GEORGIA IMMUNIZATION STUDY 2004 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 Rebecca Thompson, B.S.Ed., Project Assistant Contributors Valerie G. Jones, B.S., Project Associate Latonya M. Thomas, Assessment Coordinator 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. 2004 Executive Summary The 2004 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 2004. Identifying information about the children and their parents was collected from birth certificates. The Immunization Study showed that during 2004 most childhood immunizations (70 percent) were administered in the private sector, while County Health Departments immunized 14 percent, and the sources for 15 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 78 percent in 2002, a slight decrease in 2003 to 74 percent, but an increase in 2004 to 81 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 2004, 93 percent of infants had received two doses of hepatitis B vaccine by 12 months of age, and, at 24 months, 91 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 2004, 85 percent of children 12 months of age were appropriately immunized against diphtheria, tetanus and pertussis, and 81 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 65 percent in the Clayton district to 100 percent in the North (Gainesville) district. Eleven of the state's public health districts (Dalton, Gainesville, Gwinnett, Brunswick, Macon, Augusta, Columbus, Valdosta, Albany, Savannah, and Athens) succeeded in immunizing at least 85 percent of their two-year-olds against the 10 vaccine-preventable childhood diseases. Only the Clayton district had a rate less than 75 percent. Within Metropolitan Atlanta, the immunization rates varied from 65 percent in Clayton to 94 percent in Gwinnett. In Georgia outside Metropolitan Atlanta, the immunization rates ranged from 77 percent in LaGrange to 100 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, 87 percent were adequately immunized, while among children of black women, 82 percent were adequately immunized. Children of college-educated mothers were less likely to be adequately immunized (84 percent) than children of mothers with less than high school education (87 percent). The children of mothers who did not receive Medicaid were more likely to be adequately immunized (87 percent) than were children of mothers who did receive Medicaid (84 percent). Georgia Vaccination Rates (4:3:1) by Public Health District 2004 PUBLIC HEALTH DISTRICTS Vaccination Rate 1-1 Northwest (Rome) Dade Catoosa Fannin Murray Walker Whitfield 1-2 Gilmer Towns Union Rabun White Habersham 65.1 - 73.1 77.5 - 88.4 Chattooga 1-1 Floyd Gordon Bartow Lumpkin Stephens Pickens Dawson 2 Hall Banks Franklin Hart Cherokee Forsyth 89.5 - 100.0 Note: The State Vaccination Rate Jackson Madison Elbert (4:3:1) is 85.1 Polk Haralson Cobb 3-4 Paulding 3-1 Gwinnett 3-5 Douglas Fulton DeKalb Rock- Barrow Clarke Oglethorpe Oconee 10 Walton Wilkes Carroll 3-2 3-3 dale Newton Morgan Greene Taliaferro Lincoln Columbia Clayton McDuffie Heard Troup Fayette Coweta Henry 4 Spalding Butts Jasper Putnam Warren Hancock Glascock Meriwether Pike Lamar Monroe Jones Baldwin 5-2 Jefferson Washington Richmond 6 Burke Upson 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) Health Districts Counties Harris Talbot Crawford Bibb Wilkinson Twiggs Johnson Jenkins Screven Muscogee Taylor Peach Emanuel Chatta- Marion Macon hoochee 7 Schley Stewart Webster Sumter Houston Bleckley Laurens 5-1 Treutlen Candler Bulloch Pulaski Dooly Dodge Montgomery Wheeler Toombs Evans Tattnall Effingham 9-1 Bryan Chatham Quitman Terrell Lee Randolph Crisp Wilcox Telfair Turner Ben Hill Jeff Davis Appling Liberty Long 9-3 Clay Calhoun Dougherty Early Baker Miller 8-2 Mitchell Worth Colquitt Irwin Tift 8-1 Berrien Cook Coffee Atkinson Bacon Wayne 9-2 Pierce Brantley Ware McIntosh Glynn Seminole Decatur Grady Thomas Brooks Lanier Lowndes Clinch Charlton Camden Echols 20 0 20 Miles Georgia Department of Human Resources Division of Public Health Office of Health Information & Policy Created: May 2005 Source: Division of Public Health Classification: Natural Breaks Projection: Georgia Statewide Lambert Conformal Conic Note: Map originally printed in color Georgia Vaccination Rates (4:3:1:3:3:1) by Public Health District 2004 PUBLIC HEALTH DISTRICTS Vaccination Rate 1-1 Northwest (Rome) Dade Catoosa Fannin Murray Walker Whitfield 1-2 Gilmer Towns Union Rabun White Habersham 62.8 - 75.2 78.5 - 89.5 Chattooga 1-1 Floyd Gordon Bartow Lumpkin Stephens Pickens Dawson 2 Hall Banks Franklin Hart Cherokee Forsyth 93.1 - 100.0 Note: The State Vaccination Rate Jackson Madison Elbert (4:3:1) is 81.3 Polk Haralson Cobb 3-4 Paulding 3-1 Gwinnett 3-5 Douglas Fulton DeKalb Rock- Barrow Clarke Oglethorpe Oconee 10 Walton Wilkes Carroll 3-2 3-3 dale Newton Morgan Greene Taliaferro Lincoln Columbia Clayton McDuffie Heard Troup Fayette Coweta Henry 4 Spalding Butts Jasper Putnam Warren Hancock Glascock Meriwether Pike Lamar Monroe Jones Baldwin 5-2 Jefferson Washington Richmond 6 Burke Upson 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) Health Districts Counties Harris Talbot Crawford Bibb Wilkinson Twiggs Johnson Jenkins Screven Muscogee Taylor Peach Emanuel Chatta- Marion Macon hoochee 7 Schley Stewart Webster Sumter Houston Bleckley Laurens 5-1 Treutlen Candler Bulloch Pulaski Dooly Dodge Montgomery Wheeler Toombs Evans Tattnall Effingham 9-1 Bryan Chatham Quitman Terrell Lee Randolph Crisp Wilcox Telfair Turner Ben Hill Jeff Davis Appling Liberty Long 9-3 Clay Calhoun Dougherty Early Baker Miller 8-2 Mitchell Worth Colquitt Irwin Tift 8-1 Berrien Cook Coffee Atkinson Bacon Wayne 9-2 Pierce Brantley Ware McIntosh Glynn Seminole Decatur Grady Thomas Brooks Lanier Lowndes Clinch Charlton Camden Echols 20 0 20 Miles Georgia Department of Human Resources Division of Public Health Office of Health Information & Policy Created: May 2005 Source: Division of Public Health Classification: Natural Breaks Projection: Georgia Statewide Lambert Conformal Conic Note: Map originally printed 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. 2004 Eligible Sample, Number Located, and Response Rate by District .. 16 4. Parent Refusals by Health District for the 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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. 2004 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 2004 Study ...................... 161 116. 2004 Varicella Rates and Cases of Chicken Pox by District ................... 170 117. Statewide Percentage of Shots by Provider: 1999-2000, 2000-01, 2002, 2003 and 2004 ........................................................................................ 173 118. District Specific Percentage of Shots by Provider 2004 .......................... 174 119. Location of Immunizations by District -Four Year Comparison 2000-01, 2002, 2003 and 2004 .............................................................................. 176 120. Margins of Error for 2004 Statewide and District 4:3:1+3 Rates.............. 180 121. Margins of Error for 2004 Statewide and District 4:3:1 Rates.................. 181 122. Margins of Error for 2004 Statewide and District 3:3:1 Rates.................. 182 ix List of Figures Page 1. Sampling Procedure.................................................................................... 13 2. 2004 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 2004 Study ................................................................................................ 162 24. 2004 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 2004 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 2004 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 Georgia Immunization Survey is now in it's eighth year. The Rollins School of Public Health, Emory University did the first three years of the study and the Georgia Division of Public Health has continued on with the survey for the remaining five years. Immunization data for each year of the study evaluate rates for children born two years before the beginning of the study. In 2004, immunization rates for children born in January 2002 were examined. 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., the Project Assistant was Ms. Rebecca Thompson and Ms. Valerie Jones was the Project Associate. 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 2004. Throughout this report, we refer to study years one, two, three, four and five as, 1999-2000, 2001, 2002, 2003, and 2004 respectively. The results from these five study years refer to rates for 1998, 1999, 2000, 2001, and 2002 respectively. 2 During January, a training session for the public health representatives was held via conference call. Data were collected from February 2004 through September 2004. (Data collection continued on some difficult to obtain records through the end of October 2004). 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, 2003 Initial notification of public health community Immunization Coordinators December, 2003 Health Directors Initial notification of private health January, 2004 community Conference call training for public health January, 2004 representatives Data collection period February September, 2004 Data entry period March November, 2004 Double data entry of 5% of data forms January, 2004 Final data cleaning and analysis of data February, 2004 Final Report March, 2004 Data collection was extended beyond September 2004 to allow for followup of records for which the public health representatives had some information but needed more time to complete. 3 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 eighth 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 2002. 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 2004. 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 2002. A sample size of 4,116 children born in the month of January 2002 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 2002. 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 2004. 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, two Varicella vaccines, and four Pneumococcal Conjugate (PCV) 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 in subsequent study years by Ms. Hoban. Data Entry The principal investigator and project assistant 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 January 2004. 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 96.0% was found. 10 Analysis Plan The plan for the analysis was very similar to that used in the previous years. Additionally, trends from the previous five years of the study are shown in this Final Report. Epi Info was the main software program used to assess immunization coverage rates, and provide a measure of where the immunizations were given. The analyses include univariate, bivariate, and multivariate analyses to produce a clear description of the immunization status of two-year-old children in the State of Georgia. 