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

2. Background
2001 National Immunization Survey (NIS), 88.9% (±0.7) for ≥3 doses of Hepatitis B, 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 May 2000
Children in the 2001 NIS sample were born between February 1998-May 2000.

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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 months
Children up-to-date for Hep B if they have ≥ 3 doses at each age
Third quarter 2002 data used; children months of age born 8/16/99-1/15/01

10. Percentage of 7 Months Olds With Hep B Vaccines

11. Percentage of 19-35 Months Olds With Hep B Vaccines

12. 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 months

13. 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 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

14. 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

15. 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

16. 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

17. For Further Information Contact:
Diana Bartlett
Public Health Analyst
Registry Support Team
CDC/ National Immunization Program
1600 Clifton Rd., MS E-62
Atlanta, Ga
phone:
fax: