Georgia immunization study. 2005 Final report / Georgia Dept. of Human Resources

Metadata
Text

Collection:: Georgia Government Publications
Serial:: Georgia immunization study ... final report.
Title:: Georgia immunization study. 2005 Final report / Georgia Dept. of Human Resources
Creator:: Georgia. Department of Human Resources
Georgia. Division of Public Health
Georgia. Epidemiology Branch
Contributor to Resource:: Georgia. Epidemiology Branch
Immunization Program (Ga.)
Georgia Public Health Districts
Publisher:: [Atlanta, GA] : Georgia Dept. of Human Resources, 2005
Date of Original:: 2005
Subject:: Immunization of children--Georgia--Statistics--Periodicals
Vaccination of children--Georgia--Statistics--Periodicals
Public health--Georgia--Periodicals
Enfants--Immunisation--Géorgie (État)--Statistiques--Périodiques
Enfants--Vaccination--Géorgie (État)--Statistiques--Périodiques
Santé publique--Géorgie (État)--Périodiques
Immunization of children
Public health
Vaccination of children
Location:: United States, Georgia, 32.75042, -83.50018
Medium:: state government records
Type:: Text
Format:: application/pdf
Description:: Title from cover
"A collaboration between Georgia Dept. of Human Resources, Division of Public Health, Epidemiology Branch, Immunization Program, Georgia Public Health Districts."
External Identifiers:: Call Number GA H800.P8 S1 I43 2005
Metadata URL:: https://dlg.galileo.usg.edu/id:dlg_ggpd_y-ga-bh800-pp8-bs1-bi43-b2005-belec-p-btext
Digital Object URL:: https://dlg.galileo.usg.edu/do:dlg_ggpd_y-ga-bh800-pp8-bs1-bi43-b2005-belec-p-btext
Language:: eng
Holding Institution:: University of Georgia. Map and Government Information Library
Rights:

GEORGIA IMMUNIZATION STUDY
2005 Final Report
Georgia Department of Human Resources | Division of Public Health Epidemiology Branch | Maternal and Child Health Section | Immunization Program
Nineteen Public Health Districts
Prepared by Carol A. Hoban, M.S., M.P.H., Principal Investigator and Project Coordinator
Contributors Rebecca Thompson, B.S.Ed., Project Assistant Latonya M. Thomas, Assessment Coordinator Michelle Conner, Georgia Immunization Program Director Mike Chaney, former Georgia Immunization Program Director

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 Mrs. Michelle Conner, Georgia Immunization Program Director, for her support and leadership during this study, as well as, Mr. Mike Chaney, former Program Director for the Immunization Program.

2005 Executive Summary
The 2005 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 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 2005. Identifying information about the children and their parents was collected from birth certificates.
The Immunization Study showed that during 2005 most childhood immunizations (77 percent) were administered in the private sector, while County Health Departments immunized 13 percent, and the sources for 10 percent are unknown. The proportion of children in Georgia who have received all of the recommended vaccinations showed a steady increase from 16 percent in 1997 to 79 percent in 2002, a slight decrease in 2003 to 74 percent, but an increase in 2004 to 81 percent. The 2005 study results showed another slight decrease in the immunization rate at 77 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 2005, 93 percent of infants had received two doses of hepatitis B vaccine by 12 months of age, and, at 24 months, 89 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 2005, 86 percent of children 12 months of age were appropriately immunized against diphtheria, tetanus and pertussis, and 77 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 53 percent in the Clayton district to 98 percent in the North (Gainesville) district. Twelve of the state's public health districts (Dalton, Gainesville, Gwinnett, Dublin, Waycross, 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. Three of the state's public health districts (Fulton, Clayton, and DeKalb) had a rate less than 75

percent. Within Metropolitan Atlanta, the immunization rates varied from 53 percent in Clayton to 90 percent in Gwinnett. In Georgia outside Metropolitan Atlanta, the immunization rates ranged from 80 percent in Rome to 98 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, 85 percent were adequately immunized, while among children of black women, 74 percent were adequately immunized. Children of college-educated mothers were less likely to be adequately immunized (83 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 (82 percent) than were children of mothers who did receive Medicaid (79 percent).

Georgia Vaccination Rates (4:3:1:3)

by Public Health District

2005

PUBLIC HEALTH DISTRICTS*
Vaccination Rates 1-1 Northwest (Rome)

Dade Catoosa

Fannin

Murray

Walker Whitfield

1-2

Gilmer

Towns Union

Rabun

White Habersham

Chattooga
1-1
Floyd

Gordon Bartow

Lumpkin

Stephens

Pickens

Dawson

2
Hall Banks Franklin Hart

Cherokee Forsyth

50.4 69.7 - 85.5 86.3 - 97.0
Note: The State Vaccination Rate (4:3:1:3) is 79.5

Jackson Madison Elbert

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

Worth

Irwin

Coffee

Bacon

Wayne

McIntosh

Early

Baker

Miller

8-2
Mitchell

Colquitt

Tift 8-1 Berrien Cook

Atkinson

9-2

Pierce Brantley

Ware

Glynn

* Note: Health Districts

Seminole Decatur

Grady Thomas Brooks

Lanier Lowndes

Clinch

Echols

Charlton

Camden

9-1 and 9-3 merged in
2005.

20

0

20

Miles

Georgia Department of Human Resources Division of Public Health Office of Health Information & Policy

Created: May 2006 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

2005

PUBLIC HEALTH DISTRICTS*
Vaccination Rates 1-1 Northwest (Rome)

Dade Catoosa

Fannin

Murray

Walker Whitfield

1-2

Gilmer

Towns Union

Rabun

White Habersham

Chattooga
1-1
Floyd

Gordon Bartow

Lumpkin

Stephens

Pickens

Dawson

2
Hall Banks Franklin Hart

Cherokee Forsyth

47.1 - 70.7 76.2- 84.9 85.8 - 92.0
Note: The State Vaccination Rate (4:3:1:3:3:1) is 76.5

Jackson Madison Elbert

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

Worth

Irwin

Coffee

Bacon

Wayne

McIntosh

Early

Baker

Miller

8-2
Mitchell

Colquitt

Tift 8-1 Berrien Cook

Atkinson

9-2

Pierce Brantley

Ware

Glynn

* Note: Health Districts

Seminole Decatur

Grady Thomas Brooks

Lanier Lowndes

Clinch

Echols

Charlton

Camden

9-1 and 9-3 merged in
2005.

20

0

20

Miles

Georgia Department of Human Resources Division of Public Health Office of Health Information & Policy

Created: May 2006 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 ................................................................................. 34 Summary of Statewide Analyses ............................................................ 37
SECTION IV: RESULTS OF DISTRICT LEVEL ANALYSES .............................................. 38 Overview of District Rates ........................................................................ 39 Individual Health District Reports of Rates and Crosstabulations ............ 40 District 1-1 Northwest Health District........................................................ 40 District 1-2 North Georgia Health District ................................................. 46 District 2-0 North Health District ............................................................... 52 District 3-1 Cobb/Douglas Health District ................................................. 58 District 3-2 Fulton Health District.............................................................. 64 District 3-3 Clayton County Health District ............................................... 70 District 3-4 East Metro Health District ...................................................... 76 District 3-5 Dekalb Health District............................................................. 82 District 4-0 LaGrange Health District........................................................ 88 District 5-1 South Central Health District.................................................. 94 District 5-2 North Central Health District ................................................ 100 District 6-0 East Central Health District .................................................. 106 District 7-0 West Central Health District................................................. 112 District 8-1 South Health District ............................................................ 118
i

District 8-2 Southwest Health District ..................................................... 124 District 9-1 East Health District............................................................... 130 District 9-2 Southeast Health District...................................................... 136 District 9-3 Coastal Health District.......................................................... 142 District 10-0 Northeast Health District .................................................... 148 SECTION V: DISCUSSION OF RESULTS................................................................... 154 Summary................................................................................................ 155 Conclusions............................................................................................ 156 Strengths................................................................................................ 157 Limitations .............................................................................................. 158 APPENDICES................................................................................................... 159
ii

List of Tables

Page

1.

Project Activity Timeline ............................................................................. 3

2.

Sample Description ................................................................................... 14

3.

2005 Eligible Sample, Number Located, and Response Rate by District .. 16

4.

Parent Refusals by Health District for the 2005 Study .............................. 18

5.

4:3:1:3:3:1 State Immunization Coverage by Study Year.......................... 20

6.

4:3:1:3 State Immunization Coverage by Study Year................................ 20

7.

4:3:1 State Immunization Coverage by Study Year................................... 21

8.

3:3:1 State Immunization Coverage by Study Year................................... 22

9.

State Immunization Status by Vaccine Series by Study Year ................... 23

10. Statewide Immunization Status by Individual Vaccines at 12 Months of

Age............................................................................................................ 24

11. 4:3:1 District and State Coverage Rates by Study Year............................ 26

12. State and District Immunization Rates for DTP/DTaP by Study Year ....... 27

13. State and District Immunization Rates for OPV/IPV by Study Year .......... 28

14. State and District Immunization Rates for MMR by Study Year ................ 29

15. State and District Immunization Rates for Hib by Study Year ................... 30

16. State and District Immunization Rates for Hep B by Study Year............... 31

17. State and District Immunization Rates for Varicella by Study Year ........... 32

18. State and District Immunization Rates for PCV by Study Year ................. 33

19. Statewide Cross tabulations of Maternal Race and Child Immunization

Status by Study Year................................................................................. 35

20. Statewide Cross tabulations of Maternal Educational Attainment and Child

Immunization Status by Study Year .......................................................... 36

21. Statewide Cross tabulations of Maternal Medicaid Status and Child

Immunization Status.................................................................................. 37

22. District Immunization Rates for Health District 1-1 by Study Year............. 41

23. 2005 District Immunization Rates by Individual Vaccine at 12 Months of

Age for Health District 1-1 ......................................................................... 42

24. Cross tabulations of Maternal Race and Child Immunization Status for

Health District 1-1 by Study Year .............................................................. 43

iii

25. Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 1-1 by Study Year .............................................. 44
26. Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 1-1 ..................................................................... 45
27. District Immunization Rates for Health District 1-2 by Study Year............. 47 28. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 1-2 ......................................................................... 48 29. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 1-2 by Study Year .............................................................. 49 30. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 1-2 by Study Year .............................................. 50 31. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 1-2 ..................................................................... 51 32. District Immunization Rates for Health District 2-0 by Study Year............. 53 33. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 2-0 ......................................................................... 54 34. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 2-0 by Study Year .............................................................. 55 35. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 2-0 by Study Year .............................................. 56 36. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 2-0 ..................................................................... 57 37. District Immunization Rates for Health District 3-1 by Study Year ............. 58 38. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 3-1.......................................................................... 60 39. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 3-1 by Study Year............................................................... 61 40. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 3-1 by Study Year .............................................. 62 41. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 3-1...................................................................... 63
iv

42. District Immunization Rates for Health District 3-2 by Study Year ............. 65 43. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 3-2.......................................................................... 66 44. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 3-2 by Study Year............................................................... 67 45. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 3-2 by Study Year .............................................. 68 46. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 3-2...................................................................... 69 47. District Immunization Rates for Health District 3-3 by Study Year ............. 71 48. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 3-3.......................................................................... 72 49. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 3-3 by Study Year............................................................... 73 50. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 3-3 by Study Year .............................................. 74 51. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 3-3...................................................................... 75 52. District Immunization Rates for Health District 3-4 by Study Year ............. 77 53. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 3-4 .......................................................................... 78 54. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 3-4 by Study Year............................................................... 79 55. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 3-4 by Study Year .............................................. 80 56. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 3-4...................................................................... 81 57. District Immunization Rates for Health District 3-5 by Study Year............. 83 58. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 3-5 ......................................................................... 84 59. Cross tabulations of Maternal Race and Child Immunization Status for
v

Health District 3-5 by Study Year .............................................................. 85 60. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 3-5 by Study Year .............................................. 86 61. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 3-5 ..................................................................... 87 62. District Immunization Rates for Health District 4-0 by Study Year............. 89 63. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 4-0 ......................................................................... 90 64. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 4-0 by Study Year .............................................................. 91 65. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 4-0 by Study Year .............................................. 92 66. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 4-0 ..................................................................... 93 67. District Immunization Rates for Health District 5-1 by Study Year............. 95 68. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 5-1 ......................................................................... 96 69. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 5-1 by Study Year .............................................................. 97 70. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 5-1 by Study Year .............................................. 98 71. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 5-1 ..................................................................... 99 72. District Immunization Rates for Health District 5-2 by Study Year........... 101 73. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 5-2 ....................................................................... 102 74. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 5-2 by Study Year ............................................................ 103 75. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 5-2 by Study Year ............................................ 104 76. Cross tabulations of Maternal Medicaid Status and Child Immunization
vi

Status for Health District 5-2 ................................................................... 105 77. District Immunization Rates for Health District 6-0 by Study Year.......... 107 78. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 6-0 ....................................................................... 108 79. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 6-0 by Study Year ............................................................ 109 80. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 6-0 by Study Year ............................................ 110 81. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 6-0 ................................................................... 111 82. District Immunization Rates for Health District 7-0 by Study Year........... 113 83. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 7-0 ....................................................................... 114 84. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 7-0 by Study Year ............................................................ 115 85. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 7-0 by Study Year ............................................ 116 86. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 7-0 ................................................................... 117 87. District Immunization Rates for Health District 8-1 by Study Year........... 119 88. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 8-1 ....................................................................... 120 89. Cross tabulations of Maternal Race and Child Immunization Status for
Health District 8-1 by Study Year ............................................................ 121 90. Cross tabulations of Maternal Educational Level and Child Immunization
Status for Health District 8-1 by Study Year ............................................ 122 91. Cross tabulations of Maternal Medicaid Status and Child Immunization
Status for Health District 8-1 ................................................................... 123 92. District Immunization Rates for Health District 8-2 by Study Year........... 125 93. 2005 District Immunization Rates by Individual Vaccine at 12 Months of
Age for Health District 8-2 ....................................................................... 126
vii

94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110.

Cross tabulations of Maternal Race and Child Immunization Status for Health District 8-2 by Study Year ............................................................ 127 Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 8-2 by Study Year ............................................ 128 Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 8-2 ................................................................... 129 District Immunization Rates for Health District 9-1 by Study Year........... 131 2005 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 9-1 ....................................................................... 132 Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-1 by Study Year ............................................................ 133 Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 9-1 by Study Year ............................................ 134 Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 9-1 ................................................................... 135 District Immunization Rates for Health District 9-2 by Study Year........... 137 2005 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 9-2 ....................................................................... 138 Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-2 by Study Year ............................................................ 139 Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 9-2 by Study Year ............................................ 140 Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 9-2 ................................................................... 141 District Immunization Rates for Health District 9-3 by Study Year........... 143 2005 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 9-3 ....................................................................... 144 Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-3 by Study Year ............................................................ 145 Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 9-3 by Study Year ............................................ 146

viii

111.
112. 113.
114.
115.
116.
117. 118. 119.
120. 121.
122. 123. 124.

Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 9-3 ................................................................... 147 District Immunization Rates for Health District 10-0 by Study Year......... 149 2005 District Immunization Rates by Individual Vaccine at 12 Months of Age for Health District 10-0 ..................................................................... 150 Cross tabulations of Maternal Race and Child Immunization Status for Health District 10-0 by Study Year .......................................................... 151 Cross tabulations of Maternal Educational Level and Child Immunization Status for Health District 10-0 by Study Year .......................................... 152 Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 10-0 .................................................................. 153 Data Used for Sample Size Estimates for the 2005 Study ...................... 162 2005 Varicella Rates and Cases of Chicken Pox by District ................... 171 Statewide Percentage of Shots by Provider: 20001, 2002, 2003, 2004 and 2005 ................................................................................................. 174 District Specific Percentage of Shots by Provider 2005 .......................... 175 Location of Immunizations by District -Four Year Comparison 2002, 2003, 2004 and 2005......................................................................................... 177 Margins of Error for 2005 Statewide and District 4:3:1+3 Rates.............. 181 Margins of Error for 2005 Statewide and District 4:3:1 Rates.................. 182 Margins of Error for 2005 Statewide and District 3:3:1 Rates.................. 183

ix

List of Figures

Page

1. Sampling Procedure.................................................................................... 13 2. 2005 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 .................................................... 40 5. 4:3:1 Coverage for State and District 1-2 .................................................... 46 6. 4:3:1 Coverage for State and District 2-0 .................................................... 52 7. 4:3:1 Coverage for State and District 3-1 .................................................... 58 8. 4:3:1 Coverage for State and District 3-2 .................................................... 64 9. 4:3:1 Coverage for State and District 3-3 .................................................... 70 10. 4:3:1 Coverage for State and District 3-4 .................................................... 76 11. 4:3:1 Coverage for State and District 3-5 .................................................... 82 12. 4:3:1 Coverage for State and District 4-0 .................................................... 88 13. 4:3:1 Coverage for State and District 5-1 .................................................... 94 14. 4:3:1 Coverage for State and District 5-2 .................................................. 100 15. 4:3:1 Coverage for State and District 6-0 .................................................. 106 16. 4:3:1 Coverage for State and District 7-0 .................................................. 112 17. 4:3:1 Coverage for State and District 8-1 .................................................. 118 18. 4:3:1 Coverage for State and District 8-2 .................................................. 124 19. 4:3:1 Coverage for State and District 9-1 .................................................. 130 20. 4:3:1 Coverage for State and District 9-2 .................................................. 136 21. 4:3:1 Coverage for State and District 9-3 .................................................. 142 22. 4:3:1 Coverage for State and District 10-0 ................................................ 148 23. Explanations of Table 117 Data Used for Sample Size Estimates for the
2005 Study ................................................................................................ 163 24. 2005 State Varicella Coverage Rates and Percentage of Sample with
Chicken Pox Disease ................................................................................ 172

x

List of Appendices

Page

Appendix A: Description of Sampling Plan and Statistical Note.............. ......... 159 Appendix B: List of 2005 Public Health Representatives ......................... ........ 164 Appendix C: Data Collection Form........................................................... ........ 166 Appendix D: Varicella Vaccine and Chicken Pox Data ............................ ........ 169 Appendix E: Provider of Immunizations ................................................... ........ 173 Appendix F: Margins of Error for Immunization Coverage Rates............. ........ 179

xi

SECTION I: PROJECT OVERVIEW
1

SECTION I: PROJECT OVERVIEW AND INTRODUCTION
The Division of Public Health, Epidemiology Branch, Immunization Program and Health Districts collaborated on the 2005 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 its ninth 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 six years. Immunization data for each year of the study evaluate rates for children born two years before the beginning of the study. In 2005, immunization rates for children born in January 2003 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 Assistant Project Coordinator was La Tonya Thomas, MBA-HCM, and the Project Assistant was Ms. Rebecca Thompson.
Staff at the Georgia Division of Public Health began work on the Georgia Immunization Project in November 2004. During December 2004, 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 2005.
Throughout this report, we refer to study years one, two, three, four, and five as, 2001, 2002, 2003, 2004 and 2005 respectively. The results from these five study years refer to rates for 1999, 2000, 2001, 2002, and 2003 respectively.
2

During January, a training session for the public health representatives was held via conference call. Data were collected from February 2005 through September 2005. The Project Coordinator and Assistant 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, 2004

Initial notification of public health community

Immunization Coordinators

December, 2004

Health Directors

Initial notification of private health

January, 2005

community

Conference call training for public health

January, 2005

representatives

Data collection period

February September, 2005

Data entry period

March November, 2005

Double data entry of 5% of data forms

November, 2005

Final data cleaning and analysis of data

December, 2005

Final Report

March, 2006

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
3

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 ninth 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 2003. 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 2005. Identifying information about the children and their parents was collected from birth certificates.
Target and Sample Populations The target population of the ninth year of the Georgia Immunization Study
included all two-year-old children born in the State of Georgia in 2003. A sample size of 3,322 children born in the month of January 2003 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 2003. 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 2005. 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 November 2005. 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 97.0% was found.
10

Analysis Plan The plan for the analysis was very similar to that used in the previous
years. Additionally, trends from the previous five years of the study are shown in this Final Report. Epi Info was the main software program used to assess immunization coverage rates, and provide a measure of where the immunizations were given. The analyses include univariate, bivariate, and multivariate analyses to produce a clear description of the immunization status of two-year-old children in the State of Georgia.
11

SECTION III: RESULTS OF STATEWIDE ANALYSES
12

SECTION III: RESULTS OF STATEWIDE ANALYSES
Sampling The sample of 3,322 children was drawn from 11,009 children born in
Georgia in January 2003. A total of 135,831 children were born in Georgia during 2003.
Children who were ineligible for participation in the study were extracted from the original sample, leaving an eligible sample of 3,196. (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 2003 (N = 135,831)

All children born in Georgia in January 2003 (N = 11,009)

Original sample of 3,322 children

Eligible sample of 3,196 children

Final sample of 2,634 children
Of the 3,196 children in the eligible sample, 2,634 children were located, 494 children never were located and 68 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 immunization record included in this study. The children who were never
13

located were those for whom no evidence beyond the birth certificate could be found to confirm that the child existed. The final sample of 2,634 children represented over 82 percent of the eligible sample.

Sampling Step
Original Sample Deceased Adopted Moved out of state Military

Table 2: Sample Description

Number

3,322 3
11 87 25

Percent of Sample 100.0% 0.1% 0.3% 2.6% 0.8%

Eligible Sample

3,196

96.2%

Eligible Sample Records Not Located /Eligibility Unknown *

3,196 562

100.0% 17.6%

Final Sample (Located Records**)

2,634

82.4%

* 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=105] 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
2005 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 65.2 percent to a high of 99.3 percent, with a statewide average response rate of 84.5 percent.
15

Table 3:

2005 Eligible Sample, Number Located and Response Rates by District

Health Eligible Number Response

District Sample Located* (Number)

Rate **
(% of Eligible Sample located)

1-1

173

167

96.5%

1-2

140

139

99.3%

2-0

50

47

94.0%

3-1

239

198

82.8%

3-2

538

353

65.6%

3-3

301

244

81.1%

3-4

103

94

91.3%

3-5

311

232

74.6%

4-0

247

226

91.5%

5-1

78

76

97.4%

5-2

160

146

91.3%

6-0

119

116

97.5%

7-0

129

113

87.6%

8-1

96

90

93.8%

8-2

66

62

93.9%

9-1

64

54

84.4%

9-2

168

164

97.6%

9-3

140

115

82.1%

10-0

74

66

89.2%

State 3,196 2,702

84.5%

*sample includes parental refusals

**number located / eligible sample

16

Figure 2 2005 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 2005 Study

District Number of

Parent Refusals

Records

Found

Number Percent

1-1

167

3

0.02

1-2

139

5

0.04

2-0

47

1

0.02

3-1

198

3

0.02

3-2

351

36

0.10

3-3

244

0

0.00

3-4

94

2

0.02

3-5

232

1

0.004

4-0

226

2

0.009

5-1

76

1

0.01

5-2

146

7

0.05

6-0

116

1

0.008

7-0

113

0

0.00

8-1

90

2

0.02

8-2

62

0

0.00

9-1

54

0

0.00

9-2

164

0

0.00

9-3

115

0

0.00

10-0

66

4

0.06

Total

2,700

68

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 2,634 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:

"4:3:1:3:3:1" status "4:3:1:3" status "4:3:1" status:
"3:3:1" status:

a child has received four DTP/DaTP, three OPV/IPV, one MMR, three Hib, three Hep B, and one Varicella at anytime a child has received four DTP/DaTP, three OPV/IPV, one MMR, and three Hib vaccinations 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 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 4:3:1:3:3:1 series compared to the children in the final sample who were not adequately immunized with this series.
Of the 2,634 children who were located in 2005, 76.5 percent were adequately immunized at the 4:3:1:3:3:1 level. This percent of adequately immunized children decreased from 81.3 percent in 2004.

19

Status

Table 5:

4:3:1:3:3:1 State Immunization Coverage by Study Year

Adequately Immunized

Inadequately Immunized

Number

Percent

Number

Percent

2001

1,837

66.7

918

33.3

2002

2,146

78.9

575

21.1

2003

1,906

74.3

661

25.7

2004

2,150

81.3

495

18.7

2005

2,015

76.5

619

23.5

Note: State rates based on data weighted by health district.

Table 6 illustrates the percent of the children in the final sample 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. This is a new assessment of immunization coverage which will be used in future study years.

Status

Table 6:

4:3:1:3 State Immunization Coverage by Study Year

Adequately Immunized

Inadequately Immunized

Number

Percent

Number

Percent

2005

2,095

79.5

539

20.5

Note: State rates based on data weighted by health district.

Table 7 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 2005 assessment, the number of adequately immunized children decreased to 80.7 percent.

20

Status

Table 7:

4:3:1 State Immunization Coverage by Study Year

Adequately Immunized

Inadequately Immunized

Number

Percent

Number

Percent

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

2005

2,126

80.7

508

19.3

Note: State rates based on data weighted by health district.

Figure 3: Statewide Coverage 4:3:1 and 4:3:1:3:3:1

100

90

80

70

60

50

40

30

20

10

0
2001

2002

2003

2004

2005

4:3:1 4:3:1:3:3:1

21

Figure 3 reveals the statewide 4:3:1 coverage rates for the 2001, 2002, 2003, 2004 and 2005 studies. The figure also shows statewide 4:3:1:3:3:1 vaccination coverage for the 2001, 2002, 2003, 2004 and 2005 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 8 indicates the 3:3:1 immunization coverage rate for the state has varied during the 2001 to 2005 study years.

Status

Table 8:

3:3:1 State Immunization Coverage by Study Year

Adequately Immunized

Inadequately Immunized

Number

Percent

Number

Percent

2001

2,175

78.9

580

21.1

2002

2,417

88.8

304

11.2

2003

2,205

85.9

362

14.2

2004

2,340

88.5

305

11.5

2005

2,219

84.2

415

15.8

Note: State rates based on data weighted by health district.

The statewide immunization status for each individual vaccine series is located in Table 9. 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 4:3:1:3:3:1 shot series are shown here. In 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. Coverage levels for 2005 have decreased slightly, but still show most of the vaccines are near the 90
22

percent coverage rate with the 3 DTP/DtaP above 90 percent. (Note: The Hib vaccine status can be considered adequate with three or four shots, depending on the manufacturer of the vaccine. For this study, adequate immunization status for the Hib vaccines was calculated considering three Hib shots as "adequate").

Table 9:

State Immunization Status by Vaccine Series by Study Year*

Vaccine 3 DTP/DTaP

2001

2002

2003

Number Percent Number Percent Number Percent

2,392

86.8

2,561

94.1

2,340

91.2

4 DTP/DTaP 2,093

76.0

2,303

84.6

2,096

81.7

3 OPV/IPV 2,226

80.8

2,466

90.6

2,251

87.7

1 MMR

2,258

82.0

2,474

90.9

2,266

88.3

3 Hib

2,322

84.3

2,474

90.9

2,242

87.3

3 Hep B

2,308

83.8

2,471

90.8

2,255

87.8

1 Varicella 2,147

77.9

2,407

88.5

2,101

81.8

3 PCV

---

---

---

---

---

---

4 PCV

---

---

---

---

---

---

Note: State rates based on data weighted by health district. * PCV data not collected before 2004.

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

2005

Number Percent

2,428

92.2

2,169

82.3

2,315

87.9

2,296

87.2

2,306

87.5

2,337

88.7

2,302

87.4

2,080

79.0

1,024

38.9

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 10 provides an overview of the immunization status of the children in the final sample of the 2001, 2002, 2003, 2004 and 2005 studies at one year of age, looking at coverage status by individual doses of vaccine.

23

Table 10: Statewide Immunization Status by Individual Vaccines at 12 Months of Age

Number Percent* Number Percent* Number Percent* Number Percent* Number Percent* Vaccine 2001 2001 2002 2002 2003 2003 2004 2004 2005 2005 DTP/DTaP1 2,507 91.0% 2,667 98.0% 2,447 95.3% 2,554 96.6% 2,545 96.6%

DTP/DTaP2 2,426 88.1% 2,592 95.3% 2,367 92.2% 2,472 93.5% 2,451 93.1%

DTP/DTaP3 2,214 80.4% 2,394 88.0% 2,176 84.8% 2,255 85.3% 2,253 85.5%

DTP/DTaP4 12 0.4% 23 0.8%

8

0.3% 26 1.0% 25 0.9%

DTP/DTaP5 0

0.0%

0

0.0%

0

0.0%

0

0.0%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

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%

2,541 2,433 1,275
9

96.5% 92.4% 48.4% 0.3%

MMR1** MMR2

87 3.2% 34 1.2% 92 3.6% 110 4.2% 96 3.6%

0

0.0%

1

0.0%

1

0.0%

0

0.0%

1

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

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%

2,531 2,407 955
32 1

96.1% 91.4% 36.3% 1.2% 0.0%

HEPB1 HEPB2 HEPB3 HEPB4

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%

2,549 2,463 1,342
92

96.8% 93.5% 50.9% 3.5%

VAR1** VAR2

118 4.3% 44 1.6% 125 4.9% 136 5.1% 115 4.4%

0

0.0%

0

0.0%

1

0.0%

0

0.0%

1

0.0%

PCV1

---

---

---

---

---

---

---

--- 2,359 89.6%

PCV2

---

---

---

---

---

---

---

--- 2,209 83.9%

PCV3

---

---

---

---

---

---

---

--- 1,796 68.2%

PCV4

---

---

---

---

---

---

---

---

25 2.1%

*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 2001 study = 2,755; 2002 study = 2,721; 2003 study = 2,567; 2004 study = 2, 645; 2005 study = 2,634.

24

Table 11 shows the 2001, 2002, 2003, 2004 and 2005 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 2005 margin of error for each health district ranges from +/- 2.9 percent to +/- 9.0 percent. The District level 2005 4:3:1 immunization rates range from 53.3 percent to 97.8 percent. Of the 19 health districts, eight had an immunization coverage rate over 90 percent and seven districts had 2005 coverage rates between 80 and 90 percent. The following summary highlights the changes in 4:3:1 coverage rates between 2004 and 2005:
Coverage increased between 0 and 5 percent in seven districts (District 3-1, 4-0, 5-2, 6-0, 7-0, 8-1 and 9-2) Coverage increased between 5 and 20 percent in two districts (Districts 1-2 and 5-1) Coverage fell between 0 and 5 percent in five districts (Districts 1-1, 2-0, 3-4, 9-3 and 10-0) Coverage fell between 5 and 20 percent in five districts (Districts 3-2, 3-3, 35, 8-2 and 9-1)
25

Table 11: 4:3:1 District and State Coverage Rates by Study Year

Dist

2001

2002

2003

2004

2005

%

Margin

% Margin

% Margin of %

Margin

%

Margin

of Error

of Error

Error

of Error

of Error

1-1 78.9 +/-6.2

80.6 +/-5.5

77.5 +/-6.7

1-2 78.1 +/-6.7

79.1 +/-6.3

85.6 +/-5.6

2-0 94.8 +/-3.7

93.4 +/-5.6

94.7 +/-4.5

3-1 70.7 +/-6.8

84.5 +/-4.2

75.2 +/-7.0

3-2 42.4 +/-5.6

82.6 +/-6.2

68.1 +/-7.8

3-3 57.6 +/-8.9

73.9 +/-8.2

78.4 +/-4.9

3-4 75.9 +/-9.4

94.3 +/-3.4

90.0 +/-7.6

3-5 75.5 +/-6.0

84.6 +/-5.1

66.0 +/-7.6

4-0 83.5 +/-5.1

87.1 +/-5.4

83.6 +/-6.9

5-1 85.0 +/-9.0

80.8 +/-8.7

93.3 +/-5.2

5-2 69.1 +/-8.6

84.7 +/-4.5

83.3 +/-6.5

6-0 88.9 +/-4.8

89.2 +/-6.0

86.2 +/-6.1

7-0 73.1 +/-6.7

82.8 +/-6.9

76.4 +/-7.0

8-1 76.7 +/-8.2

82.2 +/-6.6

91.9 +/-4.8

8-2 93.2 +/-4.3

83.1 +/-8.4

74.0 +/-7.0

9-1 69.1 +/-8.2

80.9 +/-6.2

77.3 +/-6.7

9-2 90.8 +/-4.9

85.4 +/-7.3

81.2 +/-6.5

9-3 71.6 +/-9.1

85.6 +/-6.3

81.9 +/-7.8

10-0 84.4 +/-5.7

80.2 +/-7.1

90.7 +/-4.5

State 75.1

+/-1.5 83.9 +/-1.6 80.8

+/-1.6

Note: State rates based on data weighted by health district.

