4:3:1 Coverage for State and District 6-0 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 6-0 The 4:3:1+3 immunization coverage estimate is 78.9 percent (97/123). This rate is higher than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 87.8% 91.9% 91.9% 93.5% 95.1% 90.2% Table 75 reveals the coverage rates of each vaccine series. Coverage rates ranged from 87.8 to 95.1 percent for the 2003 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: 2003 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 122 99.2% 120 97.6% 109 88.6% 1 0.8% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 122 99.2% 119 96.7% 54 43.9% 0 0.0% MMR1 MMR2 4 3.3% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 122 99.2% 119 96.7% 64 52.0% 2 1.6% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 122 99.2% 118 95.9% 77 62.6% 0 0.0% VAR1 4 VAR2 0 *Percent = number immunized / sample size Sample size = 123 3.3% 0.0% 107 Table 77: Cross tabulations of Maternal Race and Child Immunization Status for Health District 6-0 by Study Year* 1998-99 4:3:1 Adequate Maternal Race #/Total (percent) White 98/102 (96.0) Black 71/74 (95.9) Other 2/2 (100.0) Total 171/178 (96.1) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 51/61 (83.6) 48/59 (81.4) 3/3 (100.0) 102/123 (82.9) 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 in District 6-0 varied with maternal race. 108 Table 78: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 6-0 by Study Year* 1998-99 4:3:1 Adequate Maternal #/Total Educational Level (percent) Less than high 4/4 school (100.0) Some high 36/37 school (97.3) High school 65/69 graduate (94.2) Some college 43/44 (97.7) College or more 23/24 (95.8) Total 171/178 (96.1) *Excludes 1999-00 study years. 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) 2003 4:3:1 Adequate #/Total (percent) 0/1 (0.0) 18/21 (81.8) 35/44 (79.5) 23/26 (88.5) 26/30 (86.7) 102/123 (82.9) 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) 2003 4:3:1 Adequate #/Total (percent) 69/83 (83.1) 33/40 (82.5) 102/123 (82.9) Table 79 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. Table 79 shows that the immunization rates of children in District 6-0 vary with maternal Medicaid status. 110 Individual Health District Report: District 7-0 The eligible sample from this district included 236 children born in January 2001. From the 236 children, 140 records were located (Response Rate=59.3%). Of the 140 located records, there were no parental refusals leaving a final sample of 140 records. The 4:3:1 immunization coverage estimate is 76.4 percent (107/140). This rate is lower than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 16: 4:3:1 Coverage for State and District 7-0 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 7-0 The 4:3:1+3 immunization coverage estimate is 67.1 percent (94/140). This rate is lower than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 77.1% 85.0% 87.9% 85.7% 87.9% 85.7% Table 80 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 77.1 to 87.9 percent for the 2003 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: 2003 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 133 95.0% 126 90.0% 112 80.0% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 133 95.0% 125 89.3% 45 32.1% 0 0.0% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 132 94.3% 124 88.6% 58 41.4% 2 1.4% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 134 95.7% 126 90.0% 76 54.3% 2 1.4% VAR1 4 VAR2 1 *Percent = number immunized / sample size Sample size = 140 2.9% 0.7% 113 Table 82: Cross tabulations of Maternal Race and Child Immunization Status for Health District 7-0 by Study Year* 1998-99 4:3:1 Adequate Maternal Race #/Total (percent) White 46/61 (75.4) Black 45/73 (61.6) Other 2/3 (66.7) Total 93/137 (67.9) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 26/38 (68.4) 74/102 (72.5) --- 100/140 (71.4) 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, 2002 and 2003 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 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) --- Total 93/137 (67.9) *Excludes 1999-00 study data. 