11 SECTION III: RESULTS OF STATEWIDE ANALYSES 12 SECTION III: RESULTS OF STATEWIDE ANALYSES Sampling The sample of 4,116 children was drawn from 11,134 children born in Georgia in January 2002. A total of 133,285 children were born in Georgia during 2002. Children who were ineligible for participation in the study were extracted from the original sample, leaving an eligible sample of 4,116. (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 2002 (N = 133,285) All children born in Georgia in January 2002 (N = 11,134) Original sample of 4,116 children Eligible sample of 3,888 children Final sample of 2,645 children Of the 3,888 children in the eligible sample, 2,645 children were located, 1,167 children never were located and 76 parental refusals were removed. The resulting final sample consisted of 2,645 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 2,645 children represented 68 percent of the eligible sample. Table 2: Sample Description Sampling Step Original Sample Deceased Adopted Moved out of state Military Number 4,116 4 13 135 76 Percent of Sample 100.0% 0.1% 0.3% 3.3% 1.8% Eligible Sample 3,888 94.5% Eligible Sample Records Not Located /Eligibility Unknown * 3,888 1,243 100.0% 32.0% Final Sample (Located Records**) 2,645 68.0% * 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=15] 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 2004 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 38.9 percent to a high of 95.2 percent, with a statewide average response rate of 68.0 percent. 15 Table 3: 2004 Eligible Sample, Number Located and Response Rates by District Health Eligible Number Response District Sample Located* (Number) Rate ** (% of Eligible Sample located) 1-1 233 222 95.2% 1-2 136 113 83.1% 2-0 75 70 93.3% 3-1 294 225 76.5% 3-2 631 244 38.9% 3-3 218 86 39.4% 3-4 185 167 90.3% 3-5 435 240 55.2% 4-0 236 189 80.1% 5-1 60 55 91.7% 5-2 184 148 80.4% 6-0 142 116 81.7% 7-0 243 201 82.7% 8-1 81 76 93.8% 8-2 189 175 92.6% 9-1 173 81 46.8% 9-2 156 135 86.5% 9-3 117 84 71.8% 10-0 100 93 93.0% State 3,888 2,645 68.0% *sample includes parental refusals **number located / eligible sample 16 Figure 2 2004 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 2004 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 222 113 70 225 244 86 167 240 189 55 148 116 201 76 175 81 135 84 93 2,645 Parent Refusals Number 4 11 3 13 18 0 14 1 2 1 1 0 2 0 0 0 0 1 5 76 Percent 0.02 0.10 0.04 0.06 0.07 0.00 0.08 0.00 0.01 0.02 0.01 0.00 0.01 0.00 0.00 0.00 0.00 0.01 0.05 0.03 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 2,645 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 2,645 children who were located in 2004, 81.3 percent were adequately immunized at the 4:3:1+3 level. This percent of adequately immunized children increased from 74.3 percent in 2003. 19 Table 5: 4:3:1+3 State Immunization Coverage by Study Year Status Adequately Immunized Number Percent 1999-00 1,573 56.3 2001 1,837 66.7 2002 2,146 78.9 2003 1,906 74.3 2004 2,150 81.3 Note: State rates based on data weighted by health district. Inadequately Immunized Number Percent 1,220 43.7 918 33.3 575 21.1 661 25.7 495 18.7 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. During the 2004 assessment, the number of adequately immunized children increased to 85.1 percent. Status Table 6: 4:3:1 State Immunization Coverage by Study Year Adequately Immunized Inadequately Immunized Number Percent Number Percent 1999-00 2,202 78.8 591 21.1 2001 2,068 75.1 687 24.9 2002 2,284 83.9 437 16.1 2003 2,075 80.8 492 19.2 2004 2,252 85.1 393 14.9 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 99-00 2001 2002 2003 2004 4:3:1 4:3:1+3 Figure 3 reveals the statewide 4:3:1 coverage rates for the 1999-00, 2001, 2002, 2003 and 2004 studies. The figure also shows statewide 4:3:1+3 vaccination coverage for the 1999-00, 2001, 2002, 2003 and 2004 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 decreased slightly during the 1999-00 and 2001 studies (82.0 and 78.9 respectively), but increased again in 2002 to 88.8 percent and again in 2004 to 88.5 percent. 21 Table 7: 3:3:1 State Immunization Coverage by Study Year Status Adequately Immunized Number Percent 1999-00 2,290 82.0 2001 2,175 78.9 2002 2,417 88.8 2003 2,205 85.9 2004 2,340 88.5 Note: State rates based on data weighted by health district. Inadequately Immunized Number Percent 503 18.0 580 21.1 304 11.2 362 14.2 305 11.5 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 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. In 2004, all but one of the vaccine series met the coverage rate of 90 percent. The coverage rate for the Varicella vaccine dramatically increased from 64.3 percent in 1999-00, to 77.9 percent in 2001 and 88.5 percent in 2002. The coverage rate for the Varicella vaccine decreased slightly in 2003 to 81.8 percent, but the rate increased and met the goal of 90 percent in 2004. (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 1999-00 2001 2002 Number Percent Number Percent Number Percent 2,491 89.2 2,392 86.8 2,561 94.1 4 DTP/DTaP 2,233 79.9 2,093 76.0 2,303 84.6 3 OPV/IPV 2,358 84.4 2,226 80.8 2,466 90.6 1 MMR 2,363 84.6 2,258 82.0 2,474 90.9 3 Hib 2,441 87.4 2,322 84.3 2,474 90.9 3 Hep B 2,422 86.7 2,308 83.8 2,471 90.8 1 Varicella 1,795 64.3 2,147 77.9 2,407 88.5 3 PCV --- --- --- --- --- --- 4 PCV --- --- --- --- --- --- Note: State rates based on data weighted by health district. * PCV data not collected before 2004. 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 --- --- --- --- 2004 Number Percent 2,459 93.0 2,268 85.7 2,401 90.8 2,405 90.9 2,387 90.2 2,400 90.7 2,378 89.9 1,262 47.7 485 18.3 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 1999-00, 2001, 2002, 2003 and 2004 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 99-00 99-00 2001 2001 2002 2002 2003 2003 2004 2004 DTP/DTaP1 2,588 92.7% 2,507 91.0% 2,667 98.0% 2,447 95.3% 2,554 96.6% DTP/DTaP2 2,507 89.8% 2,426 88.1% 2,592 95.3% 2,367 92.2% 2,472 93.5% DTP/DTaP3 2,327 83.3% 2,214 80.4% 2,394 88.0% 2,176 84.8% 2,255 85.3% DTP/DTaP4 25 0.9% 12 0.4% 23 0.8% 8 0.3% 26 1.0% DTP/DTaP5 1 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 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% 2,553 2,458 1,132 5 96.5% 92.9% 42.8% 0.2% MMR1** MMR2 117 4.2% 87 3.2% 34 1.2% 92 3.6% 110 4.2% 1 0.0% 0 0.0% 1 0.0% 1 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 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% 2,541 2,446 1,063 25 0 96.1% 92.5% 40.2% 0.9% 0.0% HEPB1 HEPB2 HEPB3 HEPB4 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% 2,551 2,478 1,229 26 96.4% 93.7% 46.5% 1.0% VAR1** 150 5.4% 118 4.3% 44 1.6% 125 4.9% 136 5.1% VAR2 0 0.0% 0 0.0% 0 0.0% 1 0.0% 0 0.0% *Percents are calculated as (number immunized/sample size). **The Advisory Committee on Immunization Practices (ACIP) does not recommend the initiation of the MMR and Varicella vaccine series until after the first birthday. Sample Size for 1999-00 study = 2,793; 2001 study = 2,755; 2002 study = 2,721; 2003 study = 2,567; 2004 study = 2, 645. 24 Table 10 shows the 1999-00, 2001, 2002, 2003 and 2004 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 2004 margin of error for each health district ranges from +/- 0.0 percent to +/- 10.0 percent. The District level 2004 4:3:1 immunization rates range from 73.1 percent to 100.0 percent. Of the 19 health districts, one had an immunization coverage rate of 100 percent, four had an immunization coverage rate over 90 percent and nine districts had 2003 coverage rates between 80 and 90 percent. The following summary highlights the changes in 4:3:1 coverage rates between 2003 and 2004: Coverage increased between 0 and 5 percent in seven districts (District 1-2, 5-2, 3-4, 6-0, 9-2, 9-3 and 10-0) Coverage increased between 5 and 20 percent in seven districts (Districts 11, 2-0, 3-2, 3-5, 7-0, 8-2, and 9-1) Coverage fell between 0 and 5 percent in two districts (Districts 3-1 and 8-1) Coverage fell between 5 and 20 percent in three districts (Districts 3-3, 4-0, and 5-1) 25 Table 10: 4:3:1 District and State Coverage Rates by Study Year Dist 1999-00 2001 2002 2003 2004 % Margin % Margin % Margin of % Margin % Margin of Error of Error Error of Error of Error 1-1 67.5 +/- 7.1 78.9 +/-6.2 80.6 +/-5.5 1-2 75.3 +/-7.0 78.1 +/-6.7 79.1 +/-6.3 2-0 88.5 +/-5.5 94.8 +/-3.7 93.4 +/-5.6 3-1 75.6 +/-6.1 70.7 +/-6.8 84.5 +/-4.2 3-2 69.6 +/-6.5 42.4 +/-5.6 82.6 +/-6.2 3-3 60.7 +/-10.4 57.6 +/-8.9 73.9 +/-8.2 3-4 94.5 +/-2.3 75.9 +/-9.4 94.3 +/-3.4 3-5 64.9 +/-6.3 75.5 +/-6.0 84.6 +/-5.1 4-0 79.7 +/-5.7 83.5 +/-5.1 87.1 +/-5.4 5-1 91.3 +/-6.2 85.0 +/-9.0 80.8 +/-8.7 5-2 83.6 +/-9.8 69.1 +/-8.6 84.7 +/-4.5 6-0 72.3 +/-12.8 88.9 +/-4.8 89.2 +/-6.0 7-0 77.1 +/-6.3 73.1 +/-6.7 82.8 +/-6.9 8-1 86.0 +/-6.6 76.7 +/-8.2 82.2 +/-6.6 8-2 83.7 +/-5.9 93.2 +/-4.3 83.1 +/-8.4 9-1 78.5 +/-7.1 69.1 +/-8.2 80.9 +/-6.2 9-2 85.0 +/-6.1 90.8 +/-4.9 85.4 +/-7.3 9-3 82.2 +/-8.8 71.6 +/-9.1 85.6 +/-6.3 10-0 73.4 +/-7.0 84.4 +/-5.7 80.2 +/-7.1 State 78.8 +/-1.5 75.1 +/-1.5 83.9 +/-1.6 Note: State rates based on data weighted by health district. 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 82.6 88.2 100 73.1 78.3 65.1 93.5 82.0 77.5 85.5 87.1 90.5 88.4 89.5 94.9 97.5 82.2 83.1 94.3 85.1 +/- 5.0 +/- 6.3 +/- 0 +/- 6.0 +/- 5.4 +/- 10.0 +/- 3.3 +/- 4.9 +/- 6.0 +/- 9.3 +/- 6.0 +/- 5.3 +/- 4.4 +/- 6.9 +/- 3.3 +/- 3.4 +/- 6.5 +/- 8.1 +/- 4.8 +/-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 1999-00, 2001, 2003 and 2004 data collection periods. 26 As shown in Table 11, 2004 district immunization rates for the DTP/DTaP vaccines ranged from 67.4 percent to 100.0 percent, with a statewide rate of 85.7 percent receiving all four doses. The 2004 statewide DTP/DTaP rate increased from the 2003 study year. Table 11: State and District Immunization Rates for DTP/DTaP by Study Year District 1-1 1999-00 Rates 4 DTP/DTaP 67.5% 2001 Rates 4 DTP/DTaP 79.5% 2002 Rates 4 DTP/DTaP 81.1% 1-2 77.4% 79.5% 82.3% 2-0 89.3% 94.8% 94.7% 3-1 77.7% 70.7% 84.9% 3-2 71.1% 42.4% 84.0% 3-3 63.1% 61.0% 73.9% 3-4 94.8% 75.9% 94.9% 3-5 66.2% 77.0% 84.6% 4-0 79.7% 83.5% 87.8% 5-1 91.3% 86.7% 80.8% 5-2 83.6% 72.7% 85.5% 6-0 74.5% 89.5% 89.2% 7-0 8-1 8-2 9-1 9-2 9-3 10-0 77.1% 86.9% 85.6% 80.8% 88.0% 82.2% 74.7% 74.3% 77.7% 94.7% 69.9% 92.4% 71.6% 85.1% 83.6% 82.2% 85.7% 81.6% 86.5% 85.6% 80.2% State 79.9% 76.0% 84.6% Note: State rates based on data weighted by health district. 2003 Rates 4 DTP/DTaP 77.1% 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% 2004 Rates 4 DTP/DTaP 85.3% 88.2% 100% 78.8% 78.8% 67.4% 94.1% 82.4% 79.1% 85.5% 87.1% 90.5% 88.4% 89.5% 94.9% 97.5% 83.0% 83.1% 94.3% 85.7% 27 Table 12 shows the 1999-00, 2001, 2003 and 2004 state and district rates for the OPV/IPV vaccines. The 2004 district coverage rates for these vaccines varied between 74.4 percent and 100.0 percent. The 2004 statewide immunization rate for OPV/IPV was 90.8 percent, which is slightly higher than the previous year's study rate. Table 12: State and District Immunization Rates for OPV/IPV by Study Year District 1999-00 Rates 3 OPV/IPV 2001 Rates 3 OPV/IPV 2002 Rates 3 OPV/IPV 2003 Rates 3 OPV/IPV 1-1 92.3% 88.6% 90.0% 1-2 82.2% 86.3% 85.4% 2-0 88.5% 97.0% 97.4% 3-1 79.3% 75.3% 90.8% 3-2 76.8% 45.5% 84.7% 3-3 71.4% 69.5% 82.9% 3-4 96.4% 77.2% 96.0% 3-5 75.7% 83.7% 88.7% 4-0 85.9% 86.4% 92.5% 5-1 5-2 6-0 7-0 8-1 8-2 9-1 9-2 9-3 10-0 State 93.8% 87.3% 85.1% 85.9% 87.9% 90.8% 88.5% 90.2% 86.3% 76.0% 84.4% 93.3% 81.8% 93.2% 78.4% 84.5% 96.2% 79.7% 92.4% 76.8% 88.3% 80.8% 96.2% 94.0% 95.1% 90.5% 95.1% 90.9% 90.1% 92.1% 89.8% 86.0% 90.6% Note: State rates based on data weighted by health district. 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% 2004 Rates 3 OPV/IPV 89.9% 92.2% 100% 83.5% 85.0% 74.4% 96.1% 89.5% 85.6% 92.7% 93.2% 94.8% 93.5% 96.1% 97.7% 98.8% 90.4% 88.0% 98.9% 90.8% 28 Table 13 shows the 1999-00, 2001, 2003 and 2004 state and district rates for MMR. The 2004 district rates for MMR ranged from a low of 75.6 percent to a high of 100.0 percent, with a statewide rate of 90.9 percent coverage. This statewide rate for the MMR vaccine increased from the 2003 rate of 88.3 percent. Table 13: State and District Immunization Rates for MMR 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 1999-00 Rates 1 MMR 73.5% 83.6% 90.1% 81.9% 77.8% 70.2% 96.4% 71.6% 84.9% 96.3% 90.9% 87.2% 85.3% 90.7% 88.9% 85.4% 91.0% 87.7% 77.3% 2001 Rates 1 MMR 89.2% 85.6% 97.0% 77.0% 45.1% 74.6% 83.5% 87.8% 86.4% 91.7% 82.7% 95.1% 80.2% 82.5% 97.0% 79.7% 93.1% 80.0% 89.6% 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% State 84.6% 82.0% 90.9% Note: State rates based on data weighted by health district. 