Georgia immunization study: 2012 final report

GEORGIA IMMUNIZATION STUDY
2012 Final Report
Georgia Department of Public Health Immunization Program | Acute Disease Epidemiology Unit
Eighteen Public Health Districts
Prepared by Rebecca M. Willis, MHS, Principal Investigator Manoj T. Rema, MPH, Author Jessica Tuttle, MD, Author and Primary Editor Cherie Drenzek, MS, DVM, Editor Steven Mitchell, MPH, Editor
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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.
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 on making this study more pertinent to pediatricians throughout Georgia.
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Executive Summary
The 2012 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 Vaccines for Children providers of Georgia that contributed to this collaborative effort. Their cooperation and assistance throughout the study was greatly appreciated.
The two-year old GIS employs a retrospective cohort research design to determine the up-to-date immunization rate for children born in the state of Georgia. Immunization history data for 18 Health District cohorts of children who turned two in January of 2012, 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 20121.
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 series dates occurred before the child reached 24 months, the child was classified as up-to-date by 24 months. Children were excluded from the up-to-date by 24 months classification if some of the 4:3:1:3:3:1:4 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 by 24 months measures for reporting purposes, since these were the rates prior to any parent or provider contact. In 2012, the Georgia statewide up-to-date immunization rate by 24 months was 84.5%, up from 82.4% in 2011 (Page 18, Table 2).
Efforts to bring children up-to-date were evident in an overall 10.8% increase in immunization rate between 24 months of age and the end of the data collection period (Page xxvi, Appendix Table E-1). This increase is evidence that the children who are not up-to-date by 24 months can be brought up-to-date within six months if adequate patient recall and educational measures are taken. Although the majority of immunizations from our sample were administered in the private sector, 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 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 2012 study sample of children who were born in Georgia in 2010, 82.7% received their first dose of hepatitis B vaccine at birth (Page xxvii, Appendix Table E-2), down from 83.4% in 2011 (children born in 2009) but up from 76.2% in 2010 (children born in 2008). In addition, the percentage of children who received the entire 3-dose hepatitis B series by 24 months of age slightly decreased from 96.5% in 2011 to 96.1% in 2012. 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. (February 10, 2012). MMWR weekly: Recommended Immunization Schedules for Persons Aged 0 Through 18 Years --- United States, 2012. MMWR 2012; 61(5). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6105a5.htm
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There was considerable variation by District in the percent of 24 month old children found to be fully immunized by 24 months, ranging from 77.3% in the Fulton District (3-2) to 92.9% in the Rome District (1-1). Between 2011 and 2012, District up-to-date by 24 months immunization rates rose by 2.5% overall for the state, with the greatest increase of 16.2% seen in the Columbus District (7-0) (Page xxvi, Appendix Table E -1).
Although the percentage of Georgia children who received the fourth dose of DTaP by 24 months of age increased in 2012, it continues to significantly lag behind the percentage of children who received the third dose by 24 months of age. In fact, 97.0% of children had received 3 doses of DTaP by 24 months of age while only 87.0% had received their fourth dose in 2012 (Page 18, Table 2). 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. Future studies will assess the role of Medicaid and what role loss of coverage may contribute to the drop in fourth dose DTaP coverage.
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 84.0% in the Fulton District (3-2) to 98.7% in the Columbus District (7-0). These data support that contact with parents and providers during data collection made a difference. The greatest impact was seen in the Dublin District (5-1), where up-to-date immunization rates rose 20.0% 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. The groups that were high risk in at least seven Districts included children of unmarried mothers, children of mothers with previous children, and children of mothers less than 25 years of age. The groups that were high risk in at least nine Districts included children receiving immunizations from two providers instead of only one, children whose birth was covered by government-assisted insurance and children of mothers without a college education. Future study years will reveal which of these associations is consistent from year to year. Please see Section III (Page 25) for individual Health District results.
A notable finding of the 2012 GIS is that no significant differences were noted in up-to-date immunization rates in any of the WIC populations. For example, there were no Districts in the state where children enrolled in WIC were significantly more likely to be up-to-date on their immunizations by 24 months (Page 24). However, in the South Central (Dublin) District (5-1), children enrolled in WIC were significantly less likely to be up-to-date on their immunizations by 24 months. Districts and healthcare providers are encouraged to review these WIC enrollment data (Page 24, Table 8) 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 2012 report is the list of the top 3 Health Districts for various categories, including response rates, series immunization rates, and antigen-specific immunization rates (Page 23, Table 7). 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 2012 GIS report offers the people of Georgia and its Public Health Districts a chance to study demographic and immunization history data simultaneously, so that evidence-based programs can be created to raise immunization rates across the state of Georgia. The 2012 data clearly show that although the vast majority of immunizations are administered outside of public health clinics, public health staff can effectively collaborate with parents and private sector providers, and have an impact on improving coverage rates.
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Abbreviations & Vaccine Names

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

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]

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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 Division of Public Health State Sampling Scheme, Immunization Summary, Immunization Rates (2000-2012) State Sample Population Demographics, Findings and Comparisons Up-to-date (UTD) Immunization Rates by Demographic Group Antigen-Specific UTD Immunization Rates (2006-2012) District Immunization Rates Immunization Success Measures by Health District Findings Related to WIC Enrollment Section III: Health District Immunization Reports District 1-1 Immunization Report (Rome District) District 1-2 Immunization Report (Dalton District) District 2-0 Immunization Report (Gainesville District) District 3-1 Immunization Report (Cobb-Douglas District) District 3-2 Immunization Report (Fulton District) District 3-3 Immunization Report (Clayton District) District 3-4 Immunization Report (Gwinnett, Newton, Rockdale District) District 3-5 Immunization Report (DeKalb District) District 4-0 Immunization Report (LaGrange District) District 5-1 Immunization Report (Dublin District) District 5-2 Immunization Report (Macon District) District 6-0 Immunization Report (Augusta District) District 7-0 Immunization Report (Columbus District) District 8-1 Immunization Report (Valdosta District) District 8-2 Immunization Report (Albany District) District 9-1 Immunization Report (Savannah District) District 9-2 Immunization Report (Waycross District) District 10-0 Immunization Report (Athens District)
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Page(s)
1 3--4
5 7--8 9--14 11--13 13--14 15--24 17-24 17 18 19 20 21 22 23 24 25--134 27--30 31--34 35--38 39--42 43--46 47--50 51--54 55--58 59--62 63--66 67--70 71--74 75--78 79--82 83--86 87--90 91--94 95--98

Table of Contents
Contents
Appendix Appendix A: Margins of Error for UTD Immunization Rates Appendix B: Sources and Characteristics of Demographic Variables Appendix C: Reasons for Incomplete Immunization History Appendix D: Sample Population Demographics, by District Appendix E: District Immunization Measures

Page(s)
i-xiii iii-iv v--vi vii ix--xxvi xxvii--xxviii

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Section I Project Overview
Georgia Immunization Study, 2012
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Methods

Study Design The annual Georgia Immunization Study (GIS) employs a retrospective cohort research design to ascertain the up-to-date (UTD) immunization rate for two-year-old children born in the state of Georgia. Immunization history data for cohorts of children who turned two in January, 2012 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 vaccine 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 2012.
At the end of the six-month data collection 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 series administration dates occurred before the child reached 24 months of age, then the child was classified as UTD by 24 months. Children were excluded from the 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 reminderrecall 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 District samples, as well as for demographic groups within these samples.
Target and Sample Populations The target population of the 2012 GIS included all 24month-old children born in the state of Georgia in 2010. A sample of 2,589 children born in the month of January 2010 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 was based on weighted data to account for differential probabilities of selection for each Health District and selected from the total number of statewide births during the month of January 2010. The number of children randomly selected from each District depended on population distribution statistics, response rates and District immunization rates from the 2011 GIS. Information for each child, including all available birth certificate variables, was collected.
Examples of the type of birth certificate information obtained 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 Father's first, middle, and last name (if available) Mother's race and ethnicity

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Methods Section, p2

Mother's level of education Mother's marital status Mother's age Payment type used to cover child's birth
Other demographic variables used in the analysis, such as Provider Type and Number of Providers, were 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. When the data were originally collected at the State Epi office, the number of providers was recorded. Each child was classified as having 1, 2, or 3+ providers.
The "Provider Type" variable was determined based on the location where each individual vaccine was administered (see Part III: Immunization History, below). If a child received vaccines exclusively in private provider offices, the child was classified as "Private Sector Only". If a child received vaccines exclusively in public health clinics, the child was classified as "Public Sector Only". If a child received vaccines in both private provider offices and public health clinics, the child was classified as "Both".

American Academy of Family Physicians (AAFP). The TWOY data collection system contains five distinct sections to be completed by the public health data collectors: Child, Notes, Guardians, Providers, and VX List (Immunization History).
Data collection was carried out primarily by County and District Public Health Nurses. Data collectors in each Health District participated in training via conference call at the start of the data collection period. A Training Manual was also provided 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 at the Health District level, the Principal Investigator at the State Epi 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 District staff, with the dates found in GRITS already entered into the TWOY system. 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 below.

Data Collection An electronic web-based data collection system named "TWOY" was used to systematically collect the required information for each child. The TWOY system follows the recommended schedule of childhood immunizations jointly approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the

Step #2: Search for immunization records through the parent(s) and/or guardian(s). In this step, data collectors used the contact information from the birth certificate or any updated contact information found at the health department or in GRITS to contact the child's parent. Data collectors also used sources such as city phone directories, directory assistance, and the internet to find current

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Methods Section, p3

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 for their child (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.

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 birth date.

Step #3: Search for immunization records through private physician(s). 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.

To account for possible scheduling delays by physician office staff, a 2-week grace period was applied to the 24-month calculations.
Limitations The following describe important limitations of the study that should be considered when interpreting study results:

Step #4: Data returned to State Epi office and checked for accuracy. Using the TWOY system, data collectors completed follow-up on all children by the end of the six-month data collection period, and all completed records were reviewed by the Principal Investigator throughout the process. Attempts were made to resolve any unclear information before data cleaning using Stata/SE 10.

1. There were three limitations related to sampling:
Although the study included a random sample of children born in January 2010 and, thus, represented a fair estimate of immunization rates for all two-year-olds born in 2010, it could not account for variations that may routinely occur in other months of the year.

Data Analysis The 2012 data analysis methods were the same as those employed in 2011. Analyses were done using Stata/SE 10 software and macros developed by the Principal Investigator.
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 at both the state and District levels.
Up-to-date (UTD) immunization rates were calculated

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
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Methods Section, p4

be found.
2. Response rates for each District are included on the first and second pages of all District reports. Response rate is calculated by subtracting the number of "Unable to Locate" children by the number of eligible participants and then dividing by the number of eligible participants. 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 state sample; this same method was used for each of the Health District samples.

For future studies, the possibility of combining the two Hispanic fields will be considered.

Table 1: Sampling Scheme, GIS Georgia, 2012

2012 (n)

Original Sample

2,973

Ineligible

130

Eligible Sample

2,835

Refused to Participate

8

Unable to Locate

246

Final Sample

2,589

Response Rate (%)

92.3

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.

3. Maternal race/ethnicity was used as a demographic variable in the analysis. The categories included in analysis were:

White, non-Hispanic (n=1058) White, Hispanic (n=112) Black (n=958) Unspecified, Hispanic (n=229) Asian (n=56) Multiracial (n=41)

Some race/ethnicity demographics were not used in analyses due to an insufficient number of cases. In addition, Hispanic ethnicity was divided between two race categories, "white, Hispanic" and "unspecified, Hispanic" because the majority of Hispanics were found in the "white" race and "unspecified" race. This issue 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.

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Section II Statewide Results
Georgia Immunization Study, 2012
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State of Georgia
2012 Georgia Immunization Study Report

Rebecca M. Willis, MHS Manoj T. Rema, MPH Jessica Tuttle, MD

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

3-4

3-2 3-5

3-3

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State of Georgia
2012 Georgia Immunization Study Report, p2

From 24 months to End of Data Collection: The UTD immunization rate by 24 months of age for the state sample was 84.5%, which increased to 93.6% by the end of the six-month data collection period (Table 2).
From 2011 to 2012: Up-to-date (UTD) coverage by 24 months increased by 2.5% from 2011 to 2012. UTD coverage rates by the end of data collection were comparable between 2011 and 2012 (Figure 1).
Sample population demographics for Georgia and their effect on immunization rates are discussed on the following pages.