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) 2003 4:3:1 Adequate #/Total (percent) 1/1 (100.0) 23/38 (60.5) 36/51 (70.6) 21/24 (87.5) 19/26 (73.1) --- 100/140 (71.4) 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). 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) 2003 4:3:1 Adequate #/Total (percent) 75/101 (74.3) 25/39 (64.1) 100/140 (71.4) Table 84 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 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 all study years. 116 Individual Health District Report: District 8-1 The eligible sample from this district included 129 children born in January 2001. From the 129 children, 124 records were located (Response Rate=96.1%). Of the 124 located records, there were no parental refusals leaving a final sample of 124 records. The 4:3:1 immunization coverage estimate is 91.9 percent (114/124). This rate is much higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 17: 4:3:1 Coverage for State and District 8-1 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 8-1 The 4:3:1+3 immunization coverage estimate is 87.1 percent (108/124). This rate is also much higher than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 91.9% 96.0% 95.2% 95.2% 96.0% 94.4% Table 85 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 91.9 to 96.0 percent for the 2003 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: 2003 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 123 99.2% 119 96.0% 112 90.3% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 123 99.2% 119 96.0% 24 19.4% 0 0.0% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 123 99.2% 119 96.0% 48 38.7% 1 0.8% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 124 100.0% 121 97.6% 62 50.0% 1 0.8% VAR1 8 VAR2 0 *Percent = number immunized / sample size Sample size = 124 6.5% 0.0% 119 Table 87: Cross tabulations of Maternal Race and Child Immunization Status for Health District 8-1 by Study Year* 1998-99 4:3:1 Adequate Maternal Race #/Total (percent) White 46/56 (82.1) Black 28/35 (80.0) Other 0/1 (0.0) Total 74/92 (80.4) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 59/69 (85.5) 45/53 (84.9) 2/2 (100.0) 106/124 (85.5) 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 immunization rate of children varies with maternal race in District 8-1. 120 Table 88: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 8-1 by Study Year* 1998-99 4:3:1 Adequate Maternal #/Total Educational Level (percent) Less than high 7/8 school (87.5) Some high 21/31 school (67.7) High school 24/27 graduate (88.9) Some college 12/15 (80.0) College or more 10/11 (90.9) Total 74/92 (80.4) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) --- 19/23 (82.6) 41/47 (87.2) 17/19 (89.5) 29/35 (82.9) 106/124 (85.5) 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) 2003 4:3:1 Adequate #/Total (percent) 80/92 (87.0) 26/32 (81.3) 106/124 (85.5) Table 89 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. For 2002 and 2003 study years, children born to women using Medicaid had a higher immunization rate than children born to non-Medicaid women. 122 Individual Health District Report: District 8-2 The eligible sample from this district included 166 children born in January 2001. From the 166 children, 151 records were located (Response Rate=91.0%). Of the 151 located records, there was 1 parental refusal leaving a final sample of 150 records. The 4:3:1 immunization coverage estimate is 74.0 percent (111/150). This rate is lower than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 18: 4:3:1 Coverage for State and District 8-2 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 8-2 The 4:3:1+3 immunization coverage estimate rate is 68.0 percent (102/150). This rate is lower than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 75.3% 80.7% 81.3% 81.3% 82.0% 78.0% Table 90 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 75.3 to 82.0 percent