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

79.5 97.0 97.8 75.9 72.6 53.3 90.2 72.3 81.6 94.7 87.8 93.9 90.3 94.3 85.5 87.0 85.4 82.6 93.5 80.7

+/- 5.7 +/- 2.9 +/- 4.2 +/- 6.0 +/- 4.9 +/- 6.3 +/- 6.1 +/- 5.8 +/- 5.1 +/- 5.1 +/- 5.4 +/- 4.4 +/- 5.4 +/- 4.8 +/- 8.8 +/- 9.0 +/- 5.4 +/- 7.0 +/- 6.1 +/-1.6

Additional information regarding 3:3:1 and 4:3:1:3:3:1 coverage rates and margins of error by district can be found in Appendix F: Margins of Error for Immunization Coverage Rates.
Tables 12-18 present the state and district rates for each individual vaccine during the 2001, 2002, 2003, 2004 and 2005 data collection periods.

26

As shown in Table 12, 2004 district immunization rates for the DTP/DTaP vaccines ranged from 58.6 percent to 97.8 percent, with a statewide rate of 82.3 percent receiving all four doses. The 2005 statewide DTP/DTaP rate decreased slightly from the 2004 study year.

Table 12: State and District Immunization Rates
for DTP/DTaP by Study Year

District
1-1 1-2 2-0 3-1 3-2 3-3 3-4 3-5 4-0 5-1 5-2 6-0 7-0 8-1 8-2 9-1 9-2 9-3 10-0 State

2001 Rates
4 DTP/DTaP
79.5% 79.5% 94.8% 70.7% 42.4% 61.0% 75.9% 77.0% 83.5% 86.7% 72.7% 89.5% 74.3% 77.7% 94.7% 69.9% 92.4% 71.6% 85.1% 76.0%

2002 Rates
4 DTP/DTaP
81.1% 82.3% 94.7% 84.9% 84.0% 73.9% 94.9% 84.6% 87.8% 80.8% 85.5% 89.2% 83.6% 82.2% 85.7% 81.6% 86.5% 85.6% 80.2% 84.6%

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%

Note: State rates based on data weighted by health district.

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%

2005 Rates
4 DTP/DTaP
82.3% 97.8% 97.8% 79.0% 73.8% 58.6% 92.4% 74.0% 83.9% 94.7% 88.5% 94.8% 90.3% 94.3% 87.1% 87.0% 86.0% 82.6% 93.5% 82.3%

27

Table 13 shows the 2001, 2002, 2003, 2004 and 2005 state and district rates for the OPV/IPV vaccines. The 2005 district coverage rates for these vaccines varied between 68.4 percent and 98.5 percent. The 2005 statewide immunization rate for OPV/IPV was 87.9 percent, which is slightly lower than the previous year's study rate.

Table 13: State and District Immunization Rates
for OPV/IPV by Study Year

District

2001 Rates
3 OPV/IPV

2002 Rates
3 OPV/IPV

2003 Rates
3 OPV/IPV

2004 Rates
3 OPV/IPV

1-1

88.6%

90.0%

84.8%

1-2

86.3%

85.4%

88.9%

2-0

97.0%

97.4%

94.7%

3-1

75.3%

90.8%

83.4%

3-2

45.5%

84.7%

71.7%

3-3

69.5%

82.9%

85.8%

3-4

77.2%

96.0%

90.0%

3-5

83.7%

88.7%

82.0%

4-0

86.4%

92.5%

92.7%

5-1

93.3%

96.2%

97.8%

5-2

81.8%

94.0%

93.7%

6-0

93.2%

95.1%

91.9%

7-0

78.4%

90.5%

85.0%

8-1

84.5%

95.1%

96.0%

8-2

96.2%

90.9%

80.7%

9-1

79.7%

90.1%

88.7%

9-2

92.4%

92.1%

88.4%

9-3

76.8%

89.8%

89.4%

10-0

88.3%

86.0%

93.2%

State

80.8%

90.6%

87.7%

Note: State rates based on data weighted by health district.

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%

2005 Rates
3 OPV/IPV
89.0% 98.5% 97.8% 86.2% 81.1% 68.4% 90.2% 83.1% 87.1% 96.0% 94.2% 97.4% 92.9% 97.7% 91.9% 94.4% 93.3% 88.7% 98.4% 87.9%

28

Table 14 shows the 2001, 2002, 2003, 2004 and 2005 state and district rates for MMR. The 2005 district rates for MMR ranged from a low of 65.6 percent to a high of 100.0 percent, with a statewide rate of 98.4 percent coverage. The 2005 statewide rate for the MMR vaccine decreased slightly from the 2004 rate of 90.9 percent.

Table 14: 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 State

2001 Rates
1 MMR
89.2% 85.6% 97.0% 77.0% 45.1% 74.6% 83.5% 87.8% 86.4% 91.7% 82.7% 95.1% 80.2% 82.5% 97.0% 79.7% 93.1% 80.0% 89.6% 82.0%

2002 Rates
1 MMR
90.5% 87.3% 96.1% 90.1% 84.7% 84.7% 97.1% 86.7% 93.2% 97.4% 92.3% 96.1% 92.2% 93.8% 90.9% 89.5% 94.4% 87.3% 90.1% 90.9%

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%

Note: State rates based on data weighted by health district.

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%

2005 Rates
1 MMR
87.8% 97.8% 97.8% 82.1% 80.4% 65.6% 91.3% 84.8% 89.3% 96.0% 92.1% 94.8% 93.8% 97.7% 93.5% 92.6% 92.1% 87.0% 98.4% 87.2%

29

As shown in Table 15, 2005 district immunization rates for the Hib vaccine varied between 71.7 and 98.4 percent. The statewide Hib coverage rate in 2005 was 87.5 percent, a slight decrease from the 2004 statewide rate of 90.2 percent.

Table 15: State and District Immunization
Rates for Hib by Study Year

District 1-1

2001 Rates
3 Hib
89.2%

2002 Rates
3 Hib
91.5%

2003 Rates
3 Hib
84.1%

1-2

95.2%

86.1%

90.8%

2-0

96.3%

96.1%

93.6%

3-1

83.9%

91.2%

82.1%

3-2

45.5%

85.4%

72.5%

3-3

81.4%

80.2%

88.4%

3-4

92.4%

96.6%

90.0%

3-5

89.3%

86.2%

76.0%

4-0

88.3%

93.2%

87.3%

5-1

91.7%

97.4%

97.8%

5-2

84.5%

92.7%

91.3%

6-0

97.5%

97.1%

93.5%

7-0

82.6%

89.7%

85.7%

8-1

81.6%

94.6%

95.2%

8-2

92.5%

92.2%

81.3%

9-1

81.3%

90.8%

87.3%

9-2

95.4%

93.3%

86.2%

9-3

81.1%

91.5%

89.4%

10-0

94.2%

86.8%

95.7%

State

84.3%

90.9%

87.3%

Note: State rates based on data weighted by health district.

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%

2005 Rates
3 Hib
87.2% 97.8% 95.7% 84.1% 81.4% 71.7% 92.4% 82.3% 88.8% 96.0% 90.6% 94.8% 91.2% 96.6% 93.5% 94.4% 91.5% 88.7% 98.4% 87.5%

30

Table 16 reports the statewide and district immunization coverage rates for the Hepatitis B vaccine. In 2005, the district coverage rates varied from a low of 75.0 percent to 98.5 percent. The 2005 statewide rate of 88.7 percent for the Hepatitis B vaccine was lower than the 2004 statewide rate of 90.7 percent.

Table 16: State and District Immunization Rates
for Hep B by Study Year

District
1-1 1-2 2-0 3-1 3-2 3-3 3-4 3-5 4-0 5-1 5-2 6-0 7-0 8-1 8-2 9-1 9-2 9-3 10-0 State

2001 Rates
3 Hep B
92.8% 93.2% 95.6% 82.8% 44.4% 81.4% 86.1% 88.8% 88.8% 93.3% 83.6% 93.2% 85.0% 84.5% 95.5% 76.4% 95.4% 81.1% 91.6% 83.8%

2002 Rates
3 Hep B
91.0% 87.3% 97.4% 92.6% 84.7% 80.2% 94.9% 85.6% 92.5% 96.2% 93.1% 96.1% 90.5% 94.6% 92.2% 90.1% 92.1% 89.0% 88.4% 90.8%

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%

Note: State rates based on data weighted by health district.

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%

2005 Rates
3 Hep B
89.0% 98.5% 93.5% 83.6% 81.1% 75.0% 91.3% 82.3% 90.2% 96.0% 92.1% 95.7% 93.8% 97.7% 98.4% 96.3% 95.7% 90.4% 98.4% 88.7%

31

Table 17 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 67.2 percent to 98.4 percent, with a statewide coverage rate of 87.4 percent for the Varicella vaccine. This is a slight decrease from the 2004 Varicella rate of 89.9 percent.

Table 17: State and District Immunization Rates for Varicella by Study Year

District 1-1

2001 Rates
1 Varicella
83.7%

2002 Rates
1 Varicella
89.1%

2003 Rates
1 Varicella
86.8%

2004 Rates
1 Varicella
89.0%

1-2

82.9%

86.1%

90.2%

95.1%

2-0

94.8%

96.1%

96.8%

98.5%

3-1

72.4%

88.4%

80.7%

83.5%

3-2

44.4%

81.9%

71.7%

81.4%

3-3

69.5%

82.9%

84.7%

74.4%

3-4

86.1%

96.0%

90.0%

94.1%

3-5

81.1%

83.6%

74.0%

89.5%

4-0

83.0%

92.5%

92.7%

85.0%

5-1

86.7%

84.6%

95.6%

90.9%

5-2

80.0%

90.3%

92.9%

91.2%

6-0

88.3%

97.1%

90.2%

94.8%

7-0

74.9%

88.8%

85.7%

93.5%

8-1

78.6%

93.0%

94.4%

92.1%

8-2

96.2%

90.9%

78.0%

97.7%

9-1

71.5%

83.6%

83.3%

98.8%

9-2

88.5%

87.6%

91.3%

90.4%

9-3

69.5%

83.9%

86.2%

88.0%

10-0

87.0%

86.8%

95.7%

94.3%

State

77.9%

88.5%

86.7%

89.9%

Notes: State rates based on data weighted by health district.

2005 Rates
1 Varicella
87.2% 97.8% 97.8% 82.6% 78.5% 67.2% 92.4% 85.7% 89.7% 97.3% 92.8% 93.9% 93.8% 96.6% 93.5% 94.4% 93.3% 87.8% 98.4% 87.4%

32

Table 18 reports the statewide and district immunization coverage rates for the PCV vaccine. In 2005, the district coverage rates varied from a low of 62.7 percent to 95.7 percent.

Table 18: State and District Immunization
Rates for PCV by Study Year

District

2005 Rates
3 PCV

Dis1t-r1ict 81.1%

1-2

95.5%

2-0

95.7%

3-1

82.1%

3-2

79.8%

3-3

62.7%

3-4

90.2%

3-5

73.2%

4-0

78.1%

5-1

82.7%

5-2

69.1%

6-0

90.4%

7-0

67.3%

8-1

88.6%

8-2

85.5%

9-1

75.9%

9-2

79.3%

9-3

73.9%

10-0 State

91.9% 79.0%

Notes: State rates based on data weighted by health district.

33

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 19-21 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.
34

Table 19 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, 2004, and 2005 study years maternal race was a significant factor in the immunization status of two-year-old children in Georgia.

Table 19: Statewide Cross tabulations of Maternal Race and Child Immunization Status by Study Year

Maternal Race White
Black
Other

2001 4:3:1 Adequate #/Total (percent) 1265/1661 (76.2) 765/1045 (73.2) 38/49 (77.6)

4:3:1 Total 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%

2005 4:3:1 Adequate #/Total (percent) 1296/1529 (84.8) 703/949 (74.1) 69/91 (75.8)
80.7%

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; 2005 Chi-square=43.88, p=<.05.

35

Table 20 shows the statewide cross-tabulation of maternal educational attainment and 4:3:1 immunization status. The top row in each cell shows the number of mothers in each group according to the immunization status of their children. The bottom row represents the percent of the total number in that category. In 2002 and 2003 maternal educational attainment was associated with child immunization status. As the mother's education level increased, the child's immunization rate increased as well. During the other study years shown in Table 20, childhood immunization status varied with maternal educational attainment.

Table 20: 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

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)

4:3:1 Total

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%

2005 4:3:1 Adequate #/Total (percent) 131/151 (86.8) 276/355 (77.7) 621/771 (80.5) 418/539 (77.6) 680/818 (83.1)
80.7%

Notes: Total rates based on data weighted by health district. 2001 Chi-square=2.09, p=0.7; 2002 Chi-square=31.97, p<0.05; 2003 Chi square=12.50, p<.05; 2004 Chisquare=5.15, p=0.27; 2005 Chi-square=12.09, p<0.05.

36

Table 21 shows the statewide cross-tabulation of maternal Medicaid status and 4:3:1 immunization status for 2002, 2003, 2004 and 2005 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 NonMedicaid recipients (Chi-square=15.34, p=0.00009 and Chi-square=17.45, p < .05, respectively). In the 2005 study year, statewide immunization rates were similar for Medicaid and non-Medicaid recipients.

Table 21: 2004 Statewide Cross tabulations of Maternal Medicaid Status and Child Immunization Status

Medicaid Status
Medicaid
NonMedicaid
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%

2005 4:3:1 Adequate #/Total (percent) 1,070/1,348 (79.4) 1,056/1,286 (82.1)
80.7%

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; 2005 Chi-square = 3.17, p=.08.

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: 4:3:1:3:3:1 coverage, 4:3:1 coverage, and 3:3:1 coverage.
In reviewing rates at the most commonly used level of coverage, 4:3:1 coverage, immunization rates decreased in 2005 statewide compared to the same rates as measured by this study in 2004.
37

SECTION IV: RESULTS OF DISTRICT LEVEL
ANALYSES
38

Section IV: Results of District Level Analyses Overview of District Rates The immunization rates for this sixth year report were calculated based on final samples. The final sample sizes in each health district varied by district. The number of children in the final sample in each district is reported in each Individual Health District Report in this section, as well as in Table 3: Response Rates for the 2005 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.
39

Individual Health District Report: District 1-1

The eligible sample from this district included 173 children born in January 2003. From the 173 children, 167 records were located (Response Rate=96.5%). Of the 167 located records, there were 3 parental refusals leaving a final sample of 164 records.

The 4:3:1 immunization coverage estimate is 79.9 percent (131/164).

This rate is slightly lower than the statewide 4:3:1 immunization rate of 80.7

percent.

Figure 4: 4:3:1 Coverage for State and District 1-1

86 84 82 80 78 76 74 72 70
2001

2002

2003

2004

2005

State Dist 1-1

The 4:3:1:3 immunization coverage estimate is 78.0 percent (128/164). This rate is slightly lower than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 76.2 percent (125/164). This rate is nearly equal to the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

40

Table 22:
District Immunization Rates for Health District 1-1 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 79.5%

81.1%

3 OPV/IPV

88.6%

90.0%

1 MMR

89.2%

90.5%

3 Hib

89.2%

91.5%

3 HepB

92.8%

91.0%

1 Varicella 83.7%

89.1%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 79.5% 88.8% 87.6% 87.0% 88.8% 87.0% 82.0% 44.1%

Table 22 reveals the coverage rates of each vaccine series. Coverage rates ranged from 44.1 to 88.8 percent for the 2005 study data.

Table 23 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.

41

Table 23: 2005 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

156

96.9%

151

93.8%

136

84.5%

1

0.6%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

155

96.3%

149

92.5%

75

46.6%

0

0.0%

MMR1 MMR2

5

3.1%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

156

96.9%

148

91.9%

47

29.2%

1

0.6%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

156

96.9%

150

93.2%

75

46.6%

5

3.1%

VAR1

5

VAR2

0

PCV1

147

PCV2

136

PCV3

111

PCV4

3

PCV5

0

*Percent = number immunized / sample size sample size = 161

3.1% 0.0% 91.3% 84.5% 68.9% 1.9% 0.0%

42

Table 24: Cross tabulations of Maternal Race and Child Immunization Status for Health District 1-1 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 123/154 (79.9) 8/12 (66.7)
----
---
131/166 (78.9)

2002 4:3:1 Adequate #/Total (percent) 140/174 (80.5) 19/23 (82.6)
3/3 (100.0) ---
162/200 (81.0)

2003 4:3:1 Adequate #/Total (percent) 96/135 (71.1) 9/16 (56.3)
----
---
105/151 (69.5)

2004 4:3:1 Adequate #/Total (percent) 154/185 (83.2) 21/27 (77.8) 5/6 (83.3)
---
180/218 (82.6)

2005 4:3:1 Adequate #/Total (percent) 119/149 (79.9) 10/13 (76.9) 1/1 (100.0) 1/1 (100.0) 131/164 (79.9)

Table 24 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 24 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, 2004 and 2005 the immunization rate of children born to white mothers was higher than that of black mothers.

43

Table 25: 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
Total

2001 4:3:1 Adequate #/Total (percent)
14/15 (93.3) 29/41 (70.7) 41/52 (78.8) 27/35 (77.1) 20/23 (87.0)
---
131/166 (78.9)

2002 4:3:1 Adequate #/Total (percent)
9/14 (64.3) 36/50 (72.0) 66/79 (83.5) 29/35 (82.9) 19/20 (95.0)
3/3 (100.0) 162/200 (81.0)

2003 4:3:1 Adequate #/Total (percent)
2/2 (100.0) 18/25 (72.0) 25/43 (58.1) 24/31 (77.4) 36/50 (72.0)
---
105/151 (69.5)

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)

2005 4:3:1 Adequate #/Total (percent)
9/9 (100.0)
9/16 (56.3) 57/70 (81.4) 22/26 (84.6) 34/43 (79.1)
---
131/164 (79.9)

Table 25 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 2005 study, immunization rates varied with educational attainment.

44

Table 26: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 1-1

Medicaid Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent) 62/77 (80.5) 69/87 (79.3) 131/164 (79.9)

Table 26 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. For the 2005 study, children born to non-Medicaid women had a slightly lower immunization rate than children born to women using Medicaid.

45

Individual Health District Report: District 1-2
The eligible sample from this district included 140 children born in January 2003. From these children, 139 records were located (Response Rate=99.3%). Of the 139 located records, there were 5 parental refusals leaving a final sample of 134 records.

4:3:1 immunization coverage estimate is 97.0 percent (130/134). This rate is much higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 5: 4:3:1 Coverage for State and District 1-2

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 1-2

4:3:1:3 immunization coverage estimate 97.0 percent (130/134). This rate is much higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. 4:3:1:3:3:1 immunization coverage estimate 91.8 percent (123/134). This rate is also much higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.
46

Table 27: District Immunization Rates for Health District 1-2 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 79.5%

82.3%

3 OPV/IPV

86.3%

85.4%

1 MMR

85.6%

87.3%

3 Hib

95.2%

86.1%

3 HepB

93.2%

87.3%

1 Varicella 82.9%

86.1%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 97.8% 98.5% 97.8% 97.8% 98.5% 97.8% 95.5% 52.2%

Table 27 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 52.2 to 98.5 percent for the 2005 study data.
Table 28 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.

47

Table 28: 2005 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

129

96.3%

126

94.0%

119

88.8%

0

0.0%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

129

96.3%

125

93.3%

67

50.0%

0

0.0%

MMR1 MMR2

2

1.5%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

129

96.3%

124

92.5%

37

27.6%

0

0.0%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

129

96.3%

128

95.5%

46

34.3%

3

2.2%

VAR1

6

VAR2

0

PCV1

128

PCV2

123

PCV3

104

PCV4

2

PCV5

0

*Percent = number immunized / sample size Sample size = 134

4.5% 0.0% 95.5% 91.8% 77.6% 1.5% 0.0%

48

Table 29: 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)
---
123/153 (80.4)

2004 4:3:1 Adequate #/Total (percent) 86/98 (87.8) 3/3 (100.0) 1/1 (100.0)
---
90/102 (88.2)

2005 4:3:1 Adequate #/Total (percent) 112/115 (97.4) 2/2 (100.0) 3/3 (100.0) 13/14 (92.9) 130/134 (97.0)

Table 29 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.

49

Table 30: 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
Total

2001 4:3:1 Adequate #/Total (percent)
14/20 (70.0) 32/37 (86.5) 30/45 (66.7) 21/23 (91.3) 17/21 (81.0)
----
114/146 (78.1)

2002 4:3:1 Adequate #/Total (percent)
10/10 (100.0) 28/37 (75.7) 25/36 (69.4) 31/37 (83.8) 29/34 (85.3)
2/4 (50.0) 125/158 (79.1)

2003 4:3:1 Adequate #/Total (percent)
3/3 (100.0) 16/22 (72.7) 36/44 (81.8) 24/30 (80.0) 44/54 (81.5)
----
123/153 (80.4)

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)

2005 4:3:1 Adequate #/Total (percent)
16/17 (94.1) 16/16 (100.0) 28/28 (100.0) 30/31 (96.8) 40/42 (95.2)
---
130/134 (97.0)

Table 30 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.

50

Table 31: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 1-2

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
61/64 (95.3) 69/70 (98.6) 130/134 (97.0)

Table 31 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 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.

51

Individual Health District Report: District 2-0
The eligible sample from this district included 50 children born in January 2003. From the 50 children, 47 records were located (Response rate = 94.0%). Of the 47 located records, there was 1 parental refusal leaving a final sample of 46 records.

4:3:1 immunization coverage estimate is 97.8% percent (45/46). This rate is much higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 6: 4:3:1 Coverage for State and District 2-0

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 2-0

4:3:1:3 immunization coverage estimate is 93.5 percent (43/46). This rate is much higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. 4:3:1:3:3:1 immunization coverage estimate is 91.3 percent (42/46). This rate is also much higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

52

Table 32: District Immunization Rates for Health District 2-0 by Study Year*

Vaccine

2001

2002

2003

2004

2005

Adequate Adequate Adequate Adequate Adequate

Rates

Rates

Rates

Rates

Rates

4 DTP/DTaP

94.8%

94.7%

95.7%

100%

97.8%

3 OPV/IPV

97.0%

97.4%

94.7%

100%

97.8%

1 MMR

97.0%

96.1%

96.8%

100%

97.8%

3 Hib

96.3%

96.1%

93.6%

100%

95.7%

3 HepB

95.6%

97.4%

93.6%

100%

93.5%

1 Varicella

94.8%

96.1%

96.8%

98.5%

97.8%

3 PCV

---

---

---

77.6%

95.7%

4 PCV

---

---

---

28.4%

65.2%

*PCV data not collected before 2004.

Table 32 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 65.2 to 97.8 percent for the 2005 study data.
Table 33 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.

53

Table 33: 2005 District Immunization Rates by Individual Vaccine at
12 months of age for Health District 2-0

Vaccine Dose

Number Immunized

Percent*

DTP1/DTaP1

45

97.8%

DTP2/DTaP2

45

97.8%

DTP3/DTaP3

44

95.7%

DTP4/DTaP4

0

0.0%

DTP5/DTaP5

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

45

97.8%

45

97.8%

20

43.5%

0

0.0%

MMR1 MMR2

4

91.3%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

45

97.8%

45

97.8%

11

23.9%

0

0.0%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

45

97.8%

45

97.8%

24

52.2%

0

0.0%

VAR1

4

VAR2

0

PCV1

44

PCV2

44

PCV3

42

PCV4

1

PCV5

0

*Percent = number immunized / sample size Sample size = 46

8.7% 0.0% 95.7% 95.7% 91.3% 2.2% 0.0%

54

Table 34: 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)

2005 4:3:1 Adequate #/Total (percent) 43/44 (97.7) 1/1 (100.0) 1/1 (100.0) 45/46 (97.8)

Table 34 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 34 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.

55

Table 35: 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
Total

2001 4:3:1 Adequate #/Total (percent)
23/25 (92.0) 24/24 (100.0) 38/42 (90.5) 15/16 (93.8) 28/28 (100.0)
---
128/135 (94.8)

2002 4:3:1 Adequate #/Total (percent)
9/9 (100.0) 15/18 (83.3) 20/21 (95.2)
7/8 (87.5) 17/17 (100.0)
3/3 (100.0) 71/76 (93.4)

2003 4:3:1 Adequate #/Total (percent)
1/1 (100.0) 11/12 (91.7) 38/41 (92.7)
5/7 (71.4) 30/33 (90.9)
---
85/94 (90.4)

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)

2005 4:3:1 Adequate #/Total (percent)
4/4 (100.0)
7/7 (100.0) 10/11 (91.0)
4/4 (100.0) 20/20 (100.0)
---
45/46 (97.8)

Table 35 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 nearly 100% for each level of educational attainment, with no correlation regarding educational level.

56

Table 36: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 2-0

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
19/19 (100.0) 26/27 (96.3) 45/46 (97.8)

Table 36 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. During the 2005 study, children born to Medicaid women had a higher immunization rate than children born to non-Medicaid women.

57

Individual Health District Report: District 3-1
The eligible sample from this district included 239 children born in January 2003. From the 239 children, 198 records were located (Response Rate=82.8%). Of the 239 located records, there were 3 parental refusals leaving a final sample of 195 records.
The 4:3:1 immunization coverage estimate is 75.9 percent (148/195). This rate is lower than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 7: 4:3:1 Coverage for State and District 3-1

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 3-1

The 4:3:1:3 immunization coverage estimate is 74.4 percent (145/195). This rate is lower than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 68.2 percent (133/195). This rate is also lower than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

58

Table 37: District Immunization Rates for Health District 3-1 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 70.7%

84.9%

3 OPV/IPV

75.3%

90.8%

1 MMR

77.0%

90.1%

3 Hib

83.9%

91.2%

3 HepB

82.8%

92.6%

1 Varicella

72.4%

88.4%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 79.0% 86.2% 82.1% 84.1% 83.6% 82.6% 82.1% 45.6%

Table 37 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 45.6 to 86.2 percent for the 2005 study data.

Table 38 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.

59

Table 38: 2005 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

189

96.9%

180

92.3%

171

87.7%

3

1.5%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

187

95.9%

178

91.3%

102

52.3%

3

1.5%

MMR1 MMR2

7

3.6%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

185

94.9%

175

89.7%

72

36.9%

3

1.5%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

187

95.9%

179

91.8%

102

52.3%

15

7.7%

VAR1

7

VAR2

0

PCV1

178

PCV2

171

PCV3

146

PCV4

5

PCV5

0

*Percent = number immunized / sample size Sample size = 195

3.6% 0.0% 91.3% 87.7% 74.9% 2.6% 0.0%

60

Table 39: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-1 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 95/128 (74.2) 22/40 (55.0) 6/6 (100.0)
---
123/174 (70.7)

2002 4:3:1 Adequate #/Total (percent) 179/207 (86.5) 51/66 (77.3) 8/9 (88.9) 2/2 (100.0) 240/284 (84.5)

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)

2005 4:3:1 Adequate #/Total (percent) 119/146 (81.5) 28/44 (63.6) 1/5 (20.0)
---
148/195 (75.9)

Table 39 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 39 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.

61

Table 40: 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
Total

2001 4:3:1 Adequate #/Total (percent)
7/16 (43.8) 17/23 (73.9) 41/53 (77.4) 22/34 (64.7) 36/48 (75.0)
---
123/174 (70.7)

2002 4:3:1 Adequate #/Total (percent)
17/26 (65.4) 21/28 (75.0) 60/74 (81.1) 38/46 (82.6) 99/105 (94.3)
5/5 (100.0) 240/284 (84.5)

2003 4:3:1 Adequate #/Total (percent)
3/3 (100.0)
7/10 (70.0) 25/38 (65.8) 14/23 (60.9) 57/71 (80.3)
---
106/145 (73.1)

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)

2005 4:3:1 Adequate #/Total (percent)
15/17 (88.2) 8/13 (61.5) 45/57 (78.9) 16/28 (57.1) 64/80 (80.0)
---
148/195 (75.9)

Table 40 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.

62

Table 41: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 3-1

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
60/78 (76.9) 88/117 (75.2) 148/195 (75.9)

Table 41 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. For the 2005 study, children born to Medicaid women had a slightly higher immunization rate than children born to women using non-Medicaid.

63

Individual Health District Report: District 3-2
The eligible sample from this district included 538 children born in January 2003. From the 538 children, 353 records were located (Response Rate=65.6%). Of the 353 located records, there were 36 parental refusals leaving a final sample of 317 records.
The 4:3:1 immunization coverage estimate is 72.6 percent (230/317). This rate is lower than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 8: 4:3:1 Coverage for State and District 3-2

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 3-2

The 4:3:1:3 immunization coverage estimate is 72.2 percent (229/317). This rate is lower than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 70.7 percent (224/317). This rate is also lower than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

64

Table 42: District Immunization Rates for Health District 3-2 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 42.4%

84.0%

3 OPV/IPV

45.5%

84.7%

1 MMR

45.1%

84.7%

3 Hib

45.5%

85.4%

3 HepB

44.4%

84.7%

1 Varicella

44.4%

81.9%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 73.8% 81.1% 80.4% 81.4% 81.1% 78.5% 79.8% 47.6%

Table 42 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 47.6 to 81.4 percent for the 2005 study data.

Table 43 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.

65

Table 43: 2005 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

294

92.7%

273

86.1%

246

77.6%

4

1.3%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

295

93.1%

271

85.5%

156

49.2%

1

0.3%

MMR1 MMR2

13

4.1%

1

0.3%

HIB1 HIB2 HIB3 HIB4 HIB5

292

92.1%

269

84.9%

120

37.9%

4

1.3%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

296

93.4%

276

87.1%

139

43.8%

17

5.4%

VAR1

19

VAR2

0

PCV1

279

PCV2

262

PCV3

226

PCV4

8

PCV5

0

*Percent = number immunized / sample size Sample size = 317

6.0% 0.0% 88.0% 82.6% 71.3% 2.5% 0.0%

66

Table 44: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-2 by Study Year

Maternal Race White
Black
Other
Unknown
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)

2005 4:3:1 Adequate #/Total (percent) 127/159 (79.9) 89/142 (62.7) 12/14 (85.7) 2/2 (100.0) 230/317 (72.6)

Table 44 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.

67

Table 45: 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
Total

2001 4:3:1 Adequate #/Total (percent)
16/30 (53.3) 24/47 (51.1) 25/69 (36.2) 15/37 (40.5) 46/114 (40.4)
---
126/297 (42.4)

2002 4:3:1 Adequate #/Total (percent)
7/9 (77.8) 15/20 (75.0) 20/26 (76.9) 22/28 (78.6) 50/55 (90.9)
5/6 (83.3) 119/144 (82.6)

2003 4:3:1 Adequate #/Total (percent)
3/3 (100.0)
7/14 (50.0) 16/27 (59.3) 7/21 (33.3) 51/73 (69.9)
---
84/138 (60.9)

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)

2005 4:3:1 Adequate #/Total (percent)
11/17 (64.7) 28/44 (63.6) 41/63 (65.1) 28/39 (71.8) 122/154 (79.2)
---
230/317 (72.6)

Table 45 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.

68

Table 46: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 3-2

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
77/124 (62.1) 153/193 (79.3) 230/317 (72.6)

Table 46 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 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.

69

Individual Health District Report: District 3-3

The eligible sample from this district included 301 children born in January 2003. From the 301 children, 244 records were located (Response Rate=81.1%). Of the 244 located records, there were 0 parental refusals leaving a final sample of 244 records.

The 4:3:1 immunization coverage estimate is 53.3 percent (130/244). This rate is much lower than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 9: 4:3:1 Coverage for State and District 3-3

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 3-3

The 4:3:1:3 immunization coverage estimate is 50.4 percent (123/244). This rate is much lower than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 47.1 percent (115/244). This rate is also much lower than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

70

Table 47: District Immunization Rates for Health District 3-3 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 61.0%

73.9%

3 OPV/IPV

69.5%

82.9%

1 MMR

74.6%

84.7%

3 Hib

81.4%

80.2%

3 HepB

81.4%

80.2%

1 Varicella

69.5%

82.9%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 58.6% 68.4% 65.6% 71.7% 75.0% 67.2% 62.7% 22.5%

Table 47 reveals the coverage rates of each vaccine series. Coverage rates ranged from 22.5 to 75.0 percent.

Table 48 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.

71

Table 48: 2005 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

232

95.1%

219

89.8%

189

77.5%

2

0.8%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

232

95.1%

217

88.9%

92

37.7%

1

0.4%

MMR1 MMR2

11

4.5%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

231

94.7%

212

86.9%

123

50.4%

4

1.6%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

235

96.3%

217

88.9%

140

57.4%

5

2.0%

VAR1

11

VAR2

1

PCV1

203

PCV2

173

PCV3

132

PCV4

2

PCV5

0

*Percent = number immunized / sample size Sample size = 244

4.5% 0.4% 83.2% 70.9% 54.1% 0.8% 0.0%

72

Table 49: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-3 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 27/49 (55.1) 39/67 (58.2) 2/2 (100.0)
---
68/118 (57.6)

2002 4:3:1 Adequate #/Total (percent) 40/52 (76.9) 38/54 (70.4) 3/4 (75.0) 1/1 (100.0) 82/111 (73.9)

2003 4:3:1 Adequate #/Total (percent) 75/104 (72.1) 103/142 (72.5) 20/23 (87.0)
---
198/269 (73.6)

2004 4:3:1 Adequate #/Total (percent) 22/35 (62.9) 31/47 (66.0) 3/4 (75.0)
---
56/86 (65.1)

2005 4:3:1 Adequate #/Total (percent) 60/84 (71.4) 63/137 (46.0) 7/23 (30.4)
---
130/244 (53.3)

Table 49 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 born to white mothers was higher than the children born to black mothers.

73

Table 50: 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
Total

2001 4:3:1 Adequate #/Total (percent)
1/4 (25.0) 17/31 (54.8) 31/48 (64.6) 15/26 (57.7)
4/9 (44.4)
---
68/118 (57.6)

2002 4:3:1 Adequate #/Total (percent)
12/13 (92.3) 10/18 (55.6) 25/36 (69.4) 17/21 (81.0) 16/20 (80.0)
2/3 (66.7) 82/111 (73.8)

2003 4:3:1 Adequate #/Total (percent)
4/6 (66.7) 28/40 (70.0) 57/85 (67.1) 52/62 (83.9) 57/76 (75.0)
---
198/269 (73.6)

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)

2005 4:3:1 Adequate #/Total (percent)
3/4 (75.0) 16/31 (51.6) 31/69 (44.9) 24/57 (42.1) 56/83 (67.5)
---
130/244 (53.3)

Table 50 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.

74

Table 51: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 3-3

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
69/134 (51.5) 61/110 (55.5) 130/244 (53.3)

Table 51 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 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.

75

Individual Health District Report: District 3-4

The eligible sample from this district included 103 children born in January 2003. From the 103 children, 94 records were located (Response Rate=91.3%). Of the 94 located records, there were 2 parental refusals leaving a final sample of 92 records.

The 4:3:1 immunization coverage estimate is 90.2 percent (83/92). This rate is much higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 10: 4:3:1 Coverage for State and District 3-4

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 3-4

The 4:3:1:3 immunization coverage estimate is 90.2 percent (83/92). This rate is much higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 88.0 percent (81/92). This rate is also much higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

76

Table 52: District Immunization Rates for Health District 3-4 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 75.9%

94.9%

3 OPV/IPV

77.2%

96.0%

1 MMR

83.5%

97.1%

3 Hib

92.4%

96.6%

3 HepB

86.1%

94.9%

1 Varicella

86.1%

96.0%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 92.4% 90.2% 91.3% 92.4% 91.3% 92.4% 90.2% 53.3%

Table 52 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 53.3 to 92.4 percent for the 2005 study data.

Table 53 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.

77

Table 53: 2005 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

91

98.9%

88

95.7%

85

92.4%

1

1.1%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

90

97.8%

85

92.4%

49

53.3%

0

0.0%

MMR1 MMR2

5

5.4%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

90

97.8%

86

93.5%

33

35.9%

2

2.2%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

90

97.8%

89

96.7%

44

47.8%

1

1.1%

VAR1

7

VAR2

0

PCV1

86

PCV2

83

PCV3

74

PCV4

1

PCV5

0

*Percent = number immunized / sample size Sample size = 92

7.6% 0.0% 93.5% 90.2% 80.4% 1.1% 0.0%

78

Table 54: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-4 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 43/56 (76.8) 12/17 (70.6) 5/6 (83.3)
---
60/79 (75.9)

2002 4:3:1 Adequate #/Total (percent) 122/127 (96.1) 30/35 (85.7) 11/11 (100.0) 2/2 (100.0) 165/175 (94.3)

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)

2005 4:3:1 Adequate #/Total (percent) 59/62 (95.2) 16/21 (76.2) 8/8 (100.0) 0/1 (0.0) 83/92 (90.2)

Table 54 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).
For the 2005 study year, the immunization rates varied among race with no clear correlation.

79

Table 55: 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
Total

2001 4:3:1 Adequate #/Total (Percent)
2/3 (66.7) 7/11 (63.6) 16/25 (64.0) 8/10 (80.0) 27/30 (90.0)
---
60/79 (75.9)

2002 4:3:1 Adequate #/Total (Percent)
4/5 (80.0) 15/18 (83.3) 58/61 (95.1) 27/29 (93.1) 55/56 (98.2)
6/6 (100.0) 165/175 (94.3)

2003 4:3:1 Adequate #/Total (Percent)
1/1 (100.0)
3/3 (100.0) 17/21 (81.0)
9/10 (90.0) 22/25 (88.0)
---
52/60 (86.7)

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)

2005 4:3:1 Adequate #/Total (Percent)
5/6 (83.3)
6/9 (66.7) 22/23 (95.7) 13/15 (86.7) 37/39 94.9
---
83/92 (90.2)

Table 55 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.

80

Table 56: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 3-4

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
26/33 (78.8) 57/59 (96.6) 83/92 (90.2)

Table 56 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. In the 2005 study, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid.

81

Individual Health District Report: District 3-5
The eligible sample from this district included 311 children born in January 2003. From the 311 children, 232 records were located (Response Rate=74.6%). Of the 232 located records, there was 1 parental refusal leaving a final sample of 231 records.
The 4:3:1 immunization coverage estimate is 72.3 percent (167/231). This rate is lower than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 11: 4:3:1 Coverage for State and District 3-5

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 3-5

The 4:3:1:3 immunization coverage estimate is 69.7 percent (161/231). This rate is lower than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 68.0 percent (157/231). This rate is also lower than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

82

Table 57: District Immunization Rates for Health District 3-5 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 77.0%

84.6%

3 OPV/IPV

83.7%

88.7%

1 MMR

87.8%

86.7%

3 Hib

89.3%

86.2%

3 HepB

88.8%

85.6%

1 Varicella

81.1%

83.6%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 74.0% 83.1% 84.8% 82.3% 82.3% 85.7% 73.2% 38.5%

Table 57 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 38.5 to 85.7 percent for the 2005 study data.

Table 58 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.

83

Table 58: 2005 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

220

95.2%

210

90.9%

188

81.4%

2

0.9%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

219

94.8%

208

90.0%

122

52.8%

3

1.3%

MMR1 MMR2

9

3.9%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

215

93.1%

206

89.2%

73

31.6%

1

0.4%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

222

96.1%

208

90.0%

94

40.7%

0

0.0%

VAR1

11

VAR2

0

PCV1

196

PCV2

184

PCV3

143

PCV4

5

PCV5

0

*Percent = number immunized / sample size Sample size = 231

4.8% 0.0% 84.8% 79.7% 61.9% 2.2% 0.0%

84

Table 59: Cross tabulations of Maternal Race and Child Immunization Status for Health District 3-5 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (Percent) 38/52 (73.1) 100/130 (76.9) 10/14 (71.4)
---
148/196 (75.5)

2002 4:3:1 Adequate #/Total (Percent) 51/63 (81.0) 101/117 (86.3) 9/10 (90.0) 4/5 (80.0) 165/195 (84.6)

2003 4:3:1 Adequate #/Total (Percent) 36/45 (80.0) 53/100 (53.0) 2/5 (40.0)
---
91/150 (60.7)

2004 4:3:1 Adequate #/Total (Percent) 62/74 (83.8) 123/154 (80.0) 11/11 (100.0)
---
196/239 (82.0)

2005 4:3:1 Adequate #/Total (Percent) 67/90 (74.4) 87/127 (68.5) 13/13 (100.0) 0/1 (0.0) 167/231 (72.3)

Table 59 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 59 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.

85

Table 60: 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
Total

2001 4:3:1 Adequate #/Total (percent)
12/17 (70.6) 17/25 (68.0) 43/59 (72.9) 33/46 (71.7) 43/49 (87.8)
---
148/196 (75.5)

2002 4:3:1 Adequate #/Total (percent)
11/15 (73.3) 19/22 (86.4) 40/48 (83.3) 38/49 (77.6) 51/54 (94.4)
6/7 (85.7) 165/195 (84.6)

2003 4:3:1 Adequate #/Total (percent)
2/5 (40.0) 9/13 (69.2) 22/42 (52.4) 21/39 (53.8) 37/51 (72.5)
---
91/150 (60.7)

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)

2005 4:3:1 Adequate #/Total (percent)
13/18 (72.2) 20/26 (76.9) 42/57 (73.7) 29/45 (64.4) 63/85 (74.1)
---
167/231 (72.3)

Table 60 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.

86

Table 61: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 3-5

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
78/106 (73.6) 89/125 (71.2) 167/231 (72.3)

Table 61 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. For the 2005 study, children born to Medicaid women had a slightly higher immunization rate than children born to women using non-Medicaid.

87

Individual Health District Report: District 4-0

The eligible sample from this district included 247 children born in January 2003. From the 247 children, 226 records were located (Response Rate=91.5%). Of the 226 located records, there were 2 parental refusals leaving a final sample of 224 records.

The 4:3:1 immunization coverage estimate is 81.7 percent (183/224). This rate is slightly higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 12: 4:3:1 Coverage for State and District 4-0

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 4-0

The 4:3:1:3 immunization coverage estimate is 81.3 percent (182/224). This rate is slightly higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 79.5 percent (178/224). This rate is also slightly higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent

88

Table 62: District Immunization Rates for Health District 4-0 by Study Year

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 83.5%

87.8%

3 OPV/IPV

86.4%

92.5%

1 MMR

86.4%

93.2%

3 Hib

88.3%

93.2%

3 HepB

88.8%

92.5%

1 Varicella

83.0%

92.5%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 83.9% 87.0% 89.2% 88.8% 90.1% 89.7% 78.0% 26.9%

Table 62 reveals the coverage rates of each vaccine series. Coverage rates ranged from 26.9 to 90.1 percent for the 2005 study data.

Table 63 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.

89

Table 63: 2005 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

220

98.7%

212

95.1%

199

89.2%

5

2.2%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

220

98.7%

212

95.1%

108

48.4%

1

0.4%

MMR1 MMR2

6

2.7%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

220

98.7%

209

93.7%

89

39.9%

4

1.8%

1

0.4%

HEPB1 HEPB2 HEPB3 HEPB4

219

98.2%

213

95.5%

125

56.1%

10

4.5%

VAR1

4

VAR2

0

PCV1

205

PCV2

196

PCV3

155

PCV4

4

PCV5

0

*Percent = number immunized / sample size Sample size = 223

1.8% 0.0% 91.9% 87.9% 69.5% 1.8% 0.0%

90

Table 64: Cross tabulations of Maternal Race and Child Immunization Status for Health District 4-0 by Study Year

Maternal Race White
Black
Other
Unknown
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)

2005 4:3:1 Adequate #/Total (percent) 116/143 (81.1) 58/72 (80.6) 6/6 (100.0) 3/3 (100.0) 183/224 (81.7)

Table 64 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 District 4-0 varies with maternal race.

91

Table 65:
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)
---

2005 4:3:1 Adequate #/Total (percent)
5/5 (100.0) 21/28 (75.0) 55/67 (82.1) 50/61 (82.0) 52/63 (82.5)
---

Total

172/206 (83.5)

128/147 (87.1)

86/110 (78.2)

145/187 (77.5)

183/224 (81.7)

Table 65 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.

92

Table 66: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 4-0

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
84/106 (79.2) 99/118 (83.9) 183/224 (81.7)

Table 66 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. For the 2005 study, the immunization rate of children born to non-Medicaid women was higher than the immunization rate of children born to women using Medicaid.

93

Individual Health District Report: District 5-1

The eligible sample from this district included 78 children born in January 2003. From the 78 children, 76 records were located (Response Rate=97.4%). Of the 76 located records, there was 1 parental refusal leaving a final sample of 75 records.

The 4:3:1 immunization coverage estimate is 94.7 percent (71/75). This rate is much higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 13: 4:3:1 Coverage for State and District 5-1

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 5-1

The 4:3:1:3 immunization coverage estimate 94.7 percent (71/75). This rate is much higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate 84.0 percent (63/75). This rate is also much higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

94

Table 67: District Immunization Rates for Health District 5-1 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 86.7%

80.8%

3 OPV/IPV

93.3%

96.2%

1 MMR

91.7%

97.4%

3 Hib

91.7%

97.4%

3 HepB

93.3%

96.2%

1 Varicella

86.7%

84.6%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 94.7% 96.0% 96.0% 96.0% 96.0% 97.3% 82.7% 32.0%

Table 67 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 32.0 to 97.3 percent for the 2005 study data.

Table 68 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.

95

Table 68: 2005 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

70

93.3%

70

93.3%

63

84.0%

0

0.0%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

70

93.3%

69

92.0%

41

54.7%

0

0.0%

MMR1 MMR2

2

2.7%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

70

93.3%

66

88.0%

11

14.7%

0

0.0%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

70

93.3%

70

93.3%

45

60.0%

1

1.3%

VAR1

2

VAR2

0

PCV1

65

PCV2

64

PCV3

49

PCV4

1

PCV5

0

*Percent = number immunized / sample size Sample size = 75

2.7% 0.0% 86.7% 85.3% 65.3% 1.3% 0.0%

96

Table 69: Cross tabulations of Maternal Race and Child Immunization Status for Health District 5-1 by Study Year

Maternal Race White
Black
Other
Total

2001 4:3:1 Adequate #/Total (percent) 32/36 (88.9) 19/24 (79.2)
---
51/60 (85.0)

2002 4:3:1 Adequate #/Total (percent) 34/44 (77.3) 29/34 (85.3)
---
63/78 (80.8)

2003 4:3:1 Adequate #/Total (percent) 56/64 (87.5) 19/25 (76.0) 1/1 (100.0) 76/90 (84.4)

2004 4:3:1 Adequate #/Total (percent) 27/32 (84.4) 20/23 (87.0)
---
47/55 (85.5)

2005 4:3:1 Adequate #/Total (percent) 39/41 (95.1) 30/32 (93.8) 2/2 (100.0) 71/75 (94.7)

Table 69 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 5-1 vary with maternal race with no clear trend emerging.

97

Table 70: 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)
---

2005 4:3:1 Adequate #/Total (percent)
1/1 (100.0) 12/14 (85.7) 36/38 (94.7)
5/5 (100.0) 17/17 (100.0)
---

Total

51/60 (85.0)

63/78 (80.8)

76/90 (84.4)

47/55 (85.5)

71/75 (94.7)

Table 70 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.

98

Table 71: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 5-1

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
43/46 (93.5) 28/29 (96.6) 71/75 (94.7)

Table 71 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. The immunization rates for District 5-1 vary with maternal Medicaid status.

99

Individual Health District Report: District 5-2

The eligible sample from this district included 160 children born in January 2003. From the 160 children, 146 records were located (Response Rate=91.3%). Of the 146 located records, there were 7 parental refusals leaving a final sample of 139 records.

The 4:3:1 immunization coverage estimate is 87.8 percent (122/139). This rate is higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 14: 4:3:1 Coverage for State and District 5-2

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 5-2

The 4:3:1:3 immunization coverage estimate is 86.3 percent (120/139). This rate is higher to the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 84.9 percent (118/139). This rate is also higher to the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

100

Table 72:
District Immunization Rates for Health District 5-2 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 72.7%

85.5%

3 OPV/IPV

81.8%

94.0%

1 MMR

82.7%

92.3%

3 Hib

84.5%

92.7%

3 HepB

83.6%

93.1%

1 Varicella

80.0%

90.3%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 88.5% 94.2% 92.1% 90.6% 92.1% 92.8% 69.1% 36.0%

Table 72 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 36.0 to 94.2 percent for the 2005 study data.

Table 73 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.