Table 2: Immunization Summary by Series and Vaccine Antigen, Georgia, 2012

2011 2012 (%) (%)

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

82.4 84.5
94.0 93.6 85.8 87.0 97.5 97.0

Table 1: Sampling Scheme, Georgia, 2012

2011 (n)

2012 (n)

Original Sample

2,447

2,973

Ineligible

82

130

Eligible Sample

2,359

2,835

Refused to Participate Unable to Locate

6

8

210

246

Final Sample

2,150

2,589

Response Rate (%)

91.4

92.3

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.

3 IPV by 24 months

96.7 96.0

1 MMR by 24 months

93.0 93.2

UTD Hib by 24 months 3 Hep B by 24 months

95.1 96.1 96.5 96.1

1 Varicella by 24 months

93.9 94.2

UTD PCV by 24 months

96.7 92.2

2 Rotavirus by 24 months

83.8 70.6

2 Hep A by 24 months

53.1 57.3

1+ Influenza by 24 months

60.1 57.1

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.

Figure 1: Georgia Immunization Study (GIS) and National Immunization Survey (NIS) Rates, 2000-2012
100%

90%

80%

70%

60%

50% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

Georgia: UTD by 24 months NIS, GA: UTD at 19-35 months

Georgia: UTD by end of data coll ection
NIS, US: UTD at 19-35 months
* 2009 data was not collected due to personnel vacancy. 18

Table 3: Sample Population Demographics, Georgia, 2012

Maternal Race/Ethnicity, White, nonHispanic (n=1,058) White, Hispanic (n=112) Black (n=958)

State Sample of Jan. 2010 Births n=2,589 (%)

All Georgia 2010 Births n= 133,668
(%)

40.9

42.7

4.3

4.2

37.0

33.0

Notable Demographic Findings: Overall, the study sample for the state was comparable to the 2010 Georgia birth cohort, but varied for certain demographic variables (Table 3).
For example, the final state sample contained a much larger percentage of children residing in a metro area versus a non-metro area (76.1% vs. 53.9%) and a lower number of mothers over 35 years of age (11.6% vs. 35.7%) compared to the 2010 birth cohort.

Unspecified, Hispanic (n=229) Asian (n=56) Multiracial (n=41) Maternal Education, Some College+ (n=1,076) HS Diploma/GED (n=779) 9th-11th grade (n=457) <9th grade (n=160) WIC Non-WIC (n=1423) WIC (n=1166)

8.8

9.5

The state sample also had a higher number of

2.2

3.3

children whose mothers were less than 25 years

1.6

3.2

of age compared to all Georgia 2010 births

(41.3% vs. 37.0%).

41.6

46.8

Other demographic measures for the state

30.1

29.0

sample were similar to the findings of the 2010 Georgia birth cohort as a whole.

17.7

14.2

6.2

5.3

Some demographic variables were measured

outside of the birth record and could not be

measured for the entire 2010 Georgia birth

54.9

-

cohort, namely WIC status, Number of Providers,

and Provider Type.

45.1

-

Metro Residence

Metro (n=1,969)

76.1

53.9

Non-metro (n=617) Maternal Marital Status

23.8

46.1

Married (n=1,269)

49.0

54.5

Unmarried (n=1,314)

50.8

45.5

Repeat Birth

First Child (n=1,102) Repeat Birth (n=1,484)
Gestational Age

42.6

42.7

57.3

57.3

Child's Gender

% of State % of Georgia Sample 2010 Births
(n=2,589) (n=133,668)

<37 weeks (n=296)

11.4

12.2

Male (n=1,303)

50.3

51.3

37+ weeks (n=2,293) Provider Type,

88.6

87.8

Female (n=1,286)

49.7

48.7

Number of Providers,

Public Sector Only (n=52)

2.0

-

1 (n=1,326)

51.2

-

Private Sector Only (n=1,728)

66.7

-

2 (n=444)

17.1

-

Both (n=172) Payment at Birth

6.6

-

3 (n=182)

Maternal Age

7.0

-

Government Assist (n=1,304)

50.4

46.6

<25 years (n=1,068)

41.3

37.0

Private Insurance (n=711)

27.5

31.0

25-34 years (n=1,220)

47.1

27.3

Other (n=129)

5.0

5.7

35+ years (n=301)

11.6

35.7

Self Pay (n=141)

5.4

5.0

Please refer to Appendix B for detailed information about the collection of information for this variable. Indicates that the percentages for this variable may not add up to 100.0% because the information was missing in some cases. Indicates that this variable corresponds to the data collected at the time of delivery.
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State of Georgia Immunization Study Report, p4

Table 4: UTD Immunization Rates by 24 months

UTD Immunization Rates by Demographic Group:

by demographic group, Georgia--2012

In Georgia, immunization rates by 24 months of age

varied between certain demographic groups

UTD by 24 UTD by end of (Table 4).

months

data collection

(%)

(%)

In terms of maternal race/ethnicity, children of

Asian, Hispanic, and multiracial mothers were the

Georgia Sample (n=2,589)

84.5

93.6

most often UTD by 24 months.

Maternal Race/Ethnicity, White, NonHispanic (n=1,058) White, Hispanic (n=112)

Higher maternal education was positively associat-

85.0

92.3

ed with UTD by 24 months coverage rates above

the high school level.

89.3

96.4

Black (n=958) Unspecified, Hispanic (n=229) Asian (n=56) Multiracial (n=41)

81.6

93.2

Children of mothers who had previous children

were less often UTD by 24 months than children of

86.5

96.5

mothers without previous children. In addition,

94.6

96.4

children of married mothers were more often UTD

90.2

100.0

by 24 months than children of unmarried mothers.

Maternal Education, Some College+ (n=1,076) HS Diploma/GED (n=779)

Children whose birth was covered by private insur-

ance were more often UTD by 24 months than chil-

86.6

94.1

dren whose birth was covered by government-

82.9

92.8

assisted insurance.

9th-11th grade (n=457) <9th grade (n=160) WIC

82.9

93.2

In terms of number of providers, children with 2

85.6

96.3

providers were less often UTD by 24 months than

those with only one provider, or three providers.

Non-WIC (n=1423)

89.4

94.2

WIC (n=1166) Maternal Age
<25 years (n=1,068) 25-29 years (n=1,220)

87.0
83.6 84.8

93.5 94.3

UTD by 24 months (%)

UTD by end of data
collection (%)

92.7

Number of Providers,

30+ years (n=301)

86.7

94.4

Maternal Marital Status and Repeat Birth Combination

1 (n=1,326) 2 (n=444)

85.4

94.0

82.4

92.3

Married, First Birth (n=494) Unmarried, First Birth (n=607)

90.7 87.6

94.9

3 (n=182)

85.0

95.9

96.9

Child's Gender

Married, Repeat Birth (n=775) Unmarried, Repeat Birth (n=707) Gestational Age

82.5 79.6

92.7

Male (n=1,303)

84.6

94.2

90.7

Female (n=1,286)

84.5

92.9

Metro Residence

<37 weeks (n=296) 37+ weeks (n=2,293) Provider Type,

83.5 84.7

94.3

Metro (n=1,969)

83.9

93.0

93.5

Non-metro (n=617)

86.4

95.3

Footnotes

Public Sector Only (n=52) Private Sector Only (n=1,728) Both (n=172) Payment at Birth, Government Assist (n=1,304) Private Insurance (n=711) Other (n=129) Self Pay (n=141)

73.1 86.0 73.8
82.1 88.2 89.2 87.2

92.3

"d.c." is an abbreviation for "data collection"

93.8

Indicates that this variable corresponds to the data

94.8

collected at the time of delivery.

Indicates that the sample size numbers for this variable

92.9

may not add up to the total District sample size because

the information was missing in some cases. 94.8

96.1

Please see Appendix C for additional information

regarding the methodology in obtaining this variable.

95.7

20

State of Georgia Immunization Study Report, p5

To varying degrees, demographic-related disparities between the study sample and the Georgia birth cohort 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.13), 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 or more providers or lacking a medical home

Please refer to Section III for Health District specific rates and trends.

Table 5: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, Georgia, 2006-2012

2006

2007

2008

2010

2011

2012

4 DTaP by 24 months

76.1

76.4

76.5

84.5

85.8

87.0

3 Polio by 24 months

87.8

87.8

87.5

95.1

96.7

96.0

1 MMR by 24 months

86.1

91.4

92.7

91.5

93.0

93.2

UTD Hib by 24 months

87.5

91.1

86.1

90.0

95.1

96.1

3 Hepatitis B by 24 months

88.4

88.8

88.7

94.8

96.5

96.1

1 Varicella by 24 months

86.5

85.2

85.5

92.9

93.9

94.2

UTD PCV by 24 months

73.6

77.2

81.6

90.5

96.7

92.2

2 Rotavirus*

-

1 Influenza*, by 24 months

-

-

-

72.6

83.8

70.6

-

-

58.2

60.1

57.1

2 Hepatitis A* by 24 months

-

-

-

--

53.1

55.1

Hepatitis B birth dose*

54.8

58.3

66.2

76.2

83.4

82.7

* 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 Vaccine Antigen: In Georgia, the UTD immunization rate by 24 months for most vaccine antigens remained steady from 2006 to 2008, but increased to higher rates than ever in 2010 and remained high through 2012 (Table 5).
Among Georgia coverage rates by antigen in 2012, the DTaP UTD immunization rate was lowest at 87.0%, similar to 85.8% in 2011. The PCV UTD immunization rate was the second-lowest at 92.2%, down from 96.7% in 2011.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased in Georgia from 43.4% in 2005 (not shown) to 92.2% in 2012.
Antigen-Specific Conclusions: Because of the lower coverage rates for DTaP and PCV vaccineshe antigenspecific data suggest that these vaccines could reasonably be the primary focus of District- and County-level immunization campaigns.

21

State of Georgia Immunization Study Report, p6

District Immunization Rates: While the statewide UTD immunization coverage rate by 24 months was 84.5%, variation was seen between Districts. The Districts with the highest UTD immunization rates by 24 months were Districts 1-1, 1-2, 4-0, 7-0 and 8-1. The Districts with the lowest UTD immunization rates by 24 months were Districts 3-2, 3-4, 5-1, 6-0, and 9-1 (Figure 3 and Table 6).
Response rates for each District are included on the second page 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 by 24 months Immunization Rates by District, Georgia, 2012

1-2 1-1

2-0 10

>87.3% 82.5%-87.3% <82.5%

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, 2012

District

UTD by 24 months (%)

UTD by end of data collection
(%)

Final Sample Size (n)

1-1 Northwest (Rome)

92.9

96.9

127

1-2 North Georgia (Dalton)

87.4

95.1

143

2-0 North (Gainesville)

84.1

94.4

126

3-1 Cobb-Douglas

82.9

95.0

140

3-2 Fulton

77.3

84.0

194

3-3 Clayton

83.9

95.2

124

3-4 Gwinnett, Newton, Rockdale

81.5

91.8

195

3-5 DeKalb

87.3

98.0

150

4-0 LaGrange

88.1

96.7

151

5-1 South Central (Dublin)

77.9

93.5

77

5-2 North Central (Macon)

85.4

93.7

158

6-0 East Central (Augusta)

82.4

93.7

159

7-0 West Central (Columbus)

91.0

98.7

156

8-1 South (Valdosta)

88.9

96.3

81

8-2 Southwest (Albany)

83.3

88.6

132

9-1 Coastal (Savannah)

80.7

93.4

181

9-2 Southeast (Waycross)

84.4

93.8

128

10-0 Northeast (Athens) Georgia

85.0 84.5

90.4 93.5

167 2,589

Color Shading Legend

: <82.5%

: 82.5%-87.3%

: >87.3%

22

State of Georgia Immunization Study Report, p7

Immunization Success Measures by Health District: Data analyses for this study were done on the statelevel, allowing for uniform data analysis covering 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 by 24 months of age.
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 coverage rates and response rates as well as one-year increases. Some of these measures represent an average over a five-year span and some are only relative to 2012 results.
The lower portion of the Table addresses the vaccine antigen-specific coverage by 24 months and only includes 2012 results.
Congratulations to all of the Districts Immunization Champions; those ranking in the top three for any of the categories!

