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. 1 2 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 3 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. 4 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] 5 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) 7 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 8 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 11 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. 12 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. 13 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. 14 Section II Statewide Results Georgia Immunization Study, 2011 15 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 17 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. 18 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.