Enrollment In And Use Of The Vaccine For Children Program Among Juvenile Residential Facilities Beatriz E Builes, Cindy Weinbaum, Abigail Shefer, Lisa Jacques-Carroll, Yuan Kong, Janet Chiancone, Catherine Gallagher, Michael Washington, Daniel Fishbein National Immunization Program, CDC Division of Viral Hepatitis, CDC Office of Juvenile Justice and Delinquency Prevention, Department of Justice George Mason University

Background Juvenile Justice System: Each year, more than 1,200,000 adolescents are detained in >3,600 public and private Juvenile Residential Facilities (JRF) Over 100,000 youth are detained for >30 days JRFs can provide and coordinate vaccination programs Most detained youth are eligible for vaccine from Vaccines for Children (VFC) Patterns and amount of vaccine ordered is unknown

Background ACIP Recommends: For all adolescents * tetanus/diphtheria/acellular pertussis meningococcal conjugate Catch up hepatitis B measles/mumps/rubella varicella† * Some vaccines given only to adolescents of specific ages † Those who have not had chickenpox

Background ACIP Recommends: For adolescents in target groups influenza hepatitis A pneumococcal polysaccharide

Objectives Determine the proportion of state owned and operated facilities enrolled and actively participating in the VFC program Determine patterns of vaccine ordering in relation to: age of detainees facility type type of medical care attend school

Methods OJJ provided data for 177 facilities owned and operated by states These facilities were chosen because they were most able to provide vaccine Median facilities per state: 3 (Range: 1-15) 160 (90%) were long term-secure Average bed capacity

Methods Based on the 2004 DOJ Census, the selected facilities housed 25% of the US juvenile residential population (~25,000 juveniles) represented 5% of all the US facilities average length of stay 204 days (range: 3-971) average bed capacity 109 (range: 36-669) average age of juveniles 13.8 years (range: 10-21y) Average bed capacity

Methods State immunization program managers from 47 states were surveyed by email. Questions: enrolled in VFC (as of January 2006) date of enrollment? VFC site visit in the previous two years? number of doses ordered of hepatitis A, hepatitis B, MMR, Td, and varicella distributed between July 01 and December 31 2005

Results (continue) 46/47 states completed the survey 135 (78%) enrolled in VFC: 17 (13%) provide vaccination through outside medical care 115 (85%) actively enrolled 88 (61%) had >1 one site visit in the last two years 79 (55%) enrolled between 1994 and 1998 there is one outlier which order more than 6000 doses, after taking it out: outlier of 6220 doses was taken out

Number of Facilities Enrolled in VFC, by Year (n=135) 55% facilities were enrolled by 1998

Number (%) of facilities ordering Vaccines Ordered by Actively VFC Enrolled Facilities (n=115), July-Dec 2005 Number (%) of facilities ordering Doses ordered median (range) * HepA 33 (29) 80 (10-660) HepB 107 (93) 50 (2-2540) MMR 56 (49) 20 (10-400) Varicella 23 (20) 10 (10-100) Td/Tdap 96 (84) 33 (10-6220) n/115 *Facilities ordering 0 doses of any type of vaccine were excluded

Estimated Number of Doses Ordered per Detainee Number of Facilities n=115 Median Range Hepatitis A 33 0.81 0.05 - 2.1 Hepatitis B 107 0.45 0.02 - 12.0 MMR 56 0.18 0.03 - 5.4 Varicella 23 0.15 0.04 - 1.5 Td/Tdap* 95 0.32 0.04 - 3.7 Certaily all detainees may not need a dose yet these numbers suggest need to learn if the coverage rate is high in the state we hope they are ordering appropiatelly Among facilities that ordered vaccine Outlier Hepatitis B 2540 Number of doses/(kids*180/average of stay days Some facilities ordered more doses than need for the six months, maybe order for a whole year; may be wasted for future recommend a limited dose based on bed occupation per six months.

Summary VFC enrollment 80% The two vaccines ordered most were Hepatitis B and Td/Tdap (73%, 69%) There was NO relationship between doses ordered and: type of medical care school inside or outside mean age in facility sex of juvenile in facility

Limitations These data are limited to 5% of US juvenile facilities The data represent 25% of juvenile population housed in long term facilities that are state owned and operated Data for vaccine distribution was based on only last six months

Next Steps Site visits to selected facilities to evaluate: vaccination policies vaccine screening practices actual vaccine coverage by chart review barriers to vaccination

Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the view of the Centers for Disease and Prevention, US Department of Health and Human Services

VFC Coordinators and Immunization Program Managers in 47 states Acknowledgements VFC Coordinators and Immunization Program Managers in 47 states NIP: Lance Rodewald, Nancy Fasano, Gary Edgar, Brad Prescott, Harry McKnight, Gary Buckett, Gayle Daniels, Lewis Anderson, Julie Orta, Steve Weems, and Jack Nemecek Harold D. Margolis All the staff and adolescents in JRF