Table 7: District Immunization Champions, Georgia, 2007-2012

Category

1st Place

2nd Place

3rd Place

Highest Response Rate, 2012

Gaines. District (2-0) 100.0%

Augusta District (6-0) 99.4%

Athens District (10-0) 98.2%

Highest UTD by 24 months in 2012

Rome District (1-1) 92.9%

Columbus District (7-0) Valdosta District (8-1)

91.0%

88.9%

Highest UTD by end of data collection, 2012

Columbus District (7-0) DeKalb District (3-5)

98.7%

98.0%

Rome District (1-1) 96.9%

Highest 5-year Average: Response Rate (2007-2012)

Augusta District (6-0) 99.9%

Gaines. District (2-0) 98.0%

Dalton District (1-2) 97.7%

Highest 5-year Average: UTD by 24 months (2007-2012)

Gainesville Dist. (2-0) 84.7%

Augusta District (6-0) 83.8%

Rome District (1-1) 82.0%

Greatest Increase in UTD by 24 months from 2011 to 2012

Columbus District (7-0) 12.7%

Dalton District (1-2) 9.1%

LaGrange District (4-0) 6.8%

Greatest Increase in UTD by end of data collection from 2011 to 2012

Columbus District (7-0) LaGrange District (4-0)

9.1%

7.2%

Dalton District (1-2) 3.8%

Greatest Increase in UTD from 24 months to end of data collection, 2012

Dublin District (5-1) 15.6%

Savannah District (9-1) 12.7%

Cobb District (3-1) 12.1%

Highest Coverage*: 4+ DTaP Doses, 2012

Rome District (1-1) 95.3%

Columbus District (7-0) 93.6%

Dalton District (1-2) 90.2%

Highest Coverage*: 3+ Polio Doses, 2012

Valdosta District (8-1) Columbus District (7-0) Savannah District (9-1)

98.8%

98.7%

98.3%

Highest Coverage*: 1 MMR Dose, 2012

Rome District (1-1) 96.9%

Columbus District (7-0) LaGrange District (4-0)

96.8%

96.7%

Highest Coverage*: UTD Hib, 2012

Columbus District (7-0) LaGrange District (4-0)

98.7%

98.7%

Rome District (1-1) 98.4%

Highest Coverage**: Hepatitis B Birth Dose, 2012

Columbus District (7-0) 94.2%

Valdosta District (8-1) 91.4%

Macon District (5-2) 90.5%

Highest Coverage*: 3+ Hepatitis B Doses, 2012

Columbus District (7-0) Savannah District (9-1) Valdosta District (8-1)

99.4%

98.9%

98.8%

Highest Coverage*: 1 Varicella Dose, 2012

LaGrange District (4-0) 98.7%

Rome District (1-1) 98.4%

Dalton District (1-2) 97.9%

Highest Coverage*: UTD PCV, 2012

Valdosta District (8-1) 98.8%

Athens District (10-0) 97.0%

Rome District (1-1) 96.9%

Highest Coverage*: 1+ Hepatitis A Doses, 2012

Albany District (8-2) 64.4%

Valdosta District (8-1) Columbus District (7-0)

64.2%

63.5%

Highest Coverage*: 1+ Influenza Doses, 2012

Dalton District (1-2) Gainesville District (2-0) Rome District (1-1)

71.3%

69.1%

64.6%

*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.
23

State 92.3% 84.5% 93.6% 92.8% 77.7% 2.1% -0.4% 9.1% 87.0% 96.0% 93.2% 96.1% 82.7% 96.1% 94.2% 92.2% 57.3% 57.1%

State of Georgia Immunization Study Report, p8

Findings Related to WIC Enrollment: Statewide results do not show an overall disparity in UTD immunization rate by 24 months between WIC-enrolled children and children not enrolled in WIC (see Table 4). This appears to be consistent with District-level analyses. In general, Health District does not appear to modify the effect of WIC on UTD immunization status by 24 months of age. District 5-1 was the only District where the children enrolled in WIC had a significant difference (lower) in immunization rate than those not enrolled in WIC. The other seventeen 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 Enrolled Children, Georgia, 2012

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

No Difference

WIC enrolled lower

Table 8: Difference in UTD Immunization Rate by 24 months between WIC Enrollment Groups, Georgia, 2012

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)

93.2

94.1

-0.9

-9.4 -- 7.6

1-2 North Georgia (Dalton)

90.4

87.9

2.5

-7.9 -- 12.9

2-0 North (Gainesville)

87.7

84.1

3.6

-8.5 -- 15.7

3-1 Cobb-Douglas

90.0

87.8

2.2

-8.5 -- 12.9

3-2 Fulton

77.3

75.6

1.7

-10.5 -- 13.9

3-3 Clayton

90.2

90.5

-0.3

-10.7 -- 10.1

3-4 Gwinnett, Newton, Rockdale

84.5

90.1

-5.6

-15.1 -- 3.9

3-5 DeKalb

98.5

96.5

2.0

-2.9 -- 6.9

4-0 LaGrange

94.7

94.7

0.0

-7.4 -- 7.4

5-1 South Central (Dublin)

76.3

97.4

-21.1

-35.5 -- -6.7

5-2 North Central (Macon)

86.3

94.1

-7.8

-17.1 -- 1.5

6-0 East Central (Augusta)

80.7

88.2

-7.5

-18.7 -- 3.7

7-0 West Central (Columbus)

91.0

95.5

-4.5

-12.2 -- 3.2

8-1 South (Valdosta)

86.0

94.7

-8.7

-21.3 -- 3.9

8-2 Southwest (Albany)

83.6

87.7

-4.1

-16.0 -- 7.8

9-1 Coastal (Savannah)

85.5

85.7

-0.2

-10.5 -- 10.1

9-2 Southeast (Waycross)

86.4

85.5

0.9

-11.2 -- 13.0

10-0 Northeast (Athens)

85.9

91.3

-5.4

-15.5 -- 4.7

Georgia

87.0

89.4

-2.4

-4.9 -- 0.1

*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, 2012
25

26

District 1-1
2012 Georgia Immunization Study Report
District 1-1 Data Collection Team Janet Eberhart, RN, BSN District Immunization Coordinator

Dade

Catoosa

County

Sample Metro

Bartow

20 Metro

Catoosa

2 Metro

Chattooga

4 Nonnetro

Dade

1 Metro

Floyd

26 Metro

Gordon

15 Nonmetro

Haralson

14 Metro

Paulding

29 Metro

Polk

9 Nonmetro

Walker

7 Metro

District 1-1 127

District UTD by 24 months 92.9% Immunization Rate

State of Georgia 2,589

State UTD by 24 months 84.5% Immunization Rate

27

Walker Chattooga

Gordon

Floyd

Bartow

Polk

Haralson

Paulding

District 1-1
Georgia Immunization Study 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 (92.9% vs. 84.5%). By the end of data collection, the District UTD immunization rate remained higher than the state rate (96.9% vs. 93.6%) (Table 1-1-B).

From 2011 to 2012: The District 1-1 UTD immunization rate by 24 months increased by 5.2% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 1.2% from 2011 to 2012 (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: GIS Sampling Scheme, District 1-1, 2012

District 1-1 State

(n)

(n)

Original Sample

150

2,973

Ineligible

4

130

Refused to Participate

1

8

Eligible Sample Unable to Locate

145

2,835

18

246

Final Sample

127

2,589

Response Rate (%)

87.6%

92.3%

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 & Vaccine Antigen, District 1-1, 2012

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
3 IPV by 24 months
1 MMR by 24 months

92.9 84.5
96.9 93.6 95.3 87.0 98.4 97.0 97.6 96.0 96.9 93.2

UTD Hib by 24 months

98.4 96.1

3 Hep B by 24 months

97.6 96.1

1 Varicella by 24 months

98.4 94.2

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

96.9 92.2 78.7 70.6 63.0 57.3 64.6 57.1

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: Georgia Immunization Study and District 1-1 Immunization Rates, 2000-2012

90% 80% 70% 60%

50%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

District 1-1: UTD by 24 months

District 1-1: 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.

28

District 1-1, Georgia Immunization Study Report, p3

Table 1-1-F: UTD Immunization Rates by Demographic group, District 1-1, 2012

State Avg. 1-1--UTD

UTD by 24 by 24

months months

(%)

(%)

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

District 1-1 Sample (n=127) Maternal Race/Ethnicity,

84.5

92.9

96.9

White, NonHispanic (n=90)

85.0

92.2

96.7

White, Hispanic (n=5) Black (n=12)

89.3 81.6

100.0 91.7

100.0 91.7

Unspecified, Hispanic (n=2)

86.5

100.0

100.0

Asian (n=0)

94.6

-

-

Multiracial (n=2) Maternal Education,

90.2

100.0

100.0

Some College+ (n=53)

86.6

96.2

96.2

HS Diploma/GED (n=41)

82.9

85.4

95.1

9th-11th grade (n=23)

82.9

100.0

100.0

<9th grade (n=9)

85.6

88.9

100.0

WIC

Non-WIC (n=68)

89.4

94.1

97.1

UTD Immunization Rates by Demographic Group: In District 1-1, the UTD immunization rates among white, non-Hispanics was higher than the state's UTD by 24 months rate (92.2% vs. 85.0%), however the District's other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 1-1-F).
For District 1-1, children of mothers with a high school diploma/GED and no college education were least often UTD by 24 months (85.4%). In terms of maternal age, children of mothers 35+ years of age were least often UTD by 24 months of age (90.9%).
In terms of the maternal marital status and repeat births, children of unmarried mothers with previous children were most often UTD by 24 months (100.0%), and this was markedly different from the overall state finding (79.6%). In addition, the District data support the importance of a medical home; children who had one provider (Number of Providers) were more often UTD than those with two providers (96.3% vs. 92.9%).
Although many demographic-related disparities resolved by the end of data collection, some still remained and some new disparities emerged (Table 1 -1-F, column in italics). For example, children of

WIC (n=59) Maternal Age
<25 years (n=63) 25-34 years (n=53)

87.0
83.6 84.8

93.2
92.1 94.3

96.6

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

UTD by 24 by 24 by end of

months months

d.c.

98.4

(%)

(%)

(%)

96.2 Number of Providers,

35+ years (n=11)

86.7

90.9

Maternal Marital Status & Repeat Birth Combination

90.9

1 (n=81)

2 (n=28)

85.4 82.4

96.3 92.9

98.8 100.0

Married, First Birth (n=38) Unmarried, First Birth (n=27)

90.7

97.4

97.4

3+ (n=6)

85.0

83.3

83.3

87.6

88.9

100.0 Child's Gender

Married, Repeat Birth (n=44)

82.5

88.6

93.2

Male (n=60)

84.6

95.0

98.3

Unmarried, Repeat Birth (n=18) Gestational Age

79.6

100.0

100.0

Female (n=67)

84.5

91.0

95.5

Metro Residence

<37 weeks (n=23)

83.5

91.3

95.7

Metro (n=99)

83.9

92.9

96.0

37+ weeks (n=104) Provider Type,

84.7

93.3

97.1

Non-metro (n=28)

86.4

92.9

Footnotes

100.0

Public Sector Only (n=1) Private Sector Only (n=107) Both (n=9) Payment at Birth, Government Assist (n=53) Private Insurance (n=46) Other (n=12) Self Pay (n=5)

73.1 86.0 73.8
82.1 88.2 89.2 87.2

100.0 94.4 100.0
88.7 95.7 100.0 100.0

100.0 98.1 100.0
96.2 95.7 100.0 100.0

"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.

29

District 1-1, Georgia Immunization Study Report, p4

mothers with a high school diploma or college education were slightly less likely to be UTD by the end of data collection, but these groups were larger than those of lesser educated mothers (96.2% and 95.1% vs. 100.0%).
In addition, the District data support the importance of a medical home; children who had one or two providers (Number of Providers) remained more often UTD by the end of the data collection, than those with 3+ providers (98.8% and 100.0% vs. 83.3%).

