Georgia immunization study: 2011 final report [2011]

GEORGIA IMMUNIZATION STUDY
2011 Final Report
Georgia Department of Public Health Immunization Program | Acute Disease Epidemiology Section
Eighteen Public Health Districts
Prepared by Rebecca M. Willis, MHS, Immunization Study Epidemiologist Editors Jessica Tuttle, MD, Primary Editor Cherie Drenzek, MS, DVM, Editor Steven Mitchell, MPH, Editor

Authors and Contributors

Authors

Editors

Rebecca Mahan Willis, MHS -- Author

Jessica Tuttle, MD -- Medical Epidemiologist

Cherie Drenzek, MS, DVM -- State Epidemiologist

Steven Mitchell, MPH -- Director of Immunization Program

District Immunization Program Coordinators

Janet Eberhart, RN, BSN (1-1)

Marie Smith, RN (1-2)

Janie Dalton (2-0)

Karen Thomas, RN (3-1)

Georgia Goseer, RN (3-2)

Freda Sheppard, LPN (3-3)

Gloria Melvin (3-4)

Mia Young, MBA, BSHA (3-5)

Amy Fenn, RN (4-0)

Kelly Knight, RN (5-1)

Sherry L. Cook, RN (5-2)

Susan Edmunds, RN (6-0)

Dianne Robinson, RN, MSN (7-0) Debra Adams, RN, APRN (8-1)

Sue Dale (8-2)

Beth Hausauer, RN, MSN (9-1)

Kay Davis, RN (9-2)

Paula L. Young, RN, MSN (10)

Additional District-Level Data Collection Staff

Thelma House (1-1)

Angie Callaway, RN (1-2) Nancy Stackhouse, LPN (1-2)

Janet Ballew (1-2)

Gail Cloer, LPN (1-2)

Jamie Henley, LPN (1-2)

Patricia Mason, LPN (1-2)

Irene Rosales (1-2)

Sandy T. Moore (2-0)

Silvia Frausto (3-1)

Jessica Harris, BS (3-2)

Patrice Little, RN (3-2)

Isidra Castro (3-2)

Trina Daniels (3-2)

Rexanna Gammage (3-2)

Mary Grover (3-2)

Frank Johnson (3-2)

Teresa McCray (3-2)

Cassandra Mitchell (3-2)

Diann Morris (3-2)

Dorothy Northcut (3-2)

Gail Robinson (3-2)

Marquesa Swarn (3-2)

Reba Vickers (3-2)

Tamara Woods (3-2)

Brenda Crowe (3-4)

Cassandra Jackson, LPN (3-5)

Darlene Sheets (4-0)

Brenda Clarke, RN (5-1)

Kitty Coleman (5-1)

Terri Griffin (5-1)

Daphenia Harmon (5-1)

Debbie Martin, RNC (5-1)

Mary Powell, RN (5-1)

Suzanne Usher, RN (5-1)

Joni R. Wilson, RN (5-1)

Bertha Ashley, RN (5-2)

Patty Cole, RN (5-2)

Patricia Cordett, RN (5-2)

Linda Harrell (5-2)

Rhonda Howell, RN (5-2)

Peggy Pettit, RN (5-2)

Patsy Pollett, RN (5-2)

Deryl Scarboro, RN (5-2)

Chris Sikes, RN (5-2)

Amy Sims (5-2)

April Tolbert, RN (5-2)

Shirley Tucker, RN (5-2)

Janet Willis, RN (5-2)

Clois Witt, RN (6-0)

Rachel Franklin, MPH (8-1)

Kelly Tillery (8-2)

Leslie L. Blewett (9-1)

Elizabeth Brandau (9-1)

Joanne Burnsed (9-1)

Kim Carter (9-1)

Michele Eitel (9-1)

Mary Fleming (9-1)

Cindy Grovenstein, RN (9-1)

Cathy Schmid, RN (9-1)

Mona Smith (9-1)

Mary Weaver, LPN (9-1)

Cherise Wilson (9-1)

Kia Young (9-1)

Dionne Hansey (10)

Acknowledgements
The Georgia Department of Public Health, Epidemiology and Immunization Programs, 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 (see inside cover).
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.
Additional gratitude goes to Mike Chaney from the Georgia Chapter of the American Academy of Pediatrics for his support and advice on making the study more pertinent to pediatricians throughout Georgia.
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Executive Summary
The 2011 Georgia Immunization Study (GIS) was conducted by the Georgia Department of Public Health Epidemiology Program, Georgia Immunization Program and Public Health Districts. However, this study could not have been conducted without the assistance of the private providers, public health providers and the Vaccines for Children providers of Georgia that contributed to this collaborative effort. Their cooperation and assistance throughout the study is greatly appreciated.
The GIS employs a retrospective cohort research design to ascertain the up-to-date immunization rate for two year old children born in the state of Georgia. Immunization history data for 18 Health District cohorts of children who turned two years old in January 2011 were analyzed to calculate these rates. Identifying information was obtained from electronic birth records and immunization history data were collected primarily via the Georgia Registry of Immunization Transactions and Services (GRITS). Immunization rates for the 4:3:1:3:3:1:4 series (4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B, 1 Varicella, and 4 PCV) were based on the childhood immunization and catch-up schedules recommended by the Advisory Committee on Immunization Practices (ACIP) in 2011.1
Each child's immunization record was reviewed in GRITS for completeness. If the child's record was not upto-date, an effort was made by local public health staff to contact parents and providers to obtain any missing immunization history data. If further follow-up revealed that the child was truly not up-to-date, the data collection process served as a reminder-recall system. If all of the 4:3:1:3:3:1:4 immunization series dates occurred before the child reached 24 months, then the child was classified as up-to-date (UTD) by 24 months. Children were excluded from up-to-date by 24 months classification if some of the 4:3:1:3:3:1:4 immunization dates occurred after the child reached 24 months of age. Due to the reminder-recall effect of the data collection process, readers are strongly encouraged to use the "up-to-date immunization rate by 24 months" measures for reporting purposes, since these were the rates prior to any parent or provider contact. In 2011, the Georgia statewide up-to-date immunization rate by 24 months was 82.4%, up from 76.3% in 2010.
Efforts to bring children up-to-date were evident in an overall 13.9 percent increase between 24 months of age and the end of the six-month data collection period. This increase is evidence that the children who are not up-to-date by 24 months can be brought up-to-date within 6 months if adequate patient recall and educational measures are taken. Although most immunizations are administered in the private sector in Georgia (93.3%), the increase in up-to-date immunization rates by the end of the data collection is a testament to how instrumental district- and county-level public health staff can be in raising childhood immunization rates for a selected group of children. In addition, this increase shows that parents want their children to stay current on their vaccinations, but may benefit from reminders and follow-up from their providers.
Although acute infection with Hepatitis B virus causes severe disease in only a small proportion of those infected, the greater burden of disease lies in those cases progressing to chronic infection, cirrhosis, and liver cancer later in life. Therefore, timely immunization practices with hepatitis B vaccine are a high priority for the Georgia Immunization Program, as well as for providers and hospitals throughout the state. Among the 2011 study sample of children who were born in Georgia in 2009, 83.4% received their first dose of hepatitis B vaccine at birth, up from 76.2% in 2010 (children born in 2008) and 66.2% in 2008 (children born in 2006). In addition, the percentage of children who received the entire 3-dose hepatitis B series by 24 months of age rose from 94.8% in 2010 to 96.5% in 2011. These data suggest that the best way to protect children from hepatitis B infection by 24 months of age is to vaccinate at birth. Credit goes to birthing hospitals, obstetricians, pediatricians and public health staff who have been dedicated to this cause.
1 Department of Health and Human Services Centers for Disease Control and Prevention. (January 8, 2010). MMWR weekly: Recommended Immunization Schedules for Persons Aged 0 Through 18 Years --- United States, 2011. MMWR 2011;60(5). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6005a6.htm
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There was considerable variation by Health District in the percent of 24 month old children found to be fully immunized by 24 months, ranging from 76.8% in the Coastal District (9-1) to 90.9% in the Valdosta District (8-1). Between 2010 and 2011, overall District up-to-date by 24 months immunization rates rose by 8.4% for the state, with the greatest increase of 26.5% seen in the Valdosta District (8-1).
Although the percentage of children who received the fourth dose of DTaP by 24 months of age increased in 2011, it continues to significantly lag behind the percentage of children who received the third dose by 24 months of age. In fact, 97.5% of children had received 3 doses of DTaP by 24 months of age while only 85.8% had received their fourth dose. The third dose can be given as early as 6 months of age; however the fourth dose must be delayed until at least 12 months and 6 months after the third dose. These results suggest that patient recall efforts specific for the fourth dose of DTaP may be helpful for children after their one year check-up. Across most Districts, rates of MMR were second-lowest after DTaP.
Some variation remained by District in the percent of two-year-olds reported to be fully immunized by the end of the data collection period, ranging from 89.5% in the LaGrange District (4-0) to 99% in the Macon District (5-2). These data support that contact with parents and providers during data collection made a difference. The greatest impact was seen in the Augusta District (6-0) where up-to-date immunization rates rose 25.4% by the end of the data collection period.
Individual Health District results revealed some common demographic themes when identifying "high risk" groups, i.e. those less often up-to-date by 24 months. High risk groups in eight districts included children of unmarried mothers, children of mothers with previous children, and children not enrolled in the Women, Infants and Children program (WIC). The groups that were high risk in seven districts were children receiving immunizations from 2 providers instead of only one and children whose birth was covered by government-assisted insurance. Demographic groups that were high risk in six districts were children of mothers less than 25 years of age, children of black mothers, and children of mothers without college education. Future study years will reveal which of these associations is consistent from year to year. Please see Section III (p 23) for individual health district results.
A notable finding in the 2011 GIS is the variable impact of the Women, Infants and Children (WIC) program enrollment on up-to-date immunization rates by district. For example, in the Columbus (7-0) and Clayton (3-3) Districts, children enrolled in WIC were significantly more likely to be up-to-date on their immunizations by 24 months (p 24). However, this trend was reversed in the DeKalb District (3-5). In other Districts, the difference was either non-existent or not significant. Districts and healthcare providers are encouraged to review these WIC enrollment data (Table 8, p 21) to determine the possible reasons for these trends, and share them with the Immunization Program as efforts continue to improve immunization rates in Georgia.
Perhaps one of the most important parts of the 2011 report is the list of the top 3 Districts for various categories, including data collection response rates, series immunization rates and antigen-specific immunization rates (Table 7, p 23). These rankings highlight our Immunization Champions; Districts challenged by a specific measure are encouraged to reach out to these champions to identify strategies for success.
The release of the 2011 GIS report presents an exciting opportunity to study demographic and immunization history data concurrently, so that evidence-based action plans can be created to raise immunization rates throughout the state of Georgia. The 2011 data clearly show that although the vast majority of immunizations are administered outside of public health clinics, public health staff can effectively collaborate with private sector providers and have an impact on improving coverage rates in Georgia.
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Abbreviations & Vaccine Names

Abbreviations
2YO ACIP CDC GIS GRITS NIS UTD WIC
Vaccine Names DTaP IPV MMR HepB Hib Varicella PCV Rotavirus Influenza HepA H1N1

Definitions
Two year old Advisory Committee on Immunization Practices Centers for Disease Control and Prevention Georgia Immunization Study Georgia Registry of Immunization Transactions and Services National Immunization Survey (CDC) Up-to-date [immunization history] Women, Infants, and Children Program
Diphtheria, Tetanus, and acellular Pertussis [vaccine] Inactivated Polio Virus [vaccine] Measles, Mumps, Rubella [vaccine] Hepatitis B [vaccine] Haemophilus influenza type b [vaccine] Varicella (chicken pox) [vaccine] Pneumococcal Conjugate Vaccine Rotavirus [vaccine] Seasonal Influenza [vaccine] Hepatitis A [vaccine] Novel H1N1 Influenza [vaccine]

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6

Table of Contents
Contents
Acknowledgements Executive Summary Abbreviations Table of Contents
Section I: Project Overview
Methods (Sampling, Data Collection, Data Analysis) Limitations
Section II: Statewide Results
State of Georgia Immunization Report Contributing Staff from Georgia Department of Public Health State Sampling Scheme, Immunization Summary, Immunization Rates (2000-2010) State Sample Population Demographics, Private vs. Public Sector Chart Up-to-date (UTD) Immunization Rates by demographic group Antigen-Specific UTD Immunization Rates (2005-2010)
Immunization Champions by Health District Findings Related to WIC Enrollment District Immunization Rates
Section III: Health District Immunization Reports
District 1-1 Immunization Report (Rome District) District 1-2 Immunization Report (Dalton District) District 2-0 Immunization Report (Gainesville District) District 3-1 Immunization Report (Cobb-Douglas District) District 3-2 Immunization Report (Fulton District) District 3-3 Immunization Report (Clayton District) District 3-4 Immunization Report (Gwinnett, Newton, Rockdale District) District 3-5 Immunization Report (DeKalb District) District 4-0 Immunization Report (LaGrange District) District 5-1 Immunization Report (Dublin District) District 5-2 Immunization Report (Macon District) District 6-0 Immunization Report (Augusta District) District 7-0 Immunization Report (Columbus District) District 8-1 Immunization Report (Valdosta District) District 8-2 Immunization Report (Albany District) District 9-1 Immunization Report (Savannah District) District 9-2 Immunization Report (Waycross District) District 10-0 Immunization Report (Athens District)
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Page(s)
1 3--4
5 7--8
9--14
11--13 14
15--24
17-24 17 18 19 20 21 22 23 24
25--134
27--32 33--38 39--44 45--50 51--56 57--62 63--68 69--74 75--80 81--86 87--92 93--98
99--104 105--110 111--116 117--122 123--128 129--134

Table of Contents
Contents
Appendices
Appendix A: Data Collection Form Appendix B: Margins of Error for UTD Immunization Rates Appendix C: Sources and Characteristics of Demographic Variables Appendix D: Multivariate Logistic Regression Model for Statewide Data Appendix E: Reasons for Incomplete Immunization History

Page(s)
i-xii
iii-v vii--viii
ix--x xi xii

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Section I Project Overview
Georgia Immunization Study, 2011
9

10

Methods

Study Design The annual Georgia Immunization Study (GIS) employs a retrospective cohort research design to ascertain the up-to-date (UTD) immunization rates for children born in the state of Georgia. Immunization history data for cohorts of children who turned two years old in January 2011 from 18 Health Districts were analyzed to calculate these rates. Identifying information was obtained from electronic birth records, and immunization history data were collected primarily via the Georgia Registry of Immunization Transactions and Services (GRITS). Immunization rates for the 4:3:1:3:3:1:4 series (4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hepatitis B, 1 Varicella, and 4 PCV vaccine doses) were based on the childhood immunization and catch-up schedules recommended by the Advisory Committee on Immunization Practices (ACIP) in 2011.
After data were collected over a six-month time period, each immunization date was compared to the child's birth date to determine whether it was administered before or after 24 months of age. If all of the 4:3:1:3:3:1:4 immunization series administration dates occurred before the child reached 24 months, then the child was classified as UTD by 24 months. Children were excluded from UTD by 24 months classification if some of the 4:3:1:3:3:1:4 administration dates occurred after the child reached 24 months of age. A distinction was made between "UTD by 24 months" and "UTD by end of data collection" because the data collection process, which involved contact with each child's parent and healthcare provider, indirectly served as a reminder-recall system. Many of the parents of study participants were simply unaware that their child was not current on their immunizations; therefore, the difference between the percentage of children UTD by 24 months and children UTD by end of data collection may be a proxy measure of the impact of parent and

provider contact in raising immunization rates. Children who were classified as UTD by 24 months were also included in the UTD by end of data collection group. UTD immunization rates (both UTD by 24 months and UTD by end of data collection) were calculated for the state sample and the Health District samples, as well as for demographic groups within these samples.
Sample Selection The target population of the 2011 GIS included all 24 month old children born in the state of Georgia in 2009. A sample size of 2,150 children born in the month of January 2009 was selected for the study. The sample design allowed for independent estimates for each of the 18 Health Districts in the state. The final sample estimate for the state is based on weighted data to account for differential probabilities of selection for each health district. With the assistance of Dr. John Carter, Epidemiologist and Assistant Professor at the Rollins School of Public Health, a systematic random sample was drawn (for each Health District) from the total births in the state for January 2009. The number of children randomly selected from each District depended on population distribution statistics, response rates from the 2010 study, and Health District immunization rates from the 2010 GIS. Information for each child, including all birth certificate variables of interest.
Data collected for each child included:
Child's first, middle, and last name Child's sex Child's date of birth Child's gestational age Mother's residential and mailing address(es) Mother's residential county Mother's first, middle, and last name

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Methods Section, p2

Father's first, middle, and last name (if available) Mother's race and ethnicity Mother's level of education Mother's marital status Mother's age Payment type used to cover child's birth
Other demographic variables, such as Provider Type and Number of Providers, were also obtained during the data collection period. The WIC enrollment variable was collected for each child by matching the names and dates of birth for all of the sample children with WIC enrollment data. If a child was found to be enrolled in WIC for any amount of time during their first 24 months of life, they were designated as "enrolled in WIC".
The provider-related variables were compiled using GRITS data. The number of providers per child was counted, then each child was classified as having either 1, 2, or 3+ providers.
The "Provider Type" variable was determined based on the location where every individual immunization was received (see Part III: Immunization History, below). If a child received shots exclusively in private provider offices, the child was classified as "Private Sector Only". If a child received immunizations exclusively in public health clinics, the child was classified as "Public Sector Only". If a child received immunizations in both private provider offices and public health clinics, the child was classified as "Both".
Data Collection Form Development Using the standardized and revised data collection form developed by the staff at the Emory University Rollins School of Public Health, a web-based data collection system named "TWOY" was created and housed in the web-based State Electronic Notifiable

Disease Surveillance System (SendSS). (See Appendix A for a copy of the original data collection form.) The TWOY system allowed collection of UTD immunization information according to the recommended schedule of childhood immunizations jointly approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).
The data collection system contained four distinct sections to be completed by the public health data collectors: Child, Notes, Guardians, Providers and VX List (Immunization History).
Preparation for Data Collection Data collection was carried out primarily by county and Health District Public Health nurses, using the TWOY system. Public health data collectors in each health district carried out the data collection procedures following a series of nine training conference calls in March and April of 2011. The data collectors also received a Training Manual that was updated as needed and made available on the TWOY log-in screen.
Data Collection Protocol Step #1: Search for immunization records at State and local health departments. Before the data collection process began on the Health District level, the Immunization Study Epidemiologist at the State office queried GRITS records and loaded the immunization history of each child into the TWOY system. If a child was up-to-date (UTD) at this point, the child was listed as "Complete, Based on Initial GRITS Record", and no longer required follow-up. If a child was not UTD at this point, the data collection process was passed to the Health District staff, with the dates found in GRITS already entered into the system.

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Methods Section, p3

Next, data collectors reviewed GRITS records or health department records for additional immunization history. If the child's immunization record was still incomplete, the data collectors proceeded to steps 2 and 3.
Step #2: Search for immunization records through the parents. In this step, data collectors used the contact information from the birth certificate or any updated contact information found at the health department to contact the parent. Data collectors 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/or letter and asked to provide an immunization history or the location of immunization information (i.e., the name of the doctor or clinic office). Data collectors also sent consent forms to parents. In some cases, representatives made home visits to collect data.
Step #3: Search for immunization records through private physicians. In this step, data collectors contacted private physicians by phone or fax and requested the child's immunization history. Most physicians preferred to respond by updating the child's immunization history in GRITS. In some cases, providers preferred to communicate by phone, fax or office visit.
Step #4: Data returned to State office and checked for accuracy. Using the TWOY system, data collectors completed follow-up on all children by the end of the data collection period, and all completed records were reviewed by the Immunization Study Epidemiologist throughout the process. Attempts were made to resolve any unclear information before the data were exported to StataSE 10 for data cleaning. Once

cleaned, the data were analyzed using programs developed by the Immunization Study Epidemiologist in 2011.
Data Analysis The 2011 data analysis methods were the same as those employed in 2010, which varied greatly from that which was used in the previous years.
Demographic variables were used to determine which demographic groups are more or less often UTD by 24 months. UTD immunization rates for demographic groups were assessed on both the state and health District levels and odds ratios (including p-values and confidence intervals) were calculated and included in Appendix D.
Up-to-date (UTD) immunization rates were calculated using each individual vaccine date for each child. An immunization was classified as given prior to the 24 months birthday if the difference between the dose date and the child's DOB was equal to or less than 24 months; this was the case even for dates that were not originally found in the child's GRITS record. For a child to be considered UTD by 24 months, all of the doses in the 4:3:1:3:3:1:4 series had to be given within 24 months of the child's birthdate.
To account for possible scheduling delays at the physician offices, a 2-week grace period was applied to the 24-month calculations.

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Methods Section, p4

Limitations The following describe important limitations of the study that should be considered when interpreting study results:
1. There were three limitations related to sampling:
Although the study included a random sample of children born in Georgia during January 2009 and, thus, represented a fair estimate of immunization rates for all two-year-olds born in 2009, 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 unable-to-locate. 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 public health data collectors because the child could not be found.

3. Maternal race/ethnicity was used as a demographic variable in the analysis, but the race variable was missing for 10.8% of the sample. Therefore, the Hispanic category had to be split into two separate race categories (White, Hispanic and Undefined race, Hispanic). The categories included were:
White, non-Hispanic (n=905) White, Hispanic (n=94) Black (n=710) Undefined race, Hispanic (n=155) Asian (n=63) Multiracial (n=98)
Please note that the black race category was not separated by ethnicity; this is because there were only two children in the state sample with black, Hispanic mothers.
This issue of missing race information occurs at the electronic birth record level, where the people collecting birth data may not understand the necessity of entering a race and ethnicity. For this to change, training will have to take place at birthing hospitals throughout the state. For future studies, the possibility of combining the two Hispanic fields will be considered.

2. Response rates for each Health District are included on the first and second pages of all District reports and caution should be taken when interpreting immunization rates for a District with a low response rate. The reason for this necessary caution is that the children who are unable-to-locate could also be the least UTD. However, we cannot use their immunization history without knowing that it is current, so they must be excluded. Table A shows how the response rate was calculated for the overall state sample; this same method was used for each of the Health District samples.

Table A: Sampling Scheme, Georgia--2011

2011 (n)

Original Sample

2,447

Ineligible

82

Eligible Sample

2,359

Refused to Participate

6

Unable to Locate

210

Final Sample

2,150

Response Rate (%)

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

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Section II Statewide Results
Georgia Immunization Study, 2011
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16

State of Georgia
Immunization Report

Rebecca M. Willis, MHS Jessica Tuttle, MD

State-Level Immunization Study Staff Immunization Study Epidemiologist, Primary Author Medical Epidemiologist, Primary Editor

1-2 1-1

2-0 10

4-0

6-0

5-2

7-0 8-2

5-1 9-1
9-2
8-1

Metro Atlanta Districts

3-1 3-2 3-5

3-4

3-3

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State of Georgia
2011 Immunization Report, p2

From 24 months to End of Data Collection: The mean up-to-date (UTD) immunization rate by 24 months of age for the state sample was 82.4%, which increased to 94.0% by the end of the six-month data collection period (Table 2).
From 2010 to 2011: The mean UTD immunization rate by 24 months increased by 8.4% from 2010 to 2011. UTD coverage rates by the end of data collection increased 3.3% from 2010 to 2011 (Figure 1).
Sample population demographics for Georgia and their effect on immunization rates are discussed on the following pages.

Table 1: Sampling Scheme, Georgia, 2011

2010 (n)

2011 (n)

Original Sample

2,541 2,447

Ineligible

116

82

Eligible Sample

2,425 2,359

Refused to Participate

13

6

Unable to Locate

248

210

Final Sample

2,164 2,150

Response Rate (%)

90.2

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 2: Immunization Summary by Series and Antigen, Georgia, 2011

2010 2011 (%) (%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

76.3 82.4
91.2 94.0 84.5 85.8 96.3 97.5

3 IPV by 24 months

95.1 96.7

1 MMR by 24 months

91.5 93.0

UTD Hib by 24 months

90.0 95.1

3 Hep B by 24 months

94.8 96.5

1 Varicella by 24 months

92.9 93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

90.5 96.7 72.6 83.8
-- 53.1 58.2 60.1
-- 27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 1: Immunization Rate History, Georgia, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
Georgia: UTD by 24 months NIS, GA: UTD at 19-35 months

2005

2006 2007 2008 2009* 2010 2011
Georgia: UTD by end of data collection NIS, US: UTD at 19-35 months * 2009 data was not collected due to personnel vacancy.

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Table 3: Sample Population Demographics, Georgia, 2011

State Sample of Jan. 2009
Births (%)

All Georgia 2009 Births n=141,332
(%)

Georgia Sample (n=2,150)

-

-

Maternal Race/Ethnicity,

Notable Demographic Findings: Overall, the study sample for the state was comparable to the 2009 GA resident birth cohort, but varied for some demographic variables (Table 3).
For example, the final state sample contains a slightly smaller percentage of children residing in a metro area when compared to the 2009 birth cohort (79.9% vs. 82.5%).

White, nonHispanic (n=905) White, Hispanic (n=94) Black (n=710) Unspecified, Hispanic (n=155)

42.1

41.6

Some demographic variables were measured

4.4

3.9

outside of the birth record and could not be

measured for the entire 2009 birth cohort, namely

33.0

32.6

WIC status, Number of Providers, and Provider

7.2

8.1

Type.

Asian (n=63) Multiracial (n=125)
Maternal Education,
Some College+ (n=935)

2.9

3.2

Private Sector vs. Public Sector: Among

4.6

3.7

immunizations administered to children in the

sample, the vast majority (93.3%) were

administered by private providers (Figure 2).

43.5

44.1

HS Diploma/GED (n=611) 9th-11th grade (n=369) <9th grade (n=126)

28.4

28.2

17.2

15.8

5.9

5.6

Figure 2: Immunizations Administered in Private VS Public Sector, Georgia, 2011
(n=48,449)

WIC
Non-WIC (n=919)

57.3

-

6.7%

WIC (n=1,231)

42.7

-

Metro Residence
Metro (n=1,718)

79.9

82.5

93.3%

Non-metro (n=432)

20.1

17.5

Maternal Marital Status

Married (n=1,120)

52.1

54.7

Unmarried (n=1,026)

47.7

45.1

Repeat Birth

Public Sector

Private Sector

First Child (n=880) Repeat Birth (n=1,270)

40.9

40.5

59.1

57.7

% of State % of Georgia Sample 2009 Births

Gestational Age

Child's Gender

<37 weeks (n=215)

10.0

12.0

Male (n=1,091)

50.7

51.2

37+ weeks (n=1,935)
Provider Type,

90.0

88.0

Female (n=1,059)

49.3

48.8

Number of Providers,

Public Sector Only (n=84)

1.2

-

1 (n=1,073)

49.9

-

Private Sector Only (n=1739)

80.8

-

2 (n=476)

22.1

-

Both (n=269)

10.9

-

3 (n=141)

6.6

-

Payment at Birth

Maternal Age

Government Assist (n=933)

43.4

41.4

<25 years (n=830)

38.6

38.2

Private Insurance (n=626)

29.1

29.3

25-29 years (n=627)

29.2

27.5

Other (n=95)

4.4

4.7

35+ years (n=693)

32.2

34.4

Self Pay (n=104)

4.8

5.2

Indicates that this variable corresponds to the data collected

at the time of delivery.

Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases. Please refer to Appendix B for detailed information about the collection of information for this variable.

19

State of Georgia Immunization Report, p4

Table 4: UTD Immunization Rates by 24 months by demographic group, Georgia--2011

UTD by 24 months (%)

UTD by end of data collection
(%)

Georgia Sample (n=2,150) Maternal Race/Ethnicity,
White, NonHispanic (n=905) White, Hispanic (n=94) Black (n=710) Unspecified, Hispanic (n=155) Asian (n=63) Multiracial (n=125)
Maternal Education,
Some College+ (n=935) HS Diploma/GED (n=611) 9th-11th grade (n=369) <9th grade (n=126)

82.4

94.0

83.2

93.0

83.0

97.9

80.7

94.5

87.7

98.1

87.3

88.9

77.6

91.8

84.5

92.5

81.7

94.9

78.6

94.9

80.2

97.6

In Georgia, immunization rates by 24 months of age varied between certain demographic groups (Table 4).
In terms of maternal race/ethnicity, children of Asian and Hispanic mothers were the most often UTD by 24 months (see Table 4).
Higher maternal education was positively associated with UTD coverage rates (see Table 4).
Children of mothers with previous children were less often UTD by 24 months than children of mothers without previous children. In addition, children of married mothers were more often UTD by 24 months than children of unmarried mothers. The logistic regression model confirms that these are both statistically significant trends (Appendix D).
Children whose birth was covered by private insurance were more often UTD by 24 months than children whose birth was covered by governmentassisted insurance. This trend was not significant in the logistic regression model.

WIC

Non-WIC (n=919)

81.5

92.9

WIC (n=1,231)
Maternal Age
<25 years (n=830) 25-29 years (n=627)

83.7

95.4

79.8

94.6

UTD by 24 months (%)

UTD by end of data collection
(%)

84.1

93.9

Number of Providers,

30+ years (n=693)

84.1

93.4

1 (n=1,073)

84.4

94.8

Maternal Marital Status and Repeat Birth Combination

2 (n=476)

78.2

95.0

Married, First Birth (n=393) Unmarried, First Birth (n=486)

88.8 85.6

95.2

3 (n=141)

83.0

97.2

95.5

Child's Gender

Married, Repeat Birth (n=727)

82.4

92.6

Male (n=1,091)

83.3

94.1

Unmarried, Repeat Birth (n=540)

74.8

93.7

Female (n=1,059)

81.5

93.9

Gestational Age

Metro Residence

<37 weeks (n=215)

82.8

94.4

Metro (n=1,718)

82.4

94.0

37+ weeks (n=1,935)
Provider Type,

82.4

94.0

Non-metro (n=432)

82.4

94.0

Footnotes

Public Sector Only (n=84) Private Sector Only (n=1739) Both (n=269)

80.8 84.1 73.1

96.2 94.7 93.6

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.

Payment at Birth,
Government Assist (n=933) Private Insurance (n=626) Other (n=95)

79.6 85.1 80.0

94.3 92.8 93.7

Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.

Self Pay (n=104)

92.3

98.1

20

State of Georgia Immunization Report, p5

In terms of number of providers, children with 2 providers were less often UTD by 24 months than those with only one provider. This trend was significant in the logistic regression model (Appendix D) and supports the importance of a medical home.
To varying degrees, demographic-related disparities resolved by the end of data collection (Table 4, column in italics).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the statewide results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age and may be reasonable recipients for targeted educational and outreach efforts:
Children of less educated mothers
Children of mothers with previous children
Children of unmarried mothers
Children receiving immunizations from two providers or lacking a medical home
Please refer to Section III for Health District-specific rates and trends.

Table 5: Antigen-Specific Immunization Coverage (%) by 24 months of age, Georgia, 2005-2011

2005

2006

2007

2008

2010

2011

4 DTaP by 24 months

77.3

76.1

76.4

76.5

84.5

85.8

3 Polio by 24 months

85.4

87.8

87.8

87.5

95.1

96.7

1 MMR by 24 months

84.6

86.1

91.4

92.7

91.5

93.0

UTD Hib by 24 months

86.6

87.5

91.1

86.1

90.0

95.1

3 Hepatitis B by 24 months

86.9

88.4

88.8

88.7

94.8

96.5

1 Varicella by 24 months

84.9

86.5

85.2

85.5

92.9

93.9

UTD PCV by 24 months

43.4

73.6

77.2

81.6

90.5

96.7

2 Rotavirus*

-

1 Influenza*, by 24 months

-

-

-

-

72.6

83.8

-

-

-

58.2

60.1

2 Hepatitis A* by 24 months

-

-

-

-

--

53.1

2 H1N1*

-

-

-

-

--

27.1

* This vaccine is not included in the 4:3:1:3:3:1:4 vaccine series, which is the series routinely measured for this age group.

The first year of receiving the influenza vaccine requires 2 doses to be protected for that year; measuring 1 dose is a way to measure general interest in receiving the influenza vaccine, not completion or protection against influenza illness.

Immunization Rates by Antigen: In Georgia, the UTD immunization rate by 24 months for most antigens remained steady from 2005 to 2008, but increased to higher rates than ever in 2010 and again for all antigens in 2011 (Table 5).
Among Georgia antigen rates in 2011, the DTaP UTD immunization rate was lowest at 85.7%, similar to 84.5% in 2010. The MMR UTD immunization rate was the second-lowest at 93.0%, up from 91.5% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 43.4% in 2005 to 96.7% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of district- and county-level immunization campaigns.

21

State of Georgia Immunization Report, p6

District Immunization Rates: While the statewide UTD immunization rate by 24 months was 76.3%, variation was seen between districts. The districts with the highest UTD immunization rates by 24 months were Districts 1-1, 2-0, and 8-1. The districts with the lowest UTD immunization rates by 24 months were Districts 1-2, 7-0, and 9-1 (Figure 3 and Table 6).
Response rates for each district are included on the first and second pages of all District reports (Section III) and caution should be taken when interpreting immunization rates for a district with a low response rate.
The reason for this necessary caution is that the children who were classified as unable-to-locate could also be the least UTD. However, we cannot use their immunization history without knowing that it is current, so they must be excluded.

Figure 3: UTD Immunization Rates by District, Georgia, 2011

1-2 1-1

2-0 10

>87.3% 80.4%-87.3% <80.4%

6-0 4-0
5-2

7-0

5-1

9-1

8-2

8-1

9-2

Table 6: District UTD Immunization Rates by 24 months and by End of Data Collection, Georgia, 2011

District

UTD by 24 months (%)

UTD by end of data collection
(%)

Final Sample Size (n)

1-1 Northwest (Rome)

88.3

95.7

94

1-2 North Georgia (Dalton)

78.3

91.3

115

2-0 North (Gainesville)

86.2

94.5

145

3-1 Cobb-Douglas

85.6

94.3

174

3-2 Fulton

81.9

94.3

160

3-3 Clayton

84.6

95.2

104

3-4 Gwinnett, Newton, Rockdale

80.0

93.3

180

3-5 DeKalb

84.8

95.7

138

4-0 LaGrange

81.3

89.5

171

5-1 South Central (Dublin)

80.0

94.0

50

5-2 North Central (Macon)

83.5

99.0

97

6-0 East Central (Augusta)

78.8

98.8

85

7-0 West Central (Columbus)

78.2

89.6

115

8-1 South (Valdosta)

90.9

96.1

77

8-2 Southwest (Albany)

83.9

96.8

93

9-1 Coastal (Savannah)

76.8

93.7

142

9-2 Southeast (Waycross)

83.8

92.8

111

10-0 Northeast (Athens) Georgia

78.8 82.4

92.9 94.0

99 2,150

Color Shading Legend

: <80.4%

: 80.4%-87.3%

: >87.3%

22

State of Georgia Immunization Report, p7

Immunization Success Measures by District: The data analysis for this study is done on the state-level, allowing for uniform data analysis for all of the 18 health districts in Georgia. However, there are key measures that can be very telling of a health district's success in keeping their children up-to-date on all of their immunizations.
Please refer to Table 7 for a list of these success measures and the first-, second-, and third-placing health districts as applicable to each measure. The top portion of the table addresses the districts

who had the highest immunization series and response rates as well as one-year increases. Some of these measures are an average over a five-year span and some are only relative to 2011 results.
The lower portion of the table addresses the antigenspecific coverage by 24 months and only includes 2011 results.
Congratulations to all of the districts ranking in the top three for any of the categories!

Table 7: District Immunization Champions, Georgia, 2006-2011

Category

1st Place

2nd Place

3rd Place

Highest Response Rate, 2011

District (6-0) 100%

Gaines. District (2-0) 99.4%

Dalton District (1-2) 99.2%

Highest UTD by 24 months in 2011

Valdosta District (8-1) 92.2%

Rome District (1-1) 88.3%

Gaines. District (2-0) 86.9%

Highest UTD by end of data collection, 2011

Macon District (5-2) 99.0%

Augusta District (6-0) 98.8%

Valdosta District (5-2) 97.4%

Highest 5-year Average: Response Rate (2006-2011)

Augusta District (6-0) 99.7%

Dalton District (1-2) 98.5%

Dublin District (5-1) 97.5%

Highest 5-year Average: UTD by 24 months (2006-2011)

Gainesville Dist. (2-0) Lawrenceville Dist (3-4) Augusta District (6-0)

85.0%

83.8%

83.2%

Greatest Increase in UTD by 24 months from 2010 to 2011

Valdosta District (8-1) Waycross District (9-2) Clayton District (3-3)

26.5%

24.5%

14.6%

Greatest Increase in UTD by end of data collection from 2010 to 2011

Clayton District (3-3) 9.2%

Gaines. District (2-0) Columbus District (7-0)

8.1%

8.0%

Greatest Increase in UTD from 24 months to end Augusta District (6-0) Savannah District (9-1)

of data collection, 2011

25.4%

21.8%

Macon District (5-2) 18.6%

Highest Coverage*: 4+ DTaP Doses, 2011

Valdosta District 8-1) 94.8%

Gainesville Dist. (2-0) Cobb-Douglas Dist (3-1)

90.3%

89.7%

Highest Coverage*: 3+ Polio Doses, 2011

Coastal District (9-1) Cobb-Douglas Dist (3-1) Gainesville Dist (2-0)

98.6%

98.3%

97.9%

Highest Coverage*: 1 MMR Dose, 2011

Macon District (5-2) 96.9%

Valdosta District (8-1) Cobb-Douglas Dist (3-1)

96.1%

94.8%

Highest Coverage*: UTD Hib, 2011

Cobb-Douglas Dist (3-1) Gainesville Dist (2-0)

97.7%

97.2%

Lawrenceville Dist. 97.2%

Highest Coverage**: Hepatitis B Birth Dose, 2011

Dublin District (5-1) 96.0%

Columbus District (7-0) Augusta District (6-0)

93.9%

92.9%

Highest Coverage*: 3+ Hepatitis B Doses, 2011

Augusta District (6-0) 98.8%

DeKalb District (3-5) 98.6%

Columbus District (7-0) 98.3%

Highest Coverage*: 1 Varicella Dose, 2011

Macon District (5-0) 96.9%

Dublin District (5-1) 96.0%

Waycross District (9-2) 95.5%

Highest Coverage*: UTD PCV, 2011

Augusta District (6-0) Cobb-Douglas Dist (3-1) Clayton District (3-3)

98.8%

98.3%

98.1%

Highest Coverage*: 2+ Rotavirus Doses, 2011

Gainesville Dist. (2-0) 92.4%

Valdosta District (8-1) Lawrenceville Dis. (3-4)

92.2%

91.7%

Highest Coverage*: 1+ Influenza Doses, 2011

Cobb-Douglas Dist (3-1) 74.7%

Rome District (1-1) 70.2%

Gainesville Dist. (2-0) 66.2%

*Highest immunization coverage by 24 months of age. **Highest percentage of children who received the first dose of Hepatitis B within their first 3 days of life.

State
91.4% 82.7% 94.2% 92.1% 75.3% 8.4% 3.3% 13.9% 85.8% 96.7% 93.0% 95.1% 83.4% 96.5% 93.9% 96.7% 83.8% 60.1%

23

State of Georgia Immunization Report, p7

Findings Related to WIC Enrollment: Although the statewide results do not show an overall disparity in UTD immunizations by 24 months between WIC-enrolled children and children not enrolled in WIC, this appears to be inconsistent with district-level analyses. Health district appears to modify the effect of WIC on UTD immunization status by 24 months of age.
In four districts, the children enrolled in WIC had significantly higher immunization rates than those not enrolled. Five districts showed the opposite trend while the other nine districts did not show any significant difference between WIC groups (Figure 4 and Table 8).
As can be seen in Section III, each district has distinct population demographics. Immunization campaigns that work for one district may not work for another, but disparities, like this one related to WIC enrollment, can lead to opportunities for idea-sharing between districts and between programs.

Figure 4: Immunization Rates among WIC and Non-WIC Children, Georgia, 2011

1-2 1-1

2-0 10

4-0

6-0

5-2

7-0

5-1

9-1

9-2 8-2
8-1

WIC enrolled higher No Difference

WIC enrolled lower

Table 8: Difference in UTD Immunization Rate by 24 months between WIC Enrollment Groups, Georgia, 2011

District

Immunization Rate for children enrolled
in WIC (%)

Immunization Rate for children not enrolled in WIC (%)

Disparity (WIC Rate-Non-WIC
Rate) (%)

95% Confidence Interval of Difference (% -- %)*

1-1 Northwest (Rome)

90.0

84.4

5.6

-3.9 -- 15.1

1-2 North Georgia (Dalton)

75.5

75.8

-0.2

-11.3 -- 10.8

2-0 North (Gainesville)

82.5

87.8

-5.3

-13.4 -- 2.9

3-1 Cobb-Douglas

80.7

86.3

-5.6

-13.4 -- 2.2

3-2 Fulton

85.9

79.2

6.8

-1.5 -- 15.1

3-3 Clayton

91.7

73.2

18.5

8.4 -- 28.5

3-4 Gwinnett, Newton, Rockdale

83.8

77.7

6.1

-2.0 -- 14.3

3-5 DeKalb

76.0

87.5

-11.5

-20.5 -- -2.5

4-0 LaGrange

81.8

77.7

4.2

-4.3 -- 12.7

5-1 South Central (Dublin)

81.0

79.3

1.6

-14.0 -- 17.3

5-2 North Central (Macon)

81.0

80.0

1.0

-10.2 -- 12.1

6-0 East Central (Augusta)

78.9

76.6

2.4

-10.1 -- 14.8

7-0 West Central (Columbus)

82.7

70.0

12.7

1.8 -- 23.5

8-1 South (Valdosta)

89.5

87.2

2.3

-7.8 -- 12.4

8-2 Southwest (Albany)

81.4

80.0

1.4

-9.9 -- 12.7

9-1 Coastal (Savannah)

77.8

68.4

9.4

-0.8 -- 19.7

9-2 Southeast (Waycross)

82.5

81.3

1.3

-8.8 -- 11.4

10-0 Northeast (Athens)

73.3

81.2

-7.8

-19.5 -- 3.8

Georgia

82.0

80.0

2.0

-0.3 -- 4.4

*If the confidence interval overlaps zero, then the difference between groups is not statistically significant.

24

Section III Health District Immunization Reports
Georgia Immunization Study, 2011
25

26

District 1-1
2011 Immunization Report
District 1-1 Data Collection Team Janet Eberhart, RN, BSN District Immunization Coordinator

County Bartow

Sample Metro 15 Metro

Catoosa Chattooga Dade Floyd Gordon Haralson Paulding Polk Walker
District 1-1 District Response Rate
State of Georgia State Response Rate

5 3 0 15 9 4 34 6 3 94 87.2% 2,150 91.4%

Metro Nonmetro Metro Metro Nonmetro Metro Metro Nonmetro Metro

Dade

Catoosa

Walker

Chattooga

Gordon

Floyd

Bartow

Polk Haralson

Paulding

27

District 1-1
Immunization Report, p2

From 24 months to End of Data Collection: In the District 1-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (88.3% vs. 82.4%). By the end of data collection, the district UTD immunization rate remained higher than the state rate (95.7% vs. 94.0%) (Table 1-1-B).

From 2010 to 2011: The District 1-1 UTD immunization rate by 24 months increased by 7.6% from 2010 to 2011. The district UTD immunization rate by the end of data collection decreased 1.4% from 2010 to 2011 (Figure 1-1-C).

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 1-1-A: Sampling Scheme, District 1-1, 2011

District 1-1 (n)

State (n)

Original Sample

109 2,447

Ineligible

1

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

108 2,359

14

210

Final Sample

94

2,150

Response Rate (%)

87.2

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 1-1-B: Immunization Summary by Series & Antigen, District 1-1, 2011

District State

1-1 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

88.3 82.4

95.7 94.0

88.3

85.8

96.8 97.5

3 IPV by 24 months

96.8 96.7

1 MMR by 24 months

92.6 93.0

UTD Hib by 24 months

95.7 95.1

3 Hep B by 24 months

96.8 96.5

1 Varicella by 24 months

92.6 93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

95.7 96.7

87.2 83.8

58.5 53.1

70.2 60.1

29.8

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 1-1-C: Immunization Rate History, District 1-1, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 1-1: UTD by 24 months
Georgia: UTD by 24 months

2005

2006 2007 2008 2009* 2010 2011
District 1-1: UTD by end of data collection
Georgia: UTD by end of data collection

* 2009 data was not collected due to personnel vacancy. 28

Table 1-1-D: Sample Population Demographics, District 1-1, 2011

District 1-1 Final (%)

State Final Sample (%)

District 1-1 Final Sample (n=94)

-

-

Maternal Race/Ethnicity,

White, NonHispanic (n=71)

75.5

42.1

White, Hispanic (n=5)

5.3

4.4

Black (n=8)

8.5

33.0

Unspecified, Hispanic (n=2)

2.1

7.2

Asian (n=0)

0

2.9

Multiracial (n=2)
Maternal Education,

2.1

4.6

Some College+ (n=37)

39.4

43.5

HS Diploma/GED (n=36)

38.3

28.4

9th-11th grade (n=11)

11.7

17.2

<9th grade (n=4)

4.3

5.9

Notable Demographic Findings: The proportion of children whose mothers were classified as white, nonHispanic was greater for the district sample than for the overall state sample (75.5% vs. 42.1%) (Table 1-1-D). A smaller proportion of children were enrolled in WIC in the district sample than the total state sample (68.1% vs. 57.3%).
The District 1-1 sample had a greater proportion of children with married mothers when compared to the state sample (68.1% vs. 52.1%) as well as a greater proportion of children who were seen by only one provider (62.8% vs. 49.9%).
Other demographic measures for this district were similar to findings for the state sample as a whole.
Private Sector vs. Public Sector: Among immunizations administered to children in District 1-1 (n=1,470), the majority were administered in the private sector, with a proportion similar to that of the state sample (97.3% vs. 93.3%) (Figure 1-1-E).
Figure 1-1-E: Immunizations Administered in Private VS Public Sector, District 1-1, 2011
(n=1,470)

WIC
Non-WIC (n=64)

68.1

57.3

2.7%

WIC (n=30)

31.9

42.7

Metro Residence

Metro (n=76) Non-metro (n=18)

80.9
19.1

79.9
20.1

97.3%

Maternal Marital Status

Married (n=64)

68.1

52.1

Unmarried (n=30)

31.9

47.7

Repeat Birth
First Child (n=38) Repeat Birth (n=56)
Gestational Age

Public Sector

Private Sector

40.4

40.9

59.6

59.1

District

State Final

1-1 Final (%) Sample (%)

Child's Gender

<37 weeks (n=6)

6.4

10.0

Male (n=50)

53.2

50.7

37+ weeks (n=88)

93.6

90.0

Female (n=44)

46.8

49.3

Provider Type,

Number of Providers,

Public Sector Only (n=0)

0

1.2

1 (n=59)

62.8

49.9

Private Sector Only (n=82)

87.2

80.8

2 (n=18)

19.2

22.1

Both (n=7)

7.4

10.9

3+ (n=2)

2.1

6.6

Payment at Birth

Maternal Age

Government Assist (n=42)

44.7

43.4

<25 years (n=39)

41.5

38.6

Private Insurance (n=40)

42.6

29.1

25-29 years (n=25)

26.6

29.2

Other (n=2)

2.1

4.4

30+ years (n=30)

31.9

32.2

Self Pay (n=4)

4.3

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

29

District 1-1 Immunization Report, p4

Table 1-1-F: UTD Immunization Rates by demographic group, District 1-1, 2011

State Avg. UTD by 24
months (%)

1-1--UTD by 24 months (%)

1-1--UTD by end of
d.c. (%)

UTD Immunization Rates by Demographic Group: Besides the white, non-Hispanic race/ethnicity group, which was comparable to the state UTD by 24 months rate (88.7% vs. 88.3%), the district's other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 1-1-F).

District 1-1 Sample (n=94) Maternal Race/Ethnicity,
White, NonHispanic (n=71) White, Hispanic (n=5) Black (n=8) Unspecified, Hispanic (n=2) Asian (n=0) Multiracial (n=2)
Maternal Education,
Some College+ (n=37) HS Diploma/GED (n=36) 9th-11th grade (n=11) <9th grade (n=4)
WIC

82.7

88.3

95.7

In terms of maternal education, children of mothers

with a high school diploma/GED and no college

education were most often UTD by 24 months

83.2

88.7

94.4

(94.4%). In terms of maternal age, children of

82.0

100*

100*

mothers in the <25 years age group were least often UTD by 24 months of age (84.6%).

80.7

75.0*

100*

87.7

100*

100*

In terms of the maternal marital status and repeat birth variable, children of married mothers with

87.3

-

-

previous children were least often UTD by 24

77.6

50.0*

100*

months (79.1%). In addition, the district data support the importance of a medical home; children

who had one provider (Number of Providers) were

84.5

83.8

91.9

more often UTD than those with two providers (91.5% vs. 83.3%).

81.7

94.4

97.2

78.6

72.7

100

Although many demographic-related disparities resolved by the end of data collection, some still

80.2

100*

100*

remained and some new disparities emerged (Table

1-1-F, column in italics).

Non-WIC (n=64)

81.5

87.5

95.3

WIC (n=30)
Maternal Age
<25 years (n=39)

83.7

90.0

96.7

79.8

84.6

97.4

State Avg. UTD by 24
months (%)

1-1--UTD by 24 months (%)

1-1--UTD by end of
d.c. (%)

25-29 years (n=25)

84.1

92.0

96.0 Number of Providers,

30+ years (n=30)

84.1

90.0

93.3

1 (n=59)

84.4

91.5

98.3

Maternal Marital Status & Repeat Birth Combination

2 (n=18)

78.2

83.3

100

Married, First Birth (n=21)

88.8

100

100

3+ (n=2)

83.0

100*

100*

Unmarried, First Birth (n=17)

85.6

88.2

100

Child's Gender

Married, Repeat Birth (n=43)

82.4

79.1

90.7

Male (n=50)

83.3

90.0

98.0

Unmarried, Repeat Birth (n=13)
Gestational Age

74.8

100

100

Female (n=44)

81.5

Metro Residence

86.4

93.2

<37 weeks (n=6)

82.8

83.3*

100*

Metro (n=76)

82.4

88.2

96.1

37+ weeks (n=88)

82.4

88.6

95.5

Non-metro (n=18)

82.4

88.9

94.4

Provider Type,

Footnotes

Public Sector Only (n=0) Private Sector Only (n=82) Both (n=7)
Payment at Birth,
Government Assist (n=42) Private Insurance (n=40) Other (n=2) Self Pay (n=4)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

93.9 57.1
88.1 87.5 100* 100*

98.8 100
100 90.0 100* 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic group.

30

District 1-1 Immunization Report, p5

For example, children of married mothers with previous children remained the least often UTD by the end of data collection (90.7%).
In addition, the district data support the importance of a medical home; children who had one provider (Number of Providers) continued tomore often UTD than those with two providers (91.5% vs. 83.3%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 1-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of mothers with less than a high school diploma/GED
Children of mothers under 25 years of age
Children of married mothers with previous children
Children receiving immunizations from more than one provider

Table 1-1-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 1-1, 2005-2011

4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months

2005
77.4 86.6 84.8 87.2 86.6 82.9 49.4
-

2006
76.1 89.0 89.6 86.5 90.8 80.4 80.4
-

2007
79.1 93.4 89.6 88.5 94.0 89.0 81.9
-

2008
74.1 90.7 86.4 84.6 93.2 86.4 82.1
-

2010
88.6 98.6 95.0 92.9 96.4 95.7 95.0 67.9 61.4

2011
88.3 96.8 92.6 95.7 96.8 92.6 95.7 87.2 70.2

Immunization Rates by Antigen: In District 1-1, the UTD immunization rate by 24 months for most antigens remained steady from 2005 to 2008, but increased to higher rates than ever in 2010, most slightly decreasing in 2011 (Table 1-1-G).
Among District 1-1 antigen rates in 2011, the DTaP UTD immunization rate was lowest at 88.3%, comparable to 88.6% in 2010. The MMR and Varicella UTD immunization rates were the second-lowest at 92.6%, down from 95.0% and 95.7%, respectively, in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 49.4% in 2005 to 95.7% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP, MMR, and Varicella vaccines could reasonably be the primary focus of district and county-level immunization campaigns.

31

32

District 1-2
2011 Immunization Report

District 1-2 Data Collection Team

Marie Smith, RN

District Immunization Coordinator

Nancy Stackhouse, LPN Secondary Data Collector

Angie Callaway, RN

Secondary Data Collector

County

Sample Metro

Cherokee

60 Metro

Fannin

5 Nonmetro

Gilmer

4 Nonmetro

Murray

12 Metro

Pickens

8 Metro

Whitfield

26 Metro

District 1-2 115

District Response Rate 99.2%

State of Georgia 2,150

State Response Rate 91.4%

Whitfield Murray

Fannin Gilmer

Pickens Cherokee

33

District 1-2
Immunization Report, p2

From 24 months to End of Data Collection: In the District 1-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (78.3% vs.82.4%). By the end of data collection, the district UTD immunization rate remained lower than the state rate (91.3 vs. 94.0%) (Table 1-2-B).

From 2010 to 2011: The District 1-2 UTD immunization rate by 24 months increased by 1.4% from 2010 to 2011. The district UTD immunization rate by the end of data collection was similar from 2010 to 2011 (Figure 1-2-C).

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 1-2-A: Sampling Scheme, District 1-2, 2011

District 1-2 (n)

State (n)

Original Sample

122 2,447

Ineligible

6

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

116 2,359

1

210

Final Sample

115 2,150

Response Rate (%)

99.2

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 1-2-B: Immunization Summary by Series & Antigen, District 1-2, 2011

District State

1-2 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection

78.3

82.4

91.3

94.0

4 DTaP by 24 months

81.7

85.8

3 DTaP by 24 months

96.5

97.5

3 IPV by 24 months

93.9

96.7

1 MMR by 24 months

90.4

93.0

UTD Hib by 24 months

91.3

95.1

3 Hep B by 24 months

95.7

96.5

1 Varicella by 24 months

93.0

93.9

UTD PCV by 24 months

93.0

96.7

2 Rotavirus by 24 months

82.6

83.8

2 Hep A by 24 months

53.0

53.1

1+ Influenza by 24 months

60.0

60.1

2 H1N1

32.2

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 1-2-C: Immunization Rate History, District 1-2, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 1-2: UTD by 24 months Georgia: UTD by 24 months

2005

2006 2007 2008 2009* 2010 2011
District 1-2: UTD by end of data collection Georgia: UTD by end of data collection

* 2009 data was not collected due to personnel vacancy. 34

Table 1-2-D: Sample Population Demographics, District 1-2, 2011

District 1-1 Final (%)

State Final Sample (%)

District 1-2 Final Sample (n=115)

-

-

Maternal Race/Ethnicity,

White, NonHispanic (n=79)

68.7

42.1

White, Hispanic (n=3)

2.6

4.4

Black (n=2)

1.7

33.0

Unspecified, Hispanic (n=15)

13.0

7.2

Asian (n=3)

2.6

2.9

Multiracial (n=4)

3.5

4.6

Maternal Education,

Some College+ (n=59)

51.3

43.5

Notable Demographic Findings: The proportion of children with mothers classified as white, non-Hispanic was greater for the district sample than for the overall state sample (68.7% vs. 42.1%) (Table 1-2-D).
A larger proportion of children in the District 1-2 sample had mothers with some college education when compared to the state sample (51.3% vs. 43.5%). The district sample also had a larger proportion of children whose mothers were married (67.8% vs. 52.1%), as well as a larger proportion of children whose birth was covered by private insurance (37.4% vs. 29.1%).
Other demographic measures for this district were similar to findings for the state sample as a whole.
Private Sector vs. Public Sector: Among immunizations administered to children in District 1-2 (n=1,974), the majority were administered in the private sector, to a similar degree to the state sample (92.5% vs. 93.3%) (Figure 1-2-E).

HS Diploma/GED (n=19) 9th-11th grade (n=18) <9th grade (n=13)

16.5

28.4

Figure 1-2-E: Immunizations Administered in

15.7

17.2

11.3

5.9

Private VS Public Sector, District 1-2, 2011 (n=1,974)

WIC
Non-WIC (n=66)

57.4

57.3

7.5%

WIC (n=4)

42.6

42.7

Metro Residence
Metro (n=106)

92.2

79.9

92.5%

Non-metro (n=9)

7.8

20.1

Maternal Marital Status

Married (n=78)

67.8

52.1

Unmarried (n=37)

32.2

47.7

Repeat Birth
First Child (n=49) Repeat Birth (n=66)
Gestational Age

42.6

40.9

57.4

59.1

Public Sector

Private Sector

District

State Final

1-2 Final (%) Sample (%)

Child's Gender

<37 weeks (n=11)

9.6

10.0

Male (n=59)

51.3

50.7

37+ weeks (n=104)

90.4

90.0

Female (n=56)

48.7

49.3

Provider Type,

Number of Providers,

Public Sector Only (n=0)

0

1.2

1 (n=60)

52.2

49.9

Private Sector Only (n=91)

87.2

80.8

2 (n=35)

30.4

22.1

Both (n=20)

7.4

10.9

3+ (n=9)

7.8

6.6

Payment at Birth

Maternal Age

Government Assist (n=42)

36.5

43.4

<25 years (n=36)

31.3

38.6

Private Insurance (n=43)

37.4

29.1

25-29 years (n=33)

28.7

29.2

Other (n=8)

7.0

4.4

30+ years (n=46)

40.0

32.2

Self Pay (n=4)

3.5

4.8

Please refer to Appendix A for information about data origin. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

35

District 1-2 Immunization Report, p4

Table 1-2-F: UTD Immunization Rates by demographic group, District 1-2, 2011

State Avg. UTD by 24
months (%)

1-2--UTD by 24 months (%)

1-2--UTD by end of
d.c. (%)

UTD Immunization Rates by Demographic Group: Children of Hispanic mothers were more often UTD by 24 months when compared to the district sample as a whole (93.3% vs. 78.3%). The district's other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 1-2-F).

District 1-2 Sample (n=114) Maternal Race/Ethnicity,
White, NonHispanic (n=79) White, Hispanic (n=3) Black (n=2) Unspecified, Hispanic (n=15) Asian (n=3) Multiracial (n=4)
Maternal Education,
Some College+ (n=59) HS Diploma/GED (n=19) 9th-11th grade (n=18)

82.7

78.3

91.3 In terms of maternal age, children of mothers in the

<25 years age group were least often UTD by 24

months of age (69.4%). In terms of maternal marital

83.2

73.4

88.6 status and the repeat birth variable, children of

82.0

66.7*

100*

married mothers without previous children were most often UTD by 24 months (89.7%).

80.7

100*

100*

87.7

93.3

100

Children born at a gestational age of less than 37 weeks were more often UTD by 24 months than

87.3

100*

100* those born at a gestational age greater than 37

77.6

100*

100*

weeks (90.9% vs. 76.9%).

In terms of provider type, children receiving

84.5

78.0

84.8

immunizations in both the public and private sectors were less often UTD by 24 months than children

81.7

79.0

100

receiving immunizations exclusively in the private

78.6

83.3

100

sector (70.0% vs. 80.2%).

<9th grade (n=13)
WIC
Non-WIC (n=66)

80.2

76.9

100

In terms of payment at birth, District 1-2 children

whose birth was covered by private insurance were

more often UTD than children whose birth was

81.5

77.3

89.4 covered by government-assisted insurance (83.7%

WIC (n=49)
Maternal Age
<25 years (n=36) 25-29 years (n=33)

83.7

79.6

93.9

79.8

69.4

91.7

State Avg. UTD by 24
months (%)

1-2--UTD by 24 months (%)

1-2--UTD by end of
d.c. (%)

84.1

87.9

97.0 Number of Providers

30+ years (n=46)

84.1

78.3

Maternal Marital Status & Repeat Birth Combination

87.0

1 (n=60)

2 (n=35)

84.4

78.3

90.0

78.2

80.0

97.1

Married, First Birth (n=29) Unmarried, First Birth (n=20)

88.8

89.7

96.6

3+ (n=9)

83.0

88.9*

100*

85.6

70.0

90.0 Child's Gender

Married, Repeat Birth (n=49)

82.4

77.6

85.7

Male (n=59)

83.3

78.0

89.8

Unmarried, Repeat Birth (n=17)
Gestational Age

74.8

70.6

100

Female (n=56)

81.5

78.6

92.9

Metro Residence

<37 weeks (n=11)

82.8

90.9

100

Metro (n=106)

82.4

77.4

90.6

37+ weeks (n=104)
Provider Type

82.4

76.9

90.4

Non-metro (n=9)

82.4

88.9*

100*

Footnotes

Public Sector Only (n=0) Private Sector Only (n=91) Both (n=20)
Payment at Birth,
Government Assist (n=42) Private Insurance (n=43) Other (n=8) Self Pay (n=4)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

80.2 70.0
73.8 83.7 87.5* 100*

91.2 95.0
95.2 88.4 100* 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this

36

District 1-2 Immunization Report, p5

vs. 73.8%).
Although many demographic-related disparities resolved by the end of data collection, some still remained and some new ones emerged (Table 1-2-F, column in italics).
For example, children of Hispanic mothers remained more often UTD at the end of data collection when compared to the district sample as a whole (100% vs. 91.3%).
An inverse disparity appeared in the payment at birth category after the data collection period; children whose birth was covered by government-assisted insurance were more often UTD than those whose birth was covered by private insurance (95.2% vs. 88.4%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 1-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of white, non-Hispanic mothers
Children with mothers under 25 years of age
Children of unmarried mothers or mothers with previous children
Children who were born at a gestational age of more than 37 weeks

Table 1-2-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 1-2, 2005-2011

4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months

2005
86.6 91.8 93.3 94.8 95.5 94.0 57.5
-

2006
94.6 100 94.6 94.6 97.3 94.6 89.2
-

2007
86.4 93.2 93.2 97.7 97.8 95.5 88.6
-

2008
75.9 91.4 86.2 89.7 91.4 87.9 86.2
-

2010
86.8 96.5 91.2 85.1 96.5 94.7 93.9 77.2 60.5

2011
81.7 93.9 90.4 91.3 95.7 93.0 93.0 82.6 60.0

Immunization Rates by Antigen: In District 1-2, the UTD immunization rates by 24 months for most antigens fluctuated from 2005 to 2011. A notable increase occurred for the UTD Hib measure, rising from 85.1% in 2010 to 91.3% in 2011 (Table 1-2-G).
Among District 1-2 antigen rates in 2011, the DTaP UTD immunization rate was lowest at 81.7%, down from 86.8% in 2010. The MMR UTD immunization rate was the second-lowest at 90.4%, down from 91.2% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 57.5% in 2005 to 93.0% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of district and countylevel immunization campaigns.