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% 2004 Rates 1 MMR 91.3% 94.1% 100% 86.3% 82.7% 75.6% 96.1% 90.8% 85.0% 90.9% 93.2% 95.7% 93.0% 92.1% 97.7% 98.8% 89.6% 89.2% 97.7% 90.9% 29 As shown in Table 14, 2004 district immunization rates for the Hib vaccine varied between 76.7 and 100.0 percent. The statewide Hib coverage rate in 2004 was 90.2 percent, an increase from the 2003 statewide rate of 87.3 percent. Table 14: State and District Immunization Rates for Hib by Study Year District 1999-00 2001 2002 Rates Rates Rates 3 Hib 3 Hib 3 Hib 1-1 76.5% 89.2% 91.5% 1-2 86.3% 95.2% 86.1% 2-0 88.5% 96.3% 96.1% 3-1 85.0% 83.9% 91.2% 3-2 79.9% 45.5% 85.4% 3-3 79.8% 81.4% 80.2% 3-4 97.5% 92.4% 96.6% 3-5 77.0% 89.3% 86.2% 4-0 88.5% 88.3% 93.2% 5-1 96.3% 91.7% 97.4% 5-2 96.4% 84.5% 92.7% 6-0 87.2% 97.5% 97.1% 7-0 85.3% 82.6% 89.7% 8-1 92.5% 81.6% 94.6% 8-2 92.8% 92.5% 92.2% 9-1 91.5% 81.3% 90.8% 9-2 95.5% 95.4% 93.3% 9-3 89.0% 81.1% 91.5% 10-0 79.9% 94.2% 86.8% State 87.4% 84.3% 90.9% Note: State rates based on data weighted by health district. 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% 2004 Rates 3 Hib 90.8% 94.1% 100% 82.1% 84.1% 76.7% 96.7% 88.3% 86.6% 87.3% 91.2% 92.2% 93.0% 94.7% 98.3% 98.8% 91.1% 84.3% 95.5% 90.2% 30 Table 15 reports the statewide and district immunization coverage rates for the Hepatitis B vaccine. In 2004, the district coverage rates varied from a low of 77.9 percent to 100.0 percent. The 2004 statewide rate of 90.7 percent for the Hepatitis B vaccine was higher than the 2003 statewide rate of 87.8 percent. Table 15: State and District Immunization Rates for Hep B by Study Year District 1-1 1999-00 Rates 3 Hep B 76.5% 2001 Rates 3 Hep B 92.8% 2002 Rates 3 Hep B 91.0% 1-2 86.3% 93.2% 87.3% 2-0 89.3% 95.6% 97.4% 3-1 85.5% 82.8% 92.6% 3-2 79.4% 44.4% 84.7% 3-3 76.2% 81.4% 80.2% 3-4 97.5% 86.1% 94.9% 3-5 77.9% 88.8% 85.6% 4-0 85.9% 88.8% 92.5% 5-1 96.3% 93.3% 96.2% 5-2 89.1% 83.6% 93.1% 6-0 85.1% 93.2% 96.1% 7-0 87.6% 85.0% 90.5% 8-1 92.5% 84.5% 94.6% 8-2 90.2% 95.5% 92.2% 9-1 89.2% 76.4% 90.1% 9-2 91.7% 95.4% 92.1% 9-3 87.7% 81.1% 89.0% 10-0 79.9% 91.6% 88.4% State 86.7% 83.8% 90.8% Note: State rates based on data weighted by health district. 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% 2004 Rates 3 Hep B 90.8% 94.1% 98.5% 83.0% 85.4% 77.9% 96.7% 89.1% 86.1% 90.9% 91.8% 94.0% 93.5% 96.1% 97.7% 100% 90.4% 86.7% 94.3% 90.7% 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 74.4 percent to 98.8 percent, with a statewide coverage rate of 89.9 percent for the Varicella vaccine. This is an increase from the 2003 Varicella rate of 86.7 percent. Table 16: State and District Immunization Rates for Varicella by Study Year District 1-1 1999-00 Rates 1 Varicella 45.2% 2001 Rates 1 Varicella 83.7% 2002 Rates 1 Varicella 89.1% 2003 Rates 1 Varicella 86.8% 1-2 58.2% 82.9% 86.1% 90.2% 2-0 81.7% 94.8% 96.1% 96.8% 3-1 66.3% 72.4% 88.4% 80.7% 3-2 67.5% 44.4% 81.9% 71.7% 3-3 52.4% 69.5% 82.9% 84.7% 3-4 89.5% 86.1% 96.0% 90.0% 3-5 57.2% 81.1% 83.6% 74.0% 4-0 65.6% 83.0% 92.5% 92.7% 5-1 61.3% 86.7% 84.6% 95.6% 5-2 61.8% 80.0% 90.3% 92.9% 6-0 61.7% 88.3% 97.1% 90.2% 7-0 53.5% 74.9% 88.8% 85.7% 8-1 61.7% 78.6% 93.0% 94.4% 8-2 66.0% 96.2% 90.9% 78.0% 9-1 51.5% 71.5% 83.6% 83.3% 9-2 58.6% 88.5% 87.6% 91.3% 9-3 57.5% 69.5% 83.9% 86.2% 10-0 58.4% 87.0% 86.8% 95.7% State 64.3% 77.9% 88.5% 86.7% Notes: State rates based on data weighted by health district. 2004 Rates 1 Varicella 89.0% 95.1% 98.5% 83.5% 81.4% 74.4% 94.1% 89.5% 85.0% 90.9% 91.2% 94.8% 93.5% 92.1% 97.7% 98.8% 90.4% 88.0% 94.3% 89.9% 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 2001 and 2002 study years the immunization rates of children born to black and white mothers were virtually the same. However, in the 2003 and 2004 study years 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 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% 2004 4:3:1 Adequate #/Total (percent) 1377/1587 (86.8) 800/977 (81.9) 75/81 (92.6) 85.1% Notes: Total rates based on data weighted by health district. 2001 Chi-square=3.15, p=0.21; 2002 Chi-square=3.81, p=0.28; 2003 Chi-square=20.49, p<.05; 2004 Chi-square=15.07, 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, 2003, and 2004 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 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% 2004 4:3:1 Adequate #/Total (percent) 28/32 (87.5) 360/428 (84.1) 687/816 (84.2) 438/523 (83.7) 739/846 (87.4) 85.1% Notes: Total rates based on data weighted by health district. 2001 Chi-square=2.09, p=0.7; 2002 Chisquare=31.97, p<0.05; 2003 Chi square=12.50, p<.05; 2004 Chi-square=5.15, p=0.27. 35 Table 19 shows the statewide cross-tabulation of maternal Medicaid status and 4:3:1 immunization status for 2002, 2003 and 2004 study years. The 4:3:1 rates are shown for Medicaid recipients and non-Medicaid recipients. During the 2002, 2003, and 2004 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: 2004 Statewide Cross tabulations of Maternal Medicaid Status and Child Immunization Status Medicaid Status Medicaid Non-Medicaid 4:3:1 Total 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% 2004 4:3:1 Adequate #/Total (percent) 1,203/1,440 (83.5) 1,049/1,205 (87.1) 85.1% Notes: 4:3:1 total rates based on data weighted by health district. 2002 Chi-square = 15.13, p<0.05; 2003 Chi-square = 17.45, p <.05; 2004 Chi-square = 6.40, 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 increased in 2004 statewide compared to the same rates as measured by this study in 2003. 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 fifth 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 2004 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 233 children born in January 2002. From the 233 children, 222 records were located (Response Rate=95.2%). Of the 222 located records, there were 4 parental refusals leaving a final sample of 218 records. The 4:3:1 immunization coverage estimate is 82.6 percent (180/218). This rate is lower than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 4: 4:3:1 Coverage for State and District 1-1 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 1-1 The 4:3:1+3 immunization coverage estimate is 79.4 percent (173/218). This rate is lower than the statewide 4:3:1+3 immunization rate of 81.3 percent. 39 Table 20: District Immunization Rates for Health District 1-1 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 67.5% 79.5% 3 OPV/IPV 82.2% 88.6% 1 MMR 73.5% 89.2% 3 Hib 76.5% 89.2% 3 HepB 76.5% 92.8% 1 Varicella 45.2% 83.7% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 85.3% 89.9% 91.3% 90.8% 90.8% 89.0% 51.4% 15.6% Table 20 reveals the coverage rates of each vaccine series. Coverage rates ranged from 15.6 to 91.3 percent for the 2004 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: 2004 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 211 96.3% 204 93.6% 187 85.8% 2 0.9% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 211 96.8% 202 92.7% 82 37.6% 1 0.5% MMR1 MMR2 13 6.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 210 96.3% 203 93.1% 81 37.2% 2 0.9% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 209 95.9% 204 93.6% 87 39.9% 0 0.0% VAR1 12 VAR2 0 *Percent = number immunized / sample size sample size = 218 5.5% 0.0% 41 Table 22: Cross tabulations of Maternal Race and Child Immunization Status for Health District 1-1 by Study Year Maternal Race White Black Other 2001 4:3:1 Adequate #/Total (percent) 123/154 (79.9) 8/12 (66.7) ---- Total 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) 2004 4:3:1: Adequate #/Total (percent) 154/185 (83.2) 21/27 (77.8) 5/6 (83.3) 180/218 (82.6) 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 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, 2003, and 2004 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 3/3 (100.0) 22/26 (84.6) 73/89 (82.0) 35/46 (76.1) 47/54 (87.0) --- 180/218 (82.6) 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 2004 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 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) 2004 4:3:1 Adequate #/Total (percent) 84/103 (81.6) 96/115 (83.5) 180/218 (82.6) Table 24 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 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 136 children born in January 2002. From these children, 113 records were located (Response Rate=83.1%). Of the 113 located records, there were 11 parental refusals leaving a final sample of 102 records. 4:3:1 immunization coverage estimate is 88.2 percent (90/102). This rate is higher than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 5: 4:3:1 Coverage for State and District 1-2 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 1-2 4:3:1+3 immunization coverage estimate 85.3 percent (87/102). This rate is higher than the statewide 4:3:1+3 immunization rate of 81.3 percent. 45 Table 25: District Immunization Rates for Health District 1-2 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 77.4% 79.5% 3 OPV/IPV 82.2% 86.3% 1 MMR 83.6% 85.6% 3 Hib 86.3% 95.2% 3 HepB 86.3% 93.2% 1 Varicella 58.2% 82.9% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 88.2% 92.2% 94.1% 94.1% 94.1% 95.1% 56.9% 14.7% Table 25 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 14.7 to 95.1 percent for the 2004 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: 2004 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 97 95.1% 95 93.1% 86 84.3% 1 1.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 97 95.1% 92 90.2% 50 49.0% 0 0.0% MMR1 MMR2 9 8.8% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 97 95.1% 93 91.2% 29 28.4% 1 1.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 97 95.1% 95 93.1% 34 33.3% 0 0.0% VAR1 9 VAR2 0 *Percent = number immunized / sample size Sample size = 102 8.8% 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 2001 4:3:1 Adequate #/Total (percent) 112/142 (78.9) 2/4 (50.0) --- Unknown --- Total 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) --- 2004 4:3:1 Adequate #/Total (percent) 86/98 (87.8) 3/3 (100.0) 1/1 (100.0) --- 123/153 (80.4) 90/102 (88.2) 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 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) ---- Total 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) 2004 4:3:1 Adequate #/Total (percent) 1/1 (100.0) 15/19 (79.0) 28/30 (93.3) 8/10 (80.0) 38/42 (90.5) --- 90/102 (88.2) 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 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) 2004 4:3:1 Adequate #/Total (percent) 43/52 (82.7) 47/50 (94.0) 90/102 (88.2) Table 29 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 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 75 children born in January 2002. From the 75 children, 70 records were located (Response rate = 93.3%). Of the 103 located records, there were 3 parental refusals leaving a final sample of 67 records. 4:3:1 immunization coverage estimate is 100% percent (67/67). This rate is much higher than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 6: 4:3:1 Coverage for State and District 2-0 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 2-0 4:3:1+3 immunization coverage estimate is 94 percent (63/67). This rate is also much higher than the statewide 4:3:1+3 immunization rate of 81.3 percent. 