Children of mothers 35+ years of age
Firstborn children of unmarried mothers and children of married mothers with previous children
Children receiving immunizations from more than two providers

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), 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 a high school diploma/GED level of education

Table 1-1-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 1-1, 2006-2012

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

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
-

Immunization Rates by Vaccine Antigen: In District 1-1, the UTD immunization rate by 24 months for most vaccine antigens increased to higher rates than ever in 2012 (Table 1-1-G).

Among District 1-1 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP showed the most improvement over 2011, rising from 88.3% to 95.3%. The UTD immunization rates for MMR and Varicella showed the second highest improvements at 96.9% and 98.4%, up from 92.6% and 92.6%, respectively, in 2011.

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

2012 95.3 97.6 96.9 98.4 97.6 98.4 96.9 78.7 64.6

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 49.4% in 2005 (not shown) to 96.9% in 2012.

Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP, MMR, and PCV vaccines could reasonably be the primary focus of District and County-level immunization campaigns, though levels are over 95% for all antigen-specific immunizations.

30

District 1-2
2012 Georgia Immunization Study Report

District 1-2 Data Collection Team

Marie Smith, RN

District Immunization Coordinator

Angie Callaway, RN

Secondary Data Collector

Patricia Mason LPN

Secondary Data Collector

Nancy Stackhouse, LPN Secondary Data Collector

County

Sample Metro

Cherokee

69 Metro

Fannin

5 Nonmetro

Gilmer

11 Nonmetro

Murray

14 Metro

Pickens

9 Metro

Whitfield

35 Metro

District 1-2 143

District UTD by 24 months 87.4% Immunization Rate

State of Georgia 2,589

State UTD by 24 months 84.5% Immunization Rate

Murray Whitfield

Fannin Gilmer

Pickens Cherokee

31

District 1-2
Georgia Immunization Study 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 higher than the state rate (87.4% vs. 84.5%), and remained higher at the end of data collection (95.1 vs. 93.6%) (Table 12-B).

From 2011 to 2012: The District 1-2 UTD immunization rate by 24 months increased by 11.6% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 4.2% from 2011 to 2012 (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: GIS Sampling Scheme, District 1-2, 2012

District 1-2 (n)

State (n)

Original Sample

159

2,973

Ineligible

9

130

Refused to Participate

1

8

Eligible Sample Unable to Locate

149

2,835

6

246

Final Sample

143

2,589

Response Rate (%)

96.0%

92.3%

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 & Vaccine Antigen, District 1-2, 2012

District State

1-2 Average

(%)

(%)

UTD immunization rate* by 24 months

87.4 84.5

UTD immunization rate* by end of data collection

95.1 93.6

4 DTaP by 24 months

90.2 87.0

3 DTaP by 24 months

97.9 97.0

3 IPV by 24 months

97.9 96.0

1 MMR by 24 months

95.8 93.2

UTD Hib by 24 months

97.9 96.1

3 Hep B by 24 months

98.6 96.1

1 Varicella by 24 months

97.9 94.2

UTD PCV by 24 months

93.0 92.2

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

69.9 70.6 59.4 57.3 71.3 57.1

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: Georgia Immunization Study and District 1-2 Immunization Rates, 2000-2012

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

District 1-2: UTD by 24 months Georgia: UTD by 24 months

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. 32

District 1-2, Georgia Immunization Study Report, p3

Table 1-2-F: UTD Immunization Rates by Demographic group, District 1-2, 2012

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: In District 1-2, children of Hispanic mothers of unspecified race were UTD by 24 months at a similar rate as children of white, non-Hispanic mothers (88.5% vs. 88.1%). 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=143) Maternal Race/Ethnicity, White, NonHispanic (n=93) White, Hispanic (n=2)

84.5

87.4

95.1

Children of mothers 25-34 years of age were least

often UTD by 24 months of age (86.8%). In terms of

85.0

88.1

93.6 maternal marital status and repeat births, children

of married mothers with previous children were

89.3

50.0

100.0 least often UTD by 24 months (78.0%).

Black (n=5) Unspecified, Hispanic (n=26) Asian (n=2) Multiracial (n=0)

81.6 86.5 94.6 90.2

60.0 88.5 100.0 NA

80.0 100.0 100.0
NA

Children born at a gestational age of 37+ weeks were more often UTD by 24 months than those born at a gestational age less than 37 weeks (88.1 vs. 77.8%).

Maternal Education, Some College+ (n=49)

Most children had only one provider, and were

more often UTD by 24 months of age than children

86.6

87.8

93.9 with 2 providers (89.2% vs. 76.7%).

HS Diploma/GED (n=38) 9th-11th grade (n=25) <9th grade (n=19) WIC Non-WIC (n=91)

82.9

92.1

94.7

Although many demographic-related disparities

82.9

84.0

96.0 resolved by the end of data collection, some still

85.6

89.5

100.0 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

89.4

87.9

94.5 end of data collection when compared to children

WIC (n=52) Maternal Age
<25 years (n=55) 25-34 years (n=68)

87.0
83.6 84.8

90.4
87.3 86.8

98.1

State Avg. 1-2--UTD 1-2--UTD

UTD by 24 by 24 by end of

months months

d.c.

98.2

(%)

(%)

(%)

92.7 Number of Providers

35+ years (n=20)

86.7

90.0

Maternal Marital Status & Repeat Birth Combination

95.0

1 (n=83)

2 (n=30)

85.4

89.2

96.4

82.4

76.7

86.7

Married, First Birth (n=39) Unmarried, First Birth (n=23)

90.7 87.6

94.9 95.7

97.4 100.0

3+ (n=12) Child's Gender

85.0

100.0

100.0

Married, Repeat Birth (n=50) Unmarried, Repeat Birth (n=28) Gestational Age

82.5

78.0

88.0

Male (n=77)

84.6

85.7

92.2

79.6

85.7

100.0

Female (n=66)

84.5

89.4

98.5

Metro Residence

<37 weeks (n=9)

83.5

77.8

100.0

Metro (n=121)

83.9

86.8

95.0

37+ weeks (n=134) Provider Type

84.7

88.1

94.8

Non-metro (n=20) 86.4

90.0

95.0

Footnotes

Public Sector Only (n=3) Private Sector Only (n=118) Both (n=12) Payment at Birth, Government Assist (n=50) Private Insurance (n=48) Other (n=8) Self Pay (n=16)

73.1 86.0 73.8
82.1 88.2 89.2 87.2

100.0 89.0 66.7

100.0 94.9 91.7

88.0 83.3 87.5 87.5

94.0 93.8 100.0 100.0 33

"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.

District 1-2, Georgia Immunization Study Report, p4
of non-Hispanic mothers, the next largest group (100% vs. 93.6%).

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), 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 of mothers 25-34 years of age
Children of married mothers with previous children
Children who were born at a gestational age of less than 37 weeks
Children whose residence is in a metropolitan county

Table 1-2-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 1-2, 2006-2012

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

2006 94.6 100.0 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
-

Immunization Rates by Vaccine Antigen: In District 1-2, the UTD immunization rates by 24 months for most vaccine antigens rose between 2006 and 2012. A notable increase occurred for the UTD 4 DTaP measure, rising from 81.7% in 2011 to 90.2% in 2012 (Table 1-2-G).

Among District 1-2 immunization rates by vaccine antigen in 2012, the UTD immunization rate for PCV showed no change at 93.0%. The UTD immunization rate for Rotavirus was the only antigen-specific

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

2012 90.2 97.9 95.8 97.9 98.6 97.9 93.0 69.9 71.3

immunization rate to actually decrease between 2011 and 2012. Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 57.5% in 2005 (not shown) to 93.0% in 2012.

Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP and PCV vaccines could reasonably be the primary focus of District and County-level immunization campaigns.

34

District 2-0
2012 Georgia Immunization Study Report

District 2-0 Data Collection Team

Constance Martin RN BSN District Immunization Coordinator

Sandy T. Moore

Primary Data Collector

County

Sample Metro

Banks

1 Nonmetro

Dawson

2 Metro

Forsyth

33 Metro

Franklin

6 Nonmetro

Habersham

17 Nonmetro

Hall

46 Metro

Hart

2 Nonmetro

Lumpkin

4 Nonmetro

Rabun

2 Nonmetro

Stephens

5 Nonmetro

Towns

0 Nonmetro

Union

3 Nonmetro

White

5 Nonmetro

District 2-0 126

District UTD by 24 months 84.1% Immunization Rate

State of Georgia 2,589

State UTD by 24 months 84.5% Immunization Rate

Union

Towns Rabun

Lumpkin

White Habersham Stephens

Dawson Hall
Forsyth

Banks Franklin Hart

35

District 2-0
Georgia Immunization Study 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 lower than the state rate (84.1% vs. 84.5%). By the end of data collection, the District UTD immunization rate was higher than the state rate (94.4% vs. 93.6%) (Table 2-0-B).

From 2011 to 2012: The District 2-0 UTD immunization rate by 24 months decreased by 3.2% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 0.8% from 2011 to 2012 (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: GIS Sampling Scheme, District 2-0, 2012

District 2-0 (n)

State (n)

Original Sample

138

2,973

Ineligible

12

130

Refused to Participate

0

8

Eligible Sample Unable to Locate

126

2,835

0

246

Final Sample

126

2,589

Response Rate (%)

100.0%

92.3%

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 & Vaccine Antigen, District 2-0, 2012

District State

2-0 Average

(%)

(%)

UTD immunization rate* by 24 months

84.1 84.5

UTD immunization rate* by end of data collection

94.4 93.6

4 DTaP by 24 months 3 DTaP by 24 months

86.5 87.0 97.6 97.0

3 IPV by 24 months

96.8 96.0

1 MMR by 24 months

96.0 93.2

UTD Hib by 24 months 3 Hep B by 24 months

96.8 96.1 93.5 96.1

1 Varicella by 24 months

95.2 94.2

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

90.5 92.2 89.7 70.6 51.6 57.3 69.1 57.1

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.

Figure 2-0-C: Georgia Immunization Study and District 2-0 Immunization Rates, 2000-2012
100%

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

District 2-0: UTD by 24 months Georgia: UTD by 24 months

District 2-0: UTD by end of data collection Georgia: UTD by end of data colle ction

* 2009 data was not collected due to personnel vacancy. 36

District 2-0, Georgia Immunization Study Report, p3

Table 2-0-F: UTD Immunization Rates by Demographic group, District 2-0, 2012

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=126)

84.5

84.1

94.4

UTD Immunization Rates by Demographic Group: In District 2-0, children of white, non-Hispanic mothers were least likely to be UTD by 24 months compared to the District sample as a whole (77.3% vs. 84.1%) and this discrepancy remained at the end of data collection (90.7% vs. 94.4%) although other race/ethnicity groups were small (Table 2-0-F).

Maternal Race/Ethnicity, White, NonHispanic (n=75) White, Hispanic (n=21)

Children of mothers with some college education

were more often UTD at 24 months compared to

85.0

77.3

90.7 children of mothers who had only completed high

89.3

95.2

100.0 school (84.8% vs. 75.6%).

Black (n=5) Unspecified, Hispanic (n=7) Asian (n=6) Multiracial (n=0) Maternal Education, Some College+ (n=46) HS Diploma/GED (n=41)

81.6

100.0

100.0 In terms of maternal age, children of mothers 35+

86.5

85.7

100.0 years of age were least often UTD by 24 months of

94.6

100.0

100.0

age (77.8%) and children of mothers 25-34 years of age were most often UTD by 24 months (89.7%).

90.2

-

-

In terms of maternal marital status and repeat

births, children of unmarried mothers who were

86.6

84.8

93.5 firstborn were least often UTD at the end of data

82.9

75.6

92.7 collection (86.4%) (see Table 2-0-F).

9th-11th grade (n=25) <9th grade (n=9) WIC Non-WIC (n=69)

82.9

92.0

96.0 The District 2-0 data support the importance of a

85.6

88.9

100.0 medical home; children who had one provider

(Number of Providers) were more often UTD by

24 months than those with two providers (85.2%

89.4

84.1

92.8

vs. 70.0%).

