Using immunization registries to track Hepatitis B vaccination coverage Diana Bartlett Immunization Registry Support Branch National Immunization Program

Background 2001 National Immunization Survey (NIS), 88.9% (±0.7) for ≥3 doses of Hepatitis B, 19-35 months of age By 7 months of age… 81.9% (±0.8) for ≥ 2 doses of Hep B 27.0% (±0.9) for ≥ 3 doses of Hep B Children in the 2001 NIS sample were born between February 1998- May 2000 Children in the 2001 NIS sample were born between February 1998-May 2000.

Background Immunization registry sentinel site project began in 2001 Collects vaccination surveillance data from CDC grantees to study immunization registry data quality, promote data use, and supplement NIS estimates

Background MMWR July 1999 Joint statement of AAP and PHS Recognition of exposure to mercury through Thimerisol Recommended postponing 1st dose of Hep B from birth until 2-6 months of age Since that time vaccine companies have removed thimerisol from their vaccines which may have caused providers to revert to the use of the birth dose.

Definition of a Sentinel Site A registry that contains a population of children with complete vaccination histories so that changes in coverage can be rapidly detected and monitored

Criteria for Site Selection Population of ≥10,000 children who are <6 years of age Vaccination data are entered into the registry’s database within 4-6 weeks of vaccine administration

Registry Sentinel Sites The only site to change since last quarterly report was Utah-changed from Utah County (Provo) to Salt Lake County New York City, NY Oregon: Cities of Salem and Portland Michigan: Jackson, Kent, Muskegon Co. Utah: Salt Lake County San Antonio, TX Arizona: Coconino County Oklahoma Washington, D.C

Data entered into registry within one month Site Profiles, Q3 2002 Site # of Children Providers Data entered into registry within one month A 10,204 ALL 19% B 17,956 PUBLIC 26%* C 17,374 PRIVATE 15% D 57,230 WIC 78% E 118,117 94% F 28,454 90% G 93,634 45%* H 15,695 Medicaid MCO’s 62% These registries maintain data on 358,664 children under the age of 6 years. The asterik i *Sites unable to exclude shot histories from time calculations

Methods Sites complete a web-based quarterly report of vaccination coverage for all ACIP recommended vaccines Sites reported Hep B data for children ages 7, 13, 19, 24, and 19-35 months Children up-to-date for Hep B if they have ≥ 3 doses at each age Third quarter 2002 data used; children 19-35 months of age born 8/16/99-1/15/01

Percentage of 7 Months Olds With Hep B Vaccines

Percentage of 19-35 Months Olds With Hep B Vaccines

Conclusion Children behind in Hep B doses as early as 7 months are at risk for not being UTD at the other age groups Registries with the lowest Hep B UTD in all age groups had 15-20% of their population that needed only one more dose to be UTD with the NIS estimates by 19-35 months

Conclusion 5 sites had UTD Hep B vaccination coverage levels for 7 month olds similar to national NIS estimates 4 sites met or exceeded their state/city specific NIS estimates for both age groups Unable to determine impact of Thimerisol recommendations on 19-35 month old population 2000 NIS 3+ Hep B vaccination estimate was 90.3 and the 2001 estimate was 88.9. In the 3 months olds, 1+ dose of Hep B was 94.2% in 2000 and 83.5% in 2001; for 2+ doses it was 70% in 2000 and 50.1% in 2001 In 5 month olds, 2+ doses of Hep B was 86% in 2000 and 73% in 2001 In 7 month olds, 2+ doses was 91% in 2000 and 82% in 2001; 3+ doses was 34.5% in 2000 and 27% in 2001

Limitations Sentinel sites determine the sample studied (e.g., county-level, state) Registry data may be incomplete Demographic data not available to determine factors influencing delayed vaccination status Collected different cohorts of children in age groups

Benefits of using registry for Hep B surveillance Timely information (3 month waiting period) Smaller geographic area and demographic groups (e.g., WIC) can be studied Many registries linked to reminder/recall for vaccine catch-up Capture birth dose from electronic birth certificate downloads

Next Steps Analyze impact of Thimerisol recommendations on 7 month old vaccination coverage levels for ≥1 dose, ≥2 doses, and ≥3 doses since July 1999 MMWR Collect information on birth dose administration on quarterly report Continue improving registry data quality and data use

For Further Information Contact: Diana Bartlett Public Health Analyst Registry Support Team CDC/ National Immunization Program 1600 Clifton Rd., MS E-62 Atlanta, Ga. 30333 phone: 404-639-1813 fax: 404-639-8171 email: dbartlett@cdc.gov