37

38

District 2-0
2011 Immunization Report

District 2-0 Data Collection Team

Janie Dalton

District Immunization Coordinator

Sandy T. Moore

Primary Data Collector

County

Sample Metro

Banks Dawson Forsyth Franklin Habersham Hall Hart Lumpkin Rabun Stephens Towns Union White

3

Nonmetro

4

Metro

38 Metro

5

Nonmetro

7

Nonmetro

66 Metro

1

Nonmetro

2

Nonmetro

2

Nonmetro

7

Nonmetro

1

Nonmetro

6

Nonmetro

3

Nonmetro

District 2-0 District Response Rate
State of Georgia

145 99.4% 2,150

State Response Rate 91.4%

Union

Towns Rabun

Lumpkin

White Habersham Stephens

Dawson Hall
Forsyth

Banks Franklin Hart

39

District 2-0
Immunization Report, p2

From 24 months to End of Data Collection: In the District 2-0 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (86.2% vs. 82.4%). By the end of data collection, the district UTD immunization rate was similar to the state rate (94.5% vs. 94.0%) (Table 2-0-B).

From 2010 to 2011: The District 2-0 UTD immunization rate by 24 months increased by 10.6% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased 8.1% from 2010 to 2011 (Figure 2-0-C).

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 2-0-A: Sampling Scheme, District 2-0, 2011

District 2-0 (n)

State (n)

Original Sample

160 2,447

Ineligible

14

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

146 2,359

1

210

Final Sample

145 2,150

Response Rate (%)

99.4

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 2-0-B: Immunization Summary by Series & Antigen, District 2-0, 2011

District State

2-0 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

86.2

82.4

94.5

94.0

90.3

85.8

97.9

97.5

3 IPV by 24 months

97.9

96.7

1 MMR by 24 months

94.5

93.0

UTD Hib by 24 months

97.2

95.1

3 Hep B by 24 months

97.9

96.5

1 Varicella by 24 months

95.2

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

97.2

96.7

92.4

83.8

56.6

53.1

66.2

60.1

37.2

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 2-0-C: Immunization Rate History, District 2-0, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 2-0: UTD by 24 months
Georgia: UTD by 24 months

2005
40

2006 2007 2008 2009* 2010 2011
District 2-0: UTD by end of data collection Georgia: UTD by end of data collection
* 2009 data was not collected due to personnel vacancy.

Table 2-0-D: Sample Population Demographics, District 2-0, 2011

District State Final 2-0 Final % Sample %

District 2-0 Final Sample (n=145)

-

-

Maternal Race/Ethnicity,

White, NonHispanic (n=91)

62.8

42.1

White, Hispanic (n=27)

18.6

4.4

Black (n=6)

4.1

33.0

Notable Demographic Findings: The proportion owsafhmcithpeil,lednrtoehnna-nwHfihsooprsatenhimec oowtvaheserragslrlewsa%tetSareoaterefmcfFsolpaairlnmsetsahiplfelieedd(i6%sat2sSro.ia8fcm%tInpilteial vs. 42.1%) (Table 2-0-D).
A larger proportion of children in the District 1-2 sample had married mothers when compared to the state sample (65.5% vs. 52.1%).
Other demographic measures for this district were similar to findings for the state sample.

Unspecified, Hispanic (n=3) Asian (n=6) Multiracial (n=2)
Maternal Education,
Some College+ (n=53) HS Diploma/GED (n=43)

2.1

7.2

Private Sector vs. Public Sector: Among

4.1

2.9

immunizations administered to children in District 2-0 (n=1,685), the majority were administered in

1.4

4.6

the private sector, to a greater degree than in the

state sample (95.3% vs. 93.3%) (Figure 2-0-E).

36.6

43.5

29.7

28.4

9th-11th grade (n=24) <9th grade (n=13)
WIC

16.6

17.2

Figure 2-0-E: Immunizations Administered

9.0

5.9

in Private VS Public Sector, District 2-0, 2011

(n=1,685)

Non-WIC (n=82) WIC (n=63)
Metro Residence

56.6

57.3

43.4

42.7

4.7%

Metro (n=108) Non-metro (n=37)
Maternal Marital Status

74.5

79.9

25.5

20.1

95.3%

Married (n=95)

65.5

52.1

Unmarried (n=50)
Repeat Birth
First Child (n=58) Repeat Birth (n=87)
Gestational Age

34.5

47.7

40.0

40.9

60.0

59.1

Public Sector

Private Sector
District State Final 2-0 Final % Sample %

Child's Gender

<37 weeks (n=15) 37+ weeks (n=130)
Provider Type

10.3

10.0

Male (n=77)

53.1

50.7

89.7

90.0

Female (n=68)

46.9

49.3

Number of Providers

Public Sector Only (n=5)

3.4

1.2

1 (n=71)

49.0

49.9

Private Sector Only (n=114)

78.6

80.8

2 (n=18)

12.4

22.1

Both (n=5)
Payment at Birth
Government Assist (n=22) Private Insurance (n=33)

3.4

10.9

3+ (n=8)

Maternal Age

15.2

43.4

<25 years (n=56)

22.8

29.1

25-29 years (n=35)

5.5

6.6

38.6

38.6

24.1

29.2

Other (n=6)

4.1

4.4

30+ years (n=54)

37.2

32.2

Self Pay (n=3)

2.1

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

41

District 2-0 Immunization Report, p4

Table 2-0-F: UTD Immunization Rates by demographic group, District 2-0, 2011

State Avg. UTD by 24
months (%)

2-0--UTD by 24 months (%)

2-0--UTD by end of
d.c. (%)

District 2-0 Sample (n=145)

82.7

86.9

95.2

Maternal Race/Ethnicity,

White, NonHispanic (n=91)

83.2

84.6

92.3

White, Hispanic (n=27)

82.0

88.9

100

Black (n=6)

80.7

100*

100*

Unspecified, Hispanic (n=3)

87.7

100*

100*

UTD Immunization Rates by Demographic Group: Immunization rate disparities were not apparent among the different race/ethnicity groups (Table 2-0-F).
In terms of maternal age, children of mothers in the <25 years age group were least often UTD by 24 months of age (78.6%) and children of mothers in the 25 to 29 years age group were most often UTD by 24 months (91.4%).
In terms of maternal marital status and the repeat birth variable, children who were repeat births were more often UTD compared to first-born children (see Table 2-0-F).

Asian (n=6) Multiracial (n=2)
Maternal Education,
Some College+ (n=53)

87.3

100*

100*

In terms of payment at birth, District 2-0 children

77.6

50.0*

100*

whose birth was covered by private insurance were

more often UTD than children whose birth was

covered by government-assisted insurance (87.9%

84.5

86.8

94.3

vs. 77.3%).

HS Diploma/GED (n=43) 9th-11th grade (n=24) <9th grade (n=13)
WIC

81.7

88.4

93.0

The District 2-0 data support the importance of a

78.6

87.5

95.8

medical home; children who had one provider

(Number of Providers) were more often UTD by 24

80.2

84.6

100

months than those with two providers (87.3% vs.

77.8%).

Non-WIC (n=82)

81.5

89.0

92.7

WIC (n=63)

83.7

82.5

Maternal Age

<25 years (n=56)

79.8

78.6

25-29 years (n=35)

84.1

91.4

30+ years (n=54)

84.1

90.7

Maternal Marital Status, & Repeat Birth Combination

Married, First Birth (n=33)

88.8

81.8

Unmarried, First Birth (n=25)

85.6

80.0

Married, Repeat Birth (n=62)

82.4

88.7

Unmarried, Repeat Birth (n=25)
Gestational Age

74.8

92.0

96.8

State Avg. 2-0--UTD 2-0--UTD

UTD by 24 by 24 by end of

months months

d.c.

92.9

(%)

(%)

(%)

97.1 Number of Providers

94.4

1 (n=71)

84.4

87.3

94.4

2 (n=18)

78.2

77.8

94.4

90.9

3+ (n=8)

83.0

100*

100*

96.0 Child's Gender

93.6

Male (n=77)

83.3

85.7

93.5

100

Female (n=68)

81.5

86.8

95.6

Metro Residence

<37 weeks (n=15) 37+ weeks (n=130)
Provider Type

82.8

80.0

93.3

Metro (n=108)

82.4

91.7

97.2

82.4

86.9

94.6

Non-metro (n=37)

82.4

70.3

86.5

Footnotes

Public Sector Only (n=5) Private Sector Only (n=114) Both (n=5)
Payment at Birth,
Government Assist (n=22) Private Insurance (n=33) Other (n=6) Self Pay (n=3)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

100* 86.0 60.0*
77.3 87.9 50.0* 100*

100* 95.6 80.0*
90.9 93.9 83.3 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

42

District 2-0 Immunization Report, p5

Children living in metro counties were more often UTD by 24 months of age than children living in non-metro counties (91.7% vs. 70.3%).
Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 2-0-F, column in italics).
For example, children living in metro counties remained more often UTD on their immunizations than children living in non-metro counties (97.2% vs. 86.5%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 2-0 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of mothers under 25 years of age
Children of mothers without previous children
Children whose birth was covered by governmentassisted insurance
Children receiving immunizations from more than one provider
Children living in non-metro counties (see page 1 of District 2-0 Immunization Report)

Table 2-0-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 2-0, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

93.5

85.2

89.3

88.0

86.9

3 Polio by 24 months

93.5

92.6

94.1

92.0

95.2

1 MMR by 24 months

97.8

85.2

94.1

94.0

92.9

UTD Hib by 24 months

93.5

96.3

94.1

88.0

91.7

3 Hepatitis B by 24 months

93.5

96.3

96.4

92.0

96.4

1 Varicella by 24 months

97.8

88.9

95.2

94.0

91.7

UTD PCV by 24 months

56.5

77.8

88.1

90.0

90.5

2 Rotavirus

-

-

-

-

79.8

1 Influenza by 24 months

-

-

-

-

65.5

2011
90.3 97.9 94.5 97.2 97.9 95.2 97.2 92.4 66.2

Immunization Rates by Antigen: In District 2-0, the UTD immunization rates for most antigens fluctuated from 2005 to 2010, but all increased to higher rates in 2011 (Table 2-0-G).
Among District 2-0 antigen rates in 2011, the DTaP UTD immunization rate was lowest at 90.3%, up from 86.9% in 2010. The MMR UTD immunization rate was the second-lowest at 94.5%, up from 92.9% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 56.5% in 2005 to 97.2% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP vaccine could reasonably be the primary focus of district and county-level immunization campaigns.

43

44

District 3-1
2011 Immunization Report

District 3-1 Data Collection Team

Karen Thomas, RN District Immunization Coordinator

Silvia Frausto

Data Collector

County

Sample Metro

Cobb

149 Metro

Douglas

25 Metro

District 3-1 174

District Response Rate 90.4%

State of Georgia 2,150

State Response Rate 91.4%

Cobb Douglas

45

District 3-1
Immunization Report, p2

From 24 months to End of Data Collection: In the District 3-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (85.6% vs. 82.4%). By the end of data collection, the district UTD immunization rate was similar to the state rate (94.3% vs. 94.0%) (Table 3-1-B).

From 2010 to 2011: The District 3-1 UTD immunization rate by 24 months increased by 9.2% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 6.2% from 2010 to 2011 (Figure 3 -1-C).

Sample population demographics for this district and their effect on UTD immunization rates are discussed on the following pages.

Table 3-1-A: Sampling Scheme, District 3-1, 2011

District 3-1 (n)

State (n)

Original Sample

198 2,447

Ineligible

5

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

193 2,359

19

210

Final Sample

174 2,150

Response Rate (%)

90.4

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 3-1-B: Immunization Summary by Series & Antigen, District 3-1, 2011

District State

3-1 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

85.6

82.4

94.3

94.0

89.7

85.8

98.9

97.5

3 IPV by 24 months

98.3

96.7

1 MMR by 24 months

94.8

93.0

UTD Hib by 24 months

97.7

95.1

3 Hep B by 24 months

96.6

96.5

1 Varicella by 24 months

95.4

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

98.3

96.7

87.4

83.8

48.3

53.1

74.7

60.1

36.8

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 3-1-C: Immunization Rate History, District 3-1, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010

District 3-1: UTD by 24 months

District 3-1: UTD by end of data collection

Georgia: UTD by 24 months

Georgia: UTD by end of data collection

* 2009 data was not collected due to personnel vacancy.

46

Table 3-1-D: Sample Population Demographics, District 3-1, 2011

District State Final 3-1 Final % Sample %

District 3-1 Final Sample (n=174)

-

-

Maternal Race/Ethnicity,

White, NonHispanic (n=72)

41.4

42.1

White, Hispanic (n=20)

11.5

4.4

Black (n=41)

23.6

33.0

Unspecified, Hispanic (n=13)

7.5

7.2

Asian (n=5)

2.9

2.9

Multiracial (n=10)
Maternal Education,

5.8

4.6

Some College+ (n=99)

56.9

43.5

HS Diploma/GED (n=34)

19.5

28.4

9th-11th grade (n=14)

8.1

17.2

<9th grade (n=13)

7.5

5.9

WIC

Non-WIC (n=117)

67.2

57.3

Notable Demographic Findings: The proportion of cwohvaeislrdagrrlelensattwaehtreofsosearmmthpoeltehde(i1srts9r.wi0c%et rsve%asSmc.oal1pfam1lsFe.spi6ilnft%eihae)ald(nTafasobrH%letiSshop3afe-amI1nnp-iiDlctei)a.l
A larger proportion of children in the District 3-1 sample had mothers with some college education when compared to the state sample (56.9% vs. 43.5%).
The district sample also had a smaller proportion of children enrolled in WIC (32.8% vs. 42.7%), as well as a larger proportion of children whose birth was covered by private insurance (51.7% vs. 29.1%).
Other demographic measures for this district were similar to findings for the state sample as a whole.
Private Sector vs. Public Sector: Among immunizations administered to children in District 3-1 (n=3,499), the majority were administered in the private sector, but to a similar degree to the state sample (92.0% vs. 93.3%) (Figure 3-1-E).
Figure 3-1-E: Immunizations Administered in Private VS Public Sector, District 3-1, 2011
(n=3,499)
8.0%

WIC (n=57)
Metro Residence
Metro (n=174) Non-metro (n=0)
Maternal Marital Status
Married (n=112)

32.8

42.7

100

79.9

0

20.1

64.4

52.1

92.0%

Unmarried (n=62)
Repeat Birth
First Child (n=75) Repeat Birth (n=99)
Gestational Age
<37 weeks (n=12) 37+ weeks (n=162)
Provider Type
Public Sector Only (n=4)

35.6

47.7

43.1

40.9

56.9

59.1

Public Sector

Private Sector
District State Final 3-1 Final % Sample %

Child's Gender

6.9

10.0

Male (n=83)

47.7

50.7

93.1

90.0

Female (n=91)

52.3

49.3

Number of Providers

2.3

1.2

1 (n=47)

27.0

49.9

Private Sector Only (n=146)

83.9

80.8

2 (n=11)

6.3

22.1

Both (n=24)
Payment at Birth
Government Assist (n=52) Private Insurance (n=90)

13.8

10.9

3+ (n=6)

Maternal Age

29.9

43.4

<25 years (n=49)

51.7

29.1

25-29 years (n=57)

3.5

6.6

28.2

38.6

32.8

29.2

Other (n=9)

5.2

4.4

30+ years (n=68)

39.1

32.2

Self Pay (n=6)

3.5

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

47

District 3-1 Immunization Report, p4

Table 3-1-F: UTD Immunization Rates by demographic group, District 3-1, 2011

State Avg. UTD by 24
months (%)

3-1--UTD by 24 months %

3-1--UTD by end of
d.c. (%)

District 3-1 Sample (n=174)

82.7

85.6

94.3

Maternal Race/Ethnicity,

UTD Immunization Rates by Demographic Group: Children of black mothers were more often UTD by 24 months when compared to the district sample as a whole (90.2% vs. 85.6%). Children of white, Hispanic mothers were less often UTD when compared to the district sample as a whole (70.0% vs. 85.6%). The district's other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-1-F).

White, NonHispanic (n=72) White, Hispanic (n=20) Black (n=41) Unspecified, Hispanic (n=13) Asian (n=5) Multiracial (n=10)

83.2

83.3

93.1

In terms of maternal education, children of

82.0

70.0

95.0

mothers with less than 9th grade education were

80.7

90.2

95.1

the least often UTD by 24 months (76.9%) among the maternal education groups.

87.7

100

100

87.3

100*

100*

In District 3-1, WIC enrollment did not appear to have an effect on UTD immunizations by 24

77.6

80.0

80.0

months.

Maternal Education,
Some College+ (n=99) HS Diploma/GED (n=34) 9th-11th grade (n=14) <9th grade (n=13)

In terms of maternal age, children of mothers in

84.5

86.9

92.9

the 25-29 years age group were most often UTD by

81.7

82.4

97.1

24 months of age (94.7%). In terms of maternal marital status and the repeat birth variable,

78.6

85.7

100

children of married mothers with previous children

80.2

76.9

92.3

were the least often UTD by 24 months (79.4%).

WIC
Non-WIC (n=117)

In district 3-1, children born at a gestational age of

81.5

86.3

94.9

less than 37 weeks were more often UTD by 24

WIC (n=57)
Maternal Age
<25 years (n=49)

83.7

84.2

93.0

79.8

73.5

89.8

State Avg. UTD by 24
months (%)

3-1--UTD by 24 months (%)

3-1--UTD by end of
d.c. (%)

25-29 years (n=57)

84.1

94.7

96.5 Number of Providers

30+ years (n=68)

84.1

83.8

95.6

1 (n=47)

84.4

89.4

95.7

Maternal Marital Status & Repeat Birth Combination

2 (n=11)

78.2

90.9

100

Married, First Birth (n=44)

88.8

90.9

93.2

3+ (n=6)

83.0

83.3*

100*

Unmarried, First Birth (n=31)

85.6

87.1

100

Child's Gender

Married, Repeat Birth (n=68)

82.4

79.4

92.7

Male (n=83)

83.3

78.3

89.2

Unmarried, Repeat Birth (n=31)

74.8

90.3

93.6

Female (n=91)

81.5

92.3

98.9

Gestational Age

Metro Residence

<37 weeks (n=12)

82.8

91.7

100

Metro (n=174)

82.4

85.6

94.3

37+ weeks (n=162)
Provider Type

82.4

85.2

93.8

Non-metro (n=0)

82.4

-

-

Footnotes

Public Sector Only (n=4) Private Sector Only (n=146) Both (n=24)
Payment at Birth,
Government Assist (n=52) Private Insurance (n=90) Other (n=9) Self Pay (n=6)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

75.0* 84.9 91.7
78.9 85.6 100* 100*

100* 93.8 95.8
90.4 94.4 100* 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

48

District 3-1 Immunization Report, p5

months than those born at a gestational age greater than 27 weeks (91.7% vs. 85.2%).
In terms of provider type, children receiving immunizations in both the public and private sector were more often UTD by 24 months than those receiving immunizations exclusively in the private sector (91.7% vs. 84.9%).
In terms of payment at birth, District 3-1 children whose birth was covered by private insurance were more often UTD than children whose birth was covered by government-assisted insurance (85.6% vs. 78.9%).
Surprisingly, male children in this district were less often UTD by 24 months than female children (78.3% vs. 92.3%).
Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 3-1-F, column in italics).
For example, children of mothers in the 25-29 years age group remained the most often UTD (96.5%).
In addition, male children remained less often UTD by the end of data collection when compared to female children (89.2% vs. 98.9%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 3-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of white, Hispanic mothers
Children whose mothers less than 9th grade education.
Children whose mothers are <25 years of age or are greater than 30 years of age
Children seen exclusively in the private sector
Children whose birth was covered by governmentassisted insurance
Male children

Table 3-1-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-1, 2005-2011

4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months

2005
73.9 84.6 80.0 84.1 82.6 78.0 45.1
-

2006
73.9 83.0 86.2 87.2 86.2 83.5 79.4
-

2007
80.1 90.3 87.2 86.7 90.3 84.1 83.2
-

2008
77.6 88.5 88.0 85.3 87.4 85.8 82.0
-

2010
88.8 94.0 94.0 90.3 94.0 93.3 91.0 79.9 61.9

2011
89.7 98.3 94.8 97.7 96.6 95.4 98.3 87.4 74.7

Immunization Rates by Antigen: In District 3-1, the UTD immunization rates by 24 months for most antigens fluctuated from 2005 to 2010, but all increased to higher rates in 2011, particularly for the Hib UTD immunization rate, which increased from 90.3% in 2010 to 97.7% in 2011. (Table 3-1-G).
Among District 3-1 antigen rates in 2011, the DTaP UTD immunization rate was lowest at 89.7%, similar to 88.8% in 2010. The MMR UTD immunization rate was the second-lowest at 94.8%, similar to 94.0% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 45.1% in 2005 to 98.3% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP vaccine could reasonably be the primary focus of district and county-level immunization campaigns.

49

50

District 3-2
2011 Immunization Report

District 3-2 Data Collection Team

Georgia Goseer, RN District Immunization Coordinator

Jessica Harris, BS Primary Data Collector

Patrice Little, RN Secondary Data Collector

Additional Data Collection Outreach

Marquesa Swarn Gail Robinson

Reba Vickers

Trina Daniels

Dorothy Northcut Mary Grover

Isidra Castro

Rexanna Gammage Cassandra Mitchell

Frank Johnson

Tamara Woods

Diann Morris

Teresa McCray

County

Sample Metro

Fulton

159 Metro

District 3-2 159

District Response Rate 82.4%

State of Georgia 2,150

State Response Rate 91.4%

Fulton

51

District 3-2
Immunization Report, p2

From 24 months to End of Data Collection: In the District 3-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was similar to the state rate (81.9% vs. 82.4%). By the end of data collection, the district UTD immunization rate remained similar to the state rate (94.4% vs. 94.0%) (Table 3-2-B).
From 2010 to 2011: The District 3-2 UTD immunization rate by 24 months increased by 7.3% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 4.2% from 2010 to 2011 (Figure 32-C).
Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 3-2-B: Immunization Summary by Series & Antigen, District 3-2, 2011

District State

3-2 Average

(%)

(%)

UTD immunization rate*
by 24 months

81.9

82.4

UTD immunization rate*
by end of data collection

94.4

94.0

4 DTaP by 24 months

86.3

85.8

3 DTaP by 24 months

96.3

97.5

Table 3-2-A: Sampling Scheme, District 3-2, 2011

3 IPV by 24 months 1 MMR by 24 months

96.3

96.7

93.8

93.0

District 3-2 (n)

State (n)

Original Sample

205 2,447

Ineligible

7

82

Refused to Participate

2

6

Eligible Sample Unable to Locate

196 2,359

36

210

Final Sample

160 2,150

Response Rate (%)

82.4

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

UTD Hib by 24 months

95.0

95.1

3 Hep B by 24 months

96.3

96.5

1 Varicella by 24 months

91.9

93.9

UTD PCV by 24 months

96.9

96.7

2 Rotavirus by 24 months

86.9

83.8

2 Hep A by 24 months

48.1

53.1

1+ Influenza by 24 months

58.8

60.1

2 H1N1

36.9

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 3-2-C: Immunization Rate History, District 3-2, 2000-2011

90%

80%

70%

60%

50%

40%

2000 2001 2002 2003
District 3-2: UTD by 24 months Georgia: UTD by 24 months

2004

2005

2006 2007 2008 2009* 2010
District 3-2: UTD by end of data collection Georgia: UTD by end of data collection

* 2009 data was not collected due to personnel vacancy. 52

Table 3-2-D: Sample Population Demographics, District 3-2, 2011

District State Final 3-2 Final % Sample %

District 3-2 Final Sample (n=160)

-

-

Maternal Race/Ethnicity,

White, NonHispanic (n=41)

25.6

42.1

White, Hispanic (n=4)

2.5

4.4

Black (n=73)

45.6

33.0

Unspecified, Hispanic (n=15)

9.4

7.2

Asian (n=8)

5.0

2.9

Multiracial (n=13)

8.1

4.6

Maternal Education,

Some College+ (n=82)

51.3

43.5

HS Diploma/GED (n=31)

19.4

28.4

Notable Demographic Findings: The proportion of children with mothers classi%fieodf aFsinballack w%asofgIrneiatitaelr for the district sample than foSar mthpeleoverall sStamteple sample (45.6% vs. 33.0%) (Table 3-2-D).
A larger proportion of children in the District 3-2 sample had mothers with some college education when compared to the state sample (51.3% vs. 43.5%). The district sample also had a larger proportion of children whose mothers were in the 30+ years age group (40.6% vs. 32.2%).
Other demographic measures for this district were similar to findings for the state sample as a whole.
Private Sector vs. Public Sector: Among immunizations administered to children in District 32 (n=2,140), the majority were administered in the private sector, to a greater degree than in the state
sample (98.1% vs. 93.3%) (Figure 3-2-E).

9th-11th grade (n=26) <9th grade (n=8)
WIC
Non-WIC (n=96) WIC (n=64)
Metro Residence
Metro (n=174) Non-metro (n=0)
Maternal Marital Status
Married (n=83)

16.3

17.2

Figure 3-2-E: Immunizations Administered in

5.0

5.9

Private VS Public Sector, District 3-2, 2011 (n=2,140)

60.0

57.3

40.0

42.7

1.9%

100

79.9

0

20.1

98.1%

51.9

52.1

Unmarried (n=77)
Repeat Birth
First Child (n=69) Repeat Birth (n=91)
Gestational Age
<37 weeks (n=18) 37+ weeks (n=142)
Provider Type
Public Sector Only (n=0)

48.1

47.7

43.1

40.9

56.9

59.1

Public Sector

Private Sector
District State Final 3-2 Final % Sample %

Child's Gender

11.3

10.0

Male (n=83)

51.9

50.7

88.7

90.0

Female (n=77)

48.1

49.3

Number of Providers

0

1.2

1 (n=78)

48.8

49.9

Private Sector Only (n=129)

80.6

80.8

2 (n=34)

21.3

22.1

Both (n=8)
Payment at Birth
Government Assist (n=45) Private Insurance (n=56)

5.0

10.9

3+ (n=12)

Maternal Age

28.1

43.4

<25 years (n=44)

35.0

29.1

25-29 years (n=51)

7.5

6.6

27.5

38.6

31.9

29.2

Other (n=13)

8.1

4.4

30+ years (n=65)

40.6

32.2

Self Pay (n=7)

4.4

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

53

District 3-2 Immunization Report, p4

Table 3-2-F: UTD Immunization Rates by demographic group, District 3-2, 2011

State Avg. UTD by 24
months (%)

3-2--UTD by 24 months %

3-2--UTD by end of
d.c. (%)

UTD Immunization Rates by Demographic Group: Children of black mothers were less often UTD when compared to the district sample as a whole (78.1% vs. 82.5%). The district's other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-2-F).

District 3-2 Sample (n=160) Maternal Race/Ethnicity,
White, NonHispanic (n=41) White, Hispanic (n=4) Black (n=73) Unspecified, Hispanic (n=15) Asian (n=8) Multiracial (n=13)
Maternal Education,
Some College+ (n=82) HS Diploma/GED (n=31) 9th-11th grade (n=26) <9th grade (n=8)
WIC
Non-WIC (n=96)

82.7

82.5

95.0

In terms of maternal education, children of mothers

with a high school diploma or GED were the least

often UTD by 24 months (77.4%). In contrast,

83.2

85.4

92.7

children of mothers with some college education

82.0

100*

100*

were the most often UTD by 24 months (85.4%).

80.7

78.1

93.2

In District 3-2, the children enrolled in WIC had a

87.7

80.0

100

higher immunization rate than those not enrolled in WIC (85.9% vs. 79.2%); this disparity was greater

87.3

87.5*

87.5* than what was seen for the state sample as a whole

77.6

84.6

100*

(83.7% vs. 81.5%).

In terms of maternal marital status and the repeat

84.5

85.4

92.7

birth variable, children of married mothers without previous children were the most often UTD by 24

81.7

77.4

90.3

months (91.2%).

78.6

80.8

100

Children born at a gestational age of less than 37

80.2

75.0*

100*

weeks were less often UTD by 24 months than those

born at a gestational age greater than 37 weeks

(77.8% vs. 82.4%).

81.5

79.2

93.8

WIC (n=64)
Maternal Age
<25 years (n=44) 25-29 years (n=51)

83.7

85.9

95.3

79.8

79.6

95.5

State Avg. UTD by 24
months (%)

3-2--UTD by 24 months (%)

3-2--UTD by end of
d.c. (%)

84.1

82.4

96.1 Number of Providers

30+ years (n=65)

84.1

83.1

92.3

1 (n=78)

84.4

87.2

98.7

Maternal Marital Status & Repeat Birth Combination

2 (n=34)

78.2

73.5

91.2

Married, First Birth (n=34)

88.8

91.2

97.1

3+ (n=12)

83.0

83.3

100

Unmarried, First Birth (n=35)

85.6

85.7

97.1 Child's Gender

Married, Repeat Birth (n=49)

82.4

81.6

93.9

Male (n=83)

83.3

83.1

94.0

Unmarried, Repeat Birth (n=42)

74.8

71.4

90.5

Female (n=77)

81.5

80.5

94.8

Gestational Age

Metro Residence

<37 weeks (n=18) 37+ weeks (n=142
Provider Type

82.8

77.8

88.9

Metro (n=174)

82.4

82.5

95.0

82.4

82.4

95.1

Non-metro (n=0)

82.4

-

-

Footnotes

Public Sector Only (n=0) Private Sector Only (n=129) Both (n=8)
Payment at Birth,
Government Assist (n=45) Private Insurance (n=56) Other (n=13) Self Pay (n=7)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

83.7 62.5*
77.8 83.9 84.6 100*

95.3 100*
91.1 96.4 100 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

54

District 3-2 Immunization Report, p5

In terms of payment at birth, children whose birth was covered by private insurance were more often UTD by 24 months than those whose birth was covered by government-assisted insurance (83.9% vs. 77.8%).
In addition, the district data support the importance of a medical home; children who receiving immunizations from only one provider (Number of Provider) were more often UTD than those receiving immunizations from two providers (87.2% vs. 73.5%).
Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 3-2-F, column in italics).
For example, children of mothers with a high school diploma or GED remained the least often UTD by the end of data collection (see Table 3-2-F).
Similarly, children receiving immunizations from only one provider remained more often UTD by the end of data collection, compared to children receiving immunizations by two providers (98.7% vs. 91.2%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 3-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of black mothers
Children whose mothers have a high school diploma or GED and no college education
Children not enrolled in WIC
Children of unmarried mothers with previous children
Children who were born at a gestational age of less than 37 weeks
Children whose birth was covered by governmentassisted insurance
Children receiving immunizations from more than one provider

Table 3-2-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-2, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

70.7

63.9

58.7

66.4

84.3

3 Polio by 24 months

80.1

79.4

72.2

79.9

94.0

1 MMR by 24 months

79.5

79.4

68.8

78.5

91.7

UTD Hib by 24 months

81.4

81.6

70.7

74.8

89.8

3 Hepatitis B by 24 months

79.5

76.5

71.3

78.5

94.0

1 Varicella by 24 months

77.9

79.8

68.1

78.1

93.1

UTD PCV by 24 months

49.8

70.8

61.8

70.8

89.8

2 Rotavirus

-

-

-

-

72.7

1 Influenza by 24 months

-

-

-

-

61.1

2011
86.3 96.3 93.8 95.0 96.3 91.9 96.9 86.9 58.8

Immunization Rates by Antigen: In District 3-2, the lowest UTD immunization rates by 24 months for most antigens occurred from 2006 to 2008, but increased to higher than ever in 2010 for all antigens, most further increasing in 2011. Particularly large increases were seen for the Hib and PCV UTD immunization rates, increasing from 89.8% in 2010 to 95.0% in 2011 for Hib and from 89.8% in 2010 to 96.9% in 2011 for PCV. (Table 3-2-G).
Among District 3-2 antigen rates in 2011, the DTaP UTD immunization rate was lowest at 86.3%, similar to 84.3% in 2010. The Varicella UTD immunization rate

was second-lowest at 91.9%, down from 93.1% in 2010.
Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 49.8% in 2005 to 96.9% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP vaccine could reasonably be the primary focus of district and county-level immunization campaigns.

55

56

District 3-3
2011 Immunization Report
District 3-3 Data Collection Team Freda Sheppard, LPN District Immunization Coordinator

County

Sample Metro

Clayton

104 Metro

District 3-3 104

District Response Rate 90.8%

State of Georgia 2,150

State Response Rate 91.4%

Clayton

57

District 3-3
Immunization Report, p2

From 24 months to End of Data Collection: In the District 3-3 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (84.6% vs. 82.4%). By the end of data collection, the district UTD immunization rate remained higher than the state rate (95.2% vs. 94.0%) (Table 3-3-B).

From 2010 to 2011: The District 3-3 UTD immunization rate by 24 months increased by 14.6% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 9.2% from 2010 to 2011 (Figure 33-C).

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are
discussed on the following pages.

Table 3-3-A: Sampling Scheme, District 3-3, 2011

District 3-3 (n)

State (n)

Original Sample

120 2,447

Ineligible

4

82

Refused to Participate

1

6

Eligible Sample Unable to Locate

115 2,359

11

210

Final Sample

104 2,150

Response Rate (%)

90.8

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 3-3-B: Immunization Summary by Series & Antigen, District 3-3, 2011

District State

3-3 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

84.6

82.4

95.2

94.0

88.5

85.8

98.1

97.5

3 IPV by 24 months

97.1

96.7

1 MMR by 24 months

93.3

93.0

UTD Hib by 24 months

94.2

95.1

3 Hep B by 24 months

97.1

96.5

1 Varicella by 24 months

94.2

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

98.1

96.7

81.7

83.8

51.9

53.1

47.1

60.1

13.5

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100% 90% 80% 70% 60% 50% 40%

Figure 3-3-C: Immunization Rate History, District 3-3, 2000-2011

2000 2001 2002 2003 2004
District 3-3: UTD by 24 months Georgia: UTD by 24 months

2005
58

2006 2007 2008 2009* 2010 2011
District 3-3: UTD by end of data collection Georgia: UTD by end of data collection
* 2009 data was not collected due to personnel vacancy.

Table 3-3-D: Sample Population Demographics, District 3-3, 2011

District State Final 3-3 Final % Sample %

District 3-3 Final Sample (n=104)

-

-

Maternal Race/Ethnicity,

White, NonHispanic (n=12)

11.5

42.1

White, Hispanic (n=3)

2.9

4.4

Black (n=51)

49.0

33.0

Unspecified, Hispanic (n=21)

20.2

7.2

Asian (n=3)

2.9

2.9

Multiracial (n=3)

2.9

4.6

Maternal Education,

Some College+ (n=23)

22.1

43.5

HS Diploma/GED (n=41)

39.4

28.4

Notable Demographic Findings: The proportion of ct(4hh9eil.d0dr%iestnvrsiw.cti3t3sha.0mm%po)tl.eheTtrhhsaecnplafrososrpifotih%reteSdioaooafnmvsFeopbriflnaleaclalchlksiltdwartaees%nsgSaworamefimtaIphntpleieltreiaflor mothers classified as white, non-Hispanic was smaller for the district than for the state sample (11.5% vs. 42.1%) (Table 3-3-D).
A smaller proportion of children in the District 3-3 sample had mothers with some college education when compared to the state sample (22.1% vs. 43.5%). In addition, the district sample had a larger proportion of first born children (51.0% vs. 40.9%).
Other demographic measures for this district were similar to findings for the state sample as a whole.
Private Sector vs. Public Sector: Among immunizations administered to children in District 3-3 (n=1,390), the majority were administered in the private sector, to a greater degree than in the state sample (99.2% vs. 93.3%) (Figure 3-3-E).

9th-11th grade (n=22) <9th grade (n=10)
WIC
Non-WIC (n=56) WIC (n=48)
Metro Residence
Metro (n=104)

21.2

17.2

Figure 3-3-E: Immunizations Administered in

9.6

5.9

Private VS Public Sector, District 3-3, 2011 (n=1,390)

53.9

57.3

46.1

42.7

0.8%

100

79.9

Non-metro (n=0)
Maternal Marital Status
Married (n=43)

0

20.1

41.4

52.1

99.2%

Unmarried (n=61)
Repeat Birth
First Child (n=53) Repeat Birth (n=51)
Gestational Age
<37 weeks (n=12) 37+ weeks (n=92)
Provider Type
Public Sector Only (n=0)

58.6

47.7

51.0

40.9

49.0

59.1

Public Sector

Private Sector
District State Final 3-1 Final % Sample %

Child's Gender

11.5

10.0

Male (n=53)

51.0

50.7

88.5

90.0

Female (n=51)

49.0

49.3

Number of Providers

0

1.2

1 (n=53)

51.0

49.9

Private Sector Only (n=95)

91.3

80.8

2 (n=27)

26.0

22.1

Both (n=4)
Payment at Birth

3.8

10.9

3+ (n=7)

Maternal Age

6.7

6.6

Government Assist (n=44) Private Insurance (n=11)

42.3

43.4

<25 years (n=45)

10.6

29.1

25-29 years (n=25)

43.3

38.6

24.0

29.2

Other (n=3)

2.9

4.4

30+ years (n=34)

32.7

32.2

Self Pay (n=8)

7.7

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

59

District 3-3 Immunization Report, p4

Table 3-3-F: UTD Immunization Rates by demographic group,

UTD Immunization Rates by Demographic Group:

District 3-3, 2011

Children of white, non-Hispanic mothers were more

often UTD by 24 months when compared to the

State Avg. 3-3--UTD 3-3--UTD district sample as a whole (91.7% vs. 84.6%). The

UTD by 24 months

by 24 months

by end of d.c.

other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-3-F).

(%)

%

(%)

District 3-3 Sample (n=104) Maternal Race/Ethnicity,
White, NonHispanic (n=12)

82.7

84.6

95.2 In terms of maternal education, children of mothers

with a high school diploma or GED and no college

education were the most often UTD by 24 months

83.2

91.7

100 (90.2%) of all of the maternal education groups.

White, Hispanic (n=3) Black (n=51) Unspecified, Hispanic (n=21) Asian (n=3)

82.0

33.3*

100* In District 3-3, the children enrolled in WIC had a

80.7

86.3

94.1

much higher UTD immunization rate by 24 months than those not enrolled in WIC (93.8% vs. 76.8%);

87.7

81.0

90.5 this disparity was much greater than what was seen

87.3

100*

100* for the state sample as a whole (83.7% vs. 81.5%).

Multiracial (n=3)
Maternal Education,
Some College+ (n=23)

77.6

100*

100* In terms of maternal marital status and the repeat

birth variable, children of unmarried mothers with

previous children were the least often UTD by 24

84.5

78.3

91.3 months (60.7%).

HS Diploma/GED (n=41) 9th-11th grade (n=22) <9th grade (n=10)
WIC

81.7

90.2

97.6 In terms of payment at birth, District 3-3 children

78.6

72.7

90.9 whose birth was covered by private insurance were

80.2

90.0

100

more often UTD by 24 months than children whose birth was covered by government-assisted insurance

(90.9% vs. 81.8%).

Non-WIC (n=56)

81.5

76.8

94.6

WIC (n=48)
Maternal Age
<25 years (n=45) 25-29 years (n=25)

83.7

93.8

95.8

79.8

82.2

93.3

State Avg. UTD by 24
months (%)

3-3--UTD by 24 months (%)

3-3--UTD by end of
d.c. (%)

84.1

88.0

96.0 Number of Providers

30+ years (n=34)

84.1

85.3

Maternal Marital Status & Repeat Birth Combination

Married, First Birth (n=20)

88.8

95.0

Unmarried, First Birth (n=33)

85.6

93.9

Married, Repeat Birth (n=23)

82.4

91.3

Unmarried, Repeat Birth (n=28)
Gestational Age

74.8

60.7

97.1

1 (n=53)

84.4

2 (n=27)

78.2

100

3+ (n=7)

83.0

97.0 Child's Gender

95.7

Male (n=53)

83.3

89.3

Female (n=51)

81.5

Metro Residence

81.1 81.5 85.7*
88.7 80.4

96.2 92.6 85.7*
96.2 94.1

<37 weeks (n=12) 37+ weeks (n=92)
Provider Type

82.8

100

100

Metro (n=104)

82.4

84.6

95.2

82.4

82.6

94.6

Non-metro (n=0)

82.4

-

-

Footnotes

Public Sector Only (n=0) Private Sector Only (n=95) Both (n=4)
Payment at Birth,
Government Assist (n=44) Private Insurance (n=11) Other (n=3) Self Pay (n=8)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

83.2 100*
81.8 90.9 100* 87.5*

94.7 100*
95.5 90.9 100* 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

60

District 3-3 Immunization Report, p5

Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 3-3-F, column in italics).
For example, children of unmarried mothers with previous children remained the least often UTD by the end of data collection compared to the other three groups (89.3%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 3-3 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of black mothers
Children whose mothers have less than a high school diploma of GED
Children not enrolled in WIC
Children whose mothers have some college education
Children of unmarried mothers with previous children
Children whose birth was covered by governmentassisted insurance

Table 3-3-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-3, 2005-2011

4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months

2005
55.3 65.2 64.8 72.1 74.2 66.0 27.5
-

2006
70.7 84.2 83.5 85.4 86.6 82.3 59.2
-

Immunization Rates by Antigen: In District 3-3, the UTD immunization rates by 24 months for most antigens fluctuated from 2005 to 2008, but increased in 2010 for all antigens, further increasing in 2011. Particularly large increases were seen for the DTaP and PCV UTD immunization rates, increasing from 78.7% in 2010 to 88.5% in 2011 for DTaP and from 85.8% in 2010 to 98.1% in 2011 for PCV. (Table 3-2-G).

Among District 3-3 antigen rates in 2011, the DTaP UTD immunization rate was lowest at 88.5%, up from 78.7% in 2010. The MMR UTD immunization rate was the second-lowest at 93.3%, up from 90.8% in 2010.

2007
68.4 87.5 79.6 81.6 88.8 80.3 61.8
-

2008
69.3 79.7 78.7 74.8 84.2 79.2 70.8
-

2010
78.7 92.9 90.8 91.5 92.9 90.1 85.8 61.7 48.9

2011
88.5 97.1 93.3 94.2 97.1 94.2 98.1 81.7 47.2

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 27.5% in 2005 to 98.1% in 2011.

Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP vaccine could reasonably be the primary focus of district and county-level immunization campaigns.

61

62

District 3-4
2011 Immunization Report

Gloria Melvin Brenda Crowe

District 3-4 Data Collection Team District Immunization Coordinator Additional Data Collector

County

Sample Metro

Gwinnett

151 Metro

Newton

15 Metro

Rockdale

14 Metro

District 3-4 180

District Response Rate 87.8%

State of Georgia 2,150

State Response Rate 91.4%

Gwinnett
Rockdale Newton

63

District 3-4
Immunization Report, p2

From 24 months to End of Data Collection: In the District 3-4 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (80.0% vs. 84.2%). By the end of data collection, the district UTD immunization rate was similar to the state rate (93.3% vs. 94.0%) (Table 3-4-B).
From 2010 to 2011: The District 3-4 UTD immunization rate by 24 months increased by 6.7% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 5.7% from 2010 to 2011 (Figure 3-4-C).
Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 3-4-A: Sampling Scheme, District 3-4, 2011

District 3-4 (n)

State (n)

Original Sample

213 2,447

Ineligible

7

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

206 2,359

26

210

Final Sample

180 2,150

Response Rate (%)

87.8

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 3-4-B: Immunization Summary by Series & Antigen, District 3-4, 2011

District State

3-4 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

80.0

82.4

93.3

94.0

83.9

85.8

97.8

97.5

3 IPV by 24 months

96.1

96.7

1 MMR by 24 months

90.6

93.0

UTD Hib by 24 months

97.2

95.1

3 Hep B by 24 months

93.3

96.5

1 Varicella by 24 months

91.7

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

97.8

96.7

91.7

83.8

48.9

53.1

60.6

60.1

34.4

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 3-4-C: Immunization Rate History, District 3-4, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 3-4: UTD by 24 months Georgia: UTD by 24 months

2005
64

2006 2007 2008 2009* 2010 2011
District 3-4: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy.

Table 3-4-D: Sample Population Demographics, District 3-4, 2011 Notable Demographic Findings: The proportion of

District 3-4 Final Sample (n=180)

District 3-4 Final %
-

State Final children whose mothers were%colafsFsiifnieald as H%isopfaInniictiawlas

Sample % greater for the district sampleStahmapnlfeor the oSvaemrapllle

state sample (21.7% vs. 11.6%). The proportion of

-

children with mothers classified as white, non-Hispanic

Maternal Race/Ethnicity,

was smaller for the district sample than for the state sample (25.6% vs. 42.1%) (Table 3-4-D).

White, NonHispanic (n=46)

25.6

42.1

White, Hispanic (n=12)

6.7

4.4

The district sample had a larger proportion of children whose mothers had some college education than the

Black (n=53)

29.4

33.0

state sample (50.0% vs. 43.5%).

Unspecified, Hispanic (n=27) Asian (n=18)

15.0

7.2

Other demographic measures for this district were

10.0

2.9

similar to findings for the state sample as a whole.

Multiracial (n=7)
Maternal Education,
Some College+ (n=90) HS Diploma/GED (n=36)

3.9

4.6

Private Sector vs. Public Sector: Among

immunizations administered to children in District 3-4

50.0

43.5

(n=2,347), the majority were administered in the private sector, to a greater degree than in the state

20.0

28.4 sample (97.6% vs. 93.3%) (Figure 3-4-E).

9th-11th grade (n=24) <9th grade (n=11)
WIC

13.3

17.2

Figure 3-4-E: Immunizations Administered in

6.1

5.9

Private VS Public Sector, District 3-4, 2011 (n=2,347)

Non-WIC (n=112) WIC (n=68)

62.2

57.3

37.8

42.7

2.4%

Metro Residence

Metro (n=180) Non-metro (n=0)

100

79.9

0

20.1

97.6%

Maternal Marital Status

Married (n=103)

57.2

52.1

Unmarried (n=77)
Repeat Birth
First Child (n=75) Repeat Birth (n=105)
Gestational Age
<37 weeks (n=21) 37+ weeks (n=159)
Provider Type
Public Sector Only (n=2)

42.8

47.7

41.7

40.9

58.3

59.1

Public Sector

Private Sector
District State Final 3-4 Final % Sample %

Child's Gender

11.7

10.0

Male (n=85)

47.2

50.7

88.3

90.0

Female (n=95)

52.8

49.3

Number of Providers

1.1

1.2

1 (n=69)

38.3

49.9

Private Sector Only (n=148)

82.2

80.8

2 (n=47)

26.1

22.1

Both (n=7)
Payment at Birth
Government Assist (n=43) Private Insurance (n=59)

3.9

10.9

3+ (n=19)

Maternal Age

23.9

43.4

<25 years (n=45)

32.8

29.1

25-29 years (n=52)

10.6

6.6

25.0

38.6

28.9

29.2

Other (n=11)

6.1

4.4

30+ years (n=83)

46.1

32.2

Self Pay (n=11)

6.1

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

65

District 3-4 Immunization Report, p4

Table 3-4-F: UTD Immunization Rates by demographic group, UTD Immunization Rates by Demographic Group:

District 3-4, 2011

Children of white, Hispanic mothers were more often

State Avg. UTD by 24
months (%)

3-4--UTD by 24 months %

3-4--UTD by end of
d.c. (%)

UTD by 24 months when compared to the district sample as a whole (91.7% vs. 80.0%). Children of black mothers and Asian mothers were less often UTD when compared to the district sample as a whole (73.6% and 77.8%, respectively, vs. 80.0%).

District 3-4 Sample (n=180)

82.7

80.0

93.3 The district's other race/ethnicity group sample sizes

Maternal Race/Ethnicity,

were too small to draw any definite conclusions (Table 3-4-F).

White, NonHispanic (n=46) White, Hispanic (n=12) Black (n=53) Unspecified, Hispanic (n=27) Asian (n=18) Multiracial (n=7)
Maternal Education,

83.2

84.8

91.3

In terms of maternal education, District 3-4 children

82.0

91.7

100 of mothers with a high school diploma or GED and no

80.7

73.6

92.5 college education were the most often UTD by 24

87.7

85.2

100

months among the maternal education groups (86.1%).

87.3

77.8

83.3

77.6

100*

100*

In District 3-4, the children enrolled in WIC had a higher immunization rate than those not enrolled in

WIC (83.8% vs. 77.7%).

Some College+ (n=90) HS Diploma/GED (n=36) 9th-11th grade (n=24) <9th grade (n=11)
WIC
Non-WIC (n=112)

84.5

76.7

90.0 In terms of maternal marital status and the repeat

81.7

86.1

97.2 birth variable, children of mothers with previous

78.6

79.2

91.7

children were less often UTD by 24 months than firstborn children (see Table 3-4-F).

80.2

72.7

100

Additionally, the district data support the

importance of a medical home; children who had

81.5

77.7

91.1 only one provider (Number of Providers) were more

WIC (n=68)
Maternal Age
<25 years (n=45)

83.7

83.8

97.1

79.8

80.0

97.8

State Avg. UTD by 24
months (%)

3-4--UTD by 24 months (%)

3-4--UTD by end of
d.c. (%)

25-29 years (n=52)

84.1

80.8

94.2 Number of Providers

30+ years (n=83)

84.1

79.5

90.4

1 (n=69)

84.4

88.4

97.1

Maternal Marital Status & Repeat Birth Combination

2 (n=47)

78.2

76.6

97.9

Married, First Birth (n=38)

88.8

86.8

97.4

3+ (n=19)

83.0

73.7

100

Unmarried, First Birth (n=37)

85.6

91.9

100

Child's Gender

Married, Repeat Birth (n=65)

82.4

72.3

86.2

Male (n=85)

83.3

82.4

91.8

Unmarried, Repeat Birth (n=40)

74.8

75.0

95.0

Female (n=95)

81.5

77.9

94.7

Gestational Age

Metro Residence

<37 weeks (n=21)

82.8

81.0

95.2

Metro (n=180)

82.4

80.0

93.3

37+ weeks (n=159)
Provider Type

82.4

79.9

93.1

Non-metro (n=0)

82.4

-

-

Footnotes

Public Sector Only (n=2) Private Sector Only (n=148) Both (n=7)
Payment at Birth,
Government Assist (n=43) Private Insurance (n=59) Other (n=11) Self Pay (n=11)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

100* 83.1 57.1*
79.1 78.0 90.9 81.8

100* 95.9 100*
97.7 84.8 100 100

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

66

District 3-4 Immunization Report, p5

often UTD than those with more than one provider (see Table 3-4-F).
Also of note, male children in this district were more often UTD by 24 months than female children (82.4% vs. 77.9%).
Although many demographic-related disparities resolved by the end of data collection, some still remained and some new ones emerged(Table 3-4-F, column in italics).
For example, children of Asian mothers remained less often UTD than the district sample as a whole (83.3% vs. 93.3%). District 3-4 children enrolled in WIC remained more often UTD than those not enrolled in WIC (97.1% vs. 91.1%).
A new disparity appeared based on Payment at Birth; children whose birth was covered by private insurance were less often UTD by the end of data collection than children whose birth was covered by governmentassisted insurance (84.8% vs. 97.7%).
In terms of the maternal marital status and repeat birth variables, children of unmarried mothers with previous children remained less often UTD by the end of data collection (see Table 3-4-F).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 3-4 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of black mothers
Children of Asian mothers
Children whose mothers have less than a high school diploma or GED
Children whose mothers have some college education
Children whose mothers have previous children
Children whose birth was covered by private insurance
Children receiving immunizations from more than one provider.

Table 3-4-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-4, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

87.0

91.5

84.0

94.4

81.7

3 Polio by 24 months

88.0

96.6

90.1

95.8

88.3

1 MMR by 24 months

90.2

93.2

91.4

95.8

86.7

UTD Hib by 24 months

91.3

94.9

93.8

95.8

85.0

3 Hepatitis B by 24 months

90.2

94.9

92.6

95.8

90.0

1 Varicella by 24 months

91.3

94.0

93.8

94.4

90.0

UTD PCV by 24 months

53.3

92.3

85.2

97.2

88.3

2 Rotavirus

-

-

-

-

75.0

1 Influenza by 24 months

-

-

-

-

61.7

2011
83.9 96.1 90.6 97.2 93.3 91.7 97.8 91.7 60.6

Immunization Rates by Antigen: In District 3-4, the UTD immunization rates by 24 months for most antigens were low in 2005, fluctuated between 2006 and 2010, with all antigen coverage levels increasing in 2011 (Table 3-4-G).
Among District 3-4 antigen rates in 2011, the DTaP UTD immunization rate was lowest at 83.9%, up from 81.7% in 2010. The MMR UTD immunization rate was the second-lowest at 90.6%, up from 86.7% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 53.3% in 2005 to 97.8% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP, MMR, and Varicella vaccines could reasonably be the primary focus of district and county-level immunization campaigns.

67

68

District 3-5
2011 Immunization Report

District 3-5 Data Collection Team

Mia Young, MBA, BSHA

District Immunization Coordinator

Cassandra Jackson, LPN, B.S.Ed Primary Data Collector

County

Sample

Metro

DeKalb District 3-5
District Response Rate State of Georgia
State Response Rate

138 138 81.1% 2,150 91.4%

Metro

DeKalb

69

District 3-5
Immunization Report, p2

From 24 months to End of Data Collection: In the District 3-5 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (84.8% vs. 82.4%). By the end of data collection, the district UTD immunization rate remained higher than the state rate (95.7% vs. 94.0%) (Table 3-5B).
From 2010 to 2011: The District 3-5 UTD immunization rate by 24 months increased by 5.9% from 2010 to 2011. The district UTD immunization rate by the end of data collection was similar from 2010 to 2011 (Figure 3-5-C).
Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 3-5-A: Sampling Scheme, District 3-5, 2011

District 3-5 (n)

State (n)

Original Sample

175 2,447

Ineligible

4

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

171 2,359

33

210

Final Sample

138 2,150

Response Rate (%)

81.1

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 3-5-B: Immunization Summary by Series & Antigen, District 3-5, 2011

District State

3-5 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

84.8

82.4

95.7

94.0

86.2

85.8

97.1

97.5

3 IPV by 24 months

97.8

96.7

1 MMR by 24 months

92.8

93.0

UTD Hib by 24 months

96.4

95.1

3 Hep B by 24 months

98.6

96.5

1 Varicella by 24 months

93.5

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

97.8

96.7

91.3

83.8

44.9

53.1

64.5

60.1

38.4

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 3-5-C: Immunization Rate History, District 3-5, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 3-5: UTD by 24 months Georgia: UTD by 24 months

2005
70

2006 2007 2008 2009* 2010 2011
District 3-5: UTD by end of data collection Georgia: UTD by end of data collection * 2009 data was not collected due to personnel vacancy.

Table 3-5-D: Sample Population Demographics, District 3-5, 2011 Notable Demographic Findings: The proportion of

children whose mothers were classified as white, nonDistrict State Final Hispanic was smaller for the di%storifctFsinamalple th%aonffIonrittihael 3-5 Final % Sample % overall state sample (21.7% vs. 4S2a.m1%p)l.e The proSpaomrtpiloen of

District 3-5 Final Sample (n=138)

-

-

children with mothers classified as black was greater for the district sample than for the state sample (46.4% vs.

Maternal Race/Ethnicity,

33.0%) (Table 3-5-D).

White, NonHispanic (n=30) White, Hispanic (n=0) Black (n=64) Unspecified, Hispanic (n=18) Asian (n=6) Multiracial (n=9)
Maternal Education,
Some College+ (n=69) HS Diploma/GED (n=33)

21.7

42.1

The district sample had a larger proportion of children

0

4.4

whose mothers had some college education than the state sample as a whole (50.0% vs. 43.5%). In addition, the

46.4

33.0

district sample had a larger proportion of first-born

children (50.7% vs. 40.9%).

13.0

7.2

4.4

2.9

Other demographic measures for this district were similar to findings for the state sample as a whole.

6.5

4.6

Private Sector vs. Public Sector: Among immunizations

administered to children in District 3-5 (n=1,569), the

majority were administered in the private sector, with a

50.0

43.5

proportion similar to that of the state sample (100% vs.

23.9

28.4

93.3%) (Figure 3-5-E).

9th-11th grade (n=16) <9th grade (n=13)
WIC
Non-WIC (n=88)

11.6

17.2

Figure 3-5-E: Immunizations Administered in

9.4

5.9

Private VS Public Sector, District 3-5, 2011 (n=1,569)

63.8

57.3

WIC (n=50)
Metro Residence
Metro (n=138)

36.2

42.7

100

79.9

100%

Non-metro (n=0)
Maternal Marital Status
Married (n=69)

0

20.1

50.0

52.1

Unmarried (n=68)
Repeat Birth
First Child (n=70) Repeat Birth (n=68)
Gestational Age
<37 weeks (n=15) 37+ weeks (n=123)
Provider Type
Public Sector Only (n=0)

49.3

47.7

50.7

40.9

49.3

59.1

Public Sector

Private Sector
District State Final 3-5 Final % Sample %

Child's Gender

10.9

10.0

Male (n=71)

51.4

50.7

89.1

90.0

Female (n=67)

48.6

49.3

Number of Providers

0

1.2

1 (n=68)

49.3

49.9

Private Sector Only (n=115)

100

80.8

2 (n=21)

15.2

22.1

Both (n=0)
Payment at Birth
Government Assist (n=37) Private Insurance (n=47)

0

10.9

3+ (n=8)

Maternal Age

26.8

43.4

<25 years (n=37)

34.1

29.1

25-29 years (n=50)

5.8

6.6

26.8

38.6

36.2

29.2

Other (n=7)

5.1

4.4

30+ years (n=51)

37.0

32.2

Self Pay (n=17)

12.3

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

71

District 3-5 Immunization Report, p4

Table 3-5-F: UTD Immunization Rates by demographic group, District 3-5, 2011

State Avg. UTD by 24
months (%)

3-5--UTD by 24 months %

3-5--UTD by end of
d.c. (%)

District 3-5 Sample (n=138)

82.7

85.5

96.4

Maternal Race/Ethnicity,

UTD Immunization Rates by Demographic Group: Children of white, non-Hispanic mothers were more often UTD by 24 months when compared to the district sample as a whole (93.3% vs. 85.5%). Children of Hispanic mothers were less often UTD when compared to the district sample as a whole (72.2% vs. 85.5%). The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-5-F).

White, NonHispanic (n=30) White, Hispanic (n=0) Black (n=64) Unspecified, Hispanic (n=18) Asian (n=6) Multiracial (n=9)
Maternal Education,
Some College+ (n=69) HS Diploma/GED (n=33) 9th-11th grade (n=16) <9th grade (n=13)

83.2

93.3

96.7

In terms of maternal education, District 3-5

82.0

-

-

children of mothers with some college education

80.7

84.4

95.3

were more often UTD by 24 months than children of less educated mothers (see Table 3-5-F).

87.7

72.2

94.4

87.3

100*

100*

In District 3-5, the children enrolled in WIC had a lower UTD immunization rate than those not

77.6

88.9*

88.9* enrolled in WIC (80.0% vs. 87.5%); this disparity

was greater than, and inverse to, what was seen

for the state sample as a whole (83.7% vs. 81.5%).

84.5

94.2

95.7

81.7

87.9

100

Children born at a gestational age of less than 37 weeks were less often UTD by 24 months than

78.6

68.8

93.8

those born at a gestational age greater than 37

80.2

76.9

92.3

weeks (73.3% vs. 86.2%).

WIC
Non-WIC (n=88)

In terms of payment at birth, District 3-5 children

81.5

87.5

95.5

whose birth was covered by private insurance were

WIC (n=50)
Maternal Age
<25 years (n=37)

83.7

80.0

96.0

79.8

83.8

91.9

State Avg. UTD by 24
months (%)

3-5--UTD by 24 months (%)

3-5--UTD by end of
d.c. (%)

25-29 years (n=50)

84.1

86.0

96.0 Number of Providers

30+ years (n=51)

84.1

84.3

98.0

1 (n=68)

84.4

80.9

94.1

Maternal Marital Status & Repeat Birth Combination

2 (n=21)

78.2

90.5

100

Married, First Birth (n=36)

88.8

86.1

91.7

3+ (n=8)

83.0

87.5*

100*

Unmarried, First Birth (n=33)

85.6

84.9

97.0 Child's Gender

Married, Repeat Birth (n=33)

82.4

87.9

100

Male (n=71)

83.3

83.1

93.0

Unmarried, Repeat Birth (n=35)

74.8

80.0

94.3

Female (n=67)

81.5

86.6

98.5

Gestational Age

Metro Residence

<37 weeks (n=15)

82.8

73.3

80.0

Metro (n=138)

82.4

85.5

96.4

37+ weeks (n=123)
Provider Type

82.4

86.2

97.6

Non-metro (n=0)

82.4

-

-

Footnotes

Public Sector Only (n=0) Private Sector Only (n=115) Both (n=0)
Payment at Birth,
Government Assist (n=37) Private Insurance (n=47) Other (n=7) Self Pay (n=17)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

84.3
-
83.8 95.7 85.7* 82.4

96.5
-
94.6 100 100* 94.1

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

72

District 3-5 Immunization Report, p5

more often UTD by 24 months than children whose birth was covered by government-assisted insurance (95.7% vs. 83.8%).
Children receiving immunizations from two providers were more often UTD by 24 months than those receiving immunizations from one provider (90.5% vs. 80.9%).
To varying degrees, demographic-related disparities resolved by the end of data collection (Table 3-5-F, column in italics).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 3-5 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of Hispanic mothers
Children of mothers without college education
Children born at a gestational age of less than 37 weeks
Children whose birth was covered by governmentassisted insurance
Children receiving immunizations from just one provider.