WIC (n=57)

87.0

87.7

Maternal Age

<25 years (n=50)

83.6

80.0

25-34 years (n=58)

84.8

89.7

35+ years (n=18)

86.7

77.8

Maternal Marital Status, & Repeat Birth Combination

Married, First Birth (n=34)

90.7

94.1

Unmarried, First Birth (n=22)

87.6

77.3

Married, Repeat Birth (n=48)

82.5

77.1

Unmarried, Repeat Birth (n=22) Gestational Age

79.6

90.9

<37 weeks (n=15)

83.5

93.3

37+ weeks (n=111) Provider Type

84.7

82.9

Public Sector Only (n=3)

73.1

100.0

Private Sector Only (n=67)

86.0

83.6

Both (n=3) Payment at Birth,

73.8

100.0

Government Assist (n=60) Private Insurance (n=39)

82.1 88.2

81.7 87.2

Other (n=12)

89.2

83.3

Self Pay (n=2)

87.2

100.0

96.5
94.0 94.8 94.4
97.1 86.4 93.8 100.0
100.0 93.7
100.0 95.5 100.0
95.0 94.9 91.7 100.0 37

State Avg. UTD by 24
months (%)

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

Number of Providers

1 (n=54)

85.4

85.2

2 (n=10)

82.4

70.0

2-0--UTD by end of
d.c. (%)
96.3 90.0

3 (n=7) Child's Gender
Male (n=74) Female (n=52) Metro Residence

85.0
84.6 84.5

100.0
78.4 92.3

100.0
90.5 100.0

Metro (n=84)

83.9

83.3

94.1

Non-metro (n=42) 86.4

85.7

95.2

Footnotes

"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.

District 2-0, Georgia Immunization Study Report, p4
Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 2-0-F, column in italics).
Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), 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 white, non-Hispanic mothers
Children of mothers who completed a high school education
Children of unmarried mothers without previous children and married mothers with previous children
Children receiving immunizations from two different providers

Table 2-0-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 2-0, 2006-2012

2006

2007

2008

2010

2011

4 DTaP by 24 months

85.2

3 Polio by 24 months

92.6

1 MMR by 24 months

85.2

UTD Hib by 24 months

96.3

3 Hepatitis B by 24 months

96.3

1 Varicella by 24 months

88.9

UTD PCV by 24 months

77.8

2 Rotavirus

-

1 Influenza by 24 months

-

89.3

88.0

86.9

90.3

94.1

92.0

95.2

97.9

94.1

94.0

92.9

94.5

94.1

88.0

91.7

97.2

96.4

92.0

96.4

97.9

95.2

94.0

91.7

95.2

88.1

90.0

90.5

97.2

-

-

79.8

92.4

-

-

65.5

66.2

2012 86.5 96.8 96.0 96.8 93.7 95.2 90.5 89.7 69.1

Immunization Rates by Vaccine Antigen: In District 2-0, the UTD immunization rates for most vaccine antigens fluctuated from 2006 to 2012, and most decreased between 2011 and 2012. Only MMR coverage rates increased from 2011 to 2012 (Table 20-G).
Among District 2-0 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 86.5%, down from 90.3% in 2011. The UTD immunization rate for PCV was the secondlowest at 90.5%, down from 97.2% in 2011.

Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine should be the primary focus of District and County-level immunization campaigns.

38

District 3-1
2012 Georgia Immunization Study Report

District 3-1 Data Collection Team

Karen Thomas, RN District Immunization Coordinator

Silvia Frausto

Data Collector

County

Sample

Metro

Cobb Douglas
District 3-1
District UTD by 24 months Immunization Rate
State of Georgia
State UTD by 24 months Immunization Rate

118 22 140 82.9%
2,589 84.5%

Metro Metro

Cobb Douglas

39

District 3-1
Georgia Immunization Study 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 lower than the state rate (82.9% vs. 84.5%). By the end of data collection, the District UTD immunization rate was higher than the state rate (95.0% vs. 93.6%) (Table 3-1B).

From 2011 to 2012: The District 3-1 UTD immunization rate by 24 months decreased by 3.2% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 0.7% from 2011 to 2012 (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: GIS Sampling Scheme, District 3-1, 2012

District 3-1 (n)

State (n)

Original Sample

171

2,973

Ineligible

14

130

Refused to Participate

0

8

Eligible Sample Unable to Locate

157

2,835

17

246

Final Sample

140

2,589

Response Rate (%)

89.8%

92.3%

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 & Vaccine Antigen, District 3-1, 2012

District State

3-1 Average

(%)

(%)

UTD immunization rate* by 24 months

82.9 84.5

UTD immunization rate* by end of data collection

95.0 93.6

4 DTaP by 24 months 3 DTaP by 24 months

85.7 87.0 95.7 97.0

3 IPV by 24 months

94.3 96.0

1 MMR by 24 months

90.7 93.2

UTD Hib by 24 months 3 Hep B by 24 months

93.6 96.1 95.0 96.1

1 Varicella by 24 months

91.4 94.2

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

92.1 92.2 75.7 70.6 52.9 57.3 60.0 57.1

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.

Figure 3-1-C: Georgia Immunization Study and District 3-1 Immunization Rates, 2000-2012
100%

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

District 3-1: UTD by 24 months Georgia: UTD by 24 months

District 3-1: UTD by end of data collection Georgia: UTD by end of data collection

* 2009 data was not collected due to personnel vacancy. 40

District 3-1, Georgia Immunization Study Report, p3

Table 3-1-F: UTD Immunization Rates by Demographic group, District 3-1, 2012

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=140)

84.5

82.9

95.0

Maternal Race/Ethnicity,

White, NonHispanic (n=58)

85.0

79.3

93.1

UTD Immunization Rates by Demographic Group: In District 3-1, children of white, non-Hispanic mothers, the largest demographic group in this District sample, were less often UTD by 24 months compared to the District sample as a whole (79.3% vs. 82.9%). Children of Black mothers were UTD by 24 months at a rate consistent with the District sample (81.8% vs. 82.9%). The District's other race/ ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-1-F).

White, Hispanic (n=14) Black (n=44) Unspecified, Hispanic (n=8)

89.3

85.7

100.0 In terms of maternal education, children of mothers

with a high school diploma were less often UTD by

81.6

81.8

95.5 24 months compared to children of mothers with

86.5

100.0

100.0 some college education (69.4% vs. 85.9%).

Asian (n=3) Multiracial (n=4) Maternal Education, Some College+ (n=78) HS Diploma/GED (n=36)

94.6

100.0

100.0 With regard to maternal age, children of mothers

90.2

100.0

100.0 <25 years of age were least often UTD by 24 months

of age (76.3%). With regard to maternal marital

status and repeat births, children of unmarried

86.6

85.9

98.7 mothers with previous children were the least often

82.9

69.4

UTD by 24 months (73.1%). 86.1

9th-11th grade (n=17) <9th grade (n=5) WIC Non-WIC (n=90)

82.9

88.2

94.1 In terms of payment at birth, District 3-1 children

whose birth costs were covered by private

85.6

100.0

100.0 insurance were more often UTD than children

whose birth costs were covered by government-

assisted insurance (91.8% vs. 76.9%).

89.4

87.8

94.4

WIC (n=50) Maternal Age
<25 years (n=38) 25-34 years (n=76)

87.0

90.0

94.0

83.6

76.3

92.1

State Avg. UTD by 24
months (%)

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

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

84.8

86.8

96.1 Number of Providers

35+ years (n=26)

86.7

80.8

96.2

1 (n=)

85.4

-

-

Maternal Marital Status & Repeat Birth Combination

2 (n=)

82.4

-

-

Married, First Birth (n=34)

90.7

91.2

94.1

3+ (n=)

85.0

-

-

Unmarried, First Birth (n=25)

87.6

88.0

100.0 Child's Gender

Married, Repeat Birth (n=55)

82.5

80.0

96.4

Male (n=78)

84.6

83.3

94.9

Unmarried, Repeat Birth (n=26) Gestational Age

79.6

73.1

88.5

Female (n=62)

84.5

82.3

95.2

Metro Residence

<37 weeks (n=13)

83.5

84.6

100.0

Metro (n=140)

83.9

82.9

95.0

37+ weeks (n=127) Provider Type

84.7

82.7

94.5

Non-metro (n=0)

86.4

0

0

Footnotes

Public Sector Only (n=) Private Sector Only (n=) Both (n=) Payment at Birth, Government Assist (n=65) Private Insurance (n=49) Other (n=8) Self Pay (n=4)

73.1 86.0 73.8
82.1 88.2 89.2 87.2

-
76.9 91.8 75.0 75.0

-
92.3 100.0 100.0 100.0 41

"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.

District 3-1, Georgia Immunization Study Report, p4

Although many demographic-related disparities resolved by the end of data collection, some still remained (Table 3-1-F, column in italics).

Children whose mothers are <25 years of age
Children whose birth was covered by governmentassisted insurance

For example, children of white non-Hispanic mothers remained the least often UTD (93.1%).

In addition, children of mothers with only a high school diploma remained less often UTD by the end of data collection compared to those whose mothers had a college level education (86.1% vs. 98.7%).

Information on provider type and number of providers per child was not available.

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), 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 have a high school graduate level of education

Table 3-1-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-1, 2006-2012

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

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
-

Immunization Rates by Vaccine Antigen: In District 3 -1, the UTD immunization rates by 24 months for most vaccine antigens fluctuated from 2006 to 2010, but all increased to higher rates in 2011, and then all decreased in 2012. (Table 3-1-G).
Among District 3-1 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 85.7%, as it has been over the last 6 years. The UTD immunization rate for MMR was the second-lowest at 90.7%, though it remained higher than in 2008 when it was 88.0%.

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

2012 85.7 94.3 90.7 93.6 95.0 91.4 92.1 75.7 60.0

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 45.1% in 2005 (not shown) to 98.3% in 2011, then fell to 92.1% in 2012.
Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP and MMR vaccines could reasonably be the primary focus of District and County-level immunization campaigns.

42

District 3-2
2012 Georgia Immunization Study Report
District 3-2 Data Collection Team Georgia Goseer, RN District Immunization Coordinator

County

Sample

Metro

Fulton
District 3-2
District UTD by 24 months Immunization Rate
State of Georgia
State UTD by 24 months Immunization Rate

194 194 77.3%
2,589 84.5%

Metro

Fulton

43

District 3-2
Georgia Immunization Study 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 lower than the state rate (77.3% vs. 84.5%). At the end of data collection, the District UTD immunization rate remained lower than the state rate (84.0% vs. 93.6%) (Table 3-2-B).

From 2011 to 2012: The District 3-2 UTD immunization rate by 24 months decreased by 5.6% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 11.0% from 2011 to 2012 (Figure 3-2-C).

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

Table 3-2-A: GIS Sampling Scheme, District 3-2, 2012

District 3-2 State

(n)

(n)

Original Sample

225

2,973

Ineligible

4

130

Refused to Participate

1

8

Eligible Sample Unable to Locate

220

2,835

26

246

Final Sample

194

2,589

Response Rate (%)

89.1%

92.3%

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 3-2-B: Immunization Summary by Series & Vaccine Antigen, District 3-2, 2012

District State

3-2 Average

(%)

(%)

UTD immunization rate* by 24 months

77.3 84.5

UTD immunization rate* by end of data collection

84.0 93.6

4 DTaP by 24 months 3 DTaP by 24 months

83.0 87.0 93.8 97.0

3 IPV by 24 months

91.2 96.0

1 MMR by 24 months

87.1 93.2

UTD Hib by 24 months 3 Hep B by 24 months

93.8 96.1 93.3 96.1

1 Varicella by 24 months

88.7 94.2

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

86.6 92.2 73.2 70.6 50.0 57.3 57.2 57.1

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 3-2-C: Georgia Immunization Study and District 3-2 Immunization Rates, 2000-2012

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

District 3-2: UTD by 24 months Georgia: UTD by 24 months

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. 44

District 3-2, Georgia Immunization Study Report, p3

Table 3-2-F: UTD Immunization Rates by Demographic group, District 3-2, 2012

State Avg. UTD by 24
months (%)

3-2--UTD by 24 months %

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

District 3-2 Sample (n=194) Maternal Race/Ethnicity,

84.5

77.3

84.0

White, NonHispanic (n=53)

85.0

79.3

81.1

White, Hispanic (n=2)

89.3

100.0

100.0

Black (n=94)

81.6

71.3

83.0

UTD Immunization Rates by Demographic Group: In District 3-2, children of black mothers were less often UTD by 24 months when compared to the District sample as a whole (71.3% vs. 77.3%). Most of the District's other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-2-F).
In terms of maternal education, children of mothers who were still in high school were the least often UTD by 24 months (65.6%). In contrast, children of mothers with a high school or some college education were the most often UTD by 24 months (80.4% and 80.7%).