51 Table 30: District Immunization Rates for Health District 2-0 by Study Year* Vaccine 1999-00 2001 2002 2003 2004 Adequate Adequate Adequate Adequate Adequate Rates Rates Rates Rates Rates 4 DTP/DTaP 89.3% 94.8% 94.7% 95.7% 100% 3 OPV/IPV 88.5% 97.0% 97.4% 94.7% 100% 1 MMR 90.1% 97.0% 96.1% 96.8% 100% 3 Hib 88.5% 96.3% 96.1% 93.6% 100% 3 HepB 89.3% 95.6% 97.4% 93.6% 100% 1 Varicella 81.7% 94.8% 96.1% 96.8% 98.5% 3 PCV --- --- --- --- 77.6% 4 PCV --- --- --- --- 28.4% *PCV data not collected before 2004. Table 30 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 28.4 to 100 percent for the 2004 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: 2004 District Immunization Rates by Individual Vaccine at 12 months of age for Health District 2-0 Vaccine Dose Number Immunized Percent* DTP1/DTaP1 67 100% DTP2/DTaP2 67 100% DTP3/DTaP3 65 97.0% DTP4/DTaP4 67 100% DTP5/DTaP5 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 67 100% 67 100% 34 50.7% 0 0.0% MMR1 MMR2 1 1.5% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 67 100% 67 100% 35 52.2% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 67 100% 66 98.5% 41 61.2% 0 0.0% VAR1 1 VAR2 0 *Percent = number immunized / sample size Sample size = 67 1.5% 0.0% 53 Table 32: Cross tabulations of Maternal Race and Child Immunization Status for Health District 2-0 by Study Year Maternal Race White Black Other Total 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) 2004 4:3:1 Adequate #/Total (percent) 65/65 (100.0) 2/2 (100.0) --- 67/67 (100.0) 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) --- 11/11 (100.0) 16/16 (100.0) 9/9 (100.0) 31/31 (100.0) --- 67/67 (100.0) 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 was at 100%, with no correlation with educational level. 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 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) 2004 4:3:1 Adequate #/Total (percent) 29/29 (100.0) 38/38 (100.0) 67/67 (100.0) Table 34 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. During the 2002 study year, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. This trend was reversed during the 2003 study year. However, in 2004 children born to Medicaid women had the same immunization rate as children born to non-Medicaid women. 56 Individual Health District Report: District 3-1 The eligible sample from this district included 294 children born in January 2002. From the 294 children, 225 records were located (Response Rate=76.5%). Of the 225 located records, there were 13 parental refusals leaving a final sample of 212 records. The 4:3:1 immunization coverage estimate is 78.3 percent (166/212). This rate is lower than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 7: 4:3:1 Coverage for State and District 3-1 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 3-1 The 4:3:1+3 immunization coverage estimate is 73.1 percent (155/212). This rate is lower than the statewide 4:3:1+3 immunization rate of 81.3 percent. 57 Table 35: District Immunization Rates for Health District 3-1 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 77.7% 70.7% 3 OPV/IPV 79.3% 75.3% 1 MMR 81.9% 77.0% 3 Hib 85.0% 83.9% 3 HepB 85.5% 82.8% 1 Varicella 66.3% 72.4% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 78.8% 83.5% 86.3% 82.1% 83.0% 83.5% 46.7% 23.1% Table 35 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 23.1 to 86.3 percent for the 2004 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: 2004 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 202 95.3% 193 91.0% 175 82.5% 2 0.9% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 200 94.3% 190 89.6% 72 34.0% 1 0.0% MMR1 MMR2 10 4.7% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 200 94.3% 189 89.2% 76 35.8% 4 1.9% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 201 94.8% 190 89.6% 93 43.9% 1 0.5% VAR1 12 VAR2 0 *Percent = number immunized / sample size Sample size = 212 5.7% 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 2001 4:3:1 Adequate #/Total (percent) 95/128 (74.2) 22/40 (55.0) 6/6 (100.0) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 118/142 (83.1) 40/60 (66.7) 8/10 (80.0) --- 166/212 (78.3) 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 5/8 (62.5) 9/11 (81.8) 37/52 (71.2) 33/46 (71.2) 82/95 (86.3) --- 166/212 (78.3) 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 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) 2004 4:3:1 Adequate #/Total (percent) 53/71 (74.6) 113/141 (80.1) 166/212 (78.3) Table 39 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 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 631 children born in January 2002. From the 631 children, 244 records were located (Response Rate=38.9%). Of the 244 located records, there were 18 parental refusals leaving a final sample of 226 records. The 4:3:1 immunization coverage estimate is 78.3 percent (177/226). This rate is lower than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 8: 4:3:1 Coverage for State and District 3-2 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 3-2 The 4:3:1+3 immunization coverage estimate is 75.2 percent (170/226). This rate is also lower than the statewide 4:3:1+3 immunization rate of 81.3 percent. 63 Table 40: District Immunization Rates for Health District 3-2 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 71.1% 42.4% 3 OPV/IPV 76.8% 45.5% 1 MMR 77.8% 45.1% 3 Hib 79.9% 45.5% 3 HepB 79.4% 44.4% 1 Varicella 67.5% 44.4% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 78.8% 85.0% 82.7% 84.1% 85.4% 81.4% 66.8% 35.8% Table 40 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 35.8 to 85.4 percent for the 2004 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: 2004 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 201 88.9% 190 84.1% 171 75.7% 3 1.3% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 201 88.9% 191 84.5% 102 45.1% 0 0.0% MMR1 MMR2 10 4/4% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 199 88.1% 187 82.7% 95 42.0% 3 1.3% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 202 89.4% 194 85.8% 101 44.7% 0 0.0% VAR1 13 VAR2 0 *Percent = number immunized / sample size Sample size = 226 5.8% 0.0% 65 Table 42: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-2 by Study Year Maternal Race White Black Other Total 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) 2004 4:3:1 Adequate #/Total (percent) 95/113 (84.1) 69/99 (69.7) 13/14 (92.9) 177/226 (78.3) 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 3/3 (100.0) 25/34 (73.5) 36/47 (76.6) 17/24 (70.8) 96/118 (81.3) --- 177/226 (78.3) 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 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) 2004 4:3:1 Adequate #/Total (percent) 74/103 (71.8) 103/123 (83.7) 177/226 (78.3) Table 44 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. For Health District 3-2, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. 68 Individual Health District Report: District 3-3 The eligible sample from this district included 218 children born in January 2002. From the 218 children, 86 records were located (Response Rate=39.4%). Of the 86 located records, there were 0 parental refusals leaving a final sample of 86 records. The 4:3:1 immunization coverage estimate is 65.1 percent (56/86). This rate is much lower than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 9: 4:3:1 Coverage for State and District 3-3 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 3-3 The 4:3:1+3 immunization coverage estimate is 62.8 percent (54/86). This rate is much lower than the statewide 4:3:1+3 immunization rate of 81.3 percent. 69 Table 45: District Immunization Rates for Health District 3-3 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 63.1% 61.0% 3 OPV/IPV 71.4% 69.5% 1 MMR 70.2% 74.6% 3 Hib 79.8% 81.4% 3 HepB 76.2% 81.4% 1 Varicella 52.4% 69.5% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 67.4% 74.4% 75.6% 76.7% 77.9% 74.4% 30.2% 11.6% Table 45 reveals the coverage rates of each vaccine series. Coverage rates ranged from 11.6 to 77.9 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: 2004 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 81 94.2% 76 88.4% 64 74.4% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 80 93.0% 75 87.2% 33 38.4% 0 0.0% MMR1 MMR2 1 1.2% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 79 91.9% 76 88.4% 46 53.5% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 80 93.0% 78 90.7% 50 58.1% 1 1.2% VAR1 5 VAR2 0 *Percent = number immunized / sample size Sample size = 86 5.8% 0.0% 71 Table 47: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-3 by Study Year Maternal Race White Black Other Unknown 2001 4:3:1 Adequate #/Total (percent) 27/49 (55.1) 39/67 (58.2) 2/2 (100.0) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 22/35 (62.9) 31/47 (66.0) 3/4 (75.0) --- 56/86 (65.1) 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) --- 4/6 (66.7) 18/30 (60.0) 13/23 (56.5) 21/27 (77.8) --- 56/86 (65.1) 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 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) 2004 4:3:1 Adequate #/Total (percent) 31/54 (57.4) 25/32 (78.1) 56/86 (65.1) Table 49 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. For Health District 3-3, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. 74 Individual Health District Report: District 3-4 The eligible sample from this district included 185 children born in January 2002. From the 185 children, 167 records were located (Response Rate=90.3%). Of the 167 located records, there were 14 parental refusals leaving a final sample of 153 records. The 4:3:1 immunization coverage estimate is 93.5 percent (143/153). This rate is much higher than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 10: 4:3:1 Coverage for State and District 3-4 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 3-4 The 4:3:1+3 immunization coverage estimate is 91.5 percent (140/153). This rate is higher than the statewide 4:3:1+3 immunization rate of 81.3 percent. 75 Table 50: District Immunization Rates for Health District 3-4 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 94.8% 75.9% 3 OPV/IPV 96.4% 77.2% 1 MMR 96.4% 83.5% 3 Hib 97.5% 92.4% 3 HepB 97.5% 86.1% 1 Varicella 89.5% 86.1% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 94.1% 96.1% 96.1% 96.7% 96.7% 94.1% 76.5% 40.5% Table 50 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 40.5 to 96.7 percent for the 2004 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: 2004 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 150 98.0% 146 95.4% 137 89.5% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 150 98.0% 146 95.4% 73 47.7% 0 0.0% MMR1 MMR2 7 4.6% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 150 98.0% 145 94.8% 63 41.2% 1 0.7% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 150 98.0% 148 96.7% 77 50.3% 5 3.3% VAR1 8 VAR2 0 *Percent = number immunized / sample size Sample size = 153 5.2% 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 2001 4:3:1 Adequate #/Total (percent) 43/56 (76.8) 12/17 (70.6) 5/6 (83.3) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 106/115 (92.2) 26/27 (96.3) 11/11 (100.0) --- 143/153 (93.5) Table 52 contains a cross tabulation of maternal race and children's immunization status. The top row in each cell shows the number of mothers in each group whose children were adequately immunized and the total number of mothers in that group. The bottom row represents the percent that corresponds to those numbers (percent of each group that was adequately immunized). Table 52 shows that in the 2004 study year, the immunization rates of children born to black mothers was greater than that of white 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (Percent) 2/2 (100.0) 12/14 (85.7) 35/35 (100.0) 29/33 (87.9) 65/69 (94.2) --- 143/153 (93.5) 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 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) 2004 4:3:1 Adequate #/Total (percent) 59/65 (90.8) 84/88 (95.5) 143/153 (93.5) Table 54 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. In the 2004 study, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid. 80 Individual Health District Report: District 3-5 The eligible sample from this district included 435 children born in January 2002. From the 435 children, 240 records were located (Response Rate=55.2%). Of the 240 located records, there was 1 parental refusal leaving a final sample of 239 records. The 4:3:1 immunization coverage estimate is 82.0 percent (196/239). This rate is lower than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 11: 4:3:1 Coverage for State and District 3-5 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 3-5 The 4:3:1+3 immunization coverage estimate is 74.9 percent (179/239). This rate is also much lower than the statewide 4:3:1+3 immunization rate of 81.3 percent. 