Table 3-5-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-5, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

72.3

72.8

78.7

77.8

88.0

3 Polio by 24 months

81.8

80.3

85.1

82.1

94.7

1 MMR by 24 months

81.8

82.3

86.0

84.6

94.7

UTD Hib by 24 months

82.3

81.5

85.1

82.1

93.3

3 Hepatitis B by 24 months

81.8

80.3

87.8

84.0

94.7

1 Varicella by 24 months

84.9

82.3

85.5

84.0

94.7

UTD PCV by 24 months

44.2

66.7

77.4

81.5

90.7

2 Rotavirus

-

-

-

-

76.0

1 Influenza by 24 months

-

-

-

-

64.0

2011
86.2 97.8 92.8 96.4 98.6 93.5 97.8 91.3 64.5

Immunization Rates by Antigen: In District 3-5, the UTD immunization rate by 24 months for most antigens remained steady from 2005 to 2008, but increased in 2010 and again for most antigens in 2011 (Table 3-5G).
Among District 3-5 antigen rates in 2011, the DTaP UTD immunization rate was lowest at 86.2%, down from 88.0% in 2010. The MMR UTD immunization rate was the second-lowest at 92.8%, down from 94.7% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 44.2% in 2005 to 97.8% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of district and countylevel immunization campaigns.

73

74

District 4-0
2011 Immunization Report

District 4-0 Data Collection Team

Amy Fenn, RN

District Immunization Coordinator

Darlene Sheets

Secondary Data Collector

County

Sample Metro

Butts

6 Metro

Carroll

35 Metro

Coweta

27 Nonmetro

Fayette

18 Nonmetro

Heard

1 Nonmetro

Henry

37 Nonmetro

Lamar

6 Nonmetro

Meriwether

4 Metro

Pike

4 Metro

Spalding

11 Nonmetro

Troup

16 Nonmetro

Upson

6 Nonmetro

District 4-0 171

District Response Rate 98.3%

State of Georgia 2,150

State Response Rate 91.4%

Carroll Heard

Coweta

Fayette

Henry

Spalding Butts

Troup

Meriwether

Pike Lamar

Upson

75

District 4-0
Immunization Report, p2

From 24 months to End of Data Collection: In the District 4-0 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (81.3% vs. 82.4%). By the end of data collection, the district UTD immunization rate remained lower than the state rate (89.5% vs. 94.0%) (Table 4-0-B).
From 2010 to 2011: The District 4-0 UTD immunization rate by 24 months increased by 8.0% from 2010 to 2011. The district UTD immunization rate by the end of data collection decreased by 1.4% from 2010 to 2011 (Figure 4 -0-C).
Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 4-0-B: Immunization Summary by Series & Antigen, District 4-0, 2011

District State

4-0 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection

81.3

82.4

89.5

94.0

4 DTaP by 24 months

84.2

85.8

3 DTaP by 24 months

97.7

97.5

3 IPV by 24 months

97.1

96.7

1 MMR by 24 months

92.4

93.0

Table 4-0-A: Sampling Scheme, District 4-0, 2011

District 4-0 (n)

State (n)

Original Sample

174 2,447

Ineligible

0

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

174 2,359

3

210

Final Sample

171 2,150

UTD Hib by 24 months

94.7

95.1

3 Hep B by 24 months

97.1

96.5

1 Varicella by 24 months

93.0

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months

96.5

96.7

79.5

83.8

53.8

53.1

57.9

60.1

2 H1N1

19.9

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

Response Rate (%)

98.3

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

100%

Figure 4-0-C: Immunization Rate History, District 4-0, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 4-0: UTD by 24 months Georgia: UTD by 24 months

2005

2006 2007 2008 2009* 2010 2011
District 4-0: UTD by end of data collection Georgia: UTD by end of data collection
* 2009 data was not collected due to personnel vacancy.

76

Table 4-0-D: Sample Population Demographics, District 4-0, 2011

District State Final 4-0 Final % Sample %

District 4-0 Final Sample (n=171)

-

-

Notable Demographic Findings: The proportion of

children whose mothers Hispanic was greater for the overall state sample

w(t5he6er.%e1dS%cioaslftmavrsFsips.ciilntf4eia2sela.d1m%ap)sl%e(wTSohtaafhimbtaInelpnei,ltef4inoa-orl0n--

D).

Maternal Race/Ethnicity,
White, NonHispanic (n=96) White, Hispanic (n=1) Black (n=51) Unspecified, Hispanic (n=8) Asian (n=3) Multiracial (n=4)
Maternal Education,
Some College+ (n=63) HS Diploma/GED (n=58) 9th-11th grade (n=35) <9th grade (n=6)
WIC

The district sample had a smaller proportion of

56.1

42.1

children whose mothers have some college education than the state sample (36.8% vs. 43.5%). In addition,

0.6

4.4

the district sample had a greater proportion of

29.8

33.0

children with mothers in the <25 years age group (50.9% vs. 38.6%).

4.7

7.2

Other demographic measures for this district were

1.8

2.9

similar to findings for the state sample as a whole.

2.3

4.6

Private Sector vs. Public Sector: Among

immunizations administered to children in District 4-0

36.8

43.5

(n=2,608), the majority were administered in the

private sector, with a proportion smaller than that of

33.9

28.4

the state sample (88.6% vs. 93.3%) (Figure 4-0-E).

20.5

17.2

Figure 4-0-E: Immunizations Administered in the

3.5

5.9

Private VS Public Sector, District 4-0, 2011

(n=2,608)

Non-WIC (n=94)

55.0

57.3

WIC (n=77)
Metro Residence

45.0

42.7

11.4%

Metro (n=149) Non-metro (n=22)
Maternal Marital Status

87.1

79.9

12.9

20.1

88.6%

Married (n=81)

47.4

52.1

Unmarried (n=90)
Repeat Birth
First Child (n=67) Repeat Birth (n=104)
Gestational Age

52.6

47.7

39.2

40.9

60.8

59.1

Public Sector

Private Sector
District State Final 4-0 Final % Sample %

Child's Gender

<37 weeks (n=9) 37+ weeks (n=162)
Provider Type

5.3

10.0

Male (n=90)

52.6

50.7

94.7

90.0

Female (n=81)

47.4

49.3

Number of Providers

Public Sector Only (n=5)

2.9

1.2

1 (n=88)

51.5

49.9

Private Sector Only (n=133)

77.8

80.8

2 (n=42)

24.6

22.1

Both (n=24)
Payment at Birth

14.0

10.9

3+ (n=14)

Maternal Age

8.2

6.6

Government Assist (n=76) Private Insurance (n=55)

44.4

43.4

<25 years (n=87)

32.2

29.1

25-29 years (n=39)

50.9

38.6

22.8

29.2

Other (n=13)

7.6

4.4

30+ years (n=45)

26.3

32.2

Self Pay (n=7)

4.1

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

77

District 4-0 Immunization Report, p4

Table 4-0-F: UTD Immunization Rates by demographic group, District 4-0, 2011

State Avg. UTD by 24
months (%)

4-0--UTD by 24 months (%)

4-0--UTD by end of
d.c. (%)

UTD Immunization Rates by Demographic Group: The UTD by 24 months immunization rates for children of white, non-Hispanic mothers and children of black mothers were similar to the state average. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 4-0-F).

District 4-0 Sample (n=171)

82.7

81.3

Maternal Race/Ethnicity,

White, NonHispanic (n=96)

83.2

82.3

White, Hispanic (n=1)

82.0

100*

Black (n=51)

80.7

82.4

Unspecified, Hispanic (n=8)

87.7

100*

Asian (n=3)

87.3

66.7*

Multiracial (n=4)
Maternal Education,

77.6

25.0*

Some College+ (n=63)

84.5

81.0

HS Diploma/GED (n=58)

81.7

86.2

9th-11th grade (n=35)

78.6

68.6

<9th grade (n=6)
WIC

80.2

100*

Non-WIC (n=94)

81.5

78.7

WIC (n=77)

83.7

84.4

Maternal Age

<25 years (n=87)

79.8

83.9

25-29 years (n=39)

84.1

76.9

30+ years (n=45)

84.1

80.0

Maternal Marital Status & Repeat Birth Combination

Married, First Birth (n=22)

88.8

86.4

Unmarried, First Birth (n=45)

85.6

88.9

Married, Repeat Birth (n=59)

82.4

81.4

Unmarried, Repeat Birth (n=45)
Gestational Age

74.8

71.1

89.5
90.6 100* 92.2 100* 66.7* 75.0*
85.7 95.6 85.7 100*
86.2 93.5
92.0 79.5 93.3
90.9 88.9 86.4 93.3

In terms of maternal education, children of mothers with a high school diploma or GED and no college education were the most often UTD by 24 months among the maternal education groups (86.2%).
In District 4-0, the children enrolled in WIC had a higher UTD immunization rate than those not enrolled in WIC (84.4% vs. 78.7%); this disparity was greater than what was seen for the state sample as a whole (83.7% vs. 81.5%).
In terms of maternal age, children of mothers in the 25-29 years age group were least often UTD by 24 months of age (76.9%). In terms of maternal marital status and the repeat birth variable, children of mothers with previous children were less often UTD by 24 months than first-born children (see Table 4-0F).
Children receiving immunizations from both public and private providers were the less often UTD by 24

State Avg. UTD by 24
months (%)

4-0--UTD by 24 months (%)

Number of Providers

1 (n=88)

84.4

84.1

2 (n=42)

78.2

83.3

3+ (n=14)

83.0

85.7

Child's Gender

Male (n=90)

83.3

85.6

Female (n=81)

81.5

Metro Residence

76.5

4-0--UTD by end of
d.c. (%)
90.9 88.1 85.7
93.3 85.2

<37 weeks (n=9) 37+ weeks (n=162)
Provider Type

82.8

77.8*

88.9*

Metro (n=149)

82.4

78.5

87.9

82.4

81.5

89.5

Non-metro (n=22)

82.4

100

100

Footnotes

Public Sector Only (n=5) Private Sector Only (n=133) Both (n=24)
Payment at Birth,
Government Assist (n=76) Private Insurance (n=55) Other (n=13) Self Pay (n=7)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

80.0* 84.2 75.0
79.0 81.8 69.2 100*

80.0* 91.7 79.2
92.1 90.9 69.2 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

78

District 4-0 Immunization Report, p5

months than those receiving immunizations exclusively in the private sector (75.0% vs. 84.2%).
Interestingly, male children were more often UTD by 24 months than female children (85.6% vs. 76.5%). In addition, children living in metro counties were less often UTD by 24 months than those living in non-metro counties (78.5% vs. 100%).
Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 4-0-F, column in italics).
For example, children of mothers with a high school diploma or GED and no college education remained the most often UTD by 24 months among the maternal education groups (95.6%). In addition, children enrolled in WIC remained more often UTD by the end of the data collection period than those not enrolled in WIC (93.5% vs. 86.2%).
Children of mothers in the 25-29 years age group remained the least often UTD by 24 months of age (79.5%).
Additionally, male children remained more often UTD than female children (93.3% vs. 85.2%). Children residing in metro counties remained less often UTD than children living in non-metro counties (87.9% vs. 100%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 4-0 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children whose mothers have some college education
Children whose mothers do not have a high school diploma or GED
Children not enrolled in WIC
Children of mothers 25-29 years of age
Children of mothers with previous children
Children receiving immunizations in both the private and public sectors
Female children
Children living in metro counties (see page 1 of District 4-0 Immunization Report)

Table 4-0-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 4-0, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

82.1

71.7

78.2

74.6

88.5

3 Polio by 24 months

84.8

88.0

92.4

85.4

96.6

1 MMR by 24 months

87.1

80.4

84.0

86.0

87.9

UTD Hib by 24 months

88.8

83.7

88.4

81.6

87.9

3 Hepatitis B by 24 months

88.4

89.1

91.6

86.5

97.1

1 Varicella by 24 months

87.5

82.1

85.8

84.3

89.7

UTD PCV by 24 months

33.9

66.3

80.0

81.1

89.7

2 Rotavirus

-

-

-

-

69.5

1 Influenza by 24 months

-

-

-

-

56.9

2011
84.2 97.1 92.4 94.7 97.1 93.0 96.5 79.5 57.9

Immunization Rates by Antigen: In District 4-0, the UTD immunization rate by 24 months for most antigens remained steady from 2005 to 2008, but increased in 2010 and again for most antigens in 2011 (Table 4-0G).
Among District 4-0 antigen rates in 2011, the DTaP immunization rate was lowest at 84.2%, down from 88.5% in 2010. The MMR UTD immunization rate was the second-lowest at 92.4%, up from 87.9% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 33.9% in 2005 to 96.5% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of district and countylevel immunization campaigns.

79

80

District 5-1
2011 Immunization Report

District 5-1 Data Collection Team

Kelly Knight, RN

District Immunization Coordinator

Additional Data Collection Staff

Brenda Clarke, RN

Kitty Coleman

Daphenia Harmon

Mary Powell, RN

Debbie Martin, RNC

Suzanne Usher, RN

Joni R. Wilson, RN

Terri Griffin, RN

Mable Harden, RN

Montgomery

County

Sample Metro

Bleckley

4 Nonmetro

Dodge

9 Nonmetro

Johnson

4 Nonmetro

Laurens

14 Nonmetro

Montgomery

2 Nonmetro

Pulaski

4 Nonmetro

Telfair

4 Nonmetro

Treutlen

1 Nonmetro

Wheeler

2 Nonmetro

Wilcox

6 Nonmetro

District 5-1 50

District Response Rate 96.2%

State of Georgia 2,150

State Response Rate 91.4%

Johnson

Bleckley

Laurens

Treutlen

Pulaski

Dodge

Wheeler

Wilcox

Telfair

81

District 5-1
Immunization Report, p2

From 24 months to End of Data Collection: In the District 5-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (80.0% vs. 82.4%). By the end of data collection, the district UTD immunization rate was equal to the state rate (94.0%) (Table 5-1-B).
From 2010 to 2011: The District 5-1 UTD immunization rate by 24 months increased by 5.1% from 2010 to 2011. The district UTD immunization rate by the end of data collection decreased by 3.1% from 2010 to 2011 (Figure 5-1-C).
Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 5-1-A: Sampling Scheme, District 5-1, 2011

District 5-1 (n)

State (n)

Original Sample

53

2,447

Ineligible

1

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

52

2,359

2

210

Final Sample

50

2,150

Response Rate (%)

96.2

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 5-1-B: Immunization Summary by Series & Antigen, District 5-1, 2011

District State

5-1 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

80.0

82.4

94.0

94.0

80.0

85.8

96.0

97.5

3 IPV by 24 months

94.0

96.7

1 MMR by 24 months

94.0

93.0

UTD Hib by 24 months

90.0

95.1

3 Hep B by 24 months

98.0

96.5

1 Varicella by 24 months

96.0

93.9

UTD PCV by 24 months

96.0

96.7

2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

66.0

83.8

62.0

53.1

44.0

60.1

8.0

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 5-1-C: Immunization Rate History, District 5-1, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 5-1: UTD by 24 months
Georgia: UTD by 24 months

2005
82

2006 2007 2008 2009* 2010 2011
District 5-1: UTD by end of data collection Georgia: UTD by end of data collection
* 2009 data was not collected due to personnel vacancy.

Table 5-1-D: Sample Population Demographics, District 5-1, 2011

District State Final 5-1 Final % Sample %

District 5-1 Final Sample (n=50)

-

-

Notable Demographic Findings: AThe proportion of cnthhoainlnd-Hrfeiosnrpatwhnheiocosweveamrsaogltlrheseatartseterwfseoarrmetpch%lleeasod(s5iisf6ti.er0idc%tav%sssaSw.omaf4hmp2Iintlp.eei1lt,e%ia)l (Table 5-1-D).

Maternal Race/Ethnicity,
White, NonHispanic (n=28) White, Hispanic (n=0) Black (n=21) Unspecified, Hispanic (n=0) Asian (n=0) Multiracial (n=0)
Maternal Education,
Some College+ (n=16) HS Diploma/GED (n=23) 9th-11th grade (n=9) <9th grade (n=0)
WIC

The district sample had a smaller proportion of

56.0

42.1

children whose mothers had some college education

than the overall state sample (32.0% vs. 43.5%). In

0

4.4

addition, the district sample had a larger proportion

42.0

33.0

of children with mothers in the <25 years age group

(48.0% vs. 38.6%).

0

7.2

0

2.9

Other demographic measures for this district were

similar to findings for the state sample as a whole.

0

4.6

Private Sector vs. Public Sector: Among

immunizations administered to children in District

32.0

43.5

5-1 (n=808), the majority were administered in the

46.0

28.4

private sector, with a proportion smaller than for

the state sample (83.7% vs. 93.3%) (Figure 5-1-E).

18.0

17.2

Figure 5-1-E: Immunizations Administered

0

5.9

in Private VS Public Sector, District 5-1, 2011

(n=808)

Non-WIC (n=29) WIC (n=21)

58.0

57.3

42.0

42.7

16.3%

Metro Residence

Metro (n=0) Non-metro (n=50)
Maternal Marital Status

0

79.9

100

20.1

83.7%

Married (n=21)

42.0

52.1

Unmarried (n=28)
Repeat Birth
First Child (n=17) Repeat Birth (n=33)
Gestational Age

56.0

47.7

34.0

40.9

66.0

59.1

Public Sector

Private Sector
District State Final 5-1 Final % Sample %

Child's Gender

<37 weeks (n=6) 37+ weeks (n=44)
Provider Type

12.0

10.0

Male (n=21)

42.0

50.7

88.0

90.0

Female (n=29)

58.0

49.3

Number of Providers

Public Sector Only (n=1)

2.0

1.2

1 (n=23)

46.0

49.9

Private Sector Only (n=34)

68.0

80.8

2 (n=19)

38.0

22.1

Both (n=15)
Payment at Birth

30.0

10.9

3+ (n=1)

Maternal Age

2.0

6.6

Government Assist (n=38) Private Insurance (n=9)

76.0

43.4

<25 years (n=24)

18.0

29.1

25-29 years (n=14)

48.0

38.6

28.0

29.2

Other (n=3)

6.0

4.4

30+ years (n=12)

24.0

32.2

Self Pay (n=0)

0

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

83

District 5-1 Immunization Report, p4

Table 5-1-F: UTD Immunization Rates by demographic group, District 5-1, 2011

State Avg. UTD by 24
months (%)

5-1--UTD by 24 months (%)

5-1--UTD by end of
d.c. (%)

District 5-1 Sample (n=50)

82.7

80.0

94.0

Maternal Race/Ethnicity,

White, NonHispanic (n=28)

83.2

78.6

92.9

UTD Immunization Rates by Demographic Group: The UTD by 24 months immunization rates for children of white, non-Hispanic mothers and children of black mothers were similar to the state average (Table 5-1-F).
In terms of maternal education, children of mothers with a high school diploma/GED were the least often UTD by 24 months (70.0%); in addition, children of mothers with some college education were the most often UTD by 24 months (87.5%).

White, Hispanic (n=0) Black (n=21) Unspecified, Hispanic (n=0) Asian (n=0) Multiracial (n=0)
Maternal Education,
Some College+ (n=16) HS Diploma/GED (n=23) 9th-11th grade (n=9) <9th grade (n=0)
WIC

82.0

-

-

In terms of maternal age, children of mothers in the

80.7

81.0

95.2 25 to 29 year age group were the least often UTD by

87.7

-

-

24 months (64.3%) among the maternal age groups. In terms of maternal marital status and the repeat

87.3

-

-

birth variable, children of unmarried mothers with

77.6

-

-

previous children were the least often UTD by 24 months (68.8%).

84.5

87.5

93.8

Children receiving immunizations from both public and private providers were the least often UTD by 24

81.7

73.9

91.3 months (60.0%). In addition, the district data

78.6

77.8

100*

support the importance of a medical home; children who had one provider (Number of Providers) were

80.2

-

-

more often UTD by 24 months than those who had

two providers (87.0% vs. 68.4%).

Non-WIC (n=29)

81.5

79.3

WIC (n=21)

83.7

81.0

Maternal Age

<25 years (n=24)

79.8

87.5

25-29 years (n=14)

84.1

64.3

30+ years (n=12)

84.1

83.3

Maternal Marital Status & Repeat Birth Combination

Married, First Birth (n=5)

88.8

80.0*

Unmarried, First Birth (n=12)

85.6

91.7

Married, Repeat Birth (n=16)

82.4

81.3

Unmarried, Repeat Birth (n=16)
Gestational Age

74.8

68.8

89.7

100

State Avg. 5-1--UTD 5-1--UTD

UTD by 24 by 24 by end of

months months

d.c.

95.8

(%)

(%)

(%)

92.9 Number of Providers

91.7

1 (n=23)

84.4

87.0

95.7

2 (n=19)

78.2

68.4

89.5

100*

3+ (n=1)

83.0

100*

100*

100

Child's Gender

87.5

Male (n=21)

83.3

85.7

100

93.8

Female (n=29)

81.5

75.9

89.7

Metro Residence

<37 weeks (n=6) 37+ weeks (n=44)
Provider Type

82.8

100*

100*

Metro (n=0)

82.4

-

-

82.4

77.3

93.2

Non-metro (n=50)

82.4

80.0

94.0

Footnotes

Public Sector Only (n=1) Private Sector Only (n=34) Both (n=15)
Payment at Birth,
Government Assist (n=38) Private Insurance (n=9) Other (n=3) Self Pay (n=0)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

100* 88.2 60.0
79.0 88.9* 66.7*
-

100* 94.1 93.3
94.7 88.9* 100*
-

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

84

District 5-1 Immunization Report, p5

Interestingly, male children were more often UTD by 24 months than female children (85.7% vs. 75.9%).
Although many demographic-related disparities resolved by the end of data collection, some still remained and a new one emerged (Table 5-1-F, column in italics).
For example, a disparity in UTD immunization rates appeared by the end of the data collection period for the WIC variable; children enrolled in WIC were more often UTD by the end of data collection than those not enrolled in WIC (100% vs. 89.7%).
In addition, children with one provider remained more often UTD than children with two providers (95.7% vs. 89.5%).
Male children also remained more often UTD by the end of the data collection period than female children (100% vs. 89.7%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 5-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of mothers without some college education
Children not enrolled in WIC
Children of mothers in the 25-29 years age group
Children of unmarried mothers with previous children
Children with more than one provider administering immunizations
Female children

Table 5-1-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 5-1, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

85.3

81.3

74.2

78.7

85.1

3 Polio by 24 months

94.7

91.7

95.5

93.4

95.5

1 MMR by 24 months

90.7

97.9

84.9

90.2

92.5

UTD Hib by 24 months

93.3

89.6

86.4

86.9

89.6

3 Hepatitis B by 24 months

93.3

97.9

92.4

98.4

98.5

1 Varicella by 24 months

85.3

89.6

86.4

90.2

94.0

UTD PCV by 24 months

40.0

85.4

74.2

86.9

95.5

2 Rotavirus

-

-

-

-

50.7

1 Influenza by 24 months

-

-

-

-

46.3

2011
80.0 94.0 94.0 90.0 98.0 96.0 96.0 66.0 44.0

Immunization Rates by Antigen: In District 5-1, the the UTD immunization rate by 24 months for most antigens fluctuated from 2005 to 2011 (Table 5-1-G).
Among antigen rates in 2011, the DTaP UTD immunization rate was the lowest at 80.0%, down from 85.1% in 2010. The UTD Hib immunization rate was second-lowest at 90.0%, similar to 89.6% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 40.0% in 2005 to 96.0% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP and Hib vaccines could reasonably be the primary focus of district and countylevel immunization campaigns.

85

86

District 5-2
2011 Immunization Report

District 5-2 Data Collection Team

Sherry Cook, RN

District Immunization Coordinator

Additional Data Collection Staff

Janet Willis, RN

Amy Sims

Patsy Pollett, RN

Patty Cole, RN

Peggy Pettit, RN

Deryl Scarboro, RN

Shirley Tucker, RN

Chris Sikes, RN

April Tolbert, RN

Rhonda Howell, RN

Linda Harrell

Patricia Cordett, RN, BSN

Bertha Ashley, RN

County

Sample Metro

Baldwin

4 Nonmetro

Bibb

35 Metro

Crawford

5 Metro

Hancock

0 Nonmetro

Houston

27 Metro

Jasper

5 Metro

Jones

5 Metro

Monroe

1 Metro

Peach

4 Nonmetro

Putnam

3 Nonmetro

Twiggs

0 Metro

Washington

5 Nonmetro

Wilkinson

3 Nonmetro

District 5-2 97

District Response Rate 89.2%

State of Georgia 2,150

State Response Rate 91.4%

Jasper Putnam

Hancock

Monroe

Baldwin Jones

Washington

Bibb Crawford

Wilkinson Twiggs

Peach

Houston

87

District 5-2
Immunization Report, p2

From 24 months to End of Data Collection: In the District 5-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (83.5% vs. 82.4%). By the end of data collection, the district UTD immunization rate was higher than the state rate (99.0% vs. 94.0%) (Table 5-2-B).
From 2010 to 2011: The District 5-2 UTD immunization rate by 24 months increased by 11.0% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 2.1% from 2010 to 2011 (Figure 5-2-C).

Table 5-2-B: Immunization Summary by Series & Antigen, District 5-2--2011

District State

5-2 Average

(%)

(%)

UTD immunization rate*
by 24 months

83.5

82.4

UTD immunization rate*
by end of data collection

99.0

94.0

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 5-2-A: Sampling Scheme, District 5-2, 2011

District 5-2 (n)

State (n)

Original Sample

110 2,447

Ineligible

3

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

107 2,359

12

210

Final Sample

97

2,150

Response Rate (%)

89.2

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

4 DTaP by 24 months 3 DTaP by 24 months

87.6

85.8

99.0

97.5

3 IPV by 24 months

96.9

96.7

1 MMR by 24 months

96.9

93.0

UTD Hib by 24 months

94.9

95.1

3 Hep B by 24 months

97.9

96.5

1 Varicella by 24 months

96.9

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

97.9

96.7

68.0

83.8

55.7

53.1

53.6

60.1

24.7

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 5-2-C: Immunization Rate History, District 5-2, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 5-2: UTD by 24 months
Georgia: UTD by 24 months

2005

2006 2007 2008 2009* 2010 2011
District 5-2: UTD by end of data collection
Georgia: UTD by end of data collection

* 2009 data was not collected due to personnel vacancy. 88

Table 5-2-D: Sample Population Demographics, District 5-2, 2011 Notable Demographic Findings: The proportion of

District 5-2 Final Sample (n=97)

District 5-2 Final %
-

State Final Sample %
-

children whose greater for the

mothers wer%e oclfaFssinifaield district sampleSatmhapnlefor

tahs%ebSoolafavmcIenpkrialtweilalals

state sample (42.3% vs. 33.0%) (Table 5-2-D).

Maternal Race/Ethnicity,
White, NonHispanic (n=49) White, Hispanic (n=1) Black (n=41)

A larger proportion of children in the district sample

were repeat births than for the state sample as a

50.5

42.1

whole (66.0% vs. 59.1%). In addition, the district

1.0

4.4

sample had a greater proportion of children seen by only one provider (54.6% vs. 49.9%).

42.3

33.0

Unspecified, Hispanic (n=0) Asian (n=2)

0

7.2

Other demographic measures for this district were similar to findings for the state sample as a whole.

2.1

2.9

Multiracial (n=1)
Maternal Education,
Some College+ (n=45) HS Diploma/GED (n=27)

1.0

4.6

Private Sector vs. Public Sector: Among immunizations administered to children in District

5-2 (n=1,229), the majority were administered in

46.4

43.5

the private sector, with a proportion similar to that of the state sample (89.2% vs. 93.3%) (Figure 5-2-E).

27.8

28.4

9th-11th grade (n=20) <9th grade (n=3)
WIC
Non-WIC (n=55) WIC (n=42)
Metro Residence
Metro (n=78) Non-metro (n=19)
Maternal Marital Status

20.6

17.2

Figure 5-2-E: Immunizations Administered

3.1

5.9

in Private VS Public Sector, District 5-2, 2011

(n=1,229)

56.7

57.3

43.3

42.7

10.8%

80.4

79.9

19.6

20.1

89.2%

Married (n=50)

51.6

52.1

Unmarried (n=46)
Repeat Birth
First Child (n=33) Repeat Birth (n=64)
Gestational Age

47.4

47.7

34.0

40.9

66.0

59.1

Public Sector

Private Sector
District State Final 5-2 Final % Sample %

Child's Gender

<37 weeks (n=9) 37+ weeks (n=88)
Provider Type

9.3

10.0

Male (n=50)

51.6

50.7

90.7

90.0

Female (n=47)

48.4

49.3

Number of Providers

Public Sector Only (n=2)

2.1

1.2

1 (n=53)

54.6

49.9

Private Sector Only (n=74)

76.3

80.8

2 (n=15)

15.5

22.1

Both (n=13)
Payment at Birth

13.4

10.9

3+ (n=3)

Maternal Age

3.1

6.6

Government Assist (n=53) Private Insurance (n=40)

54.6

43.4

<25 years (n=38)

41.2

29.1

25-29 years (n=33)

39.2

38.6

34.0

29.2

Other (n=1)

1.0

4.4

30+ years (n=26)

26.8

32.2

Self Pay (n=1)

1.0

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

89

District 5-2 Immunization Report, p4

Table 5-2-F: UTD Immunization Rates by demographic group, District 5-2, 2011

State Avg. UTD by 24
months (%)

5-2--UTD by 24 months (%)

5-2--UTD by end of
d.c. (%)

District 5-2 Sample (n=97)

82.7

83.5

99.0

Maternal Race/Ethnicity,

White, NonHispanic (n=49)

83.2

87.8

100

White, Hispanic (n=1)

82.0

100*

100*

Black (n=41)

80.7

75.6

97.6

Unspecified, Hispanic (n=0)

87.7

-

-

UTD Immunization Rates by Demographic Group: Children of black mothers were less often UTD when compared to the district sample as a whole (75.6% vs. 83.5%). The UTD by 24 months immunization rates for children of white, nonHispanic mothers were similar to the state average. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 5-2-F).
In terms of maternal education, children of mothers with a high school diploma or GED and no college education were the least often UTD by 24 months among the maternal education groups (70.4%).

Asian (n=2) Multiracial (n=1)
Maternal Education,
Some College+ (n=45) HS Diploma/GED (n=27) 9th-11th grade (n=20) <9th grade (n=3)
WIC
Non-WIC (n=55)

87.3

100*

100*

In terms of maternal marital status and the repeat

77.6

100*

100*

birth variable, children of married mothers without previous children were the least often UTD by 24

months, while children of unmarried mothers

without previous children were the most often UTD

84.5

88.9

100

(see Table 5-2-F).

81.7

70.4

100

78.6

90.0

95.0

Children receiving immunizations from both public and private providers were the least often UTD by

80.2

66.7*

100*

24 months (52.8%). In addition, the district data

support the importance of a medical home;

children who had one provider (Number of

81.5

83.6

98.2

Providers) were more often UTD by 24 months than

WIC (n=42)

83.7

83.3

Maternal Age

<25 years (n=38)

79.8

79.0

25-29 years (n=33)

84.1

84.9

30+ years (n=26)

84.1

88.5

Maternal Marital Status & Repeat Birth Combination

Married, First Birth (n=13)

88.8

76.9

Unmarried, First Birth (n=20)

85.6

90.0

Married, Repeat Birth (n=37)

82.4

81.1

Unmarried, Repeat Birth (n=26)
Gestational Age

74.8

84.6

100

State Avg. 5-2--UTD 5-2--UTD

UTD by 24 by 24 by end of

months months

d.c.