Unspecified, Hispanic (n=31) Asian (n=6)

86.5

90.3

93.6

Children of mothers 35+ years of age were most

94.6

83.3

83.3 often up to date by 24 months of age (80.7%).

Multiracial (n=4) Maternal Education,
Some College+ (n=93)

90.2

100.0

100.0

In terms of maternal marital status and the repeat

births, children of married mothers were the most

86.6

80.7

86.0 often UTD by 24 months (82.6% and 83.0%).

HS Diploma/GED (n=46) 9th-11th grade (n=32) <9th grade (n=11) WIC Non-WIC (n=119)

82.9

80.4

91.3 Children whose birth costs were covered by private

82.9

65.6

71.9 insurance were more often UTD by 24 months than

those whose birth costs were covered by

85.6

90.9

90.9 government-assisted insurance (82.7% vs. 68.4%).

In addition, the District data support the

89.4

75.6

82.4 importance of a medical home; children who

WIC (n=75) Maternal Age
<25 years (n=66) 25-34 years (n=97)

87.0
83.6 84.8

77.3
72.7 79.4

88.0

State Avg. 3-2--UTD 3-2--UTD

UTD by 24 by 24 by end of

months months

d.c.

80.3

(%)

(%)

(%)

85.6 Number of Providers

35+ years (n=31)

86.7

80.7

Maternal Marital Status & Repeat Birth Combination

87.1

1 (n=103)

2 (n=24)

85.4

74.8

82.5

82.4

66.7

70.8

Married, First Birth (n=46) Unmarried, First Birth (n=49)

90.7 87.6

82.6 75.5

87.0

3+ (n=8)

89.8 Child's Gender

85.0

100.0

100.0

Married, Repeat Birth (n=47)

82.5

83.0

87.2

Male (n=90)

84.6

77.8

85.6

Unmarried, Repeat Birth (n=52) Gestational Age

79.6

69.2

73.1

Female (n=104)

84.5

76.9

82.7

Metro Residence

<37 weeks (n=17) 37+ weeks (n=177) Provider Type

83.5

76.5

82.4

Metro (n=194)

83.9

77.3

84.0

84.7

77.4

84.2

Non-metro (n=0)

86.4

-

-

Footnotes

Public Sector Only (n=3) Private Sector Only (n=128) Both (n=4) Payment at Birth, Government Assist (n=79) Private Insurance (n=75) Other (n=12) Self Pay (n=9)

73.1 86.0 73.8
82.1 88.2 89.2 87.2

66.7 74.2 100.0
68.4 82.7 83.3 88.9

100.0 80.5 100.0
79.8 88.0 83.3 88.9 45

"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.

District 3-2, Georgia Immunization Study Report, p4

received immunizations from only one provider (Number of Providers) were more often UTD than those receiving immunizations from two providers (74.8% vs. 66.7%).
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 who were still in high school 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 (82.5% vs. 70.8%).

Children whose mothers are still in high school
Children of unmarried mothers
Children whose birth was covered by governmentassisted insurance
Children receiving immunizations from more than one provider

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), 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

Table 3-2-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-2, 2006-2012

2006

2007

2008

2010

2011

4 DTaP by 24 months

63.9

58.7

66.4

84.3

86.3

3 Polio by 24 months

79.4

72.2

79.9

94.0

96.3

1 MMR by 24 months

79.4

68.8

78.5

91.7

93.8

UTD Hib by 24 months

81.6

70.7

74.8

89.8

95.0

3 Hepatitis B by 24 months

76.5

71.3

78.5

94.0

96.3

1 Varicella by 24 months

79.8

68.1

78.1

93.1

91.9

UTD PCV by 24 months

70.8

61.8

70.8

89.8

96.9

2 Rotavirus

-

-

-

72.7

86.9

1 Influenza by 24 months

-

-

-

61.1

58.8

2012 83.0 91.2 87.1 93.8 93.3 88.7 86.6 73.2 57.2

Immunization Rates by Vaccine Antigen: In District 32, UTD immunization rates by 24 months consistently increased for most vaccine antigens occurring from 2006 to 2010, reaching an all-time high in 2011 in all but varicella and influenza vaccines. All antigenspecific rates dropped in 2012, most notably PCV (96.9% to 86.6%). (Table 3-2-G).
Among District 3-2 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP by vaccine antigen was lowest at 83.0%, even lower than 84.3% in 2010. The PCV UTD immunization rate was second-lowest at 86.6%.

Since first being ACIP-recommended in 2002, UTD coverage by 24 months for the pneumococcal conjugate vaccine increased from 49.8% in 2005 (not shown) to 96.9% in 2011, but then decreased to 86.6% in 2012.
Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that DTaP, MMR, varicella, and PCV vaccines could reasonably be the primary focus of District immunization campaigns.

46

District 3-3
2012 Georgia Immunization Study Report
District 3-3 Data Collection Team Freda Sheppard, LPN District Immunization Coordinator

County

Sample Metro

Clayton
District 3-3
District UTD by 24 months Immunization Rate
State of Georgia
State UTD by 24 months Immunization Rate

124 124 83.9%
2,589 84.5%

Metro

Clayton

47

District 3-3
Georgia Immunization Study 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 lower than the state rate (83.9% vs. 84.5%). By the end of data collection, the District UTD immunization rate was higher than the state rate (95.2% vs. 93.6%) (Table 3-3-B).

From 2011 to 2012: The District 3-3 UTD immunization rate by 24 months decreased by 0.8% from 2011 to 2012. The District UTD immunization rate by the end of data collection remained unchanged between 2011 and 2012 (Figure 3-3-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: GIS Sampling Scheme, District 3-3, 2012

District 3-3 State

(n)

(n)

Original Sample

139

2,973

Ineligible

3

130

Refused to Participate

1

8

Eligible Sample Unable to Locate

135

2,835

11

246

Final Sample

124

2,589

Response Rate (%)

91.9%

92.3%

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 & Vaccine Antigen, District 3-3, 2012

District State

3-3 Average

(%)

(%)

UTD immunization rate* by 24 months

83.9 84.5

UTD immunization rate* by end of data collection

95.2 93.6

4 DTaP by 24 months 3 DTaP by 24 months

84.7 87.0 94.4 97.0

3 IPV by 24 months

95.2 96.0

1 MMR by 24 months

94.4 93.2

UTD Hib by 24 months 3 Hep B by 24 months

93.6 96.1 96.0 96.1

1 Varicella by 24 months

96.0 94.2

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

92.0 92.2 62.9 70.6 54.0 57.3 41.9 57.1

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.

Figure 3-3-C: Georgia Immunization Study and District 3-3 Immunization Rates, 2000-2012
100%

90%

80%

70%

60%

50%

40% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

District 3-3: UTD by 24 months Georgia: UTD by 24 months

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. 48

District 3-3, Georgia Immunization Study Report, p3

Table 3-3-F: UTD Immunization Rates by Demographic group, District 3-3, 2012

State Avg. UTD by 24
months (%)

3-3--UTD by 24 months %

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

District 3-3 Sample (n=124)

84.5

83.9

95.2

UTD Immunization Rates by Demographic Group: In District 3-3, children of unspecified, Hispanic mothers were similarly UTD by 24 months when compared to the District sample as a whole (83.9%). Children of black mothers were more often UTD by 24 months (86.7%).The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-3-F).

Maternal Race/Ethnicity, White, NonHispanic (n=4) White, Hispanic (n=2) Black (n=75)

In terms of maternal education, children of mothers

85.0

50.0

75.0 with a college education were the least often UTD

by 24 months (80.0%) of all of the maternal

89.3

50.0

50.0 education groups, although this difference resolved

81.6

86.7

96.0 by the end of data collection.

Unspecified, Hispanic (n=31) Asian (n=4) Multiracial (n=2) Maternal Education, Some College+ (n=40) HS Diploma/GED (n=39) 9th-11th grade (n=23) <9th grade (n=14) WIC Non-WIC (n=63)

86.5

83.9

96.8 Children of mothers between the ages of 25 and 34

94.6

100.0

100.0 years were least likely to be UTD at 24 months

90.2

50.0

100.0 (76.1%) compared to this demographic group in the

state as a whole (84.8%).

86.6

80.0

95.0

In terms of maternal marital status and repeat births, children of married mothers with previous

82.9

87.2

94.9 children were the least often UTD by 24 months

82.9

87.0

95.7

(76.7%) although this resolved by the end of data collection.

85.6

85.7

100.0

District 3-3 children whose birth costs were covered

by private insurance were more often UTD by 24

90.5

90.5

96.8 months than children whose birth costs were

WIC (n=61) Maternal Age
<25 years (n=38) 25-34 years (n=67)

90.2

90.2

93.4

83.6

89.5

97.4

State Avg. UTD by 24
months (%)

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

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

84.8

76.1

92.5 Number of Providers

35+ years (n=19)

86.7

100.0

Maternal Marital Status & Repeat Birth Combination

100.0

1 (n=65) 2 (n=24)

85.4

84.6

93.9

82.4

87.5

95.8

Married, First Birth (n=18) Unmarried, First Birth (n=30)

90.7

83.3

94.4

3+ (n=11)

85.0

66.7

88.9

87.6

93.3

96.7 Child's Gender

Married, Repeat Birth (n=30)

82.5

76.7

96.7

Male (n=62)

84.6

87.1

95.2

Unmarried, Repeat Birth (n=45) Gestational Age

79.6

82.2

93.3

Female (n=62)

84.5

80.6

95.2

Metro Residence

<37 weeks (n=10)

83.5

80.0

90.0

Metro (n=123)

83.9

83.7

95.1

37+ weeks (n=114) Provider Type

84.7

84.2

95.6

Non-metro (n=0)

86.4

-

-

Footnotes

Public Sector Only (n=1) Private Sector Only (n=94) Both (n=6) Payment at Birth, Government Assist (n=53) Private Insurance (n=24) Other (n=10) Self Pay (n=19)

73.1 86.0 73.8
82.1 88.2 89.2 87.2

100.0 83.0 83.3

100.0 94.7 83.3

81.1 91.7 90.0 79.0

96.2 95.8 90.0 94.7 49

"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.

District 3-3, Georgia Immunization Study Report, p4

covered by government-assisted insurance (91.7% vs. 81.1%).
Children with two providers were more often UTD by 24 months than those with one provider (87.5% vs. 84.6%) but this may be explained by the larger number of children in the latter group.
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 mothers aged 25-34 years remained the least often UTD by the end of data collection compared to the other two groups (92.5%).

Children whose mothers with some college education
Children whose mothers are between 25-34 years of age
Children of married mothers with previous children
Children whose birth was covered by governmentassisted insurance

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), 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 Hispanic mothers

Table 3-3-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-3, 2006-2012

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

2006 70.7 84.2 83.5 85.4 86.6 82.3 59.2
-

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

2012 84.7 95.2 94.4 93.6 96.0 96.0 91.9 62.9 41.9

Immunization Rates by Vaccine Antigen: In District 33, the UTD immunization rates by 24 months steadily increased for all vaccine antigens through 2011. In 2012, most immunization rates by antigen fell slightly, though remained higher than rates in 2010. Both the MMR and the varicella UTD immunization rates rose in 2012 to 94.4% and 96.0% respectively (Table 3-2-G).
Among District 3-3 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 84.7%, down from 88.5% in 2011. The UTD immunization rate for PCV was the second-lowest at 91.9%, down from 98.1% in 2011.

Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP and PCV vaccines could reasonably be the primary focus of District immunization campaigns.

50

District 3-4
2012 Georgia Immunization Study Report

District 3-4 Data Collection Team

Gloria Melvin

District Immunization Coordinator

County

Sample Metro

Gwinnett

152 Metro

Newton

20 Metro

Rockdale

23 Metro

District 3-4 195

District UTD by 24 months 81.5% Immunization Rate

State of Georgia 2,589

State UTD by 24 months 84.5% Immunization Rate

Gwinnett
Rockdale Newton

51

District 3-4
Georgia Immunization Study 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 (81.5% vs. 84.5%). At the end of data collection, the District UTD immunization rate remained lower than the state rate (91.8% vs. 93.6%) (Table 3-4-B).