for the 2003 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: 2003 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 132 88.0% 128 85.3% 116 77.3% 1 0.7% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 131 87.3% 128 85.3% 64 42.7% 0 0.0% MMR1 MMR2 8 5.3% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 131 87.3% 129 86.0% 54 36.0% 2 1.3% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 131 87.3% 130 86.7% 78 52.0% 1 0.7% VAR1 6 VAR2 0 *Percent = number immunized / sample size Sample size = 150 4.0% 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 Unknown 1998-99 4:3:1 Adequate #/Total (percent) 56/71 (78.9) 62/70 (88.6) 1/1 (100.0) --- Total 119/142 (83.8) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 47/78 (60.3) 50/71 (70.4) 0/1 (0.0) --- 97/150 (64.7) 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 vary with maternal race. 126 Table 93: Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 8-2 by Study Year* 1998-99 4:3:1 Adequate Maternal #/Total Educational Level (percent) Less than high 9/11 school (81.8) Some high 41/48 school (85.4) High school 41/47 graduate (87.2) Some college 18/23 (78.2) College or more 10/13 (76.9) Total 119/142 (83.8) *Excludes 1999-00 study year. 2001 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) 2002 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) 2003 4:3:1 Adequate #/Total (percent) 0/2 (0.0) 25/37 (67.6) 30/49 (61.2) 21/29 (72.4) 21/33 (63.6) 97/150 (64.7) 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) 2003 4:3:1 Adequate #/Total (percent) 60/87 (70.0) 37/63 (58.7) 97/150 (64.7) Table 94 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. In the 2003 study year, children born to Medicaid women had a higher immunization rate than children born to women not using Medicaid. 128 Individual Health District Report: District 9-1 The eligible sample from this district included 167 children born in January 2001. From the 167 children, 150 records were located (Response Rate=89.8%). Of the 150 located records, there were no parental refusals leaving a final sample of 150 records. The 4:3:1 immunization coverage estimate is 77.3 percent (116/150). This rate is lower to the statewide 4:3:1 immunization rate of 80.8 percent. Figure 19: 4:3:1 Coverage for State and District 9-1 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 9-1 The 4:3:1+3 immunization coverage estimate is 60.7 percent (91/150). This rate is also much lower than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 77.3% 88.7% 90.0% 87.3% 79.3% 83.3% Table 95 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 77.3 to 90.0 percent for the 2003 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: 2003 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 150 100.0% 141 94.0% 127 84.7% 2 1.3% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 150 100.0% 141 94.0% 83 55.3% 2 1.3% MMR1 MMR2 4 2.7% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 150 100.0% 141 94.0% 83 55.3% 1 0.7% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 147 98.0% 138 92.0% 78 52.0% 4 2.7% VAR1 5 VAR2 0 *Percent = number immunized / sample size Sample size = 150 3.3% 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 1998-99 4:3:1 Adequate #/Total (percent) 47/66 (71.2) 68/77 (88.3) --- Unknown --- Total 115/143 (80.4) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 53/74 (71.6) 55/73 (75.3) 2/3 (66.7) --- 110/150 (73.3) 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 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) --- Total 115/143 (80.4) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) --- 10/15 (66.7) 44/61 (72.1) 22/30 (73.3) 34/44 (77.3) --- 110/150 (73.3) 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) 2003 4:3:1 Adequate #/Total (percent) 60/86 (69.8) 50/64 (78.1) 110/150 (73.3) Table 99 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 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 all study years. 