97.4

(%)

(%)

(%)

100

Number of Providers

100

1 (n=53)

84.4

86.8

100

2 (n=15)

78.2

53.3

100

100

3+ (n=3)

83.0

66.7*

66.7*

100

Child's Gender

100

Male (n=50)

83.3

80.0

100

96.2

Female (n=47)

81.5

87.2

97.9

Metro Residence

<37 weeks (n=9) 37+ weeks (n=88)
Provider Type

82.8

77.8*

88.9*

Metro (n=78)

82.4

84.6

98.7

82.4

84.1

100

Non-metro (n=19)

82.4

79.0

100

Footnotes

Public Sector Only (n=2) Private Sector Only (n=74) Both (n=13)
Payment at Birth,
Government Assist (n=53) Private Insurance (n=40) Other (n=1) Self Pay (n=1)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

100* 86.5 53.8
83.0 85.0 100* 100*

100* 100 92.3
98.1 100 100* 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

90

District 5-2 Immunization Report, p5

those with two providers (86.8% vs. 53.3%).
To varying degrees, demographic-related disparities resolved by the end of data collection (Table 5-2-F, column in italics).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 5-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of black mothers
Children of mothers with a high school diploma or GED, but no college education
Children of married mothers without previous children
Children receiving immunizations in both the private and public sectors
Children receiving immunizations from more than one provider

Table 5-2-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 5-2, 2005-2011

4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months

2005
84.2 92.1 91.4 89.2 90.7 92.1 43.2
-

2006
86.3 95.4 93.1 92.4 93.9 93.9 75.6
-

2007
76.9 91.0 84.6 82.1 88.5 84.6 78.2
-

2008
81.3 88.8 89.6 85.8 91.0 88.1 85.1
-

2010
81.2 95.5 93.2 90.2 97.0 95.5 90.2 65.4 49.6

2011
87.6 96.9 96.9 94.9 97.9 96.9 97.9 68.0 53.6

Immunization Rates by Antigen: In District 5-2, the UTD immunization rate by 24 months for most antigens fluctuated from 2005 to 2010, increasing to higher rates for all antigens in 2011 (Table 5-2-G).
Among antigen rates in 2011, the DTaP UTD immunization rate was the lowest at 87.6%, up from 81.2% in 2010. The Hib UTD immunization rate was second-lowest at 94.9%, up from 90.2% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 43.2% in 2005 to 97.9% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP vaccine could reasonably be the primary focus of district and county-level immunization campaigns.

91

92

District 6-0
2011 Immunization Report

District 6-0 Data Collection Team

Susan Edmunds, RN District Immunization Coordinator

Clois Witt, RN

Primary Data Collector

County

Sample Metro

Burke

7 Metro

Columbia

11 Metro

Emanuel

9 Nonmetro

Glascock

0 Nonmetro

Jefferson

4 Nonmetro

Jenkins

1 Nonmetro

Lincoln

3 Nonmetro

McDuffie

5 Metro

Richmond

41 Metro

Screven

1 Nonmetro

Taliaferro

0 Nonmetro

Warren

2 Nonmetro

Wilkes

1 Nonmetro

District 6-0 85

6-0 Response Rate 100%

State of Georgia 2,150

State Response Rate 91.4%

Wilkes

Lincoln

Taliaferro

Columbia

McDuffie
Warren

Richmond

Glascock

Jefferson

Burke

Jenkins Emanuel

Screven

93

District 6-0
Immunization Report, p2

From 24 months to End of Data Collection: In the District 6-0 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (78.8% vs. 82.4%). By the end of data collection, the district UTD immunization rate was higher than the state rate (98.8% vs. 94.0%) (Table 6-0-B).
From 2010 to 2011: The District 6-0 UTD immunization rate by 24 months increased by 4.2% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 3.3% from 2010 to 2011 (Figure 60-C).
Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 6-0-A: Sampling Scheme, District 6-0, 2011

District 6-0 (n)

State (n)

Original Sample

89

2,447

Ineligible

4

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

85

2,359

0

210

Final Sample

85

2,150

Response Rate (%)

100

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 6-0-B: Immunization Summary by Series & Antigen, District 6-0, 2011

District State

6-0 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

78.8

82.4

98.8

94.0

80.0

85.8

98.8

97.5

3 IPV by 24 months

97.7

96.7

1 MMR by 24 months UTD Hib by 24 months

91.8

93.0

95.3

95.1

3 Hep B by 24 months

98.8

96.5

1 Varicella by 24 months

94.1

93.9

UTD PCV by 24 months

98.8

96.7

2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

75.3

83.8

52.9

53.1

61.2

60.1

16.5

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 6-0-C: Immunization Rate History, District 6-0, 2000-2011

90%

80%

70%

60%

50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011

District 6-0: UTD by 24 months Georgia: UTD by 24 months

District 6-0: UTD by end of data collection Georgia: UTD by end of data collection
* 2009 data was not collected due to personnel vacancy.
94

Table 6-0-D: Sample Population Demographics, District 6-0, 2011
District State Final 6-0 Final % Sample %

Notable Demographic Findings: The proportion of cmsthauiltcdehreshanimgwhpehlreosf(eo6r2mt.4ho%ethdvesirs.st3rwi3ce.t0r%et%Sh)ocaa(lfmnaTFsapfsioblniefrlaieetlhd6e-a0osS-%Dvibneo)al.rfaDmaciIlpnskltilterwiiacatls

District 6-0 Final Sample (n=85) Maternal Race/Ethnicity,
White, NonHispanic (n=24) White, Hispanic (n=1) Black (n=53) Unspecified, Hispanic (n=2) Asian (n=2) Multiracial (n=2)
Maternal Education,
Some College+ (n=30) HS Diploma/GED (n=32)

-

-

In addition, the district sample had a smaller

proportion of children whose mothers were married

than the state sample (29.4% vs. 52.1%) as well as a

28.2

42.1

smaller proportion of children whose mothers were

1.2

4.4

in the 30+ years age group than the state sample (22.3% vs. 32.2%).

62.4

33.0

2.4

7.2

Other demographic measures for this district were similar to findings for the state sample as a whole.

2.4

2.9

2.4

4.6

Private Sector vs. Public Sector: Among immunizations administered to children in District 6

-0 (n=1,426), the majority were administered in the

35.3

43.5

private sector, with a proportion similar to that of the state sample (91.2% vs. 93.3%) (Figure 6-0-E).

37.7

28.4

9th-11th grade (n=17) <9th grade (n=4)
WIC
Non-WIC (n=47)

20.0

17.2

Figure 6-0-E: Immunizations Administered

4.7

5.9

in Private VS Public Sector, District 6-0, 2011 (n=1,426)

55.3

57.3

8.8%

WIC (n=38)

44.7

42.7

Metro Residence
Metro (n=64) Non-metro (n=21)
Maternal Marital Status

75.3

79.9

24.7

20.1

91.2%

Married (n=25)

29.4

52.1

Unmarried (n=60)

70.6

47.7

Repeat Birth
First Child (n=28) Repeat Birth (n=57)
Gestational Age

32.9

40.9

67.1

59.1

Public Sector

Private Sector
District State Final 6-0 Final % Sample %

Child's Gender

<37 weeks (n=12)

14.1

10.0

Male (n=41)

48.2

50.7

37+ weeks (n=73)

85.9

90.0

Female (n=44)

51.8

49.3

Provider Type

Number of Providers

Public Sector Only (n=0)

0

1.2

1 (n=59)

69.4

49.9

Private Sector Only (n=71)

83.5

80.8

2 (n=17)

20.0

22.1

Both (n=12)

14.1

10.9

3+ (n=1)

1.2

6.6

Payment at Birth

Maternal Age

Government Assist (n=72)

84.7

43.4

<25 years (n=39)

45.9

38.6

Private Insurance (n=10)

11.8

29.1

25-29 years (n=27)

31.8

29.2

Other (n=1)

1.2

4.4

30+ years (n=19)

22.3

32.2

Self Pay (n=0)

0

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

95

District 6-0 Immunization Report, p4

Table 6-0-F: UTD Immunization Rates by demographic group, District 6-0, 2011

State Avg. 6-0--UTD

UTD by 24 by 24

months months

(%)

(%)

6-0--UTD by end of
d.c. (%)

UTD Immunization Rates by Demographic Group: Children of black mothers were less often UTD by 24 months than children of white, non-Hispanic mothers (77.4% vs. 83.3%). The other race/ ethnicity group sample sizes were too small to draw any definite conclusions (Table 6-0-F).

District 6-0 Sample (n=85) Maternal Race/Ethnicity,
White, NonHispanic (n=24)

82.7

78.8

83.2

83.3

98.8 In terms of maternal education, children of mothers

with a high school diploma/GED were the most

often UTD by 24 months among the maternal

100

education groups (84.4%).

White, Hispanic (n=1) Black (n=53) Unspecified, Hispanic (n=2) Asian (n=2) Multiracial (n=2)
Maternal Education,
Some College+ (n=30) HS Diploma/GED (n=27) 9th-11th grade (n=17)

82.0

100*

80.7

77.4

87.7

100*

87.3

100*

77.6

100*

84.5

76.7

81.7

84.4

78.6

70.6

100*

In terms of maternal age, higher maternal age was

98.1 associated with higher UTD immunization rates by

100*

24 months of age (see Table 6-0-F). In terms of the maternal marital status and repeat birth variables,

100* children of married mothers were more often UTD

100*

by 24 months than children of unmarried mothers among the four groups (see Table 6-0-F).

96.7

Children born at a gestational age of less than 37 weeks were less often UTD by 24 months than those

100

born at a gestational age of more than 37 weeks

100

(66.7% vs. 80.8%).

<9th grade (n=4)
WIC
Non-WIC (n=47)

80.2

75.0*

100*

Additionally, children residing in non-metro counties

were more often UTD by 24 months than those

81.5

78.7

100

residing in metro counties (90.5% vs. 75.0%).

WIC (n=38)
Maternal Age
<25 years (n=39) 25-29 years (n=27)

83.7

79.0

79.8

71.8

84.1

74.1

97.4

State Avg. 6-0--UTD 6-0--UTD

UTD by 24 by 24 by end of

months months

d.c.

100

(%)

(%)

(%)

96.3

Number of Providers

30+ years (n=19)

84.1

100

Maternal Marital Status & Repeat Birth Combination

100

1 (n=59)

2 (n=17)

84.4

78.0

100

78.2

76.5

100

Married, First Birth (n=7)

88.8

100*

100*

3+ (n=1)

83.0

100*

100*

Unmarried, First Birth (n=21)

85.6

81.0

100

Child's Gender

Married, Repeat Birth (n=18)

82.4

94.4

100

Male (n=41)

83.3

78.1

97.6

Unmarried, Repeat Birth (n=39)
Gestational Age

74.8

66.7

97.4

Female (n=44)

81.5

79.6

100

Metro Residence

<37 weeks (n=12)

82.8

66.7

100

Metro (n=64)

82.4

75.0

98.4

37+ weeks (n=73)
Provider Type

82.4

80.8

98.6

Non-metro (n=21)

82.4

90.5

100

Footnotes

Public Sector Only (n=0) Private Sector Only (n=71) Both (n=12)
Payment at Birth,
Government Assist (n=72) Private Insurance (n=10) Other (n=1) Self Pay (n=0)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

74.6 100
77.8 80.0 100*
-

98.6 100
98.6 100 100*
-

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

96

District 6-0 Immunization Report, p5

To varying degrees, demographic-related disparities resolved by the end of data collection (Table 6-0-F, column in italics).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 6-0 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of black mothers Children of mothers without a high school diploma or
GED
Children with mothers under 30 years of age
Children of unmarried mothers
Children who were born at a gestational age of less than 37 weeks
Children residing in metro counties (see page 1 of District 6-0 Immunization Report)

Table 6-0-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 6-0, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

84.4

89.2

89.4

84.4

80.0

3 Polio by 24 months

95.7

98.7

97.9

100

95.6

1 MMR by 24 months

90.4

93.2

95.7

95.6

93.3

UTD Hib by 24 months

93.0

94.6

97.9

97.8

91.1

3 Hepatitis B by 24 months

93.9

100

97.9

100

93.3

1 Varicella by 24 months

91.3

96.0

97.9

91.1

93.3

UTD PCV by 24 months

56.5

91.9

93.6

95.6

84.4

2 Rotavirus

-

-

-

-

60.0

1 Influenza by 24 months

-

-

-

-

53.3

2011
80.0 97.7 91.8 95.3 98.8 94.1 98.8 75.3 61.2

Immunization Rates by Antigen: In District 6-0, the UTD immunization rate by 24 months for most antigens remained somewhat steady from 2005 to 2010, with some note-worthy increases in 2011, particularly for UTD PCV, which increased from 84.4% in 2010 to 98.8% in 2011 (Table 6-0-G).
Among antigen rates in 2011, the DTaP UTD immunization rate was the lowest at 80.0%, no change from 80.0% in 2010. The MMR UTD immunization rate was second-lowest at 91.8%, down from 93.3% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 56.5% in 2005 to 98.8% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of district and countylevel immunization campaigns.

97

98

District 7-0
2011 Immunization Report
District 7-0 Data Collection Team Dianne Robinson, RN, MSN District Immunization Coordinator

County

Sample Metro

Chattahoochee

1 Metro

Clay

1 Nonmetro

Crisp

3 Nonmetro

Dooly

4 Nonmetro

Harris

6 Metro

Macon

4 Nonmetro

Marion

3 Metro

Muscogee

67 Metro

Quitman

0 Nonmetro

Randolph

4 Nonmetro

Schley

3 Nonmetro

Stewart

1 Nonmetro

Sumter

16 Nonmetro

Talbot

0 Nonmetro

Taylor

1 Nonmetro

Webster

1 Nonmetro

District 7-0 115

District Response Rate 89.1%

State of Georgia 2,150

State Response Rate 91.4%

Harris

Talbot

Muscogee

Taylor

Chatta- Marion
hoochee

Macon

Schley

Stewart

Webster

Quitman
Randolph

Sumter

Dooly Crisp

Clay

99

District 7-0
Immunization Report, p2

From 24 months to End of Data Collection: In the District 7-0 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (78.3% vs. 82.4%). By the end of data collection, the district UTD immunization rate remained lower than the state rate (89.6% vs. 94.0%) (Table 7-0-B).

From 2010 to 2011: The District 7-0 UTD immunization rate by 24 months increased by 9.8% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 8.0% from 2010 to 2011 (Figure 7-0-C).

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 7-0-A: Sampling Scheme, District 7-0, 2011

District 7-0 (n)

State (n)

Original Sample

138 2,447

Ineligible

8

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

130 2,359

15

210

Final Sample

115 2,150

Response Rate (%)

89.1

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 7-0-B: Immunization Summary by Series & Antigen, District 7-0, 2011

District State

7-0 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

78.3

82.4

89.6

94.0

80.9

85.8

96.5

97.5

3 IPV by 24 months

95.7

96.7

1 MMR by 24 months

92.2

93.0

UTD Hib by 24 months

94.8

95.1

3 Hep B by 24 months

98.3

96.5

1 Varicella by 24 months

93.0

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

95.7

96.7

83.5

83.8

47.0

53.1

60.0

60.1

20.9

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 7-0-C: Immunization Rate History, District 7-0, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 7-0: UTD by 24 months Georgia: UTD by 24 months

2005
100

2006

2007 2008 2009* 2010 2011
District 7-0: UTD by end of data collection Georgia: UTD by end of data collection

* 2009 data was not collected due to personnel vacancy.

Table 7-0-D: Sample Population Demographics, District 7-0, 2011

District State Final 7-0 Final % Sample %

District 7-0 Final Sample (n=115)

-

-

Maternal Race/Ethnicity,

Notable Demographic Findings: The proportion of cgsthraeiltadetreesranmfowprhlteohs(ee56dm.is5ot%trhivcestr.ss3aw3me.0pr%e%lSe)oca.tflmahFAsapsinlnlieafafireolgdrertah%sperSbooaoflpamvIocnepkrirlttaeiiwlaolalns of children were covered by WIC in the district sample than the total state sample (65.2% vs. 42.7%) (Table 7-0-D).

White, NonHispanic (n=35) White, Hispanic (n=2) Black (n=65)

30.4

42.1

The district sample also had a larger proportion of

1.7

4.4

children with unmarried mothers than the overall

56.5

33.0

state sample (62.6% vs. 47.7%).

Unspecified, Hispanic (n=4) Asian (n=2)

3.5

7.2

Other demographic measures for this district were

1.7

2.9

similar to findings for the state sample as a whole.

Multiracial (n=4)
Maternal Education,
Some College+ (n=44) HS Diploma/GED (n=43)

3.5

4.6

Private Sector vs. Public Sector: Among

immunizations administered to children in District 7

-0 (n=1,385), the majority were administered in the

38.3

43.5

private sector, with a proportion similar to that of

37.4

28.4

the state sample (89.2% vs. 93.3%) (Figure 7-0-E).

9th-11th grade (n=21) <9th grade (n=5)
WIC
Non-WIC (n=40)

18.3

17.2

Figure 7-0-E: Immunizations Administered

4.4

5.9

in Private VS Public Sector, District 7-0, 2011

(n=1,385)

34.8

57.3

10.8%

WIC (n=75)
Metro Residence

65.2

42.7

Metro (n=77) Non-metro (n=38)
Maternal Marital Status

67.0

79.9

33.0

20.1

89.2%

Married (n=43)

37.4

52.1

Unmarried (n=72)
Repeat Birth
First Child (n=49) Repeat Birth (n=66)
Gestational Age

62.6

47.7

42.6

40.9

57.4

59.1

Public Sector

Private Sector
District State Final 7-0 Final % Sample %

Child's Gender

<37 weeks (n=22) 37+ weeks (n=93)
Provider Type

19.1

10.0

Male (n=60)

52.2

50.7

80.9

90.0

Female (n=55)

47.8

49.3

Number of Providers

Public Sector Only (n=2)

1.7

1.2

1 (n=48)

41.7

49.9

Private Sector Only (n=93)

80.9

80.8

2 (n=25)

21.7

22.1

Both (n=16)
Payment at Birth

13.9

10.9

3+ (n=14)

Maternal Age

12.2

6.6

Government Assist (n=60) Private Insurance (n=25)

52.2

43.4

<25 years (n=53)

21.7

29.1

25-29 years (n=36)

46.1

38.6

31.3

29.2

Other (n=4)

3.5

4.4

30+ years (n=26)

22.6

32.2

Self Pay (n=8)

7.0

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

101

District 7-0 Immunization Report, p4

Table 7-0-F: UTD Immunization Rates by demographic group, District 7-0, 2011

State Avg. UTD by 24
months (%)

7-0--UTD by 24 months (%)

7-0--UTD by end of
d.c. (%)

UTD Immunization Rates by Demographic Group: The UTD by 24 months immunization rates for children of white, non-Hispanic mothers and children of black mothers were similar. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 7-0-F).

District 7-0 Sample (n=115) Maternal Race/Ethnicity,
White, NonHispanic (n=35)

82.7

78.3

89.6

In terms of maternal education, children of

mothers with a high school diploma/GED and no

college education were the most often UTD by 24

83.2

77.1

94.3

months (81.4%).

White, Hispanic (n=2) Black (n=65) Unspecified, Hispanic (n=4) Asian (n=2)

82.0

50.0*

100*

In District 7-0, the children enrolled in WIC had a

80.7

76.9

86.2

much higher UTD by 24 months immunization rate

87.7

100*

100*

than those not enrolled in WIC (82.7% vs. 70.0%); this disparity was greater than what was seen for

87.3

100*

100*

the state sample as a whole (83.7% vs. 81.5%).

Multiracial (n=4)
Maternal Education,
Some College+ (n=44) HS Diploma/GED (n=43) 9th-11th grade (n=21) <9th grade (n=5)

77.6

75.0*

75.0*

In terms of maternal age, children of mothers in

the <25 years age group were the most often UTD

by 24 months (84.9%) among the maternal age

84.5

72.7

88.6

categories. In terms of the maternal marital status

81.7

81.4

88.4

and repeat birth variables, children of mothers

78.6

76.2

90.5

without previous children were the most often UTD by 24 months (see Table 7-0-F).

80.2

100*

100*

WIC

Non-WIC (n=40)

81.5

70.0

WIC (n=75)

83.7

82.7

Maternal Age

<25 years (n=53)

79.8

84.9

25-29 years (n=36)

84.1

72.2

30+ years (n=26)

84.1

73.1

Maternal Marital Status & Repeat Birth Combination

Married, First Birth (n=16)

88.8

81.3

Unmarried, First Birth (n=33)

85.6

87.9

Married, Repeat Birth (n=27)

82.4

70.4

Unmarried, Repeat Birth (n=39)
Gestational Age

74.8

74.4

92.5

88.0

State Avg. 7-0--UTD 7-0--UTD

UTD by 24 by 24 by end of

months months

d.c.

90.6

%

(%)

(%)

86.1 Number of Providers

92.3

1 (n=48)

84.4

85.4

89.6

2 (n=16)

78.2

64.0

88.0

93.8

3+ (n=14)

83.0

78.6

100

90.9 Child's Gender

92.6

Male (n=60)

83.3

78.3

88.3

84.6

Female (n=55)

81.5

78.2

90.9

Metro Residence

<37 weeks (n=22) 37+ weeks (n=93)
Provider Type

82.8

77.3

95.5

Metro (n=77)

82.4

75.3

87.0

82.4

78.5

88.2

Non-metro (n=38)

82.4

84.2

94.7

Footnotes

Public Sector Only (n=2) Private Sector Only (n=93) Both (n=16)
Payment at Birth,
Government Assist (n=60) Private Insurance (n=25) Other (n=4) Self Pay (n=8)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

100* 77.4 75.0
76.7 80.0 50.0* 100*

100* 88.2 93.8
88.3 92.0 100* 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

102

District 7-0 Immunization Report, p5

In addition, the district data support the importance of a medical home; children who had one provider (Number of Providers) were more often UTD by 24 months than those with two providers (85.4% vs. 64.0%).
Children living in metro counties were less often UTD by 24 months of age than children living in non-metro counties (75.3% vs. 84.2%).
Although many demographic-related disparities resolved by the end of data collection, some still remained and some new ones emerged (Table 7-0-F, column in italics).
For example, children of black mothers were less often UTD than children of white, non-Hispanic mothers by the end of the data collection period (86.2% vs. 94.3%).
In terms of WIC enrollment, the trend seen at the 24 months measurement was reversed by the end of the data collection period, with children enrolled in WIC less often UTD than children not enrolled in WIC (88.0% vs. 92.5%).
Children living in metro counties remained less often UTD than children living in non-metro counties (87.0% vs. 94.7%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 7-0 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of black mothers
Children of mothers with some college education Children not enrolled in WIC
Children of mothers over 25 years of age
Children of mothers with previous children
Children receiving immunizations from more than one provider
Children living in metro counties (see page 1 of District 7-0 Immunization Report)

Table 7-0-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 7-0--2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

82.3

85.0

75.2

79.5

83.7

3 Polio by 24 months

88.5

94.0

84.8

90.7

95.4

1 MMR by 24 months

89.4

92.0

88.6

88.7

89.9

UTD Hib by 24 months

90.3

92.0

90.5

88.1

91.5

3 Hepatitis B by 24 months

92.0

95.0

89.5

88.1

93.0

1 Varicella by 24 months

90.3

94.0

87.6

88.7

93.0

UTD PCV by 24 months

38.9

75.0

81.0

84.1

86.8

2 Rotavirus

-

-

-

-

83.7

1 Influenza by 24 months

-

-

-

-

67.4

2011
80.9 95.7 92.2 94.8 98.3 93.0 95.7 83.5 60.0

Immunization Rates by Antigen: In District 7-0, the UTD immunization rate by 24 months for most antigens remained somewhat steady from 2005 to 2010, with some note-worthy increases in 2011, particularly for UTD PCV, which increased from 86.8% in 2010 to 95.7% in 2011 (Table 7-0-G).
Among antigen rates in 2011, the DTaP UTD immunization rate was the lowest at 80.9%, down from 83.7% in 2010. The MMR UTD immunization rate was second-lowest at 92.2%, up from 89.9% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 38.9% in 2005 to 95.7% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of district and countylevel immunization campaigns.

103

104

District 8-1
2011 Immunization Report
District 8-1 Data Collection Team Debra Adams, RN, APRN District Immunization Coordinator Rachel Franklin, MPH Primary Data Collector

County

Sample Metro

Ben Hill

9 Nonmetro

Berrien

5 Nonmetro

Brooks

6 Metro

Cook

7 Nonmetro

Echols

1 Metro

Irwin

0 Nonmetro

Lanier

1 Metro

Lowndes

35 Metro

Tift

11 Nonmetro

Turner

2 Nonmetro

District 8-1 77

District Response Rate 92.9%

State of Georgia 2,150

State Response Rate 91.4%

Turner Tift

Ben Hill Irwin

Berrien

Cook

Lanier

Brooks

Lowndes Echols

105

District 8-1
Immunization Report, p2

From 24 months to End of Data Collection: In the District 8-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was similar to the state rate (90.9% vs. 82.4%). By the end of data collection, the district UTD immunization rate remained similar to the state rate (96.1% vs. 94.0%) (Table 8-1-B).
From 2010 to 2011: The District 8-1 UTD immunization rate by 24 months increased by 26.5% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 6.1% from 2010 to 2011 (Figure 8-1-C).
Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 8-1-B: Immunization Summary by Series & Antigen, District 8-1, 2011

District State

8-1 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection

90.9

82.4

96.1

94.0

4 DTaP by 24 months

94.8

85.8

3 DTaP by 24 months

97.4

97.5

3 IPV by 24 months

97.4

96.7

1 MMR by 24 months

96.1

93.0

Table 8-1-A: Sampling Scheme, District 8-1, 2011

District 8-1 (n)

State (n)

Original Sample

85

2,447

Ineligible

2

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

83

2,359

6

210

Final Sample

77

2,150

UTD Hib by 24 months

96.1

95.1

3 Hep B by 24 months

96.1

96.5

1 Varicella by 24 months

94.8

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months

97.4

96.7

92.2

83.8

74.0

53.1

61.0

60.1

2 H1N1

28.6

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

Response Rate (%)

92.9

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

100%

Figure 8-1-C: Immunization Rate History, District 8-1, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 8-1: UTD by 24 months Georgia: UTD by 24 months

2005
106

2006 2007 2008 2009* 2010 2011
District 8-1: UTD by end of data collection Georgia: UTD by end of data collection
* 2009 data was not collected due to personnel vacancy.

Table 8-1-D: Sample Population Demographics, District 8-1, 2011

District State Final 8-1 Final % Sample %

District 8-1 Final Sample (n=77)

-

-

NcghroeitladatbreelrenfDowrehmtohsoeegdmraisoptthrhiicectrsFsaiwnmedpri%nelSegocastflm:ahFsapTsinlnihefafeieol dpr rtaoh%speobSooralfatvmiIceonpkrinltaewiloalafls state sample (44.2% vs. 33.0%) (Table 8-1-D).

Maternal Race/Ethnicity,
White, NonHispanic (n=25) White, Hispanic (n=1) Black (n=34)

A larger proportion of children in the district sample

32.5

42.1

had unmarried mothers than the state sample (58.4% vs. 47.7%) as well as a larger proportion of

1.3

4.4

children who were repeat births than for the state

44.2

33.0

sample as a whole (66.2% vs. 59.1%).

Unspecified, Hispanic (n=4) Asian (n=1)

5.2

7.2

Other demographic measures for this district were

1.3

2.9

similar to findings for the state sample as a whole.

Multiracial (n=1)
Maternal Education,
Some College+ (n=32) HS Diploma/GED (n=22)

1.3

4.6

Private Sector vs. Public Sector: Among

immunizations administered to children in District

8-1 (n=1,434), the majority were administered in

41.6

43.5

the private sector, with a proportion similar to that

28.6

28.4

of the state sample (95.5% vs. 93.3%) (Figure 8-1-E).

9th-11th grade (n=19) <9th grade (n=4)
WIC
Non-WIC (n=39) WIC (n=)38
Metro Residence
Metro (n=43) Non-metro (n=34)
Maternal Marital Status

24.7

17.2

Figure 8-1-E: Immunizations Administered

5.2

5.9

in Private VS Public Sector, District 8-1, 2011

(n=1,434)

50.7

57.3

49.3

42.7

4.5%

55.8

79.9

44.2

20.1

95.5%

Married (n=31)

40.3

52.1

Unmarried (n=45)
Repeat Birth
First Child (n=26) Repeat Birth (n=51)
Gestational Age

58.4

47.7

33.8

40.9

66.2

59.1

Public Sector

Private Sector
District State Final 8-1 Final % Sample %

Child's Gender

<37 weeks (n=12) 37+ weeks (n=65)
Provider Type

15.6

10.0

Male (n=31)

40.3

50.7

84.4

90.0

Female (n=46)

59.7

49.3

Number of Providers

Public Sector Only (n=0)

0

1.2

1 (n=35)

45.4

49.9

Private Sector Only (n=65)

84.4

80.8

2 (n=30)

39.0

22.1

Both (n=12)
Payment at Birth

15.6

10.9

3+ (n=12)

Maternal Age

15.6

6.6

Government Assist (n=61) Private Insurance (n=6)

79.2

43.4

<25 years (n=37)

7.8

29.1

25-29 years (n=19)

48.1

38.6

24.7

29.2

Other (n=8)

10.4

4.4

30+ years (n=21)

27.3

32.2

Self Pay (n=1)

1.3

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

107

District 8-1 Immunization Report, p4

Table 8-1-F: UTD Immunization Rates by demographic group, District 8-1, 2011

State Avg. UTD by 24
months %

8-1--UTD by 24 months (%)

8-1--UTD by end of
d.c. (%)

District 8-1 Sample (n=77)

82.7

92.2

97.4

Maternal Race/Ethnicity,

White, NonHispanic (n=25)

83.2

96.0

96.0

White, Hispanic (n=1)

82.0

100*

100*

UTD Immunization Rates by Demographic Group: The UTD by 24 months immunization rates for children of white, non-Hispanic mothers and children of black mothers were similar to the state average. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 8-1-F).
In terms of the maternal marital status and repeat birth variables, children of unmarried mothers with previous children were the least often UTD by 24 months among the four groups (82.1%).

Black (n=34) Unspecified, Hispanic (n=4) Asian (n=1) Multiracial (n=1)
Maternal Education,
Some College+ (n=32)

80.7

94.1

100

Children born at a gestational age of less than 37

87.7

75.0*

100

weeks were less often UTD by 24 months than those born at a gestational age greater than 37

87.3

100*

100*

weeks (83.3% vs. 92.3%).

77.6

100*

100*

District 8-1 children with two providers were more

often UTD than those with just one provider (96.7%

84.5

100

100

vs. 85.7%).

