Vaccination Coverage Surveys in the U.S.-Affiliated Jurisdictions: Results for the Federated States of Micronesia Presented by: Tammy A. Santibanez, Ph.D Assessment Branch, ISD National Immunization Conference, April 2009

In the U.S., the National Immunization Survey (NIS) is the primary means for measuring vaccination coverage among children. RDD survey of households with landline. Vaccine histories from providers m, and 13-17y NIS-Teen. 50 states, 6 grantee cities, other areas. U.S.-affiliated jurisdictions not included in NIS.  Lower prevalence of landline phones.  V.I. included in NIS beginning in 2009 Background

Vaccination Surveys in U.S.-affiliated Jurisdictions Outbreaks: Marshall Islands (2003, Measles); U.S. Virgin Islands (2007, Pertussis); American Samoa (2008, Mumps); Federated States of Micronesia (2008, Pertussis) Prior to 2005: various methods, sporadic, and limited time & resources. In 2005, an assessment strategy developed at CDC for these jurisdictions. Surveys conducted by local staff in collaboration with the ISD. First survey done 2005 (CNMI). This presentation will show some survey results for the surveys conducted in Federated States of Micronesia (FSM) from

Surveys to Date in the Federated States of Micronesia (FSM) FSM StateHH Interview Dates Yap, proper (P)Oct , 2006 Yap, neighboring islands (NI)April 19-29, 2008 KosraeMarch 22-April 1, 2006 PohnpeiMarch 29-Sept. 1, 2006 Chuuk

Survey methods Every household included (except Pohnpei) Door-to-door screening, household interview, and abstraction of children’s vaccination dates from household retained shot cards. Abstraction of children’s vaccination dates from public health records (medical record for Kosrae and Yap; medical record and registry for Pohnpei)

Boating to islands within FSM

Survey Populations Children  1 & 2 year olds (12-35 months)  6 year olds (72-83 months)  All age-eligible children in the household included in the survey. Adults  50 years and older  All age-eligible adults in the household included in the survey

Vaccines & Series 4:3:1:3:3  4+ DTaP - diphtheria, tetanus & acellular pertussis  3+ Polio  1+ MMR – measles, mumps & rubella  3+ Hib – haemophilus influenza  3+ HepB – hepatitis B Also looked at  5:4:2:3:3 among 6 year olds  5+ DTaP  4+ Polio  2+ MMR

FSM Vaccination Recommendations VaccineAge doses recommended DTaP 2m, 4m, 6m, 12m, 5-6y Polio 2m, 4m, 6m, 12m MMR 12m, 13m Hib 2m, 4m, 12m HepBBirth, 2m, 6m BCG and TD also recommended but were not assessed for this presentation. Source for slide: Immunization Handbook, FSM Immunization Program, 2004.

HH and Child Data Collected Number of adults, infants (<12m), and children aged living in HH Combined HH income Telephone service Child’s DOB, gender, place (island) of birth, and whether born in a hospital, home, or other. Mother’s age, education level, marital status, place (island) of birth. Shot card availability, and if so vaccination dates from shot card “Are children required to be UTD to enter school?” “Has [child] received all recommended shots for age?”

Adult Data Collected Age Gender Place (island) of birth Marital status of respondent “Did he/she receive a flu shot for the last season?”

Interviews Completed Yap, PYap, NIKosraePohnpei Child-level HH interviews Age 1&2 years old Have medical record data Have shot card data Age 6 years old Have medical record data Have shot card data Age out of range Adult-level HH interviews375* Age years old Age 65+ years old Age missing 3-- 2

Demographics, 1 & 2 year olds Yap, P (n=190) Yap, NI (n=153) Kosrae (n=279) Pohnpei (n=867) Child’s gender (% Male) Maternal Educ.: <HS HS >HS Maternal Age: < Shot card (% yes)

Demographics, 6 year olds Yap, P (n=66) Yap, NI (n=73) Kosrae (n=111) Pohnpei (n=266) Child’s gender (% Male) Maternal Educ.: <HS HS >HS Maternal Age: < Shot card (% yes)

* U.S. estimate is for m old while FSM coverage is for 12-35m olds.

Considered vaccinated if “Yes” checked, else was considered unvaccinated. Adult data not collected in Yap (NI); Analysis of Pohnpei data not completed. n=257 n=116n=703n=272

Conclusions Yap (P) achieved the HP 2010 objective of at least 80% coverage for the 4:3:1:3:3 series among their 1 & 2 year old children. Yap (NI) came close to this goal while Kosrae and Pohnpei have not yet achieved this goal among their 1 & 2 year olds. Coverage for 5:4:2:3:3 among 6 year olds in FSM exceeded 80% in Yap and Kosrae but not in Pohnpei. Influenza vaccination coverage among adults aged and 65+ is low in FSM. Future analysis—look at village-specific vaccination coverage

Acknowledgements FSM staff: Louisa Helgenberger Norleen Oliver Spencer Donre Marylinda Timothy Thomas Walog Manny Umech Jackie James Interviewers All the survey respondents CDC staff: Ranee Seither John Stevenson Noelle Molinari Mark Freedman Elizabeth Luman Nidhi Jain James Singleton J.P. Chaine Ronald Balajadia Gabriel Anaya Cameron Noblit

Thank you