81 Table 55: District Immunization Rates for Health District 3-5 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 66.2% 77.0% 3 OPV/IPV 75.7% 83.7% 1 MMR 71.6% 87.8% 3 Hib 77.0% 89.3% 3 HepB 77.9% 88.8% 1 Varicella 57.2% 81.1% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 82.4% 89.5% 90.8% 88.3% 89.1% 89.5% 43.5% 19.7% Table 55 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 19.7 to 90.8 percent for the 2004 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: 2004 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 231 96.7% 225 94.1% 202 84.5% 3 1.3% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 232 97.1% 224 93.7% 110 46.0% 1 0.4% MMR1 MMR2 13 5.4% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 226 94.6% 219 91.6% 103 43.1% 2 0.8% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 232 97.1% 223 93.3% 103 43.1% 2 0.8% VAR1 15 VAR2 0 *Percent = number immunized / sample size Sample size = 239 6.3% 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 2001 4:3:1 Adequate #/Total (Percent) 38/52 (73.1) 100/130 (76.9) 10/14 (71.4) --- Total 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) 2004 4:3:1 Adequate #/Total (Percent) 62/74 (83.8) 123/154 (80.0) 11/11 (100.0) --- 196/239 (82.0) 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 5/6 (83.3) 27/37 (73.0) 49/59 (83.1) 43/49 (87.8) 72/88 (81.8) --- 196/239 (82.0) 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 varied with 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 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) 2004 4:3:1 Adequate #/Total (percent) 95/117 (81.2) 101/122 (82.8) 196/239 (82.0) Table 59 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 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 236 children born in January 2002. From the 236 children, 189 records were located (Response Rate=80.1%). Of the 189 located records, there were 2 parental refusals leaving a final sample of 187 records. The 4:3:1 immunization coverage estimate is 77.5 percent (145/187). This rate is lower than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 12: 4:3:1 Coverage for State and District 4-0 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 4-0 The 4:3:1+3 immunization coverage estimate is 74.9 percent (140/187). This rate is lower than the statewide 4:3:1+3 immunization rate of 81.3 percent. 87 Table 60: District Immunization Rates for Health District 4-0 by Study Year Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 79.7% 83.5% 3 OPV/IPV 85.9% 86.4% 1 MMR 84.9% 86.4% 3 Hib 88.5% 88.3% 3 HepB 85.9% 88.8% 1 Varicella 65.6% 83.0% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 79.1% 85.6% 85.0% 86.6% 86.1% 85.0% 32.1% 9.1% Table 60 reveals the coverage rates of each vaccine series. Coverage rates ranged from 9.1 to 86.6 percent for the 2004 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: 2004 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 183 97.9% 173 92.5% 155 82.9% 1 0.5% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 182 97.3% 172 92.0% 75 40.1% 1 0.5% MMR1 MMR2 5 2.7% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 181 96.8% 173 92.5% 70 37.4% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 181 96.8% 176 94.1% 74 39.6% 3 1.6% VAR1 8 VAR2 0 *Percent = number immunized / sample size Sample size = 187 4.3% 0.0% 89 Table 62: Cross tabulations of Maternal Race and Child Immunization Status for Health District 4-0 by Study Year Maternal Race White Black Other Total 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) 2004 4:3:1 Adequate #/Total (percent) 108/141 (76.6) 34/43 (79.1) 3/3 (100.0) 145/187 (77.5) 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. However, in the 2004 study year children born to black mothers had a slightly higher immunization rate than children born to white 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 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) --- 2004 4:3:1 Adequate #/Total (percent) 1/1 (100.0) 21/28 (75.0) 57/71 (80.3) 23/32 (71.9) 43/55 (78.2) Total 172/206 (83.5) 128/147 (87.1) 86/110 (78.2) 145/187 (77.5) 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 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) 2004 4:3:1 Adequate #/Total (percent) 76/95 (80.0) 69/92 (75.0) 145/187 (77.5) Table 64 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 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 60 children born in January 2002. From the 60 children, 55 records were located (Response Rate=98.9%). Of the 91 located records, there was 0 parental refusals leaving a final sample of 55 records. The 4:3:1 immunization coverage estimate is 85.5 percent (47/55). This rate is similar to the statewide 4:3:1 immunization rate of 85.1 percent. Figure 13: 4:3:1 Coverage for State and District 5-1 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 5-1 The 4:3:1+3 immunization coverage estimate 80.0 percent (44/55). This rate is lower than the statewide 4:3:1+3 immunization rate of 81.3 percent. 93 Table 65: District Immunization Rates for Health District 5-1 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 91.3% 86.7% 3 OPV/IPV 93.8% 93.3% 1 MMR 96.3% 91.7% 3 Hib 96.3% 91.7% 3 HepB 96.3% 93.3% 1 Varicella 61.3% 86.7% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 85.5% 92.7% 90.9% 87.3% 90.9% 90.9% 23.6% 3.6% Table 65 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 3.6 to 92.7 percent for the 2004 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: 2004 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 54 98.2% 51 92.7% 45 81.8% 1 1.8% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 54 98.2% 51 92.7% 28 50.9% 0 0.0% MMR1 MMR2 1 1.8% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 54 98.2% 50 90.9% 16 29.1% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 54 98.2% 50 90.9% 22 40.0% 0 0.0% VAR1 4 VAR2 0 *Percent = number immunized / sample size Sample size = 55 7.3% 0.0% 95 Table 67: Cross tabulations of Maternal Race and Child Immunization Status for Health District 5-1 by Study Year Maternal Race White Black Other 2001 4:3:1 Adequate #/Total (percent) 32/36 (88.9) 19/24 (79.2) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 27/32 (84.4) 20/23 (87.0) --- 47/55 (85.5) 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 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) --- 2004 4:3:1 Adequate #/Total (percent) --- 9/10 (90.0) 18/23 (78.3) 8/9 (88.9) 12/13 (92.3) --- Total 51/60 (85.0) 63/78 (80.8) 76/90 (84.4) 47/55 (85.5) 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 2002 4:3:1 Adequate #/Total (percent) 35/43 (81.4) 28/35 (80.0) 63/78 (80.8) 2003 4:3:1 Adequate #/Total (percent) 37/48 (77.1) 39/42 (92.9) 76/90 (84.4) 2004 4:3:1 Adequate #/Total (percent) 34/40 (80.0) 13/15 (86.7) 47/55 (85.5) Table 69 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 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 184 children born in January 2002. From the 184 children, 148 records were located (Response Rate=80.4%). Of the 148 located records, there was 1 parental refusal leaving a final sample of 147 records. The 4:3:1 immunization coverage estimate is 87.1 percent (128/147). This rate is higher than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 14: 4:3:1 Coverage for State and District 5-2 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 5-2 The 4:3:1+3 immunization coverage estimate is 83.7 percent (123/147). This rate is higher to the statewide 4:3:1+3 immunization rate of 81.3 percent. 99 Table 70: District Immunization Rates for Health District 5-2 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 83.6% 72.7% 3 OPV/IPV 87.3% 81.8% 1 MMR 90.9% 82.7% 3 Hib 96.4% 84.5% 3 HepB 89.1% 83.6% 1 Varicella 61.8% 80.0% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 87.1% 93.2% 93.2% 91.2% 91.8% 91.2% 39.5% 15.0% Table 70 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 15.0 to 93.2 percent for the 2004 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: 2004 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 5-2 Vaccine Dose Number Immunized DTP1/DTaP1 142 DTP2/DTaP2 140 DTP3/DTaP3 124 DTP4/DTaP4 6 DTP5/DTaP5 0 OPV/IPV1 144 OPV/IPV2 140 OPV/IPV3 76 OPV/IPV4 0 MMR1 15 MMR2 0 HIB1 144 HIB2 140 HIB3 59 HIB4 5 HIB5 0 HEPB1 143 HEPB2 141 HEPB3 72 HEPB4 1 VAR1 8 VAR2 0 *Percent = number immunized / sample size Sample size = 147 Percent* 96.2% 95.2% 84.4% 4.1% 0.0% 98.0% 95.2% 51.7% 0.0% 10.2% 0.0% 98.0% 95.2% 40.1% 3.4% 0.0% 97.3% 95.9% 49.0% 0.7% 5.4% 0.0% 101 Table 72: Cross tabulations of Maternal Race and Child Immunization Status for Health District 5-2 by Study Year Maternal Race White Black Other 2001 4:3:1 Adequate #/Total (percent) 33/52 (63.5) 43/58 (74.1) --- Unknown ---- Total 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) 2004 4:3:1 Adequate #/Total (percent) 63/71 (88.8) 62/73 (85.0) 3/3 (100.0) --- 128/147 (87.1) 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 Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Total 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) 1/4 (25.0) 13/17 (76.5) 41/53 (77.4) 12/23 (52.2) 9/13 (69.2) 76/110 (69.1) 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) 2004 4:3:1 Adequate #/Total (percent) 1/1 (100.0) 22/23 (95.7) 47/53 (88.7) 31/40 (78.0 27/30 (90.0) 128/147 (87.1) 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 2002 4:3:1 Adequate #/Total (percent) 103/131 (78.6) 107/117 (91.5) 210/248 (84.7) 2003 4:3:1 Adequate #/Total (percent) 48/70 (68.6) 50/56 (89.3) 98/126 (77.8) . 2004 4:3:1 Adequate #/Total (percent) 79/91 (86.8) 49/56 (88.0) 128/147 (87.1) Table 74 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. In all 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 142 children born in January 2002. From the 142 children, 116 records were located (Response Rate=81.7%). Of the 116 located records, there were 0 parental refusals leaving a final sample of 116 records. The 4:3:1 immunization coverage estimate is 90.5 percent (105/116). This rate is higher than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 15: 4:3:1 Coverage for State and District 6-0 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 6-0 The 4:3:1+3 immunization coverage estimate is 85.3 percent (99/116). This rate is higher than the statewide 4:3:1+3 immunization rate of 81.3 percent. 