1. PEDIATRIC INFLUENZA IMMUNIZATION IN BALTIMORE CITY Anne Bailowitz, MD, MPH John Lamoureux, MPH Baltimore City Health Department March 7, 2006

2. Baltimore City Health Department
Learning Objectives
To describe changes in pediatric influenza immunization in Baltimore City,
To characterize changes by age, gender, race, season and type of clinic practice.
To appreciate the evolution of influenza immunization policy and practice.
To appreciate the utility of immunization registries to define trends in immunization.
Baltimore City Health Department

3. Baltimore City Health Department
Background
Influenza is a major public health threat.
United States: 36,000 deaths and 200,000 hospitalizations annually.
Until 2002, influenza immunization policy was primarily focused on adults and children with chronic diseases.
In 2002, CDC expanded indications, encouraging the immunization of healthy 6-23 month olds.
The impact of this policy change on practitioner behavior and pediatric influenza immunization coverage in Baltimore City was assessed using our immunization registry.
Baltimore City Health Department

4. Baltimore City Health Department
Setting
The Baltimore Immunization Registry (BIRP) was launched in 1995.
BIRP is a population based, central repository of immunization records from birth through high school.
City ordinance mandates Baltimore-based health care provider reporting of all immunizations administered to children under 6 years of age.
The Registry has been a useful tool in achieving high pre-K through 12th grade immunization coverage rates.
Baltimore City Health Department

5. Baltimore City Health Department
Methods
Extract and analyze BIRP data for all doses of administered influenza vaccine, 1999 – Group non-duplicated records by dose age, residence, healthcare provider, et al.
Population estimates extrapolated from 2000 US Census and Maryland Department of Planning projections.
Baltimore City Health Department

6. The Number of Children & Adolescents Receiving 1+ Yearly Dose of Influenza Vaccine Increased Steadily from 2000 to 2004
Baltimore City Health Department

7. # of Baltimore City Children & Adolescents by Age Receiving 1+ Yearly Dose of Influenza Vaccine
Baltimore City Health Department

8. Influenza Vaccination Coverage for Children < 3 Years Old Increased from 1% of Baltimore’s Cohort in 2000 to 12% in 2004
Baltimore City Health Department

9. 83% of Influenza Vaccine was Administered from October-December
Baltimore City Health Department

10. Baltimore City Health Department
VFC Providers Administering Influenza Vaccine to Children Under 3 Years Old Increased from 29% in 2000 to 70% in 2004
Baltimore City Health Department

11. In Baltimore, University (Johns Hopkins + Univ
In Baltimore, University (Johns Hopkins + Univ. of Maryland) Affiliated Clinical Practices are Twice as Likely to Administer Influenza Vaccine to < 3 Year Olds
Healthcare Provider Type
(As of Dec 2004)
Estimated Pct of Total Baltimore City < 3 Year Old Patients
Est Pct of < 3 Yr Old Patients Receiving 1+ Dose of Flu Vaccine in CY 2004
University Affiliated Clinical Practices
(n = 12 of 15 )
30 %
24 %
Other Multiple Clinic Networks
(n = 23 of 32 )
32 %
10 %
“Stand Alone” Solo & Small Group Practices
(n = 29 of 45 )
38 %
Mean Average = 14%. Median = 9%. Range: 0% to 49%
Baltimore City Health Department

12. Baltimore City Health Department
Influenza BIRP Records for Gender and Race Correlate Well with US Census Data
Gender
BIRP Flu Records
US Census (2000)
Female
47 %
51 %
Male
53 %
49 %
Race / Ethnicity
African-American
70 %
74 %
White
24 %
22 %
Hispanic
2 %
Asian
1 %
Baltimore City Health Department

13. Correlation of BIRP with CDC/NIP National Immunization Survey’s Measure of Pediatric Influenza Vaccination Coverage
The National Immunization Survey (NIS) reports a 1+ Influenza Vaccine Dose Rate among Baltimore’s 6 – 23 Month Olds of:
= 12.5%
2002 – = %
How well BIRP and other immunization registries correlate with NIS data, especially in metropolitan areas, can be suggested by the NIP’s IIS Sentinel Site project.
Source: MMWR. Feb 3, (04);
MMWR. Sep 24, (37);
Baltimore City Health Department

14. Baltimore City Health Department
Lessons Learned
Adoption of a new immunization policy can be assessed using an immunization registry.
Rapid adoption of the influenza immunization policy in Baltimore is due to:
- Well-educated, pro-active providers
- Dedicated outreach efforts by the
Baltimore City Health Department
and Maryland VFC Program to educate
providers and parents
- Effective Medicaid enrollment
Baltimore City Health Department

15. Questions? Need Additional Information?
Anne Bailowitz, MD MPH
John Lamoureux, MPH
Bureau of Child Health & Immunization
Division of Maternal & Child Health
Baltimore City Health Department
4 S. Frederick St. Floor 3
Baltimore MD
Tel: or
Baltimore City Health Department