101

Table 73: 2005 District Immunization Rates by Individual Vaccine at
12 Months of Age for Health District 5-2

Vaccine Dose

Number Immunized

DTP1/DTaP1

135

DTP2/DTaP2

134

DTP3/DTaP3

115

DTP4/DTaP4

1

DTP5/DTaP5

0

OPV/IPV1

135

OPV/IPV2

134

OPV/IPV3

67

OPV/IPV4

0

MMR1

6

MMR2

0

HIB1

133

HIB2

129

HIB3

41

HIB4

0

HIB5

0

HEPB1

136

HEPB2

134

HEPB3

78

HEPB4

3

VAR1

4

VAR2

0

PCV1

120

PCV2

110

PCV3

76

PCV4

4

PCV5

0

*Percent = number immunized / sample size Sample size = 139

Percent*
97.1% 96.4% 82.7% 0.7% 0.0%
97.1% 96.4% 48.2% 0.0%
4.3% 0.0%
95.7% 92.8% 29.5% 0.0% 0.0%
97.8% 96.4% 56.1% 2.2%
2.9% 0.0% 86.3% 79.1% 54.7% 2.9% 0.0%

102

Table 74: Cross tabulations of Maternal Race and Child Immunization Status for Health District 5-2 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 33/52 (63.5) 43/58 (74.1)
---
----
76/110 (69.1)

2002 4:3:1 Adequate #/Total (percent) 109/123 (88.6) 96/120 (80.0) 4/4 (100.0) 1/1 (100.0) 210/248 (84.7)

2003 4:3:1 Adequate #/Total (percent) 55/68 (80.9) 41/56 (73.2) 2/2 (100.0)
---
98/126 (77.8)

2004 4:3:1 Adequate #/Total (percent) 63/71 (88.8) 62/73 (85.0) 3/3 (100.0)
---
128/147 (87.1)

2005 4:3:1 Adequate #/Total (percent) 54/61 (88.5) 49/58 (84.5) 2/2 (100.0) 17/18 (94.4) 122/139 (87.8)

Table 74 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.

103

Table 75: 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)

2005 4:3:1 Adequate #/Total (percent)
22/23 (95.7) 13/16 (81.3) 42/49 (85.7) 24/28 (85.7) 21/23 (91.3) 122/139 (87.8)

Table 75 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.

104

Table 76: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 5-2

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
72/86 (83.7) 50/53 (94.3) 122/139 (87.8)

Table 76 shows immunization status of children born to women stratified

by Medicaid status for the 2002, 2003, 2004 and 2005 study years. In all study

years, children born to women not using Medicaid had a higher immunization

rate than children born to Medicaid women.

105

Individual Health District Report: District 6-0

The eligible sample from this district included 119 children born in January 2003. From the 119 children, 116 records were located (Response Rate=97.5%). Of the 116 located records, there was 1 parental refusal leaving a final sample of 115 records.

The 4:3:1 immunization coverage estimate is 93.9 percent (108/115). This rate is much higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 15: 4:3:1 Coverage for State and District 6-0

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 6-0

The 4:3:1:3 immunization coverage estimate is 93.0 percent (107/115). This rate is much higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 88.7 percent (102/115). This rate is also much higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.
106

Table 77: District Immunization Rates for Health District 6-0 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 89.5%

89.2%

3 OPV/IPV

93.2%

95.1%

1 MMR

95.1%

96.1%

3 Hib

97.5%

97.1%

3 HepB

93.2%

96.1%

1 Varicella

88.3%

97.1%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 94.8% 97.4% 94.8% 94.8% 95.7% 93.9% 90.4% 52.2%

Table 77 reveals the coverage rates of each vaccine series. Coverage rates ranged from 52.2 to 97.4 percent for the 2005 study data.

Table 78 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.

107

Table 78: 2005 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

115

100.0%

110

95.7%

105

91.3%

0

0.0%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

115

100.0%

110

95.7%

68

59.1%

0

0.0%

MMR1 MMR2

3

2.6%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

115

100.0%

110

95.7%

59

51.3%

2

1.7%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

115

100.0%

114

99.1%

82

71.3%

12

10.4%

VAR1

6

VAR2

0

PCV1

111

PCV2

101

PCV3

85

PCV4

3

PCV5

0

*Percent = number immunized / sample size Sample size = 115

5.2% 0.0% 96.5% 87.8% 73.9% 2.6% 0.0%

108

Table 79: Cross tabulations of Maternal Race and Child Immunization Status for Health District 6-0 by Study Year

Maternal Race White
Black
Other
Unknown
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)

2005 4:3:1 Adequate #/Total (percent) 47/50 (94.0) 44/46 (95.7) 3/3 (100.0) 14/16 (87.5) 108/115 (93.9)

Table 79 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 79 shows that the immunization rates of children in District 6-0 varied with maternal race.

109

Table 80: 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)

2005 4:3:1 Adequate #/Total (percent)
15/17 (88.2) 17/19 (89.5) 23/26 (88.5) 26/26 (100.0) 27/27 (100.0) 108/115 (93.9)

Table 80 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.

110

Table 81: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 6-0

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
61/67 (91.0) 47/48 (97.9) 108/115 (93.9)

Table 81 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. Table 79 shows that the immunization rates of children in District 6-0 vary with maternal Medicaid status.

111

Individual Health District Report: District 7-0

The eligible sample from this district included 129 children born in January 2003. From the 129 children, 113 records were located (Response Rate=87.6%). Of the 113 located records, there were 0 parental refusals leaving a final sample of 113 records.

The 4:3:1 immunization coverage estimate is 90.3 percent (102/113). This rate is higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 16: 4:3:1 Coverage for State and District 7-0

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 7-0

The 4:3:1:3 immunization coverage estimate is 88.5 percent (100/113). This rate is higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 85.8 percent (97/113). This rate is also higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

112

Table 82: District Immunization Rates for Health District 7-0 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 74.3%

83.6%

3 OPV/IPV

78.4%

90.5%

1 MMR

80.2%

92.2%

3 Hib

82.6%

89.7%

3 HepB

85.0%

90.5%

1 Varicella

74.9%

88.8%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 90.3% 92.9% 93.8% 91.2% 93.8% 93.8% 67.3% 35.4%

Table 82 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 35.4 to 93.8 percent for the 2005 study data.

Table 83 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.

113

Table 83: 2005 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

110

97.3%

108

95.6%

100

88.5%

0

0.0%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

110

97.3%

108

95.6%

45

39.8%

0

0.0%

MMR1 MMR2

3

2.7%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

110

97.3%

106

93.8%

56

49.6%

2

1.8%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

110

97.3%

109

96.5%

76

67.3%

2

1.8%

VAR1

4

VAR2

0

PCV1

87

PCV2

83

PCV3

69

PCV4

1

PCV5

0

*Percent = number immunized / sample size Sample size = 113

3.5% 0.0% 77.0% 73.5% 61.1% 0.9% 0.0%

114

Table 84: Cross tabulations of Maternal Race and Child Immunization Status for Health District 7-0 by Study Year

Maternal Race White
Black
Other
Unknown
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)

2005 4:3:1 Adequate #/Total (percent) 38/43 (88.4) 60/65 (92.3) 3/3 (100.0) 1/2 (50.0) 102/113 (90.3)

Table 84 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 84 shows that the immunization rates of children in District 7-0 varied with maternal race.

115

Table 85: 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
Total

2001 4:3:1 Adequate #/Total (percent)
4/6 (66.7) 41/53 (77.4) 55/72 (76.4) 10/13 (76.9) 12/23 (52.2)
---
122/167 (73.1)

2002 4:3:1 Adequate #/Total (percent)
3/3 (100.0) 34/40 (85.0) 35/42 (83.3) 18/23 (78.3)
6/7 (85.7)
0/1 (0.0) 96/116 (82.8)

2003 4:3:1 Adequate #/Total (percent)
1/1 (100.0) 23/38 (60.5) 36/51 (70.6) 21/24 (87.5) 19/26 (73.1)
---
100/140 (71.4)

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)

2005 4:3:1 Adequate #/Total (percent)
2/3 (66.7) 16/18 (88.9) 40/40 (100.0) 25/30 (83.3) 19/22 (86.4)
---
102/113 (90.3)

Table 85 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.

116

Table 86: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 7-0

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
68/74 (91.9) 34/39 (87.2) 102/113 (90.3)

Table 86 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. For Health District 7-0, immunization rates of children vary with maternal Medicaid status.

117

Individual Health District Report: District 8-1

The eligible sample from this district included 96 children born in January 2003. From the 96 children, 90 records were located (Response Rate=93.8%). Of the 90 located records, there were 2 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 much higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 17: 4:3:1 Coverage for State and District 8-1

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 8-1

The 4:3:1:3 immunization coverage estimate is 92.0 percent (81/88). This rate is much higher than the statewide 4:3:1:3 immunization rate of percent 79.5. The 4:3:1:3:3:1 immunization coverage estimate is 92.0 percent (81/88). This rate is also much higher than the statewide 4:3:1:3:3:1 immunization rate of percent 76.5.

118

Table 87: District Immunization Rates for Health District 8-1 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 77.7%

82.2%

3 OPV/IPV

84.5%

91.5%

1 MMR

82.5%

93.8%

3 Hib

81.6%

94.6%

3 HepB

84.5%

94.6%

1 Varicella

78.6%

93.0%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 94.3% 97.7% 97.7% 96.6% 97.7% 96.6% 88.6% 31.8%

Table 87 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 31.8 to 97.7 percent for the 2005 study data.

Table 88 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.

119

Table 88: 2005 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

88

100.0%

87

98.9%

78

88.6%

0

0.0%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

88

100.0%

86

97.7%

43

48.9%

0

0.0%

MMR1 MMR2

2

2.3%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

88

100.0%

86

97.7%

22

25.0%

0

0.0%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

88

100.0%

88

100.0%

39

44.3%

4

4.5%

VAR1

3

VAR2

0

PCV1

86

PCV2

81

PCV3

64

PCV4

3

PCV5

0

*Percent = number immunized / sample size Sample size = 88

3.4% 0.0% 97.7% 92.0% 72.7% 3.4% 0.0%

120

Table 89: Cross tabulations of Maternal Race and Child Immunization Status for Health District 8-1 by Study Year

Maternal Race White
Black
Other
Unknown
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)

2005 4:3:1 Adequate #/Total (percent) 58/62 (93.5) 20/21 (95.2) 2/2 (100.0) 3/3 (100.0) 83/88 (94.3)

Table 89 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 89 shows that the immunization rate of children varies with maternal race in District 8-1.

121

Table 90: 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)

2005 4:3:1 Adequate #/Total (percent)
4/4 (100.0) 18/19 (94.7) 21/23 (91.3) 22/22 (100.0) 18/20 (90.0) 83/88 (94.3)

Table 90 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.

122

Table 91: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 8-1

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
55/59 (93.2) 28/29 (96.6) 83/88 (94.3)

Table 91 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. Table 91 shows that the immunization rates of children in District 8-1 vary with maternal Medicaid status.

123

Individual Health District Report: District 8-2

The eligible sample from this district included 66 children born in January 2003. From the 66 children, 62 records were located (Response Rate=93.9%). Of the 62 located records, there were no parental refusals leaving a final sample of 62 records.

The 4:3:1 immunization coverage estimate is 85.5 percent (53/62). This rate is higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 18: 4:3:1 Coverage for State and District 8-2

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 8-2

The 4:3:1:3 immunization coverage estimate rate is 85.5 percent (53/62). This rate is higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate rate is 83.9 percent (52/62). This rate is also higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

124

Table 92: District Immunization Rates for Health District 8-2 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 94.7%

85.7%

3 OPV/IPV

96.2%

90.9%

1 MMR

97.0%

92.2%

3 Hib

92.5%

92.2%

3 HepB

95.5%

92.2%

1 Varicella

96.2%

90.9%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 87.1% 91.9% 93.5% 93.5% 98.4% 93.5% 85.5% 27.4%

Table 92 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 27.4 to 98.4 percent for the 2005 study data.

Table 93 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.

125

Table 93: 2005 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

61

98.4%

61

98.4%

60

96.8%

2

3.2%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

61

98.4%

60

96.8%

28

45.2%

0

0.0%

MMR1 MMR2

2

3.2%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

62

100.0%

60

96.8%

26

41.9%

1

1.6%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

62

100.0%

61

98.4%

38

61.3%

1

1.6%

VAR1

3

VAR2

0

PCV1

61

PCV2

57

PCV3

46

PCV4

1

PCV5

0

*Percent = number immunized / sample size Sample size = 62

4.8% 0.0% 98.4% 91.9% 74.2% 1.6% 0.0%

126

Table 94: Cross tabulations of Maternal Race and Child Immunization Status for Health District 8-2 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 55/58 (94.8) 67/73 (91.8) 2/2 (100.0)
---
124/133 (93.2)

2002 4:3:1 Adequate #/Total (percent) 21/28 (75.0) 40/46 (87.0) 1/1 (100.0) 2/2 (100.0) 64/77 (83.1)

2003 4:3:1 Adequate #/Total (percent) 47/78 (60.3) 50/71 (70.4) 0/1 (0.0)
---
97/150 (64.7)

2004 4:3:1 Adequate #/Total (percent) 83/88 (94.3) 83/87 (95.4)
---
---
166/175 (94.9)

2005 4:3:1 Adequate #/Total (percent) 24/30 (80.0) 27/30 (90.0)
---
2/2 (100.0) 53/62 (85.5)

Table 94 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 94 shows that the immunization rates of children in District 8-2 vary with maternal race.

127

Table 95: 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)

2005 4:3:1 Adequate #/Total (percent)
4/4 (100.0)
8/10 (80.0) 19/23 (82.6) 14/15 (93.3) 8/10 (80.0) 53/62 (85.5)

Table 95 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.

128

Table 96: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 8-2

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
34/41 (82.9) 19/21 (90.5) 53/62 (85.5)

Table 96 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. In the 2005 study year, children born to non-Medicaid women had a higher immunization rate than children born to women using Medicaid.

129

Individual Health District Report: District 9-1

The eligible sample from this district included 64 children born in January 2003. From the 64 children, 54 records were located (Response Rate=84.4%). Of the 54 located records, there were no parental refusals leaving a final sample of 54 records.

The 4:3:1 immunization coverage estimate is 87.0 percent (47/54). This rate is higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 19: 4:3:1 Coverage for State and District 9-1

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 9-1

The 4:3:1:3 immunization coverage estimate is 87.0 percent (47/54). This rate is higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 87.0 percent (47/54). This rate is also higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

130

Table 97: District Immunization Rates for Health District 9-1 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 69.9%

81.6%

3 OPV/IPV

79.7%

90.1%

1 MMR

79.7%

89.5%

3 Hib

81.3%

90.8%

3 HepB

76.4%

90.1%

1 Varicella

71.5%

83.6%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 87.0% 94.4% 92.6% 94.4% 96.3% 94.4% 75.9% 33.3%

Table 97 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 33.3 to 96.3 percent for the 2005 study data.

Table 98 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.

131

Table 98: 2005 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

54

100.0%

49

90.7%

47

87.0%

1

1.9%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

54

100.0%

49

90.7%

31

57.4%

0

0.0%

MMR1 MMR2

3

5.6%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

54

100.0%

49

90.7%

22

40.7%

3

5.6%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

54

100.0%

54

100.0%

32

59.3%

3

5.6%

VAR1

2

VAR2

0

PCV1

46

PCV2

41

PCV3

34

PCV4

2

PCV5

0

*Percent = number immunized / sample size Sample size = 54

3.7% 0.0% 85.2% 75.9% 63.0% 3.7% 0.0%

132

Table 99: Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-1 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 36/55 (65.5) 47/66 (71.2) 2/2 (100.0)
---
85/123 (69.1)

2002 4:3:1 Adequate #/Total (percent) 51/65 (78.5) 70/83 (84.3) 0/1 (0.0) 2/3 (66.7) 123/152 (80.9)

2003 4:3:1 Adequate #/Total (percent) 53/74 (71.6) 55/73 (75.3) 2/3 (66.7)
---
110/150 (73.3)

2004 4:3:1 Adequate #/Total (percent) 23/24 (96.3) 51/52 (98.1) 5/5 (100.0)
---
79/81 (98.3)

2005 4:3:1 Adequate #/Total (percent) 18/22 (81.8) 26/29 (89.7) 3/3 (100.0)
---
47/54 (87.0)

Table 99 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 99 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.

133

Table 100: 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
Total

2001 4:3:1 Adequate #/Total (percent)
0/2 (0.0) 18/22 (81.8) 38/58 (65.5) 11/22 (50.0) 18/19 (94.7)
---
85/123 (69.1)

2002 4:3:1 Adequate #/Total (percent)
2/2 (100.0) 21/29 (72.4) 50/60 (83.3) 19/27 (70.4) 30/33 (90.9)
1/1 (100.0) 123/152 (80.9)

2003 4:3:1 Adequate #/Total (percent)
---
10/15 (66.7) 44/61 (72.1) 22/30 (73.3) 34/44 (77.3)
---
110/150 (73.3)

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)

2005 4:3:1 Adequate #/Total (percent)
---
7/7 (100.0) 18/21 (85.7) 13/16 (81.3)
9/10 (90.0)
---
47/54 (87.0)

Table 100 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.