HS Diploma/GED (n=22) 9th-11th grade (n=19) <9th grade (n=4)
WIC
Non-WIC (n=39)

81.7

86.4

90.9

In addition, children residing in metro counties

78.6

89.5

94.7

were more often UTD by 24 months than those residing in non-metro counties (95.4% vs. 85.3%).

80.2

50.0*

100*

To varying degrees, demographic-related

disparities resolved by the end of data collection

81.5

89.7

92.3

(Table 8-1-F, column in italics).

WIC (n=38)
Maternal Age
<25 years (n=37)

83.7

92.1

100

79.8

94.6

100

State Avg. UTD by 24
months %

8-1--UTD by 24 months (%)

8-1--UTD by end of
d.c. (%)

25-29 years (n=19)

84.1

89.5

94.7 Number of Providers

30+ years (n=21)

84.1

85.7

90.5

1 (n=35)

84.4

85.7

94.3

Maternal Marital Status & Repeat Birth Combination

2 (n=30)

78.2

96.7

96.7

Married, First Birth (n=9)

88.8

100*

100*

3+ (n=12)

83.0

91.7

100

Unmarried, First Birth (n=17)

85.6

100

100

Child's Gender

Married, Repeat Birth (n=22)

82.4

90.9

90.9

Male (n=31)

83.3

90.3

96.8

Unmarried, Repeat Birth (n=28)

74.8

82.1

96.4

Female (n=46)

81.5

91.3

95.7

Gestational Age

Metro Residence

<37 weeks (n=12)

82.8

83.3

91.7

Metro (n=43)

82.4

95.4

97.7

37+ weeks (n=65)

82.4

92.3

96.9

Non-metro (n=34)

82.4

85.3

94.1

Provider Type

Footnotes

Public Sector Only (n=0) Private Sector Only (n=65) Both (n=12)
Payment at Birth,
Government Assist (n=61) Private Insurance (n=6) Other (n=8) Self Pay (n=1)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

90.7 91.7
90.2 83.3* 100* 100*

95.4 100
96.7 83.3* 100* 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

108

District 8-1 Immunization Report, p5
Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 8-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of unmarried mothers with previous children
Children born at a gestational age of less than 37 weeks
Children receiving immunizations from just one provider
Children residing in non-metro counties (see page 1 of District 8-1 Immunization Report)

Table 8-1-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 8-1, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

88.6

81.0

83.2

79.5

84.7

3 Polio by 24 months

93.2

91.4

93.7

91.5

92.9

1 MMR by 24 months

89.8

86.2

90.5

85.5

88.2

UTD Hib by 24 months

95.5

89.7

96.8

92.3

92.9

3 Hepatitis B by 24 months

92.1

94.8

97.9

92.3

92.9

1 Varicella by 24 months

92.1

87.9

92.6

87.2

90.6

UTD PCV by 24 months

37.5

70.7

84.2

87.2

87.1

2 Rotavirus

-

-

-

-

83.5

1 Influenza by 24 months

-

-

-

-

60.0

2011
94.8 97.4 96.1 96.1 96.1 94.8 97.4 92.2 61.0

Immunization Rates by Antigen: In District 8-1, the UTD immunization rate by 24 months for most antigens remained somewhat steady in District 8-1 from 2005 to 2010, with all antigens increasing in 2011 (Table 8-1G).
Among antigen rates in 2011, the DTaP and PCV UTD immunization rates tied for the lowest at 94.8%, up from 84.7% in 2010 for DTaP and 87.1% in 2010 for PCV.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 37.5% in 2005 to 97.4% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP vaccine could reasonably be the primary focus of district and county-level immunization campaigns.

109

110

District 8-2
2011 Immunization Report

Sue Dale Kelly Tillery

District 8-2 Data Collection Team District Immunization Coordinator Primary Data Collector

County

Sample Metro

Baker

0 Metro

Calhoun

0 Nonmetro

Colquitt

14 Nonmetro

Decatur

6 Nonmetro

Dougherty

31 Metro

Early

5 Nonmetro

Grady

6 Nonmetro

Lee

4 Metro

Miller

3 Nonmetro

Mitchell

7 Nonmetro

Seminole

2 Nonmetro

Terrell

2 Metro

Thomas

5 Nonmetro

Worth

8 Metro

District 8-2 93

District Response Rate 96.2%

State of Georgia 2,150

State Response Rate 91.4%

Terrell Lee

Calhoun Dougherty

Early

Baker

Miller

Mitchell

Worth
Colquitt

Seminole

Decatur Grady Thomas

111

District 8-2
Immunization Report, p2

From 24 months to End of Data Collection: In the District 8-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (83.9% vs. 82.4%). By the end of data collection, the district UTD immunization rate remained higher than the state rate (96.8% vs. 94.0%) (Table 8-2-B).

From 2010 to 2011: The District 8-2 UTD immunization rate by 24 months increased by 10.0% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 7.1% from 2010 to 2011 (Figure 8-2-C).

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 8-2-A: Sampling Scheme, District 8-2, 2011

District 8-2 (n)

State (n)

Original Sample

85

2,447

Ineligible

9

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

76

2,359

4

210

Final Sample

72

2,150

Response Rate (%)

96.2

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 8-2-B: Immunization Summary by Series & Antigen, District 8-2, 2011

District State

8-2 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

83.9

82.4

96.8

94.0

86.0

85.8

96.8

97.5

3 IPV by 24 months

95.7

96.7

1 MMR by 24 months

94.6

93.0

UTD Hib by 24 months

93.6

95.1

3 Hep B by 24 months

96.8

96.5

1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

94.6

93.9

96.8

96.7

90.3

83.8

54.8

53.1

58.1

60.1

19.4

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 8-2-C: Immunization Rate History, District 8-2, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 8-2: UTD by 24 months Georgia: UTD by 24 months

2005
112

2006 2007 2008 2009* 2010 2011
District 8-2: UTD by end of data collection Georgia: UTD by end of data collection
* 2009 data was not collected due to personnel vacancy.

Table 8-2-D: Sample Population Demographics, District 8-2, 2011 Notable Demographic Findings: The proportion of

children whose mothers were classified as black was

District State Final greater for the district sample%tohfanFifnoarlthe %ovoefraInllitsitaalte

8-2 Final % Sample % sample (43.0% vs. 33.3%) (TableSa8m-2p-Dle).

Sample

District 8-2 Final Sample (n=93) Maternal Race/Ethnicity,
White, NonHispanic (n=40)

-

-

The district sample had a smaller proportion of mothers

who were married (43.0% vs. 52.1%) and a smaller

proportion of children whose mothers were in the 30+

43.0

42.1

years age group (20.4% vs. 32.2%).

White, Hispanic (n=2) Black (n=40) Unspecified, Hispanic (n=6) Asian (n=0) Multiracial (n=0)
Maternal Education,
Some College+ (n=35) HS Diploma/GED (n=27) 9th-11th grade (n=22) <9th grade (n=7)
WIC

2.2

4.4

The district also had a larger proportion of children who

43.0

33.0

were repeat births (66.7% vs. 59.1%) as well as a greater proportion of children seen by only one provider (68.8%

6.4

7.2

vs. 49.9%).

0

2.9

Other demographic measures for this district were

0

4.6

similar to findings for the state sample as a whole.

Private Sector vs. Public Sector: Among

immunizations administered to children in District 8-2

37.6

43.5

(n=1,610), the majority were administered in the

29.0

28.4

private sector, but to a lesser degree than the state sample as a whole (95.4% vs. 93.3%) (Figure 8-2-E).

23.7

17.2

Figure 8-2-E: Immunizations Administered

7.5

5.9

in Private VS Public Sector, District 8-2, 2011

(n=1,610)

Non-WIC (n=50) WIC (n=43)
Metro Residence

53.8

57.3

46.2

42.7

4.6%

Metro (n=45) Non-metro (n=48)
Maternal Marital Status
Married (n=40) Unmarried (n=53)
Repeat Birth
First Child (n=31) Repeat Birth (n=62)
Gestational Age

48.4

79.9

51.6

20.1

95.4%

43.0

52.1

57.0

47.7

33.3

40.9

66.7

59.1

Public Sector

Private Sector
District State Final 8-2 Final % Sample %

Child's Gender

<37 weeks (n=11) 37+ weeks (n=82)
Provider Type

11.8

10.0

Male (n=54)

58.1

50.7

88.2

90.0

Female (n=39)

41.9

49.3

Number of Providers

Public Sector Only (n=0)

0

1.2

1 (n=64)

68.8

49.9

Private Sector Only (n=83)

89.2

80.8

2 (n=17)

18.3

22.1

Both (n=7)
Payment at Birth
Government Assist (n=37) Private Insurance (n=4)

7.5

10.9

3+ (n=4)

Maternal Age

39.8

43.4

<25 years (n=51)

4.3

29.1

25-29 years (n=23)

4.3

6.6

54.8

38.6

24.7

29.2

Other (n=0)

0

4.4

30+ years (n=19)

20.4

32.2

Self Pay (n=6)

6.4

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

113

District 8-2 Immunization Report, p4

Table 8-2-F: UTD Immunization Rates by demographic group, District 8-2, 2011

State Avg. UTD by 24
months (%)

8-2--UTD by 24 months (%)

8-2--UTD by end of
d.c. (%)

District 8-2 Sample (n=93)

82.7

83.9

96.8

Maternal Race/Ethnicity,

White, NonHispanic (n=40)

83.2

82.5

95.0

White, Hispanic (n=2)

82.0

100*

100*

Black (n=40)

80.7

82.5

97.5

Unspecified, Hispanic (n=6)

87.7

83.3*

100*

Asian (n=0)

87.3

-

-

Multiracial (n=0)

77.6

-

-

UTD Immunization Rates by Demographic Group: Immunization rate disparities were not apparent among the different race/ethnicity groups (Table 8-2-F).
In district 8-2, higher maternal education was positively associated with UTD coverage rates by 24 months, although the sample size for the <9th grade maternal education group was too small to draw any conclusions (see Table 8-2-F).
In terms of maternal age, children of mothers less than 25 years of age were the least often UTD by 24 months (78.4%). In terms of the maternal marital status and repeat birth variables, children of unmarried mothers were less often UTD by 24 months than children of married mothers (see Table 8-2-F).

Maternal Education,
Some College+ (n=35) HS Diploma/GED (n=27)

To varying degrees, demographic-related

84.5

91.4

97.1

disparities resolved by the end of data collection (Table 8-2-F, column in italics).

81.7

85.2

100

9th-11th grade (n=22)

78.6

72.7

95.5

<9th grade (n=7)
WIC

80.2

71.4*

85.7*

Non-WIC (n=50)

81.5

84.0

98.0

WIC (n=43)

83.7

83.7

Maternal Age

<25 years (n=51)

79.8

78.4

25-29 years (n=23)

84.1

91.3

30+ years (n=19)

84.1

89.5

Maternal Marital Status & Repeat Birth Combination

Married, First Birth (n=10)

88.8

100

Unmarried, First Birth (n=21)

85.6

76.2

Married, Repeat Birth (n=30)

82.4

86.7

Unmarried, Repeat Birth (n=32)
Gestational Age

74.8

81.3

95.4

State Avg. 8-2--UTD 8-2--UTD

UTD by 24 by 24 by end of

months months

d.c.

98.0

(%)

(%)

(%)

95.7 Number of Providers

94.7

1 (n=64)

84.4

85.9

96.9

2 (n=17)

78.2

82.4

100

100

3+ (n=4)

83.0

75.0*

100*

100

Child's Gender

96.7

Male (n=54)

83.3

85.2

96.3

93.8

Female (n=39)

81.5

82.1

97.4

Metro Residence

<37 weeks (n=11) 37+ weeks (n=82)
Provider Type

82.8

81.8

100

Metro (n=45)

82.4

84.4

95.6

82.4

84.2

96.3

Non-metro (n=48)

82.4

83.3

97.9

Footnotes

Public Sector Only (n=0) Private Sector Only (n=83) Both (n=7)
Payment at Birth,
Government Assist (n=37) Private Insurance (n=4) Other (n=0) Self Pay (n=6)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

85.5 71.4*
81.1 100*
83.3*

96.4 100*
94.6 100*
100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

114

District 8-2 Immunization Report, p5
Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 8-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of less educated mothers
Children not enrolled in WIC
Children of mothers less than 25 years of age
Children of unmarried mothers

Table 8-2-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 8-2, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

83.9

71.7

78.2

78.4

86.8

3 Polio by 24 months

90.3

84.3

88.5

90.7

98.3

1 MMR by 24 months

91.9

85.0

88.5

87.1

92.1

UTD Hib by 24 months

91.9

91.3

89.7

82.7

90.4

3 Hepatitis B by 24 months

98.4

88.2

92.7

94.2

97.4

1 Varicella by 24 months

90.3

84.3

89.4

86.3

96.5

UTD PCV by 24 months

35.5

72.4

78.2

80.6

93.9

2 Rotavirus

-

-

-

-

83.3

1 Influenza by 24 months

-

-

-

-

62.3

2011
86.0 95.7 94.6 93.6 96.8 94.6 96.8 90.3 58.1

Immunization Rates by Antigen: In District 8-2, the UTD immunization rate by 24 months for most antigens dropped from 2006 to 2008 in District 8-2, but increased in 2010 and again for some antigens in 2011 (Table 8-2-G).
Among antigen rates in 2011, the DTaP UTD immunization rate was the lowest at 86.0%, similar to 86.8% in 2010. The Hib UTD immunization rate was second-lowest at 93.6%, up from 90.4% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 35.5% in 2005 to 96.8% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP vaccine could reasonably be the primary focus of district and county-level immunization campaigns.

115

116

District 9-1
2011 Immunization Report

District 9-1 Data Collection Team

Beth Hausauer, RN, MSN District Immunization Coordinator

Data Collection Staff

Cathy Schmid, RN

Joanne Burnsed

Kim Carter

Elizabeth Brandau

Cherise Wilson

Mary Weaver, LPN

Leslie L. Blewett

Kia Young

Mary Fleming

Cindy Grovenstein, RN Mona Smith

Michele Eitel

Effingham

County

Sample Metro

Bryan

5 Metro

Camden

8 Nonmetro

Chatham

71 Metro

Effingham

12 Metro

Glynn

32 Metro

Liberty

8 Metro

Long

4 Metro

McIntosh

2 Metro

District 9-1 142

Response Rate 90.6%

State of Georgia 2,150

Response Rate 91.4%

Bryan Chatham Liberty Long
McIntosh Glynn Camden
117

District 9-1
Immunization Report, p2

From 24 Months to End of Data Collection: In the District 9-1 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (76.8% vs. 82.4%). By the end of data collection, the district UTD immunization rate was similar to the state rate (93.7% vs. 94.0%) (Table 9-1-B).

From 2010 to 2011: The District 9-1 UTD immunization rate by 24 months increased by 11.8% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 7.4% from 2010 to 2011 (Figure 9-1-C).

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 9-1-A: Sampling Scheme, District 9-1--2011

District 9-1 (n)

State (n)

Original Sample

160 2,447

Ineligible

0

82

Refused to Participate

3

6

Eligible Sample

157 2,359

Unable to Locate

15

210

Final Sample

142 2,150

Response Rate (%)

90.6

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 9-1-B: Immunization Summary by Series & Antigen, District 9-1--2011

District State

9-1 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

76.8 82.4

93.7 94.0

83.8

85.8

98.6 97.5

3 IPV by 24 months

98.6 96.7

1 MMR by 24 months

90.9 93.0

UTD Hib by 24 months

94.4 95.1

3 Hep B by 24 months

94.4 96.5

1 Varicella by 24 months

93.7 93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

94.4 96.7

71.8 83.8

58.5 53.1

61.3 60.1

19.0

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 9-1-C: Immunization Rate History, District 9-1--2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 9-1: UTD by 24 months
Georgia: UTD by 24 months

2005
118

2006 2007 2008 2009* 2010 2011
District 9-1: UTD by end of data collection Georgia: UTD by end of data collection
* 2009 data was not collected due to personnel vacancy.

Table 9-1-D: Sample Population Demographics, District 9-1--2011 Notable Demographic Findings: The proportion of

District State Final children whose mothers wer%e oclfaFssinifaield as% of Initial

9-1 Final % Sample % multiracial was greater for thehidgihsetrrict samSpalempthlean

District 9-1 Final Sample (n=142)

-

-

for the overall state sample (16.9% vs. 4.6%) (Table 9-1-D).

Maternal Race/Ethnicity,
White, NonHispanic (n=43) White, Hispanic (n=6) Black (n=61) Unspecified, Hispanic (n=4) Asian (n=1)

A larger proportion of children in the District 9-1

30.3

42.1

sample had mothers with some college education

4.2

4.4

when compared to the state as a whole (50.0% vs. 43.5%).

43.0

33.0

2.8

7.2

Other demographic measures for this district were similar to findings for the state sample as a whole.

0.7

2.9

Multiracial (n=24)
Maternal Education,
Some College+ (n=71) HS Diploma/GED (n=42)

16.9

4.6

Private Sector vs. Public Sector: Among

immunizations administered to children in District

9-1 (n=2,169), the majority were administered in

50.0

43.5

the private sector, with a proportion similar to that of the state sample (93.5% vs. 93.3%) (Figure 9-1-E).

29.6

28.4

9th-11th grade (n=22) <9th grade (n=4)

15.5

17.2

Figure 9-1-E: Immunizations Administered

in Private VS Public Sector, District 9-1--2011

2.8

5.9

(n=2,169)

WIC
Non-WIC (n=79)

55.6

57.3

6.5%

WIC (n=63)
Metro Residence

44.4

42.7

Metro (n=134) Non-metro (n=8)
Maternal Marital Status

94.4

79.9

5.6

20.1

93.5%

Married (n=68)

47.9

52.1

Unmarried (n=74)
Repeat Birth
First Child (n=58) Repeat Birth (n=84)
Gestational Age

52.1

47.7

40.9

40.9

59.1

59.1

Public Sector

Private Sector
District State Final 9-1 Final % Sample %

Child's Gender

<37 weeks (n=7) 37+ weeks (n=95.1)
Provider Type

4.9

10.0

Male (n=70)

49.3

50.7

95.1

90.0

Female (n=72)

50.7

49.3

Number of Providers

Public Sector Only (n=3)

2.1

1.2

1 (n=80)

56.3

49.9

Private Sector Only (n=116)

81.7

80.8

2 (n=46)

32.4

22.1

Both (n=19)
Payment at Birth

13.4

10.9

3+ (n=6)

Maternal Age

4.2

6.6

Government Assist (n=81) Private Insurance (n=45)

57.0

43.4

<25 years (n=56)

31.7

29.1

25-29 years (n=52)

39.4

38.6

36.6

29.2

Other (n=0)

0

4.4

30+ years (n=34)

23.9

32.2

Self Pay (n=9)

6.3

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

119

District 9-1 Immunization Report, p4

Table 9-1-F: UTD Immunization Rates by demographic group, District 9-1--2011

State Avg. UTD by 24
months (%)

9-1--UTD by 24 months (%)

9-1--UTD by end of
d.c. (%)

District 9-1 Sample (n=142)

82.7

77.5

94.4

Maternal Race/Ethnicity,

White, NonHispanic (n=43)

83.2

79.1

93.0

White, Hispanic (n=6)

82.0

83.3*

83.3

Black (n=61)

80.7

73.8

95.1

Unspecified, Hispanic (n=4)

87.7

100*

100*

Asian (n=1)

87.3

100*

100*

Multiracial (n=24)

77.6

75.0

91.7

UTD Immunization Rates by Demographic Group: The UTD by 24 months immunization rates for children of white, non-Hispanic mothers and children of black mothers were similar to the state average. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 9-1-F).
In terms of maternal education, children of mothers with a high school diploma/GED were the least often UTD by 24 months (59.5%) among the maternal education groups.
In District 9-1, the children enrolled in WIC had a higher immunization rate than those not enrolled in WIC (81.0% vs. 73.4%); this disparity was greater than what was seen for the state sample as a whole (83.7% vs. 81.5%).

Maternal Education,
Some College+ (n=71) HS Diploma/GED (n=42) 9th-11th grade (n=22) <9th grade (n=4)
WIC

In terms of maternal age, children with mothers in

84.5

81.7

94.4

the 30+ years age group were the most likely to be UTD by 24 months (85.3%).

81.7

59.5

90.5

78.6

90.9

95.5

In terms of the maternal marital status and repeat birth variables, children of unmarried mothers with

80.2

75.0*

100* previous children were the least often UTD by 24

months of age (56.4%).

Non-WIC (n=79) WIC (n=63)
Maternal Age
<25 years (n=56) 25-29 years (n=52)

81.5

73.4

91.1

83.7

81.0

96.8

79.8

75.0

94.6

State Avg. UTD by 24
months (%)

9-1--UTD by 24 months (%)

9-1--UTD by end of
d.c. (%)

84.1

73.1

92.3 Number of Providers

30+ years (n=34)

84.1

85.3

Maternal Marital Status & Repeat Birth Combination

Married, First Birth (n=23)

88.8

87.0

Unmarried, First Birth (n=35)

85.6

82.9

94.1

1 (n=80)

84.4

2 (n=46)

78.2

91.3

3+ (n=6)

83.0

91.4 Child's Gender

80.0

93.8

69.6

95.7

83.3*

100*

Married, Repeat Birth (n=45) Unmarried, Repeat Birth (n=39)
Gestational Age

82.4

84.4

95.6

Male (n=70)

83.3

80.0

95.7

74.8

56.4

94.9

Female (n=72)

81.5

73.6

91.7

Metro Residence

<37 weeks (n=7) 37+ weeks (n=135)
Provider Type

82.8

100*

100*

Metro (n=134)

82.4

78.4

94.8

82.4

75.6

93.3

Non-metro (n=8)

82.4

50.0*

75.0*

Footnotes

Public Sector Only (n=3) Private Sector Only (n=116) Both (n=19)
Payment at Birth,
Government Assist (n=81) Private Insurance (n=45) Other (n=0) Self Pay (n=9)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

33.3* 81.0 63.2
71.6 84.4
88.9*

100* 95.7 89.5
92.6 95.6
88.9

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

120

District 9-1 Immunization Report, p5

Children receiving immunizations from both public and private providers were the less often UTD by 24 months than those receiving immunizations exclusively in the private sector (63.2% vs. 81.0%).
In terms of payment at birth, District 9-1 children whose birth was covered by private insurance were more often UTD by 24 months than children whose birth was covered by government-assisted insurance (84.4% vs. 71.6%).
In addition, the district data support the importance of a medical home; children who had one provider (Number of Providers) were more often UTD by 24 months than those with two providers (80.0% vs. 69.6%).
Interestingly, male children were more often UTD by 24 months than female children (80.0% vs. 73.6%).
Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 9-1-F).
For example, children enrolled in WIC remained more UTD by the end of the data collection period than those not enrolled (96.8% vs. 91.1%).
Children receiving immunizations from both public and private providers remained less often UTD than those

receiving immunizations exclusively in the private sector (89.5% vs. 95.7%).
Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 9-1 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of mothers with a high school diploma/GED, but no college education
Children not enrolled in WIC
Children of mothers less than 30 years of age
Children of unmarried mothers with previous children
Children receiving immunizations in both the private and public sectors
Children of mothers using government-assisted insurance for the birth event
Children with more than one provider
Female children

Table 9-1-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 9-1--2005-2011

4 DTaP by 24 months 3 Polio by 24 months 1 MMR by 24 months UTD Hib by 24 months 3 Hepatitis B by 24 months 1 Varicella by 24 months UTD PCV by 24 months 2 Rotavirus 1 Influenza by 24 months

2005
77.8 87.0 88.9 87.0 92.6 92.6 44.4
-

2006
76.8 92.3 85.7 90.5 92.3 89.9 69.6
-

Immunization Rates by Antigen: In District 9-1, the UTD immunization rate by 24 months for most antigens remained somewhat steady from 2005 to 2010, with all antigens increasing in 2011 (Table 9-1-G).

Among antigen rates in 2011, the DTaP UTD immunization rate was the lowest at 83.8%, up from 74.3% in 2010. The MMR UTD immunization rate was second-lowest at 90.9%, up from 87.9% in 2010.

2007
77.1 87.9 86.4 87.1 87.1 86.4 77.9
-

2008
75.4 88.6 80.7 88.6 89.5 83.3 80.7
-

2010
74.3 92.1 87.9 87.1 91.4 90.0 89.3 65.7 57.9

2011
83.8 98.6 90.9 94.4 94.4 93.7 94.4 71.8 61.3

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine has increased from 49.4% in 2005 to 94.4% in 2011.

Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of district and countylevel immunization campaigns.

121

122

District 9-2
2011 Immunization Report

District 9-2 Data Collection Team

Kay Davis, RN

District Immunization Coordinator

County Appling Atkinson Bacon Brantley Bulloch Candler Charlton Clinch Coffee Evans Jeff Davis Pierce Tattnall Toombs Ware Wayne
District 9-2 District Response Rate
State of Georgia State Response Rate

Sample 2 1 3 7 22 2 2 6 18 5 6 8 5 6 9 9
111 96.7% 2,150 91.4%

Metro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro Nonmetro

Bulloch Candler

Jeff Davis

Toombs

Evans

Tattnall

Appling

Coffee
Atkinson

Bacon

Wayne

Pierce

Ware

Brantley

Clinch

Charlton

123

District 9-2
Immunization Report, p2

From 24 months to End of Data Collection: In the District 9-2 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was higher than the state rate (83.8% vs. 82.4%). By the end of data collection, the district UTD immunization rate was lower than the state rate (92.8% vs. 94.0%) (Table 9-2-B).

From 2010 to 2011: The District 9-2 UTD immunization rate by 24 months increased by 24.5% from 2010 to 2011. The district UTD immunization rate by the end of data collection increased by 6.8% from 2010 to 2011 (Figure 9-2-C).

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 9-2-A: Sampling Scheme, District 9-2, 2011

District 9-2 (n)

State (n)

Original Sample

122 2,447

Ineligible

7

82

Refused to Participate

0

6

Eligible Sample

115 2,359

Unable to Locate

4

210

Final Sample

111 2,150

Response Rate (%)

96.7

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 9-2-B: Immunization Summary by Series & Antigen, District 9-2, 2011

District State

9-2 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

83.8

82.4

92.8

94.0

85.6

85.8

96.4

97.5

3 IPV by 24 months

95.5

96.7

1 MMR by 24 months

94.6

93.0

UTD Hib by 24 months

92.8

95.1

3 Hep B by 24 months

95.5

96.5

1 Varicella by 24 months

95.5

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

96.4

96.7

81.1

83.8

56.8

53.1

49.6

60.1

21.6

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 9-2-C: Immunization Rate History, District 9-2, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 9-2: UTD by 24 months
Georgia: UTD by 24 months

2005

2006 2007 2008 2009* 2010 2011
District 9-2: UTD by end of data collection
Georgia: UTD by end of data collection

* 2009 data was not collected due to personnel vacancy. 124

Table 9-2-D: Sample Population Demographics, District 9-2, 2011

Notable Demographic Findings: The proportion of children whose mothers were classified as white,

District State Final non-Hispanic was greater fo%r tohfeFdiinsatrlict s%amofpIlneitial

9-2 Final % Sample % than for the overall state samSpalme p(5le9.5% vs.Sa4m2.p1l%e).

District 9-2 Final Sample (n=111)

-

-

A larger proportion of children were covered by WIC in the district sample than in the total state

Maternal Race/Ethnicity,

sample (56.8% vs. 42.7%) (Table 9-2-D).

White, NonHispanic (n=66) White, Hispanic (n=4) Black (n=25) Unspecified, Hispanic (n=3) Asian (n=0)

59.5

42.1

The District 9-2 sample had a larger proportion of

3.6

4.4

children whose mothers had 9th to 11th grade education than the state sample (31.5% vs. 17.2%).

22.5

33.0

A larger proportion of children received

2.7

7.2

immunizations from both public and private providers in the District 9-2 sample when compared

0

2.9

to the state sample (22.5% vs. 10.9%).

Multiracial (n=10)
Maternal Education,
Some College+ (n=41) HS Diploma/GED (n=31)

9.0

4.6

Private Sector vs. Public Sector: Among

immunizations administered to children in District

9-2 (n=2,155), the majority were administered in

36.9

43.5

the private sector, but to a lesser degree than in

27.9

28.4

the state sample (87.7% vs. 93.3%) (Figure 9-2-E).

9th-11th grade (n=35) <9th grade (n=4)
WIC

31.5

17.2

Figure 9-2-E: Immunizations Administered

3.6

5.9

in Private VS Public Sector, District 9-2, 2011 (n=2,155)

Non-WIC (n=48)

43.2

57.3

12.3%

WIC (n=63)

56.8

42.7

Metro Residence
Metro (n=7)

6.3

79.9

87.7%

Non-metro (n=104)
Maternal Marital Status
Married (n=55)

93.7

20.1

49.6

52.1

Unmarried (n=56)
Repeat Birth
First Child (n=43) Repeat Birth (n=68)
Gestational Age

50.4

47.7

38.7

40.9

61.3

59.1

Public Sector

Private Sector
District State Final 9-2 Final % Sample %

Child's Gender

<37 weeks (n=7) 37+ weeks (n=104)
Provider Type

6.3

10.0

Male (n=67)

60.4

50.7

93.7

90.0

Female (n=44)

39.6

49.3

Number of Providers

Public Sector Only (n=0) Private Sector Only (n=86)

0

1.2

1 (n=74)

77.5

80.8

2 (n=30)

66.7

49.9

27.0

22.1

Both (n=25)
Payment at Birth
Government Assist (n=83) Private Insurance (n=16)

22.5

10.9

3+ (n=6)

Maternal Age

74.8

43.4

<25 years (n=55)

14.4

29.1

25-29 years (n=30)

5.4

6.6

49.6

38.6

27.0

29.2

Other (n=6)

5.4

4.4

30+ years (n=26)

23.4

32.2

Self Pay (n=6)

5.4

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

125

District 9-2 Immunization Report, p4

Table 9-2-F: UTD Immunization Rates by demographic group, District 9-2, 2011

State Avg. UTD by 24
months (%)

9-2--UTD by 24 months (%)

9-2--UTD by end of
d.c. (%)

District 9-2 Sample (n=111)

82.7

83.8

92.8

Maternal Race/Ethnicity,

White, NonHispanic (n=66)

83.2

84.9

89.4

White, Hispanic (n=4)

82.0

75.0*

100*

UTD Immunization Rates by Demographic Group: The UTD by 24 months immunization rates for children of white, non-Hispanic mothers and children of black mothers were similar to the state average. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 9-2-F).
Higher maternal education was associated with higher UTD immunizations by 24 months, with the exception of children whose mothers had less than a 9th grade education (see Table 9-2-F).

Black (n=25) Unspecified, Hispanic (n=3) Asian (n=0) Multiracial (n=10)
Maternal Education,

80.7

80.0

96.0 Higher maternal age was positively associated with

87.7

100*

100* UTD immunizations by 24 months. In terms of the

87.3

-

-

maternal marital status and repeat birth variables, children with married mothers were more often UTD

77.6

80.0

100 by 24 months than those with unmarried mothers

(see Table 9-2-F).

Some College+ (n=41) HS Diploma/GED (n=31) 9th-11th grade (n=35)

84.5

92.7

95.1 Children receiving immunizations from both public

81.7

77.4

87.1

and private providers were the less often UTD by 24 months than those receiving immunizations

78.6

77.1

94.3 exclusively in the private sector (72.0% vs. 87.2%).