From 2011 to 2012: The District 3-4 UTD immunization rate by 24 months increased by 1.9% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 1.6% from 2011 to 2012 (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: GIS Sampling Scheme, District 3-4, 2012

District 3-4 (n)

State (n)

Original Sample

232

2,973

Ineligible

17

130

Refused to Participate

0

8

Eligible Sample Unable to Locate

215

2,835

20

246

Final Sample

195

2,589

Response Rate (%)

90.7%

92.3%

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 & Vaccine Antigen, District 3-4, 2012

District State

3-4 Average

(%)

(%)

UTD immunization rate* by 24 months

81.5 84.5

UTD immunization rate* by end of data collection

91.8 93.6

4 DTaP by 24 months 3 DTaP by 24 months

83.6 87.0 97.4 97.0

3 IPV by 24 months

95.9 96.0

1 MMR by 24 months

91.8 93.2

UTD Hib by 24 months 3 Hep B by 24 months

96.9 96.1 92.8 96.1

1 Varicella by 24 months

91.8 94.2

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

91.3 92.2 81.0 70.6 54.4 57.3 59.0 57.1

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.

Figure 3-4-C: Georgia Immunization Study and District 3-4 Immunization Rates, 2000-2012
100%

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

District 3-4: UTD by 24 months Georgia: UTD by 24 months

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. 52

District 3-4, Georgia Immunization Study Report, p3

Table 3-4-F: UTD Immunization Rates by Demographic group, District 3-4, 2012

State Avg. UTD by 24
months (%)

3-4--UTD by 24 months %

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

District 3-4 Sample (n=195) Maternal Race/Ethnicity,

84.5

81.5

91.8

White, NonHispanic (n=46)

85.0

78.3

87.0

White, Hispanic (n=21)

89.3

76.2

85.7

Black (n=58)

81.6

79.3

93.1

Unspecified, Hispanic (n=38)

86.5

84.2

97.4

Asian (n=12)

94.6

91.7

91.7

Multiracial (n=4) Maternal Education,

90.2

100.0

100.0

Some College+ (n=84)

86.6

84.5

89.3

HS Diploma/GED (n=55)

82.9

78.2

92.7

9th-11th grade (n=19)

82.9

68.4

89.5

<9th grade (n=25)

85.6

88.0

100.0

WIC

Non-WIC (n=111)

89.4

90.1

93.7

UTD Immunization Rates by Demographic Group: In District 3-4, children of Asian mothers were more often UTD by 24 months compared to the District sample as a whole (91.7% vs. 81.5%). Children of white Hispanic mothers were least often UTD compared to the District sample as a whole (76.2% vs. 81.5%) (Table 3-4-F).
In terms of maternal education, District 3-4 children of mothers with a college education and those of mothers with a <9th grade education were the most often UTD by 24 months (84.5% and 88.0% respectively).
Children of mothers 35+ years of age were most often UTD by 24 months (87.9%).
In terms of maternal marital status and repeat births, children of mothers with previous children were less often UTD by 24 months than first-born children (see Table 3-4-F).
Additionally, the District data support the importance of a medical home (Number of Providers); children who had only one provider (82.5%) were more often UTD than those with more than one provider (see Table 3-4-F).
Although most demographic-related disparities

WIC (n=84) Maternal Age
<25 years (n=66) 25-34 years (n=96)

87.0

84.5

90.5

83.6

78.8

92.4

State Avg. UTD by 24
months (%)

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

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

84.8

81.3

90.6 Number of Providers

35+ years (n=33)

86.7

87.9

Maternal Marital Status & Repeat Birth Combination

93.9

1 (n=97)

2 (n=39)

85.4

82.5

95.9

82.4

79.5

84.6

Married, First Birth (n=44)

90.7

84.1

90.9

3+ (n=18)

85.0

75.0

83.3

Unmarried, First Birth (n=34)

87.6

85.3

94.1 Child's Gender

Married, Repeat Birth (n=75)

82.5

78.7

90.7

Male (n=99)

84.6

79.8

91.9

Unmarried, Repeat Birth (n=42) Gestational Age

79.6

81.0

92.9

Female (n=96)

84.5

83.3

91.7

Metro Residence

<37 weeks (n=20)

83.5

60.0

80.0

Metro (n=195)

83.9

81.5

91.8

37+ weeks (n=175) Provider Type

84.7

84.0

93.1

Non-metro (n=0)

86.4

-

-

Footnotes

Public Sector Only (n=5) Private Sector Only (n=143) Both (n=6) Payment at Birth, Government Assist (n=59) Private Insurance (n=61) Other (n=8) Self Pay (n=11)

73.1 86.0 73.8
82.1 88.2 89.2 87.2

60.0 83.2 66.7
79.7 80.3 87.5 100.0

100.0 92.3 83.3
89.8 86.9 100.0 100.0 53

"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.

District 3-4, Georgia Immunization Study Report, p4

resolved by the end of data collection, some still remained and some new ones emerged (Table 3-4-F, column in italics).
A new disparity was identified in District 3-4; children whose birth costs were covered by private insurance were less often UTD by the end of data collection than children whose birth was covered by governmentassisted insurance (86.9% vs. 89.8%).

Children born at <37 weeks gestation
Children receiving immunizations from more than one provider.

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), 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 white, Hispanic mothers
Children whose mothers have not completed high school
Children of mothers < 25 years of age. Children whose mothers have previous children

Table 3-4-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-4, 2006-2012

2006

2007

2008

2010

2011

4 DTaP by 24 months

91.5

84.0

94.4

81.7

83.9

3 Polio by 24 months

96.6

90.1

95.8

88.3

96.1

1 MMR by 24 months

93.2

91.4

95.8

86.7

90.6

UTD Hib by 24 months

94.9

93.8

95.8

85.0

97.2

3 Hepatitis B by 24 months

94.9

92.6

95.8

90.0

93.3

1 Varicella by 24 months

94.0

93.8

94.4

90.0

91.7

UTD PCV by 24 months

92.3

85.2

97.2

88.3

97.8

2 Rotavirus

-

-

-

75.0

91.7

1 Influenza by 24 months

-

-

-

61.7

60.6

2012 83.6 95.9 91.8 96.9 92.8 91.8 91.3 81.0 59.0

Immunization Rates by Vaccine Antigen: In District 34, the UTD immunization rates by 24 months for most vaccine antigens fluctuated between 2006 and 2010, increased in 2011, and then decreased in 2012 (Table 3-4-G).

Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP, MMR, and varicella vaccines could reasonably be the primary focus of District and County-level immunization campaigns.

Among District 3-4 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 83.6%, down from 83.9% in 2011. The UTD immunization rate for PCV was the second-lowest at 91.3%, down from 97.8% in 2011.

54

District 3-5
2012 Georgia Immunization Study Report

District 3-5 Data Collection Team

Jotonna Tulloch, BS

District Immunization Coordinator

Cassandra Jackson, LPN

Primary Data Collector

County

Sample Metro

DeKalb
District 3-5
District UTD by 24 months Immunization Rate
State of Georgia
State UTD by 24 months Immunization Rate

150 150 87.3%
2,589 84.5%

Metro

DeKalb

55

District 3-5
Georgia Immunization Study 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 (87.3% vs. 84.5%). By the end of data collection, the District UTD immunization rate remained higher than the state rate (98.0% vs. 93.6%) (Table 3-5-B).
From 2011 to 2012: The District 3-5 UTD immunization rate by 24 months increased by 2.9% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 2.4% from 2011 to 2012 (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: GIS Sampling Scheme, District 3-5, 2012

District 3-5 State

(n)

(n)

Original Sample

195

2,973

Ineligible

2

130

Refused to Participate

0

8

Eligible Sample Unable to Locate

193

2,835

43

246

Final Sample

150

2,589

Response Rate (%)

83.4%

92.3%

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 & Vaccine Antigen, District 3-5, 2012

District State

3-5 Average

(%)

(%)

UTD immunization rate* by 24 months

87.3 84.5

UTD immunization rate* by end of data collection

98.0 93.6

4 DTaP by 24 months 3 DTaP by 24 months

90.0 87.0 98.7 97.0

3 IPV by 24 months

98.0 96.0

1 MMR by 24 months

96.0 93.2

UTD Hib by 24 months 3 Hep B by 24 months

97.3 96.1 96.0 96.1

1 Varicella by 24 months

96.7 94.2

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

96.0 92.2 75.3 70.6 60.7 57.3 64.0 57.1

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.

Figure 3-5-C: Georgia Immunization Study and District 3-5 Immunization Rates, 2000-2012
100% 90%

80% 70% 60%

50%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

District 3-5: UTD by 24 months Georgia: UTD by 24 months

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. 56

District 3-5, Georgia Immunization Study Report, p3

Table 3-5-F: UTD Immunization Rates by Demographic group, District 3-5, 2012

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=150)

84.5

87.3

98.0

Maternal Race/Ethnicity,

UTD Immunization Rates by Demographic Group: In District 3-5, children of white, non-Hispanic mothers were more often UTD by 24 months compared to the District sample as a whole (91.2% vs. 87.3%). Children of Hispanic mothers were less often UTD compared to the District sample as a whole (82.6% vs. 87.3%). The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 3-5-F).

White, NonHispanic (n=34) White, Hispanic (n=4) Black (n=69) Unspecified, Hispanic (n=19) Asian (n=8) Multiracial (n=2) Maternal Education, Some College+ (n=67) HS Diploma/GED (n=41) 9th-11th grade (n=12)

85.0 89.3 81.6 86.5 94.6 90.2
86.6 82.9 82.9

91.2 100.0 84.1 79.0 100.0 100.0
88.1 80.5 91.7

94.1 100.0 98.6 100.0 100.0 100.0
97.0 97.6 100.0

In terms of maternal education, District 3-5 children of mothers with a high school diploma/GED were least often UTD by 24 months (see Table 3-5F).
District 3-5 children whose birth costs were covered by private insurance were more often UTD by 24 months than children whose birth was covered by government-assisted insurance (92.7% vs. 86.7%).
Children receiving immunizations from one provider were more often UTD by 24 months than those receiving immunizations from two providers(88.0 vs. 76.2%).

<9th grade (n=14) WIC
Non-WIC (n=85)

85.6 89.4

100.0 96.5

100.0 98.8

To varying degrees, demographic-related disparities resolved by the end of data collection (Table 3-5-F, column in italics).

WIC (n=65) Maternal Age
<25 years (n=42) 25-34 years (n=85)

87.0
83.6 84.8

98.5
88.1 88.2

100.0
100.0 96.5

State Avg. UTD by 24
months (%)

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

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

Number of Providers

35+ years (n=23)

86.7

82.6

Maternal Marital Status & Repeat Birth Combination

100.0

1 (n=75) 2 (n=21)

85.4

88.0

98.7

82.4

76.2

95.2

Married, First Birth (n=19)

90.7

89.5

94.7

3+ (n=9)

85.0

87.5

87.5

Unmarried, First Birth (n=37)

87.6

86.5

100.0 Child's Gender

Married, Repeat Birth (n=53)

82.5

88.7

96.2

Male (n=73)

84.6

87.7

97.3

Unmarried, Repeat Birth (n=41) Gestational Age

79.6

85.4

100.0

Female (n=77)

84.5

87.0

98.7

Metro Residence

<37 weeks (n=18)

83.5

88.9

94.4

Metro (n=150)

83.9

87.3

98.0

37+ weeks (n=132) Provider Type

84.7

87.1

98.5

Non-metro (n=0)

86.4

-

-

Footnotes

Public Sector Only (n=0) Private Sector Only (n=99) Both (n=6) Payment at Birth, Government Assist (n=60) Private Insurance (n=55) Other (n=8) Self Pay (n=16)

73.1 86.0 73.8
82.1 88.2 89.2 87.2

87.9 50.0
86.7 92.7 87.5 87.5

98.0 83.3
96.7 98.2 100.0 100.0 57

"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.

District 3-5, Georgia Immunization Study Report, p4
Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), 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 whose birth costs were covered by government-assisted insurance
Children receiving immunizations from more than one provider.

