Dialing up for Teen Shots: Immunization Status of San Diego County Adolescents Wendy Wang, MPH County of San Diego ● Health and Human Services Agency ● Public Health Services ● Immunization Branch

Objectives Monitor the adolescent immunization coverage rates for San Diego County Establish the baseline rates for the newly recommended adolescent vaccines Measure knowledge and attitudes concerning vaccines

Methods Random digit dialing (RDD) telephone survey 5 pm-9 pm M-F and 10 am-2 pm Sat Parents of adolescents 11-15 years old in 2006 11-18 years old in 2007 Conducted immunization registry verification with parental permission

Results

Sample Size And Response Rate* Survey Year 2006 (11-15 yrs) 2007 (11-18 yrs) Sample 582 1,143 Response Rate 59.6% 73.1% *Response Rate= interviews completed /(interviews completed + interviews terminated)

The following analysis will use 11-15 year olds as comparison of 2006 and 2007 surveys

Age Distribution 2006 and 2007 Surveys Ages in Yrs San Diego Co Population 2005 # (%) 2006 survey 2007 survey 11 44,382 (20.2) 119 (20.4) 212 (22.8) 12 43,737 (19.7) 138 (23.7) 209 (22.5) 13 44,431 (20.0) 121 (20.8) 188 (20.2) 14 45,108 (20.3) 111 (19.1) 150 (16.1) 15 44,093 (19.9) 93 (16.0) 170 (18.3) Total 221,751 582 929

Gender Distribution 2006 and 2007 Surveys San Diego Co Population 2005 # (%) 2006 survey 2007 survey Male 111,155 (50.7) 323 (55.5) 489 (52.6) Female 107,898 (49.3) 258 (44.3) 440 (47.4) Refused - 1 (0.2) Total 219,053 582 929

Race/Ethnicity Distribution 2006 and 2007 Surveys Ethnicities/ Races San Diego Co Population 2005 # (%) 2006 survey 2007 survey Hispanic 90,960 (41.0) 257 (44.2) 374 (40.3) White 84,628 (38.2) 194 (33.3) 351 (37.8) Other & Missing 46,163 (20.8) 131 (22.5) 204 (21.9) Total 221,751 582 929

Availability of Shot Records at the Time of Survey, Permission and Verification* Rates 2006 and 2007 Surveys 2006 survey # (%) 2007 survey Shot record 390 (67.7) 476 (51.2) Permission 497 (85.4) 733 (78.9) Verification 251 (43%) 335 (36%) Total 582 929 Verified through San Diego Immunization Registry for 1DTP after age 7, 2MMR, 3HBV, 2HAV, 1Vzv or history of disease, 1MCV4 (2007 only) and 3HPV (2007 only)

Using Recall Histories May inflate the Coverage Rates, 2007 ^Children with history of chickenpox of disease were excluded from VAR rates. ^Flu rate was mainly based on recall

Adolescent Coverage Rates* 2006 vs. 2007 Healthy People 2010 Goal = 90% *Using shot records and SDIR verified info, recall were excluded, except flu rates ^ Children with history of chickenpox disease were excluded from the VAR rates

History of Varicella Diseases 2006 and 2007 *Parental recall of Varicella disease history / 2006 (n=276); 2007 (n=349)

Had Varicella Disease by Age *78% of children with history of chickenpox disease were diagnosed by a doctor, 2007 survey

“Would you want your child to receive it?” “Have you heard of the new vaccine against whooping cough or pertussis, called Tdap, for adults and children aged >=7 yrs ?” “Would you want your child to receive it?”

“Would you want your child to receive it?” “Have you heard of the meningococcal meningitis vaccine recommendation for children aged >=11 yrs ?” “Would you want your child to receive it?” This question was not asked in 2007

“Would you want your child to receive it?” “Have you heard of the new vaccine against Human Papilloma virus, also called HPV?” “Would you want your child to receive it?”

“Would you want your child to receive the HPV?” by Gender

More Results (1) 85.2-87.6% of adolescents surveyed had some type of health insurance 75.9-79.7% had dental insurance 17.0-18.6% children had asthma 23.4% of children hadn’t seen their doctors for more than a year (2006 survey) A very low percentages of the vaccinations (2% and 4-6%) were received at alternative vaccination sites such as pharmacies and schools gave

More Results (2) Hispanic adolescents were significantly more likely to receive the HepA vaccines and more accepted HPV when compared to other ethnicities* The adolescents with history of asthma had significant higher coverage for flu vaccine *Other ethnicities = Non-Hispanic white, non-Hispanic black, non-Hispanic Asian, & Other combined

Conclusions (1) Approaching HP2010 Objectives except Tdap after age 7 Coverage rates of HepB, HepA and flu vaccines have been increased Number of chickenpox disease cases was down and was shifted to the younger age cohorts

Conclusions (2) Efforts to achieve the HP2010 Objectives Significant room for vaccine education about new vaccines Explore the opportunities for providing adolescent vaccines at alternative vaccination sites Special effort needed to get Tdap vaccine. HPV, Meningoccocal, and Tdap

Limitations Telephone survey Volunteer bias Recall bias

Thank you for your support and contribution. Acknowledgements Coauthors: Michelle Picardal, Naomi Katzir, BS, Mark Sawyer, MD, Michelle DeGuire, MPH, MSW, Kathe Gustafson, MPH, Adrienne Collins-Yancey, MPH, San Diego Immunization Branch staff San Diego Public Health Officer Wilma Wooten, MD, MPH San Diego Assistant Deputy Director Adrienne Yancey Thank you for your support and contribution. County of San Diego ● Health and Human Services Agency ● Public Health Services ● Immunization Branch

Visit our website at: www.sdiz.org Contact Information Wendy Wang, MPH Evaluation Manager Wendy.wang@sdcounty.ca.gov (619) 692-5683 Visit our website at: www.sdiz.org