Justin Weisser, MPH; Nathan Crawford, MPH; Mimi Luther, BA An Exploration: - Using Oregon’s AFIX Data - Evaluating 4th DTaP Administration Justin Weisser, MPH; Nathan Crawford, MPH; Mimi Luther, BA

Background: Importance of the 4th DTaP Shot in 4:3:1:3:3 Series Completion Many have theorized that completion of the 4:3:1:3:3 series by 24 months of age is often contingent on the receipt of the 4th shot in the DTaP series. In the past five years of AFIX assessments in Oregon, absence of a 4th DTaP was the most common reason children were found not to be up-to-date with the full 4:3:1:3:3 series.

Study Data Data were taken from 74 AFIX Assessments conducted by Oregon’s VFC/AFIX program in ‘06 Clinics varied by type, size and geographic location Kids assessed from varied SES backgrounds and insurance coverage

Study Data (Con’t) Only kids who had a 4th DTaP were included Only kids at least 24 months old at time of assessment were included A total of 9,316 kids were assessed in this study ALERT Registry source of data

What Is ALERT? Oregon’s Award-Winning Registry! “data warehouse” model public-private partnership voluntary private participation Population-based registry with strong provider participation 100% of public clinics 87% of private clinics

ALERT Registry ALERT contains approximately 95% of kids resident in Oregon between the ages of 0-36 months who have had two or more shots. ALERT registry data are used by the AFIX program to assess individual kid’s immunization status for clinic assessments.

Study Methods Data were received from ALERT and entered into CASA v2.6 at the time of clinic assessment Later, data were exported from CASA as individual clinic data files Individual files were grouped into a single database Merged database was de-duplicated Data were imported into SPSS v14.0 Chi-square test showed an association between the timing of DTaP administration and up-to-date status at 24 months of age

Analysis Results Did receive by 14 months, and UTD: 88% Received after 14 months, and UTD: 81% p <.000  OR= 1.7 95% CI 1.5-2.1

Conclusions Initial results seem to indicate that giving the 4th DTaP before 14 months greatly increases chances of being up-to-date by 2 years of age If correct spacing allows, co-administration of all vaccines due at the 12 months visit.

Limitations & Strengths Shots not evaluated with valid-spacing criteria Participating clinics were self-selected Reasons for early immunization not investigated Very well-populated registry Oregon AFIX data: Oregon specific, timely, relevant, inexpensive (no chart pulls!)

Future Directions Further explore data to find influencing factors (clinic size, practice type, etc…) including valid spacing methodology Design and implement a study to compare practices which switch to a “early 4th DTaP shot” set of standing orders vs. practices which continue with the standard ACIP schedule

Mimi Luther Oregon Public Health Division, Immunization Program 800 NE Oregon, #370 Portland OR 97232 971-673-0296 Lydia.M.Luther@state.or.us