134

Table 101: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 9-1

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
33/38 (86.8) 14/16 (87.5) 47/54 (87.0)

Table 101 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. For the 2005 study, children born to non-Medicaid women had a slightly higher immunization rate than children born to women using Medicaid.

135

Individual Health District Report: District 9-2

The eligible sample from this district included 168 children born in January 2003. From the 168 children, 164 records were located (Response Rate=97.6%). Of the 164 located records, there were no parental refusals leaving a final sample of 164 records.

The 4:3:1 immunization coverage estimate is 85.4 percent (140/164). This rate is higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 20: 4:3:1 Coverage for State and District 9-2

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 9-2

The 4:3:1:3 immunization coverage estimate is 84.1 percent (138/164). This rate is higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 77.4 percent (127/164). This rate is slightly higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

136

Table 102: District Immunization Rates for Health District 9-2 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 92.4%

86.5%

3 OPV/IPV

92.4%

92.1%

1 MMR

93.1%

94.4%

3 Hib

95.4%

93.3%

3 HepB

95.4%

92.1%

1 Varicella

88.5%

87.6%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 86.0% 93.3% 92.1% 91.5% 95.7% 93.3% 79.3% 28.7%

Table 102 reveals the coverage rates of each vaccine series. Coverage rates ranged from 28.7 to 95.7 percent for the 2005 study data.

Table 103 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.

137

Table 103: 2005 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

163

99.4%

156

95.1%

146

89.0%

0

0.0%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

163

99.4%

156

95.1%

72

43.9%

0

0.0%

MMR1 MMR2

5

3.0%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

163

99.4%

156

95.1%

46

28.0%

1

0.6%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

162

98.8%

157

95.7%

80

48.8%

6

3.7%

VAR1

7

VAR2

0

PCV1

156

PCV2

148

PCV3

117

PCV4

3

PCV5

0

*Percent = number immunized / sample size Sample size = 164

4.3% 0.0% 95.1% 90.2% 71.3% 1.8% 0.0%

138

Table 104: Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-2 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 82/92 (89.1) 36/38 (94.7) 1/1 (100.0)
---
119/131 (90.8)

2002 4:3:1 Adequate #/Total (percent) 50/59 (84.7) 24/28 (85.7)
---
2/2 (100.0) 76/89 (85.4)

2003 4:3:1 Adequate #/Total (percent 76/104 (73.1) 25/32 (78.1) 1/2 (50.0)
---
102/138 (73.9)

2004 4:3:1 Adequate #/Total (percent 81/97 (83.5) 29/37 (78.4) 1/1 (100.0)
---
111/135 (82.2)

2005 4:3:1 Adequate #/Total (percent 98/116 (84.5) 40/46 (87.0) 1/1 (100.0) 1/1 (100.0) 140/164 (85.4)

Table 104 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 104 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.

139

Table 105: 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
Total
.

2001 4:3:1 Adequate #/Total (percent)
12/12 (100.0) 28/33 (84.8) 48/55 (87.3) 21/21 (100.0) 10/10 (100.0)
---
119/131 (90.8)

2002 4:3:1 Adequate #/Total (percent)
7/9 (77.8) 17/19 (89.5) 33/37 (89.2) 13/18 (72.2)
5/5 (100.0)
1/1 (100.0) 76/89 (85.4)

2003 4:3:1 Adequate #/Total (percent)
1/1 (100.0) 10/17 (58.8) 39/59 (66.1) 26/31 (83.9) 26/30 (86.7)
---
102/138 (73.9)

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)

2005 4:3:1 Adequate #/Total (percent)
1/1 (100.0) 36/41 (87.8) 43/48 (89.6) 30/38 (78.9) 30/36 (83.3)
---
140/164 (85.4)

Table 105 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 varies with level of maternal educational attainment.

140

Table 106: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 9-2

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
101/116 (87.1) 39/48 (81.3)
140/164 (85.4)

Table 106 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. The immunization status of the children in District 9-2 varied with maternal Medicaid status.

141

Individual Health District Report: District 9-3

The eligible sample from this district included 140 children born in January 2003. From the 140 children, 115 records were located (Response Rate=82.1%). Of the 115 located records, there were 0 parental refusals leaving a final sample of 115 records.

The 4:3:1 immunization coverage estimate is 82.6 percent (95/115). This rate is slightly higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 21: 4:3:1 Coverage for State and District 9-3

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 9-3

The 4:3:1:3 immunization coverage estimate is 81.7 percent (94/115). This rate is higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 80.9 percent (93/115). This rate is also higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

142

Table 107: District Immunization Rates for Health District 9-3 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 71.6%

85.6%

3 OPV/IPV

76.8%

89.8%

1 MMR

80.0%

87.3%

3 Hib

81.1%

91.5%

3 HepB

81.1%

89.0%

1 Varicella

69.5%

83.9%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 82.6% 88.7% 87.0% 88.7% 90.4% 87.8% 73.9% 46.1%

Table 107 reveals the coverage rates of each vaccine series. Coverage rates ranged from 46.1 to 90.4 percent for the 2005 study data.

Table 108 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.

143

Table 108: 2005 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

107

93.0%

107

93.0%

99

86.1%

3

2.6%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

107

93.0%

106

92.2%

58

50.4%

0

0.0%

MMR1 MMR2

4

3.5%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

107

93.0%

106

92.2%

50

43.5%

4

3.5%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

107

93.0%

106

92.2%

62

53.9%

3

2.6%

VAR1

5

VAR2

0

PCV1

100

PCV2

94

PCV3

72

PCV4

4

PCV5

1

*Percent = number immunized / sample size Sample size = 115

4.3% 0.0% 87.0% 81.7% 62.6% 3.5% 0.9%

144

Table 109: Cross tabulations of Maternal Race and Child Immunization Status for Health District 9-3 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 47/67 (70.1) 21/28 (75.0)
---
---
68/95 (71.6)

2002 4:3:1 Adequate #/Total (percent) 61/70 (87.1) 39/46 (84.8) 1/1 (100.0) 0/1 (0.0) 101/118 (85.6)

2003 4:3:1 Adequate #/Total (percent) 51/62 (82.3) 21/29 (72.4) 3/3 (100.0)
---
75/94 (79.8)

2004 4:3:1 Adequate #/Total (percent) 41/49 (83.7) 26/31 (83.9) 2/3 (66.7)
---
69/83 (83.1)

2005 4:3:1 Adequate #/Total (percent) 56/67 (83.6) 38/47 (80.9)
---
1/1 (100.0) 95/115 (82.6)

Table 109 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 109 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.

145

Table 110: 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
Total

2001 4:3:1 Adequate #/Total (percent)
7/8 (87.5) 15/23 (65.2) 23/31 (74.2) 15/21 (71.4) 8/12 (66.7)
---
68/95 (71.6)

2002 4:3:1 Adequate #/Total (percent)
3/3 (100.0) 26/29 (89.7) 38/48 (79.2) 22/24 (91.7)
9/11 (81.8)
3/3 (100.0) 101/118 (85.6)

2003 4:3:1 Adequate #/Total (percent)
---
15/17 (88.2) 25/35 (71.4) 15/17 (88.2) 20/25 (80.0)
---
75/94 (79.8)

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)

2005 4:3:1 Adequate #/Total (percent)
1/1 (100.0) 10/12 (83.3) 33/42 (78.6) 30/38 (78.9) 21/22 (95.5)
---
95/115 (82.6)

Table 110 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 vary with educational attainment.

146

Table 111: Cross tabulations of Maternal Medicaid Status and
Child Immunization Status for Health District 9-3

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
41/51 (80.4) 54/64 (84.4) 95/115 (82.6)

Table 111 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 study years. The immunization status of the children in the sample in District 9-3 varies with maternal Medicaid status.

147

Individual Health District Report: District 10-0

The eligible sample from this district included 74 children born in January 2003. From the 74 children, 66 records were located (Response Rate=89.2%). Of the 66 located records, there were 4 parental refusals leaving a final sample of 62 records.

The 4:3:1 immunization coverage estimate is 93.5 percent (58/62). This rate is much higher than the statewide 4:3:1 immunization rate of 80.7 percent.

Figure 22: 4:3:1 Coverage for State and District 10-0

100 90 80 70 60 50 40 30 20 10 0 2001

2002

2003

2004

2005

State Dist 10-0

The 4:3:1:3 immunization coverage estimate is 93.5 percent (58/62). This rate is much higher than the statewide 4:3:1:3 immunization rate of 79.5 percent. The 4:3:1:3:3:1 immunization coverage estimate is 91.9 percent (57/62). This rate is also much higher than the statewide 4:3:1:3:3:1 immunization rate of 76.5 percent.

148

Table 112: District Immunization Rates for Health District 10-0 by Study Year*

Vaccine

2001

2002

Adequate Adequate

Rates

Rates

4 DTP/DTaP 85.1%

80.2%

3 OPV/IPV

88.3%

86.0%

1 MMR

89.6%

90.1%

3 Hib

94.2%

86.8%

3 HepB

91.6%

88.4%

1 Varicella

87.0%

86.8%

3 PCV

---

---

4 PCV

---

---

*PCV data not collected before 2004.

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%

2005 Adequate
Rates 93.5% 98.4% 98.4% 98.4% 98.4% 98.4% 91.9% 35.5%

Table 112 reveals the coverage rates of each vaccine series. Vaccine coverage rates ranged from 35.5 to 98.4 percent for the 2005 study data.

Table 113 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.

149

Table 113: 2005 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

62

100.0%

61

98.4%

59

95.2%

0

0.0%

0

0.0%

OPV/IPV1 OPV/IPV2 OPV/IPV3 OPV/IPV4

62

100.0%

61

98.4%

29

46.8%

0

0.0%

MMR1 MMR2

4

6.5%

0

0.0%

HIB1 HIB2 HIB3 HIB4 HIB5

62

100.0%

61

98.4%

16

25.8%

0

0.0%

0

0.0%

HEPB1 HEPB2 HEPB3 HEPB4

62

100.0%

61

98.4%

19

30.6%

1

1.6%

VAR1

5

VAR2

0

PCV1

58

PCV2

56

PCV3

49

PCV4

1

PCV5

0

*Percent = number immunized / sample size Sample size = 62

8.1% 0.0% 93.5% 90.3% 79.0% 1.6% 0.0%

150

Table 114: Cross tabulations of Maternal Race and Child Immunization Status for Health District 10-0 by Study Year

Maternal Race White
Black
Other
Unknown
Total

2001 4:3:1 Adequate #/Total (percent) 98/118 (83.1) 32/35 (91.4) 0/1 (0.0)
---
130/154 (84.4)

2002 4:3:1 Adequate #/Total (percent) 69/88 (78.4) 26/31 (83.9) 1/1 (100.0) 1/1 (100.0) 97/121 (80.2)

2003 4:3:1 Adequate #/Total (percent) 111/127 (87.4) 23/30 (76.7) 4/5 (80.0)
---
138/162 (85.2)

2004 4:3:1 Adequate #/Total (percent) 63/65 (96.9) 18/21 (85.7) 2/2 (100.0)
---
83/88 (94.3)

2005 4:3:1 Adequate #/Total (percent) 42/45 (93.3) 15/16 (93.8) 1/1 (100.0)
---
58/62 (93.5)

Table 114 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 114 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.

151

Table 115: 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
Total

2001 4:3:1 Adequate #/Total (percent)
14/18 (77.8) 28/32 (87.5) 48/59 (81.4) 23/26 (88.5) 17/19 (89.5)
---
130/154 (84.4)

2002 4:3:1 Adequate #/Total (percent)
5/7 (71.4) 25/29 (86.2) 35/47 (74.5) 12/14 (85.7) 20/23 (87.0)
0/1 (0.0) 97/121 (80.2)

2003 4:3:1 Adequate #/Total (percent)
---
26/32 (81.3) 45/59 (76.3) 28/31 (90.3) 39/40 (97.5)
---
138/162 (85.2)

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)

2005 4:3:1 Adequate #/Total (percent)
---
8/9 (88.9) 15/16 (93.8) 13/15 (86.7) 22/22 (100.0)
---
58/62 (93.5)

Table 115 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 seems to vary with maternal educational attainment.

152

Table 116: Cross tabulations of Maternal Medicaid Status and Child Immunization Status for Health District 10-0

Maternal Medicaid
Status Medicaid
NonMedicaid
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)

2005 4:3:1 Adequate #/Total (percent)
26/29 (89.7) 32/33 (97.0) 58/62 (93.5)

Table 116 shows immunization status of children born to women stratified by Medicaid status for the 2002, 2003, 2004 and 2005 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.

153

Section V: Discussion of Results
154

Section V: Discussion
Summary The purpose of the ninth 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 2005. To assess these rates, the study drew an original sample of 3,322 children born in January 2003. The final sample of returned immunization records totaled 3,322. After removal of ineligible children (those deceased, adopted, moved out of state, born in military hospitals) the eligible sample was 3,196. Of these, 2,634 were located and make up the final sample.
The ninth year of the GIS, 2005, measured immunization coverage for children born in 2003 at three levels:
4:3:1:3:3:1 coverage, defined as 4 DTaP, 3 OPV/IPV, 1 MMR, 3 Hib, 3 Hep B, and 1 Varicella 4:3:1:3 coverage, defined as 4 DTaP, 3 OPV/IPV, 1 MMR, and 3 Hib 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, 4:3:1:3:3:1 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 2001, 2002, 2003, 2004 and 2005. The newer 4:3:1:3:3:1
*It must be remembered that the 2005 study is estimating 2003 rates. The 2004 study is estimating 2002 rates, 2003 study estimated 2001 rates, 2002 study estimated 2000 rates, and the 2001 study estimated rates for 1999.
155

measure of coverage was added in 1997-98. Therefore, 4:3:1:3:3:1 rates can be compared using study data from the 1997-98 on.
The 2005 results reflect immunization rates for children born in 2003. The results of the study indicate that, of the 2,634 children whose immunization records were located during data collection:
76.5 percent of children born in January of 2003 in Georgia were adequately immunized with the 4:3:1:3:3:1 vaccine series.
80.7 percent of children born in January of 2003 in Georgia were adequately immunized with the 4:3:1 vaccine series.
4:3:1 immunization rates in the individual health districts ranged from: 53.3 percent to 97.8 percent in the 2005 study 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 ninth study year, 76.0 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.
Conclusions Immunization rates for the 4:3:1:3:3:1 vaccine series decreased from the
2004 study (81.3 to 76.5). The 2005 Georgia Immunization Study (GIS) measured Varicella rates for the eighth year. From one perspective, the rates represent a success for the Georgia Immunization Program and the health
156

districts. Measurement of rates for a new vaccine series has to begin at some time. The collection of data on 4:3:1:3:3:1 rates from the first point at which these rates became available (i.e. the 1997-98 Georgia Immunization Study) will allow public health staff to survey trends and monitor rates.
In reviewing the 4:3:1 vaccine series, rates decreased statewide from the 2004 study (85.1 percent) to 80.7 percent in 2005.
The results of the previous four years of the GIS study (2001, 2002, 2003 and 2004) show that immunization-specific coverage rates for the state remained relatively similar during the years when all shots were given, 1999-00, 19971998, 1996-97 and 1995-96, respectively.
Strengths 1. This study represents Georgia's ninth successful statewide, population-based
assessment of immunization coverage rates. Dr. Joan Herold, Demographer/Survey Specialist at Emory University, originally developed the sampling methodology for the study. 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. 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. Assessment of immunization status based on the most recent recommended 4:3:1:3:3:1 vaccine series. Comparison of rates for children born in 2001, 2002, 2003, 2004 and 2005 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 7 percent for the 2005 study.
157

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 2003 and, thus, represented a generalizable estimate of coverage rates for all two-year-olds born in 2003, it could not account for variations that may routinely occur in other months of the year. Second, limiting the sample to children born in one month does not form the basis of a surveillance system capable of detecting changes in the health care system. Third, there may be children in the eligible sample who were erroneously included in the eligible sample and listed as not located. Examples of this type of error would be cases where a child died, was adopted, or was part of a military family, but the child's ineligibility related to these circumstances never became known to the study participants because the child could not be found. Although public health representatives were trained to follow the same protocol, each worked independently with limited supervision and may have deviated from the stated protocol in order to obtain all of the information. 2. Each year of the study fewer records were found in the public health system and consequently more parents had to be located. Parents in the Metro Atlanta District more often refused to participate (District 3-2). Response rates tended to be lower in the Metro area (Districts 3-2 and 3-5).
158