134 Individual Health District Report: District 9-2 The eligible sample from this district included 147 children born in January 2001. From the 147 children, 140 records were located (Response Rate=95.2%). Of the 140 located records, there were 2 parental refusals leaving a final sample of 138 records. The 4:3:1 immunization coverage estimate is 81.2 percent (112/138). This rate is essentially the same as the statewide 4:3:1 immunization rate of 80.8 percent. Figure 20: 4:3:1 Coverage for State and District 9-2 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 9-2 The 4:3:1+3 immunization coverage estimate is 73.9 percent (102/138). This rate is also essentially the same as the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 82.6% 88.4% 90.6% 86.2% 87.7% 91.3% Table 100 reveals the coverage rates of each vaccine series. Coverage rates ranged from 82.6 to 91.3 percent for the 2003 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: 2003 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 136 98.6% 134 97.1% 122 88.4% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 135 97.8% 131 94.9% 23 16.7% 0 0.0% MMR1 MMR2 9 6.5% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 136 98.6% 131 94.9% 35 25.4% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 136 98.6% 132 95.7% 35 25.4% 2 1.4% VAR1 9 VAR2 0 *Percent = number immunized / sample size Sample size = 138 6.5% 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 1998-99 4:3:1 Adequate #/Total (percent) 81/96 (84.4) 20/25 (80.0) --- Unknown --- Total 101/121 (83.5) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent 76/104 (73.1) 25/32 (78.1) 1/2 (50.0) --- 102/138 (73.9) 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 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) --- Total 101/121 (83.5) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 1/1 (100.0) 10/17 (58.8) 39/59 (66.1) 26/31 (83.9) 26/30 (86.7) --- 102/138 (73.9) 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) 2003 4:3:1 Adequate #/Total (percent) 56/81 (69.1) 46/57 (80.7) 102/138 (73.9) Table 104 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. The immunization status of the children in District 9-2 varied with maternal Medicaid status. 140 Individual Health District Report: District 9-3 The eligible sample from this district included 110 children born in January 2001. From the 110 children, 94 records were located (Response Rate=85.5%). Of the 94 located records, there were no parental refusals leaving a final sample of 94 records. The 4:3:1 immunization coverage estimate is 81.9 percent (77/94). This rate is slightly higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 21: 4:3:1 Coverage for State and District 9-3 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 9-3 The 4:3:1+3 immunization coverage estimate is 73.4 percent (69/94). This rate is essentially the same as the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 83.0% 89.4% 89.4% 89.4% 86.2% 86.2% Table 105 reveals the coverage rates of each vaccine series. Coverage rates ranged from 83.0 to 89.4 percent for the 2003 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: 2003 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 89 94.7% 88 93.6% 81 86.2% 1 1.1% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 89 94.7% 87 92.6% 42 44.7% 0 0.0% MMR1 MMR2 4 4.3% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 89 94.7% 86 91.5% 32 34.0% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 88 93.6% 85 90.4% 39 41.5% 3 3.2% VAR1 4 VAR2 0 *Percent = number immunized / sample size Sample size = 94 4.3% 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 Unknown 1998-99 4:3:1 Adequate #/Total (percent) 38/60 (63.3) 26/46 (56.5) 2/3 (66.7) --- Total 66/109 (60.6) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 51/62 (82.3) 21/29 (72.4) 3/3 (100.0) --- 75/94 (79.8) 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, 2002 and 2003 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 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) --- Total 66/109 (60.6) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) --- 15/17 (88.2) 25/35 (71.4) 15/17 (88.2) 20/25 (80.0) --- 75/94 (79.8) 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) 2003 4:3:1 Adequate #/Total (percent) 43/60 (71.7) 32/34 (94.1) 75/94 (79.8) Table 109 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 study years. The immunization status of the children in the sample in District 9-3 varies with maternal Medicaid status. 