105 Table 75: District Immunization Rates for Health District 6-0 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 74.5% 89.5% 3 OPV/IPV 85.1% 93.2% 1 MMR 87.2% 95.1% 3 Hib 87.2% 97.5% 3 HepB 85.1% 93.2% 1 Varicella 61.7% 88.3% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 90.5% 94.8% 95.7% 92.2% 94.0% 94.8% 54.3% 23.3% Table 75 reveals the coverage rates of each vaccine series. Coverage rates ranged from 23.3 to 95.7 percent for the 2004 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: 2004 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 111 95.7% 106 91.4% 101 87.1% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 111 95.7% 107 92.2% 50 43.1% 0 0.0% MMR1 MMR2 0 0.0% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 112 96.6% 107 92.2% 68 58.6% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 113 97.4% 110 94.8% 65 56.0% 3 2.6% VAR1 4 VAR2 0 *Percent = number immunized / sample size Sample size = 116 3.4% 0.0% 107 Table 77: Cross tabulations of Maternal Race and Child Immunization Status for Health District 6-0 by Study Year Maternal Race White Black Other Total 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) 2004 4:3:1 Adequate #/Total (percent) 53/56 (94.6) 49/57 (86.0) 3/3 (100.0) 105/116 (90.5) 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 Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Total 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) 2004 4:3:1 Adequate #/Total (percent) --- 23/24 (95.8) 32/37 (86.5) 19/20 (95.0) 31/35 (88.6) 105/116 (90.5) 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 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) 2004 4:3:1 Adequate #/Total (percent) 60/68 (88.2) 45/48 (93.8) 105/116 (90.5) Table 79 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 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 243 children born in January 2002. From the 243 children, 201 records were located (Response Rate=82.7%). Of the 201 located records, there were 2 parental refusals leaving a final sample of 199 records. The 4:3:1 immunization coverage estimate is 88.4 percent (176/199). This rate is higher than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 16: 4:3:1 Coverage for State and District 7-0 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 7-0 The 4:3:1+3 immunization coverage estimate is 82.9 percent (165/199). This rate is slightly higher to the statewide 4:3:1+3 immunization rate of 81.3 percent. 111 Table 80: District Immunization Rates for Health District 7-0 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 77.1% 74.3% 3 OPV/IPV 85.9% 78.4% 1 MMR 85.3% 80.2% 3 Hib 85.3% 82.6% 3 HepB 87.6% 85.0% 1 Varicella 53.5% 74.9% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 88.4% 93.5% 93.0% 93.0% 93.5% 93.5% 34.2% 10.1% Table 80 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 10.1 to 93.5 percent for the 2004 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: 2004 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 195 98.0% 190 95.5% 170 85.4% 1 0.5% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 195 98.0% 190 95.5% 65 32.7% 0 0.0% MMR1 MMR2 3 1.5% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 195 98.0% 188 94.5% 94 47.2% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 195 98.0% 190 95.5% 111 55.8% 2 1.0% VAR1 3 VAR2 0 *Percent = number immunized / sample size Sample size = 199 1.5% 0.0% 113 Table 82: Cross tabulations of Maternal Race and Child Immunization Status for Health District 7-0 by Study Year Maternal Race White Black Other Total 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) 2004 4:3:1 Adequate #/Total (percent) 79/86 (91.9) 94/110 (85.5) 3/3 (100.0) 176/199 (88.4) 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 for the 2001 through 2003 study years, the immunization rate of children born to black mothers was greater than white mothers. However, this trend was reversed in the 2004 study year. 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 2/2 (100.0) 44/52 (84.6) 56/62 (90.3) 41/46 (89.1) 33/37 (89.2) --- 176/199 (88.4) 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 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) 2004 4:3:1 Adequate #/Total (percent) 127/147 (86.4) 49/52 (94.2) 176/199 (88.4) Table 84 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. For Health District 7-0, immunization rates of children vary with maternal Medicaid status. 116 Individual Health District Report: District 8-1 The eligible sample from this district included 81 children born in January 2002. From the 81 children, 76 records were located (Response Rate=93.8%). Of the 76 located records, there were no parental refusals leaving a final sample of 76 records. The 4:3:1 immunization coverage estimate is 89.5 percent (68/76). This rate is higher than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 17: 4:3:1 Coverage for State and District 8-1 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 8-1 The 4:3:1+3 immunization coverage estimate is 89.5 percent (68/76). This rate is higher than the statewide 4:3:1+3 immunization rate of percent 81.3. 117 Table 85: District Immunization Rates for Health District 8-1 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 86.9% 77.7% 3 OPV/IPV 87.9% 84.5% 1 MMR 90.7% 82.5% 3 Hib 92.5% 81.6% 3 HepB 92.5% 84.5% 1 Varicella 61.7% 78.6% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 89.5% 96.1% 92.1% 94.7% 96.1% 92.1% 39.5% 13.2% Table 85 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 13.2 to 96.1 percent for the 2004 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: 2004 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 76 100.0% 75 98.7% 65 85.5% 1 1.3% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 76 100.0% 75 98.7% 28 36.8% 1 1.3% MMR1 MMR2 3 3.9% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 76 100.0% 75 98.7% 27 35.5% 1 1.3% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 76 100.0% 75 98.7% 36 47.4% 2 2.6% VAR1 5 VAR2 0 *Percent = number immunized / sample size Sample size = 76 6.6% 0.0% 119 Table 87: Cross tabulations of Maternal Race and Child Immunization Status for Health District 8-1 by Study Year Maternal Race White Black Other Total 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) 2004 4:3:1 Adequate #/Total (percent) 48/51 (94.1) 19/24 (79.2) 1/1 (100.0) 68/76 (89.5) 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 Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Total 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) 2004 4:3:1 Adequate #/Total (percent) 1/1 (100.0) 17/19 (89.5) 15/18 (83.3) 19/20 (95.0) 16/18 (88.9) 68/76 (89.5) 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 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) 2004 4:3:1 Adequate #/Total (percent) 42/48 (87.5) 26/28 (92.9) 68/76 (89.5) Table 89 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. Table 89 shows that the immunization rates of children in District 8-1 vary with maternal Medicaid status. 122 Individual Health District Report: District 8-2 The eligible sample from this district included 189 children born in January 2002. From the 189 children, 175 records were located (Response Rate=92.6%). Of the 175 located records, there was no parental refusals leaving a final sample of 175 records. The 4:3:1 immunization coverage estimate is 94.9 percent (166/175). This rate is higher than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 18: 4:3:1 Coverage for State and District 8-2 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 8-2 The 4:3:1+3 immunization coverage estimate rate is 93.1 percent (163/175). This rate is much higher than the statewide 4:3:1+3 immunization rate of 81.3 percent. 123 Table 90: District Immunization Rates for Health District 8-2 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 85.6% 94.7% 3 OPV/IPV 90.8% 96.2% 1 MMR 88.9% 97.0% 3 Hib 92.8% 92.5% 3 HepB 90.2% 95.5% 1 Varicella 66.0% 96.2% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 94.9% 97.7% 97.7% 98.3% 97.7% 97.7% 38.9% 8.0% Table 90 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 8.0 to 98.3 percent for the 2004 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: 2004 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 175 100.0% 173 98.9% 161 92.0% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 175 100.0% 171 97.7% 92 52.6% 1 0.6% MMR1 MMR2 8 4.6% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 175 100.0% 170 97.1% 82 46.9% 2 1.1% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 174 99.4% 171 97.7% 114 65.1% 1 0.6% VAR1 11 VAR2 0 *Percent = number immunized / sample size Sample size = 175 6.3% 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 2001 4:3:1 Adequate #/Total (percent) 55/58 (94.8) 67/73 (91.8) 2/2 (100.0) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 83/88 (94.3) 83/87 (95.4) --- --- 166/175 (94.9) 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 Maternal Educational Level Less than high school Some high school High school graduate Some college College or more Total 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) 2004 4:3:1 Adequate #/Total (percent) 2/2 (100.0) 41/42 (97.6) 52/56 (92.9) 39/40 (97.5) 32/35 (91.4) 166/175 (94.9) 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 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) 2004 4:3:1 Adequate #/Total (percent) 105/110 (95.5) 61/65 (93.8) 166/175 (94.9) Table 94 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. In the 2004 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 173 children born in January 2002. From the 173 children, 81 records were located (Response Rate=46.8%). Of the 81 located records, there were no parental refusals leaving a final sample of 81 records. The 4:3:1 immunization coverage estimate is 97.5 percent (79/81). This rate is much higher to the statewide 4:3:1 immunization rate of 85.1 percent. Figure 19: 4:3:1 Coverage for State and District 9-1 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 9-1 The 4:3:1+3 immunization coverage estimate is 97.5 percent (79/81). This rate is much higher than the statewide 4:3:1+3 immunization rate of 81.3 percent. 129 Table 95: District Immunization Rates for Health District 9-1 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 80.8% 69.9% 3 OPV/IPV 88.5% 79.7% 1 MMR 85.4% 79.7% 3 Hib 91.5% 81.3% 3 HepB 89.2% 76.4% 1 Varicella 51.5% 71.5% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 97.5% 98.8% 98.8% 98.8% 100% 98.8% 53.1% 17.3% Table 95 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 17.3 to 100 percent for the 2004 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: 2004 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 81 100.0% 81 100.0% 79 97.5% 3 3.7% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 81 100.0% 81 100.0% 53 65.4% 0 0.0% MMR1 MMR2 4 4.9% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 81 100.0% 81 100.0% 25 30.9% 2 2.5% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 81 100.0% 80 98.8% 44 54.3% 1 1.2% VAR1 4 VAR2 0 *Percent = number immunized / sample size Sample size = 81 4.9% 0.0% 131 Table 97: Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-1 by Study Year Maternal Race White Black Other Unknown 2001 4:3:1 Adequate #/Total (percent) 36/55 (65.5) 47/66 (71.2) 2/2 (100.0) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 23/24 (96.3) 51/52 (98.1) 5/5 (100.0) --- 79/81 (98.3) 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) --- 10/10 (100.0) 24/26 (92.3) 20/20 (100.0) 25/25 (100.0) --- 79/81 (97.5) 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 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) 2004 4:3:1 Adequate #/Total (percent) 49/50 (98.0) 30/31 (96.8) 79/81 (97.5) Table 99 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. For Health District 9-1, children born to Medicaid women had a higher immunization rate than children born to women not using Medicaid for all study years. 