APPENDIX A: DESCRIPTION OF SAMPLING PLAN
AND STATISTICAL NOTE
159

APPENDIX A: DESCRIPTION OF SAMPLING PLAN AND STATISTICAL NOTE
The target population for this study was children born in the state of Georgia in 2003 who were residing in the state in 2005. 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 2003 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 2003. 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 2005. 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 117: Data Used for Sample Size Estimates for the 2005 Study. Response rates and immunization coverage levels from the 2004 study were used in the sample size calculation for the 2005 study. The sample sizes were adjusted for small population size. The desired
160

sample size was then increased by a factor equivalent to the non-response rate (non-locatable immunization records) for each district from the 2004 study. The final calculated sample size is shown in the last column (Column H) of Table 117. 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 65.6 percent to a high of 99.3 percent, with the average response rate for the state at 84.5 percent. The state level data are based on a sample stratified by health district, with differing probabilities of selection. Therefore, the district data were weighted in order to provide more accurate, weighted estimates for the state level coverage rates.
161

Table 117: Data Used for Sample Size Estimates
for the 2005 Study

A Health District
1-1

B Jan 2003 Total Births
684

C Jan 2003 Eligible Births
669

D 2004 4:3:1 Immunization Rates
0.826

E

F

2005

2005

First Second

Sample Sample

Estimate Estimate

221

166

G
Return Rate
based on 2004
Eligible Sample
0.952

H 2005 Adjusted Sample Size
174

1-2 474 467

0.882

160

119

0.831

143

2-0 665 648

0.999

2

2

0.933

50

3-1 995 973

0.783

261

206

0.765

269

3-2 1,073 1,030

0.783

261

208

0.386

540

3-3 332 322

0.651

349

168

0.394

322

3-4 1,192 1,165

0.935

93

86

0.903

96

3-5 915 900

0.82

227

181

0.552

328

4-0 804 781

0.775

268

200

0.801

249

5-1 141 139

0.855

191

80

0.917

88

5-2 575 558

0.871

173

132

0.804

164

6-0 564 542

0.905

132

106

0.817

130

7-0 437 364

0.884

158

110

0.827

133

8-1 274 269

0.895

144

94

0.938

100

8-2 416 409

0.949

74

63

0.926

68

9-1 330 302

0.975

37

33

0.468

71

9-2 408 396

0.822

225

143

0.865

166

9-3 294 236

0.831

216

113

0.718

157

10-0 436 426

0.943

83

69

0.93

74

State 11,009 10,596

3,322

162

Figure 23: Explanations of Table 117 Data Used for Sample Size Estimates
For the 2005 Study

Column A: Health District Column B: January 2003 Total Births Column C: January 2003 Eligible Births Column D: 2004 4:3:1 Immunization Rates
Column E: First Sample Estimate 2005 Study
Column F: Second Sample Estimate 2005 Study
Column G: Estimated Return Rate (Based on 2004 Study)

District number.
Given. Source: DHR Vital Statistics Office.
Given. Source: Georgia Birth Cohort Follow-up Study (2004).
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 (2004).

Column H: Adjusted Sample Size 2005 Study

Formula Used: (Column F) / (Column G)

163

APPENDIX B: LIST OF 2005 PUBLIC HEALTH REPRESENTATIVES
FOR THE
GEORGIA IMMUNIZATION STUDY
164

APPENDIX B: LIST OF 2005 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. Marian Babb, R.N. Ann Vossen, R.N. Sandy Moore, LPN Janie Dalton, R.N. Joy Stymest Karen Dibling, R.N., B.S.N. Georgia Goseer, R.N. Jessica Harris Lisa Germany Freda Sheppard, L.P.N. Brenda Crowe Gloria Melvin Vivian Womack 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. Yugonda Thomas
D. Geneine Godfrey, M.P.H. Edward W. Sullivan Susan Malone, R.N. Betty Miller Jessie Jones Doris Wilbon, B.S. Stacy Giles, R.N. JoAnn Deas, R.N. Pat Thomas, R.N. Hollard Phillips, M.S. Jennifer Foster, M.S.
Deborah A. Dawson, R.N., B.S.N. Dionne Hansey
Barbie Bushey, R.N., C.P.N., M.P.H.

165

APPENDIX C: DATA COLLECTION FORM
166

167

168

APPENDIX D: VARICELLA VACCINE AND
CHICKEN POX DATA
169

APPENDIX D: Varicella Vaccine and Chicken Pox Data Table 118 elaborates on the information found on the Varicella vaccine as
well as information with regard to chicken pox. The results of this study have considered a child immunized for Varicella if the vaccine was administered anytime before or during the data collection period.
The table below demonstrates the utilization of the Varicella vaccine results in two ways. The first column describes the Varicella results had the twoyear cut off been applicable. The second column depicts the Varicella results without the two-year restriction. The Varicella vaccination rates that report vaccination within the first two years of a child's life are lower than the Varicella vaccination rates that report vaccination at any point in time during the data collection period. These rates have not been adjusted for children who had natural Varicella immunity due to the chicken pox.
The final column describes the frequency of cases of chicken pox by district. A child's chicken pox status was provided by health department records, parents, or physicians. The percent column is equal to the number of children who had chicken pox divided by the district's final sample size.
170

Table 118: 2005 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

136

82.9

125

93.3

44

95.7

151

77.4

247

77.9

161

66.0

84

91.3

194

84.0

196

87.5

64

85.3

128

92.1

105

91.3

101

89.4

81

92.0

56

90.3

50

92.6

148

90.2

100

87.0

60

96.8

Statewide 2,231

84.7

Number

Percent

143

87.2

131

97.8

45

97.8

161

82.6

249

78.5

164

67.2

85

92.4

198

85.7

201

89.7

73

97.3

129

92.8

108

93.9

106

93.8

85

96.6

58

93.5

51

94.4

153

93.3

101

87.8

61

98.4

2,302

87.4

Number

Percent

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

1

0.4

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

1

0.04

171

Figure 24: 2005 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.

172

Appendix E: Provider of Immunizations
173

Appendix E: Provider of Immunizations
Information about the provider of the immunizations was collected by noting where the shots were given (Public Health, Private Health, or Both) and who provided the information (Health Department, Private Provider, or Parent). If there was no indication of who gave the individual shot, the location for that shot was classified as unknown. The total number and percentage of shots given at each of the provider categories is shown in Table 119.

Table 119: Statewide Percentage of Shots by Provider: 2001, 2002, 2003, 2004 and
2005

Provider

2001 Total %
#

Public 9,472 25.5 Health Dept Private 25,797 69.5 Physician

Unknown 1,866 5.0

2002 Total %
# 8,085 20.3
28,667 71.9
3,112 7.8

2003 Total % # 5,873 16.3
26,956 74.8
3,205 8.9

2004

Total

%

#

5,449 14.3

26,734 70.1 5,966 15.6

2005 Total %
# 6,013 13.2
35,065 77.1
4,407 9.7

Total 37,135 100.0 39,864 100.0 36,034 100.0 38,149 100.0 45,485 100.0

As shown in Table 119, in 2005, over 77% of the shots recorded for the sampled children were given by a private provider.

174

Location of Immunizations by District
Table 120 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 120: District Specific Percentage of Shots by Provider 2005

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 281 102 55 437 430 324 73 820 589 181 375 177 232 220 295 139 878 171 234

Percent 9.8 4.1 6.5
13.1 8.3 8.7 4.4
21.4 15.0 13.8 15.4
8.2 11.7 13.7 26.4 14.6 30.2
8.7 20.7

# Shots Given 2,360 2,316 705 753 4,527 2,841 1,577 2,874 3,147 1,041 1,706 1,912 1,724 1,391 824 814 1,914 1,759 880

6,013

13.2 35,065

Percent 82.3 92.7 82.8 22.5 87.3 75.9 94.2 75.1 80.2 79.1 70.2 89.0 86.7 86.3 73.6 85.4 65.9 89.3 78.0

# Shots Given 226 81 91 2,153 231 577 24 135 187 93 349 61 32 0 0 0 113 39 15

Percent 7.9 3.2
10.7 64.4
4.4 15.4
1.4 3.5 4.8 7.1 14.4 2.8 1.6 0.0 0.0 0.0 3.9 2.0 1.3

77.1 4,407

9.7

2,867 2,499
851 3,343 5,188 3,742 1,674 3,829 3,923 1,315 2,430 2,150 1,988 1,611 1,119
953 2,905 1,969 1,129
45,485

175

In Year Nine: Seventeen health districts gave more than 50% of the shots in the Private sector.
Results by region: North (Districts 1-1, 1-2, 2-0, and 10-0) In all of these districts private physicians gave the majority of the immunizations. Metro Atlanta (Districts 3-1, 3-2, 3-3, 3-4, and 3-5) In the metro-Atlanta area more of the immunizations were administered in the private sector than in the public sector. District 3-1, Cobb County, had a high number of unknown shot locations (64.4 percent).
Central (Districts 4-0, 5-1, 5-2, 6-0, 7-0) Children in all of the central districts received the majority of their shots at a private provider.
South (Districts 8-1, 8-2, 9-1, 9-2, 9-3) Private providers provided the majority of vaccinations in all health districts.
176

Four Year Comparison of Provider Information
The following table shows a comparison of results from the current year and the three previous years of the study. The comparisons reflect a movement of immunization services into the private sector in Georgia.
Table 121: Location of Immunizations by District
Four Year Comparison 2002, 2003, 2004, and 2005

District

Public Health Department

2002 2003 2004 2005

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 Totals

20.3 13.7 24.3 19.1 24.0 26.6
7.4 11.7 19.9 29.9 26.7 24.1 22.8 20.5 22.8 17.5 36.4 16.9 19.9
20.3

16.4 16.2 25.2 18.4 32.1
5.4 2.1 11.6 19.7 23.1 22.2 6.4 21.7 22.4 11.7 9.2 32.6 6.2 14.7
16.3

8.0

9.8

14.4

4.1

15.2

6.5

16.0 13.1

24.8

8.3

12.8

8.7

0.6

4.4

8.9 21.4

10.6 15.0

13.2 13.8

20.1 15.4

14.8

8.2

25.9 11.7

22.1 13.7

11.9 26.4

11.3 14.6

38.3 30.2

7.2

8.7

9.4 20.7

14.3 13.2

Private Physician 2002 2003 2004 2005

73.2 66.9 75.0 54.4 56.5 59.1 87.9 86.4 76.5 69.0 66.2 74.6 77.1 78.7 73.9 78.2 59.7 82.2 80.1
71.9

66.9 73.9 82.3 81.0 76.2 92.7 73.0 85.4 82.8 42.2 42.6 22.5 48.2 69.4 87.3 90.7 69.4 75.9 97.9 95.5 94.2 73.5 45.7 75.1 64.0 50.9 80.2 74.1 76.1 79.1 73.9 61.8 70.2 89.7 85.0 89.0 76.8 71.5 86.7 77.6 77.6 86.3 62.2 86.0 73.6 86.0 87.4 85.4 66.4 60.6 65.9 93.8 88.8 89.3 79.6 88.6 78.0
74.8 70.1 77.1

177

Four-Year Comparison: Summary of Table 121

In 2002 In 2003 In 2004 In 2005

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
13.2% of the shots were received at the public health department 77.1% of the shots were given in the private sector
9.7% of the shot locations were unknown

178

APPENDIX F: MARGINS OF ERROR FOR IMMUNIZATION COVERAGE RATES
179

APPENDIX F: MARGINS OF ERROR FOR IMMUNIZATION COVERAGE RATES
Margins of error were calculated for all statewide and district immunization coverage rates, including 4:3:1:3:3:1 rates, 4:3:1 rates, and 3:3:1 rates. These margins of error can be found in Tables 122-124. 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 2003 is between 79.2 and 82.2 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 4:3:1:3:3:1 immunization coverage rates Statewide 4:3:1 immunization coverage rates Statewide 3:3:1 immunization coverage rates District 4:3:1:3:3:1 immunization coverage rates District 4:3:1 immunization coverage rates District 3:3:1 immunization coverage rates
These margins of error and confidence intervals are noted in this appendix.
180

Table 122: Margins of Error for 2005 Statewide and District 4:3:1:3:3:1 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)

164 134 46 195 317 244 92 231 224 75 139 115 113 88 62 54 164 115 62
2,634

4:3:1+3 Immunization Coverage Rates
(percent)
76.2 91.8 91.3 68.2 70.7 47.1 88 68 79.5 84 84.9 88.7 85.8 92 83.9 87 77.4 80.9 91.9

Margins of Error
(percent)
+/- 6.5 +/- 4.6 +/- 8.1 +/- 6.5 +/- 5.0 +/- 6.3 +/- 6.6 +/- 6.0 +/- 5.3 +/- 8.3 +/- 6.0 +/- 5.8 +/- 6.4 +/- 5.7 +/- 9.1 +/- 9.0 +/- 6.4 +/- 7.2 +/- 6.8

95% Confidence
Intervals (percent) 69.7 82.7 87.2 96.4 83.2 99.4 61.7 74.7 65.7 75.7 40.8 53.4 81.4 94.6 62 74 74.2 84.8 75.7 92.3 78.9 90.9 82.9 94.5 79.4 92.2 86.3 97.7 74.8 93 78 96 71 83.8 73.7 88.1 85.1 98.7

76.5

+/- 1.6 74.9 78.1

181

Table 123: Margins of Error for 2005 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) 164 134 46 195 317 244 92 231 224 75 139 115 113 88 62 54 164 115 62

4:3:1 Immunization Coverage Rates
(percent) 79.5 97 97.8 75.9 72.6 53.3 90.2 72.3 81.6 94.7 87.8 93.9 90.3 94.3 85.5 87 85.4 82.6 93.5

Margins of Error
(percent) +/- 5.7 +/- 2.9 +/- 4.2 +/- 6.0 +/- 4.9 +/- 6.3 +/- 6.1 +/- 5.8 +/- 5.1 +/- 5.1 +/- 5.4 +/- 4.4 +/- 5.5 +/- 4.8 +/- 8.8 +/- 9.0 +/- 5.4 +/- 6.9 +/- 6.1

95% Confidence Intervals (percent) 73.8 85.2 94.1 99.9 93.6 102 69.9 81.9 67.7 77.5 47 59.6 84.1 96.3 66.5 78.1 76.5 86.7 89.6 99.8 82.4 93.2 89.5 98.3 84.8 95.8 89.5 99.1 76.7 94.3 78 96 80 90.8 75.7 89.5 87.4 99.6

Statewide Rate
(weighted)

2,634

80.7

+/- 1.5

79.2 82.2

182

Table 124: Margins of Error for 2005 Statewide and District 3:3:1 Rates

Sizes of Final

Health

Sample

District (Records

Located)

1-1

164

1-2

134

2-0

46

3-1

195

3-2

317

3-3

244

3-4

92

3-5

231

4-0

224

5-1

75

5-2

139

6-0

115

7-0

113

8-1

88

8-2

62

9-1

54

9-2

164

9-3

115

10-0

62

Statewide

Rate

2,634

(weighted)

3:3:1 Immunization Coverage Rates
(percent) 84.8 97.8 97.8 79 76.7 59.8 90.2 78.8 84.8 94.7 90.6 94.8 92 96.6 88.7 92.6 90.2 84.3 98.5
84.2

Margins of Error
(percent) +/- 5.5 +/- 2.5 +/- 4.2 +/- 5.7 +/- 4.7 +/- 6.2 +/- 6.1 +/- 5.3 +/- 4.7 +/- 5.1 +/- 4.9 +/- 4.1 +/- 5.0 +/- 3.8 +/- 7.9 +/- 7.0 +/- 4.6 +/- 6.6 +/- 3.0

95% Confidence Intervals (percent) 79.3 90.3
95.3 100.3 93.6 102 73.3 84.7 72 81.4 53.6 66 84.1 96.3 73.5 84.1 80.1 89.5 89.6 99.8 85.7 95.5 90.7 98.9
87 97 92.8 100.4 80.8 96.6 85.6 99.6 85.6 94.8 77.7 90.9 95.5 101.5

+/- 1.4

82.8 85.6

183