146 Individual Health District Report: District 10-0 The eligible sample from this district included 185 children born in January 2001. From the 185 children, 169 records were located (Response Rate=91.4%). Of the 169 located records, there were 7 parental refusals leaving a final sample of 162 records. The 4:3:1 immunization coverage estimate is 90.7 percent (147/162). This rate is much higher than the statewide 4:3:1 immunization rate of 80.8 percent. Figure 22: 4:3:1 Coverage for State and District 10-0 100 90 80 70 60 50 40 30 20 10 0 98-99 99-00 2001 2002 2003 State Dist 10-0 The 4:3:1+3 immunization coverage estimate is 86.4 percent (140/162). This rate is also much higher than the statewide 4:3:1+3 immunization rate of 74.3 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 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% 2003 Adequate Rates 93.2% 93.2% 93.8% 95.7% 95.1% 95.7% Table 110 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 93.2 to 95.7 percent for the 2003 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: 2003 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 159 98.1% 157 96.9% 148 91.4% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 159 98.1% 157 96.9% 50 30.9% 0 0.0% MMR1 MMR2 2 1.2% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 158 97.5% 155 95.7% 47 29.0% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 157 96.9 154 95.1% 49 30.2% 0 0.0% VAR1 2 VAR2 0 *Percent = number immunized / sample size Sample size = 162 1.2% 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 1998-99 4:3:1 Adequate #/Total (percent) 109/141 (77.3) 25/28 (89.2) 1 /2 (50.0) --- Total 135/171 (78.9) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) 111/127 (87.4) 23/30 (76.7) 4/5 (80.0) --- 138/162 (85.2) 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 vary with maternal race. 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 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) --- Total 135/171 (78.9) *Excludes 1999-00 study year. 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) 2003 4:3:1 Adequate #/Total (percent) --- 26/32 (81.3) 45/59 (76.3) 28/31 (90.3) 39/40 (97.5) --- 138/162 (85.2) 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 maternal 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) 2003 4:3:1 Adequate #/Total (percent) 71/86 (82.6) 67/76 (88.2) 138/162 (85.2) Table 114 shows immunization status of children born to women stratified by Medicaid status for the 2001, 2002 and 2003 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 seventh 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 2002-03. To assess these rates, the study drew an original sample of 3,813 children born in January 2001. The final sample of returned immunization records totaled 3,813. After removal of ineligible children (those deceased, adopted, moved out of state, born in military hospitals) the eligible sample was 3,613. Of these, 2,567 were located and make up the final sample. The seventh year of the GIS, 2003, measured immunization coverage for children born in 2001 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 1998-99, 1999-00, 2001, 2002 and 2003. The newer 4:3:1+3 measure of *It must be remembered that the 2003 study is estimating 2001 rates. The 2002 study is estimating 2000 rates, 2001 study estimated 1999 rates, 1999-00 study estimated 1997 rates, and the 1998-99 study estimated rates for 1996. 