<9th grade (n=4)
WIC
Non-WIC (n=48)

80.2

100*

100* In terms of payment at birth, District 9-2 children

whose birth was covered by government-assisted

81.5

83.3

87.5 insurance were less often UTD by 24 months than

WIC (n=63)
Maternal Age
<25 years (n=55)

83.7

84.1

96.8

79.8

78.2

94.6

State Avg. UTD by 24
months (%)

9-2--UTD by 24 months (%)

9-2--UTD by end of
d.c. (%)

25-29 years (n=30)

84.1

86.7

86.7 Number of Providers

30+ years (n=26)

84.1

92.3

Maternal Marital Status & Repeat Birth Combination

Married, First Birth (n=13)

88.8

100

Unmarried, First Birth (n=30)

85.6

76.7

Married, Repeat Birth (n=39)

82.4

92.9

Unmarried, Repeat Birth (n=26)
Gestational Age

74.8

69.2

96.2

1 (n=74)

84.4

2 (n=30)

78.2

100

3+ (n=6)

83.0

93.3 Child's Gender

95.2

Male (n=67)

83.3

84.6

Female (n=44)

81.5

Metro Residence

85.1

90.5

83.3

96.7

66.7*

100*

89.6

95.5

75.0

88.6

<37 weeks (n=7) 37+ weeks (n=104)
Provider Type

82.8

71.4*

85.7 Metro (n=7)

82.4

100*

100*

82.4

84.6

93.3 Non-metro (n=104)

82.4

82.7

92.3

Footnotes

Public Sector Only (n=0) Private Sector Only (n=86) Both (n=25)
Payment at Birth,
Government Assist (n=83) Private Insurance (n=16) Other (n=6) Self Pay (n=6)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

87.2 72.0
83.1 93.8 50.0* 100*

90.7 100
94.0 87.5 83.3 100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

126

District 9-2 Immunization Report, p5

children whose birth was covered by private insurance (83.1% vs. 93.5%).
Additionally, male children were more often UTD by 24 months than female children (89.6% vs. 75.0%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 9-2 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:

Although many demographic-related disparities resolved by the end of data collection, some still remained and some new ones emerged (Table 9-2-F, column in italics).
For example, children of black mothers were more often UTD by the end of the data collection period than children of white, non-Hispanic mothers (96.0% vs. 89.4%).
Additionally, children enrolled in WIC became more often UTD than children not enrolled in WIC (96.8% vs. 87.5%).
In terms of payment at birth, the trend reversed: children whose birth was covered by governmentassisted insurance were more often UTD than children whose birth was covered by private insurance (94.0% vs. 87.5%).

Children of mothers without college education Children not enrolled in WIC Children of younger mothers Children of unmarried mothers Children immunized in both the private and public
sectors Children whose birth was covered by government-
assisted insurance Female children

Male children remained more often UTD by the end of data collection than female children (95.5% vs. 88.6%).

Table 9-2-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 9-2, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

78.1

73.2

81.4

79.5

75.7

3 Polio by 24 months

89.6

91.1

91.5

91.6

94.4

1 MMR by 24 months

87.2

83.7

87.6

88.0

86.9

UTD Hib by 24 months

90.2

84.6

88.4

88.0

82.2

3 Hepatitis B by 24 months

92.1

89.4

93.0

95.2

92.5

1 Varicella by 24 months

90.2

86.2

90.7

91.6

88.8

UTD PCV by 24 months

32.3

68.3

76.7

85.5

86.0

2 Rotavirus

-

-

-

-

73.8

1 Influenza by 24 months

-

-

-

-

51.4

2011
85.6 95.5 94.6 92.8 95.5 95.5 96.4 81.1 49.6

Immunization Rates by Antigen: In District 9-2, the UTD immunization rates by 24 months for most antigens fluctuated from 2005 to 2010, with all antigens increasing in 2011 (Table 9-2-G).
Among antigen rates in 2011, the DTaP UTD immunization rate was the lowest at 85.6%, up from 75.7% in 2010. The Hib UTD immunization rate was second-lowest at 92.8%, up from 82.2% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 32.3% in 2005 to 96.4% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP vaccine could reasonably be the primary focus of district and county-level immunization campaigns.

127

128

District 10
2011 Immunization Report

District 10 Data Collection Team

Paula L. Young, RN, MSN, ARNP, NNP-BC

District Immunization Coordinator

Dionne Hansey

Primary Data Collector

County

Sample Metro

Barrow

21 Metro

Clarke

27 Metro

Elbert

4 Nonmetro

Greene

3 Nonmetro

Jackson

10 Nonmetro

Madison

7 Metro

Morgan

5 Nonmetro

Oconee

4 Metro

Oglethorpe

2 Metro

Walton

16 Metro

District 10 99

District Response Rate 92.6%

State of Georgia 2,150

State Response Rate 91.4%

Jackson

Madison

Elbert

Barrow Walton

Clarke Oconee

Oglethorpe

Morgan

Greene

129

District 10
Immunization Report, p2

From 24 months to End of Data Collection: In the District 10 sample, the up-to-date (UTD) immunization rate of children by 24 months of age was lower than the state rate (78.8% vs. 82.4%). By the end of data collection, the district UTD immunization rate remained lower than the state rate (92.9% vs. 94.0%) (Table 10-B).

From 2010 to 2011: The District 10 UTD immunization rate by 24 months decreased by 9.4% from 2010 to 2011. The district UTD immunization rate by the end of data collection decreased by 2.6% from 2010 to 2011 (Figure 10-C).

Sample population demographics for this district and their effect on up-to-date (UTD) immunization rates are discussed on the following pages.

Table 10-0-A: Sampling Scheme, District 10, 2011

District 10 (n)

State (n)

Original Sample

108 2,447

Ineligible

1

82

Refused to Participate

0

6

Eligible Sample Unable to Locate

107 2,359

8

210

Final Sample

99

2,150

Response Rate (%)

92.6

91.4

Children were classified as "Unable to Locate" if every conceivable effort was made to locate and communicate with the child's guardian and the child's provider was either unknown or also unable to locate the guardian.

Table 10-0-B: Immunization Summary by Series & Antigen, District 10, 2011

District State

10 Average

(%)

(%)

UTD immunization rate*
by 24 months
UTD immunization rate*
by end of data collection
4 DTaP by 24 months
3 DTaP by 24 months

78.8

82.4

92.9

94.0

84.9

85.8

98.0

97.5

3 IPV by 24 months

96.0

96.7

1 MMR by 24 months

89.9

93.0

UTD Hib by 24 months

95.0

95.1

3 Hep B by 24 months

95.0

96.5

1 Varicella by 24 months

93.9

93.9

UTD PCV by 24 months 2 Rotavirus by 24 months 2 Hep A by 24 months 1+ Influenza by 24 months 2 H1N1

95.0

96.7

82.8

83.8

49.5

53.1

53.5

60.1

20.2

27.1

This value includes children who become UTD during the data collection period. This number, when compared to the values followed with "by 24 months", is a testament to the efforts of district staff to reach the children originally listed as incomplete in their district. * This rate includes children up-to-date by ACIP-recommended catch-up schedule.

100%

Figure 10-0-C: Immunization Rate History, District 10, 2000-2011

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004
District 10: UTD by 24 months
Georgia: UTD by 24 months

2005

2006 2007 2008 2009* 2010 2011
District 10: UTD by end of data collection
Georgia: UTD by end of data collection

* 2009 data was not collected due to personnel vacancy.

130

Table 10-0-D: Sample Population Demographics, District 10, 2011

District State Final 10 Final % Sample %

District 10 Final Sample (n=99)

-

-

Notable Demographic Findings: The proportion of cnthhoainlnd-Hrfeiosnrpatwhnheiocosweveamrsaogltlrheseatartseterwfseoar%rmeStoapchfmlleeaFpsdi(sln5iiesfa7ti.ler6idc%tav%sssaSw.omaf4hmpI2intlp.eie1lte,%ia)l (Table 10-D).

Maternal Race/Ethnicity,
White, NonHispanic (n=57) White, Hispanic (n=2) Black (n=21)

The district sample had a smaller proportion of

57.6

42.1

children enrolled in WIC than the state sample

(30.3% vs. 42.7%) as well as a smaller proportion of

2.0

4.4

children seen exclusively in the private sector

21.2

33.0

(63.6% vs. 80.8%).

Unspecified, Hispanic (n=10) Asian (n=3)

10.1

7.2

Other demographic measures for this district were

3.0

2.9

similar to findings for the state sample as a whole.

Multiracial (n=2)
Maternal Education,
Some College+ (n=46) HS Diploma/GED (n=33)

2.0

4.6

Private Sector vs. Public Sector: Among

immunizations administered to children in District

10 (n=1,191), the majority were administered in the

46.5

43.5

private sector, to a greater degree than in the state

33.3

28.4

sample (90.4% vs. 93.3%) (Figure 10-E).

9th-11th grade (n=14) <9th grade (n=4)
WIC
Non-WIC (n=69) WIC (n=30)
Metro Residence

14.1

17.2

Figure 10-0-E: Immunizations Administered

4.0

5.9

in Private VS Public Sector, District 10, 2011 (n=1,191)

69.7

57.3

30.3

42.7

9.6%

Metro (n=77) Non-metro (n=22)
Maternal Marital Status

77.8

79.9

22.2

20.1

90.4%

Married (n=59)

59.6

52.1

Unmarried (n=40)
Repeat Birth
First Child (n=41) Repeat Birth (n=58)
Gestational Age

40.4

47.7

41.4

40.9

58.6

59.1

Public Sector

Private Sector
District State Final 10 Final % Sample %

Child's Gender

<37 weeks (n=10) 37+ weeks (n=89)
Provider Type

10.1

10.0

Male (n=46)

46.5

50.7

89.9

90.0

Female (n=53)

53.5

49.3

Number of Providers

Public Sector Only (n=2)

2.0

1.2

1 (n=44)

44.4

49.9

Private Sector Only (n=63)

63.6

80.8

2 (n=24)

24.2

22.1

Both (n=16)
Payment at Birth

16.2

10.9

3+ (n=9)

Maternal Age

9.1

6.6

Government Assist (n=45) Private Insurance (n=37)

45.4

43.4

<25 years (n=39)

37.4

29.1

25-29 years (n=26)

39.4

38.6

26.3

29.2

Other (n=0)

0

4.4

30+ years (n=34)

34.3

32.2

Self Pay (n=6)

6.1

4.8

Please see Appendix C for additional information regarding the methodology in obtaining this variable. Indicates that this variable corresponds to the data collected at the time of delivery. Indicates that the percentages for this variable may not add up to 100% because the information was missing in some cases.

131

District 10 Immunization Report, p4

Table 10-0-F: UTD Immunization Rates by demographic group, District 10, 2011

State Avg. UTD by 24
months (%)

10--UTD by 24 months (%)

10--UTD by end of
d.c. (%)

District 10 Sample (n=99)

82.7

78.8

92.9

Maternal Race/Ethnicity,

UTD Immunization Rates by Demographic Group: Children of white, non-Hispanic mothers and black mothers had similar UTD immunization rates by 24 months (77.2% and 81.0%, respectively). Children of Hispanic mothers were more often UTD when compared to the district sample as a whole (100% vs. 78.8%). The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 10-0-F).

White, NonHispanic (n=57) White, Hispanic (n=2) Black (n=21) Unspecified, Hispanic (n=10) Asian (n=3) Multiracial (n=2)
Maternal Education,

83.2

77.2

93.0 Higher maternal education was positively associated

82.0

100*

100*

with UTD coverage rates, although the sample size for the <9th grade maternal education group was too

80.7

81.0

95.2 small to draw any conclusions (see Table 10-0-F).

87.7

100

100

In District 10, the children enrolled in WIC had a

87.3

66.7*

66.7* lower UTD immunization rate than those not enrolled

77.6

50.0*

50.0* in WIC (73.3% vs. 81.2%); this disparity was greater

than, and inverse to, what was seen for the state

sample as a whole (83.7% vs. 81.5%).

Some College+ (n=46) HS Diploma/GED (n=33) 9th-11th grade (n=14) <9th grade (n=4)
WIC

84.5

84.8

89.1 In terms of maternal age, children of mothers

81.7

72.7

93.9 between 25 and 29 years of age were the most often

78.6

71.4

100

UTD by 24 months (96.2%). In terms of the maternal marital status and repeat birth variables, children of

80.2

75.0*

100* unmarried mothers with previous children were the

most often UTD by 24 months (100%).

Non-WIC (n=69)

81.5

81.2

92.8

WIC (n=30)
Maternal Age
<25 years (n=39)

83.7

73.3

93.3

79.8

71.8

94.9

State Avg. UTD by 24
months (%)

10--UTD by 24 months (%)

10--UTD by end of
d.c. (%)

25-29 years (n=26)

84.1

96.2

100

Number of Providers

30+ years (n=34)

84.1

73.5

85.3

1 (n=44)

84.4

79.6

90.9

Maternal Marital Status & Repeat Birth Combination

2 (n=24)

78.2

75.0

91.7

Married, First Birth (n=20)

88.8

80.0

90.0

3+ (n=9)

83.0

77.8*

100*

Unmarried, First Birth (n=21)

85.6

81.0

85.7 Child's Gender

Married, Repeat Birth (n=39)

82.4

79.5

94.9

Male (n=46)

83.3

82.6

97.8

Unmarried, Repeat Birth (n=19)

74.8

100

100

Female (n=53)

81.5

75.5

88.7

Gestational Age

Metro Residence

<37 weeks (n=10)

82.8

100

100

Metro (n=77)

82.4

79.2

93.5

37+ weeks (n=89)

82.4

76.4

92.1

Non-metro (n=22)

82.4

77.3

90.9

Provider Type

Footnotes

Public Sector Only (n=2) Private Sector Only (n=63) Both (n=16)
Payment at Birth,
Government Assist (n=45) Private Insurance (n=37) Other (n=0) Self Pay (n=6)

80.8 84.1 73.1
79.6 85.1 80.0 92.3

50.0* 82.5 68.8
73.3 83.8
100*

100* 93.7 87.5
93.3 89.2
100*

"d.c." is an abbreviation for "data collection"
Indicates that this variable corresponds to the data collected
at the time of delivery.
Indicates that the sample size numbers for this variable may
not add up to the total district sample size because the information was missing in some cases.
Please see Appendix C for additional information regarding the methodology in obtaining this variable.
* Indicates that there were less than 10 children in this
demographic category.

132

District 10 Immunization Report, p5

Children born at a gestational age of less than 37 weeks were more often UTD by 24 month than those born at a gestational age of greater than 37 weeks (100% vs. 76.4%).

collection period (87.5%). Male children also remained more UTD than female children (97.8% vs. 88.7%).

Children receiving immunizations from both public and private providers were the least often UTD by 24 months among the three groups (68.8%).
In terms of payment at birth, District 10 children whose birth was covered by government-assisted insurance were less often UTD by 24 months than children whose birth was covered by private insurance (73.3% vs. 83.8%).
Interestingly, male children in this district were more often UTD by 24 months than female children (82.6% vs. 75.5%).
Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 10-0-F, column in italics).
For example, children of mothers 25-29 years of age remained the most UTD among the maternal age categories (100%). Additionally, children receiving immunizations from both public and private providers remained less often UTD by the end of the data

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 14), the District 10 results suggest that the following groups are the least often up-to-date on their immunizations by 24 months of age:
Children of mothers without college education
Children of mothers less than 25 years of age
Children of mothers 30 years of age or older
Children enrolled in WIC
Children receiving immunizations from both public and private providers
Children whose birth was covered by governmentassisted insurance
Female children

Table 10-0-G: Antigen-Specific Immunization Coverage (%) by 24 months of age, District 10, 2005-2011

2005

2006

2007

2008

2010

4 DTaP by 24 months

90.3

86.1

80.8

78.0

91.6

3 Polio by 24 months

96.8

93.1

86.5

87.1

97.7

1 MMR by 24 months

96.8

91.7

88.5

84.1

95.4

UTD Hib by 24 months

96.8

95.8

86.5

87.1

95.4

3 Hepatitis B by 24 months

95.2

93.1

88.5

87.9

97.0

1 Varicella by 24 months

96.8

91.7

89.4

85.6

97.0

UTD PCV by 24 months

37.1

76.4

79.8

84.1

97.7

2 Rotavirus

-

-

-

-

74.8

1 Influenza by 24 months

-

-

-

-

59.5

2011
84.9 96.0 89.9 95.0 95.0 93.9 95.0 82.8 53.5

Immunization Rates by Antigen: In District 10, the UTD immunization rates by 24 months for most antigens fluctuated from 2005 to 2011 (Table 10-0-G).
Among antigen rates in 2011, the DTaP UTD immunization rate was the lowest at 84.9%, down from 91.6% in 2010. The MMR UTD immunization rate was the second-lowest at 89.9%, down from 95.4% in 2010.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 37.1% in 2005 to 95.0% in 2011.
Antigen-Specific Conclusions: The antigen-specific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of district and countylevel immunization campaigns.

133

134

Appendix
Georgia Immunization Study, 2011
i

ii

Appendix A: Data Collection Form, p1
iii

Appendix A: Data Collection Form, p2
iv

Appendix A: Data Collection Form, p3
v

vi

Appendix B: Margins of Error, p1

Appendix Table B-1: Margins of Error for UTD Immunization Rates by 24 months, Georgia, 2011

District

Final Sample
(n)

UTD Immunization
Rate

1-UTD Immunization
Rate

Margin of Error

95% Confidence Intervals

1-1 Northwest (Rome)

94

88.3%

11.7%

6.5%

81.8% -- 94.8%

1-2 North Georgia (Dalton)

115

78.3%

21.7%

7.5%

70.7% -- 85.8%

2-0 North (Gainesville)

145

86.2%

13.8%

5.6%

80.6% -- 91.8%

3-1 Cobb-Douglas

174

85.6%

14.4%

5.2%

80.4% -- 90.8%

3-2 Fulton

160

81.9%

18.1%

6.0%

75.9% -- 87.8%

3-3 Clayton

104

84.6%

15.4%

6.9%

77.7% -- 91.5%

3-4 Gwinnett, Newton, Rockdale

180

80.0%

20.0%

5.8%

74.2% -- 85.8%

3-5 DeKalb

138

84.8%

15.2%

6.0%

78.8% -- 90.8%

4-0 LaGrange

171

81.3%

18.7%

5.8%

75.4% -- 87.1%

5-1 South Central (Dublin)

50

80.0%

20.0%

11.1%

68.9% -- 91.1%

5-2 North Central (Macon)

97

83.5%

16.5%

7.4%

76.1% -- 90.9%

6-0 East Central (Augusta)

85

78.8%

21.2%

8.7%

70.1% -- 87.5%

7-0 West Central (Columbus)

115

78.3%

21.7%

7.5%

70.7% -- 85.8%

8-1 South (Valdosta)

77

90.9%

9.1%

6.4%

84.5% -- 97.3%

8-2 Southwest (Albany)

93

83.9%

16.1%

7.5%

76.4% -- 91.3%

9-1 Coastal (Savannah)

142

76.8%

23.2%

6.9%

69.8% -- 83.7%

9-2 Southeast (Waycross)

111

83.8%

16.2%

6.9%

76.9% -- 90.6%

10-0 Northeast (Athens)

99

78.8%

21.2%

8.1%

70.7% -- 86.8%

Georgia

2,150

82.4%

17.6%

1.6%

80.8% -- 84.0%

vii

Appendix B: Margins of Error, p2

Appendix Table B-2: Margins of Error for UTD Immunization Rates by End of Data Collection, Georgia, 2011

District

Final Sample (n)

UTD Immunization
Rate

1-UTD Immunization
Rate

Margin of Error

95% Confidence Intervals

1-1 Northwest (Rome)

94

95.7%

4.3%

4.1%

91.7% -- 99.8%

1-2 North Georgia (Dalton)

115

91.3%

8.7%

5.1%

86.2% -- 96.5%

2-0 North (Gainesville)

145

94.5%

5.5%

3.7%

90.8% -- 98.2%

3-1 Cobb-Douglas

174

94.3%

5.7%

3.5%

90.8% -- 97.7%

3-2 Fulton

160

94.4%

5.6%

3.6%

90.8% -- 97.9%

3-3 Clayton

104

95.2%

4.8%

4.1%

91.1% -- 99.3%

3-4 Gwinnett, Newton, Rockdale

180

93.3%

6.7%

3.6%

89.7% -- 97.0%

3-5 DeKalb

138

95.7%

4.3%

3.4%

92.2% -- 99.1%

4-0 LaGrange

171

89.5%

10.5%

4.6%

84.9% -- 94.1%

5-1 South Central (Dublin)

50

94.0%

6.0%

6.6%

87.4% -- 100.0%

5-2 North Central (Macon)

97

99.0%

1.0%

2.0%

97.0% -- 100.0%

6-0 East Central (Augusta)

85

98.8%

1.2%

2.3%

96.5% -- 100.0%

7-0 West Central (Columbus)

115

89.6%

10.4%

5.6%

84.0% -- 95.2%

8-1 South (Valdosta)

77

96.1%

3.9%

4.3%

91.8% -- 100.0%

8-2 Southwest (Albany)

93

96.8%

3.2%

3.6%

93.2% -- 100.0%

9-1 Coastal (Savannah)

142

93.7%

6.3%

4.0%

89.7% -- 97.7%

9-2 Southeast (Waycross)

111

92.8%

7.2%

4.8%

88.0% -- 97.6%

10-0 Northeast (Athens)

99

92.9%

7.1%

5.0%

87.9% -- 98.0%

Georgia

2,150

94.0%

6.0%

1.0%

93.0% -- 95.0%

viii

Appendix C: Description of Demographic Variables, p1

Variable Maternal Race Maternal Ethnicity Maternal Education Maternal Age Maternal Marital Status Repeat Birth Gestational Age <37 weeks Payment at Birth Child's Gender
Provider Type
Number of Providers

Percent Missing for State Sample
10.8% 5.8% 4.1% 0% 0.1%
0% 0% 27.4% 0%
3.3%
3.0%

Source

Additional Information

Electronic Birth Records
Electronic Birth Records
Electronic Birth Records
Electronic Birth Records
Electronic Birth Records
Electronic Birth Records
Electronic Birth Records
Electronic Birth Records
Electronic Birth Records
GRITS/Data Collectors
GRITS/Data Collectors

Was combined with maternal ethnicity variable to form race/ethnicity category.
Only used in combination with white race and undefined race because the statewide sample had fewer than 10 children for whom maternal race was defined, not "white", with Hispanic ethnicity.
Additional Coding not needed; standard measure in GA Electronic Birth Records.
Originally coded as number of days. Maternal age break-down chosen based on HEDIS measures
Additional Coding not needed; standard measure in GA Electronic Birth Records. See below for more information about combination with repeat birth variable.
Additional Coding not needed; standard measure in GA Electronic Birth Records. Combined with maternal marital status to limit possible effect modification or confounding between the two variables.
Additional Coding not needed; standard measure in GA Electronic Birth Records.
Additional coding was required to create "Government Assist" classification, combining all different codes involving Medicaid, Medicare, and Georgia Better Health Care
Additional Coding not needed; standard measure in GA Electronic Birth Records.
For each administered vaccine, the provider was assessed as either private, public or unknown. If a child only received immunizations from a public health department, they were classified as "public only". If a child received immunizations exclusively from (a) private provider/s, they were classified as "private only". If they received immunizations from a mixture, they were classified as "both"
For each administered vaccine, the provider was researched. For records where the same provider administered all vaccines, the child was classified as having "1" provider. For two different providers, the child would have "2" providers. The number of providers was limited to 3.

ix

Appendix C: Description of Demographic Variables, p2

Variable WIC Enrollment Metro Residence

Percent Missing for State Sample

Source

Additional Information

Yearly cumulative lists of enrolled

children were used to match children

from the study sample to the enrollment

list using names and dates of birth. The

N/A

WIC Program duration of enrollment was not

calculated, so the children classified as

"WIC enrolled" could have been enrolled

for a short amount of time or for their

entire lives.

2003 Rural-Urban R-U Continuum Code was assigned by

0%

Continuum Codes, child's residential county and later Economic Research categorized as metro or non-metro using

Service

guide in below table.

2003 Rural-Urban Continuum Codes* Metro Counties 1 Counties in metro areas of 1 million population or more 2 Counties in metro areas of 250,000 to 1 million population 3 Counties in metro areas of fewer than 250,000 population Non-Metro Counties 4 Urban population of 20,000 or more, adjacent to metro area 5 Urban population of 20,000 or more, not adjacent to metro area 6 2,500 to 19,999, adjacent to metro area 7 2,500 to 19,999, not adjacent to metro area 8 Completely rural or less than 2,500 population, adjacent to metro area 9 Completely rural or less than 2,500 population, not adjacent to metro area
* This coding scheme was originated in 1975 by David L. Brown, Fred K. Hines, and John M. Zimmer, then of the Economic Research Service, for a report Social and Economic Characteristics of the Population in Metro and Nonmetro Counties: 1970. It was updated after both the 1980 and 1990 censuses, with a somewhat more restrictive procedure for determining metro adjacency. The versions based on the 1970, 1980, and 1990 Censuses are all found on
this ERS website ; http://www.ers.usda.gov/briefing/rurality/ruralurbcon/

x

Appendix D: Logistic Regression Model

Table B-1: Odds of UTD Immunization Rates at 24 months by demographic group, Georgia--2010

Odds Ratio Odds Ratio

of UTD by Standard

z

24 months

Error

p>|z|

95% Confidence Interval

Maternal Race/Ethnicity,

White, NonHispanic (n=905) White, Hispanic (n=94) Black (n=710) Unspecified, Hispanic (n=155) Asian (n=63) Multiracial (n=125)
Maternal Education,
Some College+ (n=935) HS Diploma/GED (n=611) 9th-11th grade (n=369)

Ref.

1.58

0.84

0.86

0.387

0.56 -- 4.48

1.06

0.19

0.35

0.728

0.75 -- 1.51

2.02

0.99

1.44

0.149

0.78 -- 5.26

1.41

0.78

0.62

0.537

0.47 -- 4.18

0.75

0.26

-0.84

0.399

0.38 -- 1.48

Ref.

0.81

0.16

-1.08

0.280

0.55 -- 1.19

0.81

0.19

-0.90

0.368

0.51 -- 1.28

<9th grade (n=126)
Medicaid

0.51

0.20

-1.71

0.087

0.24 -- 1.10

Non-WIC (n=919) WIC (n=1,231)

Ref.

1.33

0.22

1.71

0.088

0.96 -- 1.85

Maternal Age
<25 years (n=830) 25-29 years (n=627)

0.85

0.16

-0.85

0.394

0.58 -- 1.24

Ref.

30+ years (n=693)
Maternal Marital Status
Married (n=1,120) Unmarried (n=1,026)
Repeat Birth
First Birth (n=880) Repeat Birth (n=1,270)
Gestational Age

1.20

0.26

0.87

0.386

Ref.

0.56**

0.11

-2.91

0.004

Ref.

0.43**

0.08

-4.81

0.000

0.79 -- 1.83 0.38 -- 0.83 0.31 -- 0.61

<37 weeks (n=215) 37+ weeks (n=1,935)
Number of Providers,

1.05

0.27

0.18

0.861

0.63 -- 1.73

Ref.

1 (n=1,073) 2 (n=476) 3 (n=141)
Payment at Birth,
Government Assist (n=933) Private Insurance (n=626) Other (n=95) Self Pay (n=104)

Ref.

0.59**

0.10

-3.27

0.001

1.36

0.43

0.95

0.340

0.95

0.21

-0.25

0.803

Ref.

0.52

0.18

-1.91

0.056

1.89

1.04

1.16

0.247

0.43 -- 0.81 0.72 -- 2.53
0.61 -- 1.46
0.27 -- 1.02 0.64 -- 5.54

*Indicates statistical significance, p-value<0.05 **Indicated statistical significance, p-value<0.01

xi

Appendix E: Reasons for Incomplete Immunization History

Appendix Table C: Reasons Cited by Parents and Physicians for Incomplete Immunizations by End of Data Collection, Georgia, 2011

A. Religious Exemption B. Medical Exemption C. Temporary Vaccine Shortage D. Parent Refuses to Vaccinate* E. Parent Chooses to use Delayed Schedule F. Physician Chooses to use Delayed Schedule G. Missed Appointments/Convenience Issue H. Unable to Locate Parent and/or Physician I. Other

District

A

B

C

D

E

F

G

H

I

Total

1-1 Northwest (Rome)

1

0

0

2

1

0

0 14 0

18

1-2 North Georgia (Dalton)

4

0

0

2

2

2

0

1

0

11

2-0 North (Gainesville)

1

0

0

1

4

0

1

1

0

8

3-1 Cobb-Douglas

0

0

0

2

4

1

3 19 0

29

3-2 Fulton

0

0

0

1

3

0

1 36 4

45

3-3 Clayton

0

1

0

1

3

0

0 11 0

16

3-4 Gwinnett, Newton, Rockdale 1

0

0

8

0

2

0 26 1

38

3-5 DeKalb

0

0

0

1

1

0

3 33 0

38

4-0 LaGrange

0

0

0

2

0

4

1

3 11

21

5-1 South Central (Dublin)

0

0

0

1

0

0

1

2

1

5

5-2 North Central (Macon)

0

0

0

0

0

0

1 12 0

13

6-0 East Central (Augusta)

0

0

0

0

0

0

1

0

0

1

7-0 West Central (Columbus)

0

0

0

0

8

2

1 15 1

27

8-1 South (Valdosta)

0

0

0

0

1

0

1

6

0

8

8-2 Southwest (Albany)

0

0

0

0

0

1

2

4

0

7

9-1 Coastal (Savannah)

0

0

0

0

0

3

1 15 4

23

9-2 Southeast (Waycross)

0

0

1

1

3

1

3

4

0

13

10-0 Northeast (Athens)

1

0

0

0

3

0

1

8

2

15

Georgia

8

1

1 22 33 16 21 210 24 126

*Child was classified as "Parent Refusal to Vaccinate" if a parent refused one or more vaccine series.

xii

Additional Resources
For more information about the Georgia Department of Public Health Immunization Program, please visit the following website: health.state.ga.us/programs/immunization/
For past Georgia Immunization Study Final Reports, please visit the following link: health.state.ga.us/programs/immunization/publications.asp
For more information about the Georgia Department of Public Health Acute Disease Epidemiology Unit, please visit the following website: health.state.ga.us/epi/ades/
For more information about the Centers for Disease Control and Prevention's (CDC) National Immunization Survey (NIS), please visit the following website: www.cdc.gov/ nchs/nis.htm
To access current vaccine schedules, vaccine information sheets and other immunization materials, please visit the Immunization Action Coalition website at www.immunize.org
The Georgia Epidemiology Report (GER) The Georgia Epidemiology Report (GER) is a quarterly electronic publication of the Georgia Department of Public Health. The GER focuses on public health issues in Georgia and is distributed to medical and public health professionals across the state. If you are interested in subscribing to the GER, please email GER@dhr.state.ga.us with your name, title, organization, and email. The GER will also be available on the Acute Disease Epidemiology Unit website above.
For questions relating specifically to this document, please email the author at rmwillis@dhr.state.ga.us.