Table 3-5-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 3-5, 2006-2012

2006

2007

2008

2010

2011

4 DTaP by 24 months

72.8

78.7

77.8

88.0

86.2

3 Polio by 24 months

80.3

85.1

82.1

94.7

97.8

1 MMR by 24 months

82.3

86.0

84.6

94.7

92.8

UTD Hib by 24 months

81.5

85.1

82.1

93.3

96.4

3 Hepatitis B by 24 months

80.3

87.8

84.0

94.7

98.6

1 Varicella by 24 months

82.3

85.5

84.0

94.7

93.5

UTD PCV by 24 months

66.7

77.4

81.5

90.7

97.8

2 Rotavirus

-

-

-

76.0

91.3

1 Influenza by 24 months

-

-

-

64.0

64.5

2012 90.0 98.0 96.0 97.3 96.0 96.7 96.0 75.3 64.0

Immunization Rates by Vaccine Antigen: In District 35, the UTD immunization rate by 24 months for most vaccine antigens remained steady from 2006 to 2008, and then increased from 2010 to 2012 (Table 3-5-G).
Among District 3-5 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 90.0%, but rose from 86.2% in 2011. The UTD immunization rate for MMR was the second-lowest in 2011 but has risen to 96.0% in 2012.

Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine could reasonably be the primary focus of District immunization campaigns.

58

District 4-0
2012 Georgia Immunization Study 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

21 Metro

Coweta

24 Nonmetro

Fayette

10 Nonmetro

Heard

1 Nonmetro

Henry

49 Nonmetro

Lamar

3 Nonmetro

Meriwether

2 Metro

Pike

5 Metro

Spalding

8 Nonmetro

Troup

15 Nonmetro

Upson

7 Nonmetro

District 4-0 151

District UTD by 24 months 88.1% Immunization Rate

State of Georgia 2,589

State UTD by 24 months 84.5% Immunization Rate

Carroll Heard

Coweta

Fayette

Henry

Spalding Butts

Troup Meriwether Pike Lamar

Upson

59

District 4-0
Georgia Immunization Study 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 higher than the state rate (88.1% vs. 84.5%). By the end of data collection, the District UTD immunization rate remained higher than the state rate (96.7% vs. 93.6%) (Table 4-0-B).

From 2011 to 2012: The District 4-0 UTD immunization rate by 24 months increased by 8.4% from 2011 to 2012. The District UTD immunization rate by the end of data collection increased by 8.0% from 2011 to 2012 (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-A: GIS Sampling Scheme, District 4-0, 2012

District 4-0 State

(n)

(n)

Original Sample

184

2,973

Ineligible

2

130

Refused to Participate

0

8

Eligible Sample Unable to Locate

182

2,835

31

246

Final Sample

151

2,589

Response Rate (%)

86.3%

92.3%

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 4-0-B: Immunization Summary by Series & Vaccine Antigen, District 4-0, 2012

District State

4-0 Average

(%)

(%)

UTD immunization rate* by 24 months

88.1 84.5

UTD immunization rate* by end of data collection

96.7 93.6

4 DTaP by 24 months 3 DTaP by 24 months

89.4 87.0 98.7 97.0

3 IPV by 24 months

97.4 96.0

1 MMR by 24 months

96.7 93.2

UTD Hib by 24 months 3 Hep B by 24 months

98.7 96.1 98.7 96.1

1 Varicella by 24 months

98.7 94.2

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

96.0 92.2 66.2 70.6 62.3 57.3 51.7 57.1

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.

Figure 4-0-C: Georgia Immunization Study and District 4-0 Immunization Rates, 2000-2012
100%

90%

80%

70%

60%

50%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009* 2010 2011 2012

District 4-0: UTD by 24 months Georgia: UTD by 24 months

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. 60

District 4-0, Georgia Immunization Study Report, p3

Table 4-0-F: UTD Immunization Rates by Demographic group, District 4-0, 2012

State Avg. UTD by 24
months (%)

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

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

District 4-0 Sample (n=151) Maternal Race/Ethnicity,

84.5

88.1

96.7

White, NonHispanic (n=79)

85.0

87.3

94.9

White, Hispanic (n=2)

89.3

100.0

100.0

Black (n=50)

81.6

88.0

98.0

UTD Immunization Rates by Demographic Group: In District 4-0, the UTD by 24 months immunization rates for the two largest race/ethnicity groups-- children of white, non-Hispanic mothers and children of black mothers, were above the state average. The other race/ethnicity group sample sizes were too small to draw any definite conclusions (Table 4-0 -F).
In terms of maternal education, children of mothers without a high school diploma or GED and no college education remained the least often UTD by 24 months among the maternal education groups (75.0%).

Unspecified, Hispanic (n=9) Asian (n=4) Multiracial (n=3) Maternal Education, Some College+ (n=75)

86.5

88.9

100.0

In terms of maternal age, children of mothers in the

94.6

100.0

100.0 <25 years age group were least often UTD by 24

90.2

100.0

100.0 months of age (85.5%). In terms of maternal marital

status and repeat births, children of unmarried

mothers were less often UTD by 24 months than

86.6

89.3

97.3 children of married mothers (see Table 4-0-F).

HS Diploma/GED (n=28) 9th-11th grade (n=32) <9th grade (n=3) WIC Non-WIC (n=94)

82.9

100.0

100.0 Children whose birth costs were covered by private

82.9

75.0

90.6 insurance were more likely to be UTD at 24 months

than those whose birth costs were covered by

85.6

66.7

100.0 government assisted insurance.

In District 4-0, children with one healthcare provider

89.4

94.7

97.9 were more often UTD by 24 months than those with

WIC (n=57) Maternal Age
<25 years (n=62) 25-34 years (n=69)

87.0
83.6 84.8

94.7
85.5 89.9

96.5

State Avg. 4-0--UTD 4-0--UTD

UTD by 24 by 24 by end of

months months

d.c.

96.8

(%)

(%)

(%)

97.1 Number of Providers

35+ years (n=20)

86.7

90.0

Maternal Marital Status & Repeat Birth Combination

95.0

1 (n=77)

2 (n=34)

85.4

92.2

98.7

82.4

79.4

88.2

Married, First Birth (n=36)

90.7

94.4

97.2

3+ (n=18)

85.0

85.7

100.0

Unmarried, First Birth (n=32)

87.6

87.5

100.0 Child's Gender

Married, Repeat Birth (n=49)

82.5

89.8

100.0

Male (n=84)

84.6

86.9

96.4

Unmarried, Repeat Birth (n=34) Gestational Age

79.6

79.4

88.2

Female (n=67)

84.5

89.6

97.0

Metro Residence

<37 weeks (n=13)

83.5

84.6

100.0

Metro (n=129)

83.9

86.8

96.1

37+ weeks (n=138) Provider Type

84.7

88.4

96.4

Non-metro (n=22) 86.4

95.5

Footnotes

100.0

Public Sector Only (n=5) Private Sector Only (n=110) Both (n=14) Payment at Birth, Government Assist (n=59) Private Insurance (n=60) Other (n=10) Self Pay (n=3)

73.1 86.0 73.8
82.1 88.2 89.2 87.2

80.0 90.0 64.3
81.4 91.7 90.0 100.0

80.0 97.3 92.9
94.9 98.3 90.0 100.0 61

"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.

District 4-0, Georgia Immunization Study Report, p4

two providers (92.2% vs. 79.4%). In addition, children living in metro counties (see page 1 of District 4-0 Immunization Report) were less often UTD by 24 months than those living in non-metro counties (86.8% vs. 95.5%).
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 without a high school diploma or GED and no college education remained the least often UTD by the end of the data collection (90.6%).
Children residing in metro counties remained slightly less often UTD by the end of the data collection than children living in non-metro counties (96.1% vs. 100%).

Children of mothers with previous children
Children with two healthcare providers as opposed to one
Children living in metro counties (see page 1 of District 4-0 Immunization Report)

Demographic Conclusions: In spite of the small sample size and inherent limitations of the data (Methods, p 13), 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 no high school or college education
Children of mothers <25 years of age

Table 4-0-G: Vaccine Antigen-Specific Immunization Coverage (%) by 24 months of age, District 4-0, 2006-2012

2006

2007

2008

2010

2011

4 DTaP by 24 months

71.7

78.2

74.6

88.5

84.2

3 Polio by 24 months

88.0

92.4

85.4

96.6

97.1

1 MMR by 24 months

80.4

84.0

86.0

87.9

92.4

UTD Hib by 24 months

83.7

88.4

81.6

87.9

94.7

3 Hepatitis B by 24 months

89.1

91.6

86.5

97.1

97.1

1 Varicella by 24 months

82.1

85.8

84.3

89.7

93.0

UTD PCV by 24 months

66.3

80.0

81.1

89.7

96.5

2 Rotavirus

-

-

-

69.5

79.5

1 Influenza by 24 months

-

-

-

56.9

57.9

2012 89.4 97.4 96.7 98.7 98.7 98.7 96.1 66.2 51.7

Immunization Rates by Vaccine Antigen: In District 40, the UTD immunization rate by 24 months for most vaccine antigens remained steady from 2005 to 2008, but then increased steadily through 2012 (Table 4-0G).
Among District 4-0 immunization rates by vaccine antigen in 2012, the UTD immunization rate for DTaP was lowest at 89.4%, but rose from 88.5% in 2010. The UTD immunization rate for MMR rose from 87.9% in 2010 to 96.7% in 2012. The PCV UTD immunization rate

was the only major antigen that decreased but only to 96.1% from 96.5% in 2011.
Vaccine Antigen-Specific Conclusions: The antigenspecific data suggest that the DTaP vaccine could reasonably be the primary focus of District and County -level immunization campaigns.

62

District 5-1
2012 Georgia Immunization Study Report

District 5-1 Data Collection Team

Patty Portwood, BS, Ed District Immunization Coordinator

Additional Data Collection Staff

JIna Adams, RN, MSN

Brenda Clarke, RN

Kitty Coleman

Donna Collins, RN

Terri Griffin, RN

Mable Harden, RN

Daphenia Harmon

Daisy Haines, RN

Allison Ledford, LPN

Debbie Martin, RNC

Wanda Moore, RNC

Mary Powell, RN

Brittany Swain, LPN

Amy Tanner, RN

Suzanne Usher, RN

Brenda Williams, RN

Joni R. Wilson, RN

Montgomery

County

Sample Metro

Bleckley

10 Nonmetro

Dodge

14 Nonmetro

Johnson

3 Nonmetro

Laurens

27 Nonmetro

Montgomery

4 Nonmetro

Pulaski

3 Nonmetro

Telfair

3 Nonmetro

Treutlen

6 Nonmetro

Wheeler

3 Nonmetro

Wilcox

4 Nonmetro

District 5-1 77

District UTD by 24 months 77.9% Immunization Rate

State of Georgia 2,589

State UTD by 24 months 84.5% Immunization Rate

Johnson

Bleckley

Laurens

Treutlen

Pulaski

Dodge

Wheeler

Wilcox

Telfair

63

District 5-1
Georgia Immunization Study 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 (77.9% vs. 84.5%). By the end of data collection, the District UTD immunization rate was equal to the state rate (93.5% vs. 93.6%) (Table 5-1-B).

Table 5-1-B: Immunization Summary by Series & Vaccine Antigen, District 5-1, 2012

District State

5-1 Average

(%)

(%)

From 2011 to 2012: The District 5-1 UTD immunization rate by 24 months decreased by 2.6% from 2011 to 2012. The District UTD immunization rate by the end of data collection decreased by 0.5% from 2011 to 2012 (Figure 5-1-C).

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

77.9 84.5 93.5 93.6

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

4 DTaP by 24 months 3 DTaP by 24 months

79.2 87.0 94.8 97.0

Table 5-1-A: GIS Sampling Scheme, District 5-1, 2012

3 IPV by 24 months 1 MMR by 24 months

92.2 96.0 85.7 93.2

District 5-1 State

(n)

(n)

Original Sample

87

2,973

Ineligible

4

130

Refused to Participate

0

8

Eligible Sample Unable to Locate

83

2,835

6

246

Final Sample

77

2,589

Response Rate (%)

94.0%

92.3%

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

90.9 96.1

3 Hep B by 24 months 1 Varicella by 24 months UTD PCV by 24 months

96.1 96.1 87.0 94.2 89.6 92.2

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

45.5 70.6 54.5 57.3 46.8 57.1

This value includes children who become UTD d