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 2003 results reflect immunization rates for children born in 2001. The results of the study indicate that, of the 2,567 children whose immunization records were located during 2003 data collection: 74.3 percent of children born in January of 2001 in Georgia were adequately immunized with the 4:3:1+3 vaccine series. 80.8 percent of children born in January of 2001 in Georgia were adequately immunized with the 4:3:1 vaccine series, compared to 83.9 percent of children born in January of 2000, 75.1 percent of children born in January of 1999, 78.8 percent of children born in November of 1997, and 73.3 percent of children born in April of 1996 4:3:1 immunization rates in the individual health districts ranged from 66.0 percent to 94.7 percent in the 2003 study 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 The study investigated where the immunizations are being administered in Georgia (See Appendix E). In the seventh study year, 74.8 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 Immunization rates for the 4:3:1+3 vaccine series decreased slightly from the 2002 study (78.9 to 74.3). The 2003 Georgia Immunization Study (GIS) measured Varicella rates for the sixth 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 decreased slightly statewide from the 2002 study (83.9 percent) to 80.8 percent in 2003. The results of the previous four years of the GIS study (1998-99, 1999-00, 2001 and 2002) 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 seventh 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: 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. 156 Assessment of immunization status based on the most recent recommended 4:3:1+3 vaccine series. Comparison of rates for children born in 1996, 1997, 1999, 2000 and 2001 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 2003 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 2001 and, thus, represented a generalizable estimate of coverage rates for all two-year-olds born in 2001, 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. 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). Response rates tended to be lower in the Metro area (District 3-1, 3-2 and 3-5). 157 APPENDIX A: DESCRIPTION OF SAMPLING PLAN AND STATISTICAL NOTE 158 APPENDIX A: DESCRIPTION OF SAMPLING PLAN AND STATISTICAL NOTE The target population for this study was children born in the state of Georgia in 2001 who were residing in the state in 2003. 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 2001 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 2001. 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 2003. 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 2003 Study. Response rates and immunization coverage levels from the 2002 study were used in the sample size calculation for the 2003 study. The sample sizes were adjusted for small population size. The desired 159 sample size was then increased by a factor equivalent to the non-response rate (non-locatable immunization records) for each district from the 2002 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 36.1 percent to a high of 98.9 percent, with the average response rate for the state at 74.2 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. 160 Table 115: Data Used for Sample Size Estimates for the 2003 Study A Health District 1-1 B C D E F G H Jan 2001 Total Births Jan 2001 Eligibl e Births 2002 4:3:1 Immunizatio n Rates 2003 2003 First Second Sample Sample Estimate Estimate Return 2003 Rate Adjusted based on Sample 2002 Size Eligible Sample 694 670 0.806 240.275 176.852 0.882 201 1-2 500 490 0.791 254.036 167.300 0.893 187 2-0 628 610 0.934 94.725 81.9923 0.724 113 3-1 1,016 980 0.845 201.261 166.971 0.675 247 3-2 1,109 1,063 0.826 220.852 182.860 0.367 498 3-3 391 374 0.739 296.386 165.350 0.307 374 3-4 1,104 1,078 0.943 82.596 76.7178 0.848 90 3-5 908 868 0.846 200.200 162.679 0.579 281 4-0 784 749 0.871 172.655 140.312 0.796 176 5-1 163 155 0.808 238.388 93.928 0.988 95 5-2 576 549 0.847 199.135 146.130 0.790 185 6-0 546 526 0.892 148.033 115.522 0.843 137 7-0 447 430 0.828 218.842 145.031 0.571 254 