134 Individual Health District Report: District 9-2 The eligible sample from this district included 156 children born in January 2002. From the 156 children, 135 records were located (Response Rate=86.5%). Of the 135 located records, there were no parental refusals leaving a final sample of 135 records. The 4:3:1 immunization coverage estimate is 82.2 percent (111/135). This rate is lower than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 20: 4:3:1 Coverage for State and District 9-2 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 9-2 The 4:3:1+3 immunization coverage estimate is 78.5 percent (106/135). This rate is also lower than the statewide 4:3:1+3 immunization rate of 81.3 percent. 135 Table 100: District Immunization Rates for Health District 9-2 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 88.0% 92.4% 3 OPV/IPV 90.2% 92.4% 1 MMR 91.0% 93.1% 3 Hib 95.5% 95.4% 3 HepB 91.7% 95.4% 1 Varicella 58.6% 88.5% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 83.0% 90.4% 89.6% 91.1% 90.4% 90.4% 39.3% 5.2% Table 100 reveals the coverage rates of each vaccine series. Coverage rates ranged from 5.2 to 91.1 percent for the 2004 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: 2004 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 132 97.8% 127 94.1% 115 85.2% 1 0.7% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 132 97.8% 124 91.9% 31 23.0% 0 0.0% MMR1 MMR2 2 1.5% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 131 97.0% 125 92.6% 32 23.7% 1 0.7% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 132 97.8% 128 94.8% 33 24.4% 1 0.7% VAR1 7 VAR2 0 *Percent = number immunized / sample size Sample size = 135 5.2% 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 Unknown 2001 4:3:1 Adequate #/Total (percent) 82/92 (89.1) 36/38 (94.7) 1/1 (100.0) --- Total 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) 2004 4:3:1 Adequate #/Total (percent 81/97 (83.5) 29/37 (78.4) 1/1 (100.0) --- 111/135 (82.2) 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 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) --- Total . 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) 2004 4:3:1 Adequate #/Total (percent) 1/1 (100.0) 27/35 (77.1) 31/39 (79.5) 25/29 (86.2) 27/31 (87.1) --- 111/135 (82.2) 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 vary with level of maternal 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 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) 2004 4:3:1 Adequate #/Total (percent) 82/103 (79.6) 29/32 (90.6) 111/135 (82.2) Table 104 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 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 117 children born in January 2002. From the 117 children, 84 records were located (Response Rate=71.8%). Of the 84 located records, there was 1 parental refusal leaving a final sample of 83 records. The 4:3:1 immunization coverage estimate is 83.1 percent (69/83). This rate is lower than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 21: 4:3:1 Coverage for State and District 9-3 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 9-3 The 4:3:1+3 immunization coverage estimate is 79.5 percent (66/83). This rate is lower than the statewide 4:3:1+3 immunization rate of 81.3 percent. 141 Table 105: District Immunization Rates for Health District 9-3 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 82.2% 71.6% 3 OPV/IPV 86.3% 76.8% 1 MMR 87.7% 80.0% 3 Hib 89.0% 81.1% 3 HepB 87.7% 81.1% 1 Varicella 57.5% 69.5% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 83.1% 88.0% 89.2% 84.3% 86.7% 88.0% 41.0% 15.7% Table 105 reveals the coverage rates of each vaccine series. Coverage rates ranged from 15.7 to 89.4 percent for the 2004 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: 2004 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 77 92.8% 72 86.7% 67 80.7% 0 0.0% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 77 92.8% 72 86.7% 35 42.2% 0 0.0% MMR1 MMR2 3 3.6% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 76 91.6% 70 84.3% 29 34.9% 1 1.2% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 77 92.8% 73 88.0% 37 44.6% 1 1.2% VAR1 3 VAR2 0 *Percent = number immunized / sample size Sample size = 83 3.6% 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 2001 4:3:1 Adequate #/Total (percent) 47/67 (70.1) 21/28 (75.0) --- Unknown --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 41/49 (83.7) 26/31 (83.9) 2/3 (66.7) --- 69/83 (83.1) 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 similar to that of black mothers. 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 1/1 (100.0) 9/13 (69.2) 34/41 (82.9) 8/9 (88.9) 17/19 (89.5) --- 69/83 (83.1) 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 seems to increase 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 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) 2004 4:3:1 Adequate #/Total (percent) 42/51 (82.4) 27/32 (84.4) 69/83 (83.1) Table 109 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 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 100 children born in January 2002. From the 100 children, 93 records were located (Response Rate=93.0%). Of the 93 located records, there were 5 parental refusals leaving a final sample of 88 records. The 4:3:1 immunization coverage estimate is 94.3 percent (83/88). This rate is higher than the statewide 4:3:1 immunization rate of 85.1 percent. Figure 22: 4:3:1 Coverage for State and District 10-0 100 90 80 70 60 50 40 30 20 10 0 99-00 2001 2002 2003 2004 State Dist 10-0 The 4:3:1+3 immunization coverage estimate is 86.4 percent (76/88). This rate is higher than the statewide 4:3:1+3 immunization rate of 81.3 percent. 147 Table 110: District Immunization Rates for Health District 10-0 by Study Year* Vaccine 1999-00 2001 Adequate Adequate Rates Rates 4 DTP/DTaP 74.7% 85.1% 3 OPV/IPV 76.0% 88.3% 1 MMR 77.3% 89.6% 3 Hib 79.9% 94.2% 3 HepB 79.9% 91.6% 1 Varicella 55.8% 87.0% 3 PCV --- --- 4 PCV --- --- *PCV data not collected before 2004. 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% ----- 2004 Adequate Rates 94.3% 98.9% 97.7% 95.5% 94.3% 94.3% 60.2% 25.0% Table 110 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 25.0 to 98.9 percent for the 2004 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: 2004 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 88 100.0% 88 100.0% 86 97.7% 1 1.1% 0 0.0% OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4 88 100.0% 88 100.0% 43 48.9% 0 0.0% MMR1 MMR2 2 2.3% 0 0.0% HIB1 HIB2 HIB3 HIB4 HIB5 88 100.0% 88 100.0% 33 37.5% 0 0.0% 0 0.0% HEPB1 HEPB2 HEPB3 HEPB4 87 98.9% 86 97.7% 35 39.8% 2 2.3% VAR1 4 VAR2 0 *Percent = number immunized / sample size Sample size = 88 4.5% 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 2001 4:3:1 Adequate #/Total (percent) 98/118 (83.1) 32/35 (91.4) 0/1 (0.0) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) 63/65 (96.9) 18/21 (85.7) 2/2 (100.0) --- 83/88 (94.3) 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 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) --- Total 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) 2004 4:3:1 Adequate #/Total (percent) --- 12/14 (85.7) 29/32 (90.6) 18/18 (100.0) 24/24 (100.0) --- 83/88 (94.3) 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 seem to increase 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 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) 2004 4:3:1 Adequate #/Total (percent) 39/43 (90.7) 44/45 (97.8) 83/88 (94.3) Table 114 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003 and 2004 study years. For Health District 10-0, children born to non-Medicaid women had a 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 eighth 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 2004. To assess these rates, the study drew an original sample of 4,116 children born in January 2002. The final sample of returned immunization records totaled 4,116. After removal of ineligible children (those deceased, adopted, moved out of state, born in military hospitals) the eligible sample was 3,888. Of these, 2,645 were located and make up the final sample. The eighth year of the GIS, 2004, measured immunization coverage for children born in 2002 at three levels: 4:3:1+3 coverage, defined as 4 DTaP, 3 OPV/IPV, 1 MMR, 3 Hib, 3 Hep B, and 1 Varicella 4:3:1 coverage, defined as 4 DTaP, 3 OPV/IPV, and 1 MMR 3:3:1 coverage, defined as 3 DTaP, 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 1999-00, 2001, 2002, 2003 and 2004. The newer 4:3:1+3 measure of coverage was added in 1997-98. Therefore, 4:3:1+3 rates can be compared using study data from the 1997-98 on. *It must be remembered that the 2004 study is estimating 2002 rates. The 2003 study is estimating 2001 rates, 2002 study estimated 2000 rates, 2001 study estimated 1999 rates, and the 1999-00 study estimated rates for 1998. 154 The 2004 results reflect immunization rates for children born in 2002. The results of the study indicate that, of the 2,645 children whose immunization records were located during data collection: 81.3 percent of children born in January of 2002 in Georgia were adequately immunized with the 4:3:1+3 vaccine series. 84.5 percent of children born in January of 2002 in Georgia were adequately immunized with the 4:3:1 vaccine series, compared to 80.8 percent of children born in January of 2001, 83.9 percent of children born in January of 2000, 75.1 percent of children born in January of 1999, and 78.8 percent of children born in November of 1997. 4:3:1 immunization rates in the individual health districts ranged from 65.1 percent to 100 percent in the 2004 study 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 The study investigated where the immunizations are being administered in Georgia (See Appendix E). In the eighth study year, 70.1 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 increased from the 2003 study (74.3 to 81.3). The 2004 Georgia Immunization Study (GIS) measured Varicella rates for the seventh year. From one perspective, the rates represent a success for the Georgia Immunization Program and the health districts. Measurement of rates for a new vaccine series has to begin at some time. The collection of data on 4:3:1+3 rates from the first point at which these rates became available (i.e. the 1997-98 Georgia Immunization Study) will allow public health staff to survey trends and monitor rates. In reviewing the 4:3:1 vaccine series, rates increased statewide from the 2003 study (80.8 percent) to 84.5 percent in 2004. The results of the previous four years of the GIS study (1999-00, 2001, 2002 and 2003) 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 eighth 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 1997, 1999, 2000, 2001 and 2002 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 4 percent for the 2004 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 2002 and, thus, represented a generalizable estimate of coverage rates for all two-year-olds born in 2002, 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 Northern and Metro Atlanta Districts more often refused to participate (District 1-2, 3-2 and 3-4). Response rates tended to be lower in the Metro area (District 3-2, 3-3 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 2002 who were residing in the state in 2004. 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 2002 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 2002. 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 2004. 