8-1 305 298 0.822 224.835 128.149 0.942 136 8-2 482 469 0.831 215.804 147.797 0.875 169 9-1 383 375 0.809 237.440 145.386 0.817 178 9-2 408 394 0.854 191.594 128.909 0.891 145 9-3 314 296 0.856 189.412 115.502 0.758 152 10-0 430 416 0.802 244.012 153.799 0.790 195 State 11,188 10,790 0.839 0.686 3,813 161 Figure 23: Explanations of Table 115 Data Used for Sample Size Estimates For the 2003 Study Column A: Health District Column B: January 2001 Total Births Column C: January 2001 Eligible Births Column D: 2002 4:3:1 Immunization Rates Column E: First Sample Estimate 2003 Study Column F: Second Sample Estimate 2003 Study Column G: Estimated Return Rate (Based on 2002 Study) District number. Given. Source: DHR Vital Statistics Office. Given. Source: Georgia Birth Cohort Follow-up Study (2001). 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 (2001). Column H: Adjusted Sample Size 2003 Study Formula Used: (Column F) / (Column G) 162 APPENDIX B: LIST OF 2003 PUBLIC HEALTH REPRESENTATIVES FOR THE GEORGIA IMMUNIZATION STUDY 163 APPENDIX B: LIST OF 2003 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. Sandy Moore, LPN Joy Stymest Georgia Goseer, R.N. Likesar McCray Lisa Germany Freda Sheppard Kathy Heidish, R.N. Gloria Melvin Eunice Rose Joyce Hess, R.N. Tina Dempsey, L.P.N. Deborah Cox, L.P.N. Amy Fenn, RN Donna Forth, R.N. Debbie Liby, R.N. German Gonzales, MD Melba McNorril, R.N. Clois Witt, R.N., B.S.N. Beverly Roberson, R.N., B.S.N. Simple Singh, M.D, M.P.H Yugonda Thomas Dorene Wilson Edward W. Sullivan 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. Jennifer Foster, M.S. Dionne Hansey Barbie Bushey, R.N., C.P.N., M.P.H. 164 APPENDIX C: DATA COLLECTION FORM 165 166 167 APPENDIX D: VARICELLA VACCINE AND CHICKEN POX DATA 168 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. 169 Table 116: 2003 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 116 76.8 132 86.3 89 94.7 112 77.2 96 69.6 221 82.5 50 83.3 104 69.3 99 90.0 78 86.7 104 82.5 104 84.6 112 80.0 111 89.5 112 74.7 115 76.7 121 87.7 75 79.8 149 92.0 2,101 81.8 Number Percent 131 86.8 138 90.2 91 96.8 117 80.7 99 71.7 227 84.7 54 90.0 111 74.0 102 92.7 86 95.6 117 92.9 111 90.2 120 85.7 117 94.4 117 78.0 125 83.3 126 91.3 81 86.2 155 95.7 2,226 86.7 Number Percent 0 0.0 1 0.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 0.7 0 0.0 1 1.1 0 0.0 1 0.8 0 0.0 0 0.0 0 0.0 2 1.3 0 0.0 1 1.1 0 0.0 7 0.3 170 Figure 24: 2003 State Varicella Coverage Rates and Percentage of Sample with Chicken Pox Disease 90 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. 171 Appendix E: Provider of Immunizations 172 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, 2002 and 2003 Provider 1998-99 Total % # Public 20,222 45.1 Health Dept Private 22,686 50.6 Physician Unknown 1,934 4.3 1999-00 Total % # 11,248 29.1 23,984 61.9 3,503 9.0 2001 Total % # 9,472 25.5 25,797 69.5 1,866 5.0 2002 Total % # 8,085 20.3 28,667 71.9 3,112 7.8 2003 Total % # 5,873 16.3 26,956 74.8 3,205 8.9 Total 44,842 100.0 38,735 100.0 37,135 100.0 39,864 100.0 36,034 100.0 As shown in Table 117, in 2003, over 70% of the shots recorded for the sampled children were given by a private provider. 173 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 2003 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 347 358 344 358 532 206 18 225 319 318 411 117 422 416 229 200 644 83 326 Percent 16.4 16.2 25.2 18.4 32.1 5.4 2.1 11.6 19.7 23.1 22.2 6.4 21.7 22.4 11.7 9.2 32.6 6.2 14.7 # Shots Given 1,410 1,788 999 822 798 3,486 821 1,421 1,033 1,021 1,365 1,643 1,495 1,446 1,214 1,866 1,311 1,245 1,772 5,873 16.3 26,956 Percent 66.9 81.0 73.0 42.2 48.2 90.7 97.9 73.5 64.0 74.1 73.9 89.7 76.8 77.6 62.2 86.0 66.4 93.8 79.6 # Shots Given 351 61 25 768 325 150 0 288 264 38 72 71 30 0 510 104 21 0 127 Percent 16.7 2.8 1.8 39.4 19.7 3.9 0.0 14.9 16.3 2.8 3.9 3.9 1.5 0.0 26.1 4.8 1.0 0.0 5.7 74.8 3,205 8.9 2,108 2,207 1,368 1,948 1,655 3,842 839 1,934 1,616 1,377 1,848 1,831 1,947 1,862 1,953 2,170 1,976 1,328 2,225 36,034 174 In Year Seven: Seventeen health districts gave more than 50% of the shots 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 (39.4 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. 175 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 1999-00, 2001, 2002, 2003 District Public Health Department 99-00 2001 2002 2003 1-1 51.7 1-2 24.9 2-0 35.5 3-1 18.8 3-2 30.6 3-3 19.1 3-4 8.9 3-5 25.9 4-0 35.8 5-1 51.8 5-2 46.3 6-0 34.9 7-0 36.1 8-1 23.1 8-2 26.5 9-1 14.4 9-2 57.9 9-3 31.0 10-0 34.1 State 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 16.4 13.7 16.2 24.3 25.2 19.1 18.4 24.0 32.1 26.6 5.4 7.4 2.1 11.7 11.6 19.9 19.7 29.9 23.1 26.7 22.2 24.1 6.4 22.8 21.7 20.5 22.4 22.8 11.7 17.5 9.2 36.4 32.6 16.9 6.2 19.9 14.7 20.3 16.3 Private Physician 99-00 2001 2002 2003 44.2 65.7 72.6 81.3 48.3 75.9 57.5 55.3 60.2 48.9 53.4 66.2 77.1 96.9 65.9 75.7 61.0 74.2 43.2 52.5 53.6 51.4 59.8 84.9 55.6 63.8 76.3 69.3 59.8 70.4 81.7 81.1 39.7 45.5 61.2 75.7 65.8 80.1 61.9 69.5 73.2 66.9 66.9 81.0 75.0 73.0 54.4 42.2 56.5 48.2 59.1 90.7 87.9 97.9 86.4 73.5 76.5 64.0 69.0 74.1 66.2 73.9 74.6 89.7 77.1 76.8 78.7 77.6 73.9 62.2 78.2 86.0 59.7 66.4 82.2 93.8 80.1 79.6 71.9 74.8 176 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 In 2003 16.3% of the shots were received at the public health department 74.8% of the shots were given in the private sector 8.9% of the shot locations were unknown 177 APPENDIX F: MARGINS OF ERROR FOR IMMUNIZATION COVERAGE RATES 178 APPENDIX F: 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 2001 is between 79.2 and 82.4 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. 179 Table 120: Margins of Error for 2003 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) 151 153 94 145 138 269 60 150 110 90 126 123 140 124 150 150 138 94 162 2,567 4:3:1+3 Immunization Coverage Rates (percent) 66.9 81.7 91.5 72.4 65.9 74.6 83.3 58.7 79.1 83.3 74.6 78.9 67.1 87.1 68.0 60.7 73.9 73.4 86.4 Margins of Error (percent) +/- 7.5 +/- 6.1 +/- 5.6 +/- 7.3 +/- 7.9 +/- 5.2 +/- 9.4 +/- 7.9 +/- 7.6 +/- 7.7 +/- 7.6 +/- 7.2 +/- 7.8 +/- 5.9 +/- 7.5 +/- 7.8 +/- 7.3 +/- 8.9 +/- 5.3 95% Confidence Intervals (percent) 59.4 74.4 75.6 87.8 85.9 97.1 65.1 79.7 58.0 73.8 69.4 79.8 73.9 92.7 50.8 66.6 71.5 86.7 75.6 91.0 67.0 82.2 71.7 86.1 59.3 74.9 81.2 93.0 60.5 75.5 52.9 68.5 66.6 81.2 64.5 82.3 81.1 91.7 74.3 +/- 1.7 72.6 76.0 180 Table 121: Margins of Error for 2003 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) 151 153 94 145 138 269 60 150 110 90 126 123 140 124 150 150 138 94 162 4:3:1 Immunization Coverage Rates (percent) 77.5 85.6 94.7 75.2 68.1 78.4 90.0 66.0 83.6 93.3 83.3 86.2 76.4 91.9 74.0 77.3 81.2 81.9 90.7 Margins of Error (percent) +/- 6.7 +/- 5.6 +/- 4.5 +/- 7.0 +/- 7.8 +/- 4.9 +/- 7.6 +/- 7.6 +/- 6.9 +/- 5.2 +/- 6.5 +/- 6.1 +/- 7.0 +/- 4.8 +/- 7.0 +/- 6.7 +/- 6.5 +/- 7.8 +/- 4.5 95% Confidence Intervals (percent) 70.8 84.2 80.0 91.2 90.2 99.2 68.2 82.2 60.3 75.9 73.5 83.3 82.4 97.6 58.4 73.6 76.7 90.5 88.1 98.5 76.8 89.8 80.1 92.3 69.4 83.4 87.1 96.7 67.0 81.0 70.6 84.0 74.7 87.7 74.1 89.7 86.2 95.2 Statewide Rate (weighted) 2,567 80.8 +/- 1.6 79.2 82.4 181 Table 122: Margins of Error for 2003 Statewide and District 3:3:1 Rates Sizes of Final Health Sample District (Records Located) 1-1 151 1-2 153 2-0 94 3-1 145 3-2 138 3-3 269 3-4 60 3-5 150 4-0 110 5-1 90 5-2 126 6-0 123 7-0 140 8-1 124 8-2 150 9-1 150 9-2 138 9-3 94 10-0 162 Statewide Rate 2,567 (weighted) 3:3:1 Immunization Coverage Rates (percent) 82.1 88.9 94.7 80.0 69.6 83.6 90.0 78.7 90.0 96.7 92.9 90.2 84.3 95.2 79.3 86.0 86.2 87.2 91.4 85.9 Margins of Error (percent) +/- 6.1 +/- 5.0 +/- 4.5 +/- 6.5 +/- 7.7 +/- 4.4 +/- 7.6 +/- 6.6 +/- 5.6 +/- 3.7 +/- 4.5 +/- 5.3 +/- 6.0 +/- 3.8 +/- 6.5 +/- 5.6 +/- 5.8 +/- 6.8 +/- 4.3 95% Confidence Intervals (percent) 76.0 88.2 83.9 93.9 90.2 99.2 73.5 86.5 61.9 77.3 79.2 88.0 82.4 97.6 72.1 85.3 84.4 95.6 93.0 100.4 88.4 97.4 84.9 95.5 78.3 90.3 91.4 99.0 72.8 85.8 80.4 91.6 80.4 92.0 80.4 94.0 87.1 95.7 +/- 1.3 84.6 87.2 182