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 2004 Study. Response rates and immunization coverage levels from the 2003 study were used in the sample size calculation for the 2004 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 2003 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 38.9 percent to a high of 95.2 percent, with the average response rate for the state at 68.0 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 2004 Study A Health District 1-1 B Jan 2002 Total Births 710 C Jan 2002 Eligible Births 703 D E F G H 2003 2004 2004 Return 2004 4:3:1 First Second Rate Adjusted Immunization Sample Sample based on Sample Rates Estimate Estimate 2003 Size Eligible Sample 0.775 268 194 0.783 248 1-2 524 521 0.856 189 139 0.959 145 2-0 657 655 0.947 77 69 0.945 73 3-1 993 989 0.752 287 222 0.688 323 3-2 1,126 1,118 0.681 334 257 0.361 712 3-3 373 367 0.784 260 152 0.788 193 3-4 1,123 1,115 0.9 138 123 0.73 169 3-5 889 879 0.66 345 248 0.563 440 4-0 758 752 0.836 211 165 0.661 249 5-1 168 168 0.933 96 61 0.989 62 5-2 540 532 0.833 214 152 0.789 193 6-0 572 566 0.862 183 138 0.926 149 7-0 446 442 0.764 277 170 0.593 287 8-1 277 274 0.919 114 81 0.961 84 8-2 453 450 0.74 296 178 0.91 196 9-1 377 372 0.773 270 156 0.898 174 9-2 412 409 0.812 235 149 0.952 157 9-3 309 309 0.819 228 131 0.855 153 10-0 427 426 0.907 130 99 0.914 109 State 11,134 11,047 4,116 161 Figure 23: Explanations of Table 115 Data Used for Sample Size Estimates For the 2004 Study Column A: Health District Column B: January 2002 Total Births Column C: January 2002 Eligible Births Column D: 2002 4:3:1 Immunization Rates Column E: First Sample Estimate 2004 Study Column F: Second Sample Estimate 2004 Study Column G: Estimated Return Rate (Based on 2003 Study) District number. Given. Source: DHR Vital Statistics Office. Given. Source: Georgia Birth Cohort Follow-up Study (2002). 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 (2002). Column H: Adjusted Sample Size 2004 Study Formula Used: (Column F) / (Column G) 162 APPENDIX B: LIST OF 2004 PUBLIC HEALTH REPRESENTATIVES FOR THE GEORGIA IMMUNIZATION STUDY 163 APPENDIX B: LIST OF 2004 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 Gayle Brannon, R.N., B.S.N. Patricia Mason Ann Vossen, R.N. Sandy Moore, LPN Janie Dalton, R.N. Joy Stymest Karen Dibling, R.N., B.S.N. Georgia Goseer, R.N. Likesar McCray Lisa Germany Freda Sheppard, L.P.N. Brenda Crowe Gloria Melvin Stephanie Phillips 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. Melba McNorrill, 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 D. Geneine Godfrey, M.P.H. Edward W. Sullivan Sue Dale Susan Malone, R.N. Betty Miller Jessie Jones Hollard Phillips, M.S. Doris Wilbon, B.S. Stacy Giles, R.N. JoAnn Deas, R.N. Pat Thomas, R.N. Jennifer Foster, M.S. Deborah A. Dawson, R.N., B.S.N. Dionne Hansey Barbie Bushey, R.N., C.P.N., M.P.H. 164 APPENDIX C: DATA COLLECTION FORM 165 GEORGIA IMMUNIZATION STUDY 2004: TWO YEAR-OLD ASSESSMENT A Collaboration between Georgia DHR, Division of Public Health and the Health Districts Part A: Identifying Information Tracking Information Update Information Code:BCNum District: districtCounty:County Infant's Name: Infant LName:Last Infant FName: First Mname:Middle Parent/Guardian's Name: Gender: Sex DOBDoB Ever WIC Enrolled :Yes __ No __ Unknown__ Address:Street New Address: City: City State: GA Zip:Zip Mother's Last Name: Field11 First:Field9 New Phone Number(s): ( ) Father's Last Name: Field19 First:Field17 Part B: Immunization History VACCINES DATE #1 DTP/DTaP (4) mm dd yr / / Administered by: OPV/IPV (3) HD MD UNK mm dd yr / / Administered by: MMR (1) HD MD UNK mm dd yr / / Administered by: Hib (3) HD MD UNK mm dd yr / / Administered by: HEP-B (3) HD MD UNK mm dd yr / / Administered by: Varicella (1) HD Hosp./ MD UNK mm dd year / / Administered by: or Hx PCV (4) (Pneumococcal Conjugate) HD MD UNK mm dd year / / DATE #2 mm dd yr / / HD MD UNK mm dd yr / / HD MD UNK / / HD MD UNK mm dd yr / / HD MD UNK mm dd yr / / HD MD UNK / / HD MD UNK mm dd year / / DATE #3 mm dd yr / / HD MD UNK mm dd yr / / HD MD UNK / / HD MD UNK mm dd yr / / HD MD UNK mm dd yr / / HD MD UNK / / HD MD UNK mm dd year / / DATE #4 mm dd yr / / HD MD UNK / / HD MD UNK / / HD MD UNK / / HD MD UNK / / HD MD UNK / / HD MD UNK mm dd year / / DATE #5 / / HD MD UNK / / HD MD UNK / / HD MD UNK / / HD MD UNK / / HD MD UNK / / HD MD UNK mm dd year / / Administered by: HD MD UNK HD MD UNK HD MD UNK HD MD UNK HD MD UNK Part C: Data Collection A. Health Department 1. All immunizations complete (END) 2. Child ineligible (go to D) 3. No record of the child (go to B) 9. Incomplete Immunizations (go to B) B. Parent 1. All immunizations complete (END) 2. Child ineligible (go to D) 3. Parent refused (END) 4. Parent moved to another health district Write new address in the upper right space (Send to state) 5. Parent not found (go to C) 6. Parent failed to follow up (go to C) 9. Incomplete immunizations (go to C) C. Physician 1. All immunizations complete (END) 2. Child ineligible (go to D) 3. Physician refused (go to E) 4. Physician not found (go to E) 5. Record not found (go to E) 6. Physician not known (go to E) 9. Incomplete immunizations (go to E) D. Reason Ineligible 1. Child died (END) 2. Parent in military (END) 3. Parent moved out of state (END) 4. Child adopted (END) Approved Abbreviations HD = Health Department PC = Phone Call MD = Physician TU = Thank You Hosp. = Hospital UNK = Unknown Hx = History of Varicella Disease, record the date. Part D: Tracking Log Description of Contact Activity CONTINUE PART D ON THE BACK OF THIS FORM AS NECESSARY Print Name of Public Health Rep. who completed form: Date completed E. Incomplete Immunization Due to: 1. Religious reasons (END) 2. Medical reasons (END) 3. Other Specify_________________________(END) 4. Unknown (END) Signature of Public Health Rep. who completed form: 166 Part D: Tracking Log Description of Contact Activity DATE TIME A C T I O N 2004 Assessment Form.doc Revised: January 7, 2004 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: 2004 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 Number Percent 188 86.2 93 91.2 64 95.5 171 80.7 180 79.6 60 69.8 143 93.5 207 86.6 154 82.4 46 83.6 129 87.8 104 89.7 177 88.9 70 92.1 168 96.0 80 98.8 117 86.7 69 83.1 79 89.8 Statewide 2,299 86.9 Number Percent 194 89.0 97 95.1 66 98.5 177 83.5 184 81.4 64 74.4 144 94.1 214 89.5 159 85.0 50 90.9 134 91.2 110 94.8 186 93.5 70 92.1 171 97.7 80 98.8 122 90.4 73 88.0 83 94.3 2,378 89.9 Number Percent 0 0.0 0 0.0 1 1.5 1 0.5 1 0.4 0 0.0 1 0.7 0 0.0 0 0.0 0 0.0 1 0.7 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 1.1 6 0.2 170 Figure 24: 2004 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: 1999-00, 2001, 2002, 2003, and 2004 Provider 1999-00 Total % # Public 11,24 29.1 Health 8 Dept Private 23,98 61.9 Physician 4 Unknown 3,503 9.0 2001 Total % # 9,472 25.5 25,79 69.5 7 1,866 5.0 2002 Total % # 8,085 20.3 28,66 71.9 7 3,112 7.8 2003 Total % # 5,873 16.3 26,95 74.8 6 3,205 8.9 2004 Total % # 5,449 14.3 26,73 70.1 4 5,966 15.6 Total 38,73 100.0 37,13 100.0 39,86 100.0 36,03 100.0 38,14 100.0 5 5 4 4 9 As shown in Table 117, in 2004, 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 2004 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 251 213 157 464 744 146 45 306 279 104 346 260 511 252 318 140 742 44 127 Percent 8.0 14.4 15.2 16.0 24.8 12.8 0.6 8.9 10.6 13.2 20.1 14.8 25.9 22.1 11.9 11.3 38.3 7.2 9.4 # Shots Given 2,327 1,129 879 1,238 1,838 791 2,203 1,558 1,340 598 1,336 1,484 2,408 868 2,291 1,077 1,175 1,015 1,179 5,449 14.3 26,734 Percent 73.9 76.2 85.4 42.6 69.4 69.4 95.5 45.7 50.9 76.1 61.8 85.0 71.5 77.6 86.0 87.4 60.6 88.8 88.6 # Shots Given 569 139 3 1,205 411 202 57 1,545 1,009 83 480 1 48 18 52 14 20 83 27 Percent 18.1 9.4 0.2 41.4 13.7 17.7 2.4 45.3 38.3 10.5 22.1 0.0 2.4 1.5 1.9 1.1 1.0 3.8 1.8 70.1 5,966 15.6 3,147 1,481 1,029 2,907 2.993 1,139 2,305 3,409 2,628 785 2,162 1,745 2,967 1,138 2,661 1,231 1,937 1,142 1,332 38,149 174 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 and District 3-5 had a high number of unknown shot locations (41.4 percent and 45.3, respectively). 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 2001, 2002, 2003, and 2004 District Public Health Department 2001 2002 2003 2004 1-1 26.5 1-2 16.0 2-0 20.3 3-1 18.9 3-2 28.7 3-3 20.2 3-4 3.1 3-5 22.0 4-0 25.4 5-1 43.7 5-2 44.9 6-0 14.5 7-0 36.1 8-1 30.6 8-2 29.6 9-1 16.7 9-2 53.9 9-3 23.6 10-0 19.7 State 25.5 Totals 20.3 16.4 8.0 13.7 16.2 14.4 24.3 25.2 15.2 19.1 18.4 16.0 24.0 32.1 24.8 26.6 5.4 12.8 7.4 2.1 0.6 11.7 11.6 8.9 19.9 19.7 10.6 29.9 23.1 13.2 26.7 22.2 20.1 24.1 6.4 14.8 22.8 21.7 25.9 20.5 22.4 22.1 22.8 11.7 11.9 17.5 9.2 11.3 36.4 32.6 38.3 16.9 6.2 7.2 19.9 14.7 9.4 20.3 16.3 14.3 Private Physician 2001 2002 2003 2004 65.7 73.2 66.9 73.9 81.3 66.9 81.0 76.2 75.9 75.0 73.0 85.4 55.3 54.4 42.2 42.6 48.9 56.5 48.2 69.4 66.2 59.1 90.7 69.4 96.9 87.9 97.9 95.5 75.7 86.4 73.5 45.7 74.2 76.5 64.0 50.9 52.5 69.0 74.1 76.1 51.4 66.2 73.9 61.8 84.9 74.6 89.7 85.0 63.8 77.1 76.8 71.5 69.3 78.7 77.6 77.6 70.4 73.9 62.2 86.0 81.1 78.2 86.0 87.4 45.5 59.7 66.4 60.6 75.7 82.2 93.8 88.8 80.1 80.1 79.6 88.6 69.5 71.9 74.8 70.1 176 Four-Year Comparison: Summary of Table 119 In 2001 In 2002 In 2003 In 2004 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 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 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 14.3% of the shots were received at the public health department 70.1% of the shots were given in the private sector 15.6% 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 2002 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 2004 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) 218 102 67 212 226 86 153 239 187 55 147 116 199 76 175 81 135 83 88 2,645 4:3:1+3 Immunization Coverage Rates (percent) 79.4 85.3 100 73.1 75.2 62.8 91.5 74.9 74.9 80.0 83.7 85.3 82.9 89.5 93.1 97.5 78.5 79.5 86.4 Margins of Error (percent) +/- 5.4 +/- 6.9 +/- 0 +/- 6.0 +/- 5.6 +/- 10.2 +/- 2.8 +/- 5.5 +/- 6.2 +/- 10.6 +/- 6.0 +/- 6.4 +/- 5.2 +/- 6.9 +/- 3.8 +/- 3.4 +/- 7.0 +/- 8.1 +/- 7.2 95% Confidence Intervals (percent) 74 84.8 78.4 92.2 100 67.1 79.1 69.6 80.8 52.6 73 93.9 99.5 69.4 80.4 68.7 81.1 69.4 90.6 77.7 89.7 78.9 91.7 77.7 88.1 82.5 96.5 89.3 96.9 94.1 100 71.5 85.5 75 91.2 79.2 93.6 81.3 +/- 1.7 72.6 76 180 Table 121: Margins of Error for 2004 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) 218 102 67 212 226 86 153 239 187 55 147 116 199 76 175 81 135 83 88 4:3:1 Immunization Coverage Rates (percent) 82.6 88.2 100 78.3 78.3 65.1 93.5 82.0 77.5 85.5 87.1 90.5 88.4 89.5 94.9 97.5 82.2 83.1 94.3 Margins of Error (percent) +/- 5.0 +/- 6.3 +/- 0 +/- 6.0 +/- 5.4 +/- 10.0 +/- 3.3 +/- 4.9 +/- 6.0 +/- 9.3 +/- 6.0 +/- 5.3 +/- 4.4 +/- 6.9 +/- 3.3 +/- 3.4 +/- 6.5 +/- 8.1 +/- 4.8 95% Confidence Intervals (percent) 77.6 87.6 81.9 94.5 100 67.1 79.1 72.9 83.7 55.1 75.1 92.1 98.7 77.1 86.9 71.5 83.5 76.2 94.8 77.7 89.7 85.2 95.8 84 92.8 82.6 96.4 91.6 98.2 94.1 100 75.7 88.7 75 91.2 89.5 99.1 Statewide Rate (weighted) 2,645 85.1 +/- 1.6 79.2 82.4 181 Table 122: Margins of Error for 2004 Statewide and District 3:3:1 Rates Sizes of Final Health Sample District (Records Located) 1-1 218 1-2 102 2-0 67 3-1 212 3-2 226 3-3 86 3-4 153 3-5 239 4-0 187 5-1 55 5-2 147 6-0 116 7-0 199 8-1 76 8-2 175 9-1 81 9-2 135 9-3 83 10-0 88 Statewide Rate 2,645 (weighted) 3:3:1 Immunization Coverage Rates (percent) 86.7 92.2 100 82.1 82.3 68.8 95.4 86.2 80.7 90.9 91.8 93.1 91.0 90.8 96.6 98.8 87.4 86.7 97.7 88.5 Margins of Error (percent) +/- 4.5 +/- 5.2 +/- 0 +/- 5.2 +/- 5.0 +/- 7.1 +/- 3.3 +/- 4.4 +/- 5.7 +/- 7.6 +/- 4.4 +/- 4.6 +/- 4.0 +/- 6.5 +/- 2.7 +/- 2.4 +/- 5.6 +/- 7.3 +/- 3.1 95% Confidence Intervals (percent) 82.2 91.2 87 97.4 100 76.9 87.3 77.3 87.3 79.5 93.7 92.1 98.7 81.8 90.6 75 86.4 83.3 98.5 87.4 96.2 88.5 97.7 87 95 84.3 97.3 93.9 99.3 96.4 101.2 81.8 93 79.4 94 94.6 100.8i +/- 1.3 84.6 87.2 182