1. 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

2. 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

3. 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

4. Results

5. 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)

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

7. 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

8. 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

9. 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

10. Availability of Shot Records at the Time of Survey, Permission and Verification* Rates 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)

11. 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

12. 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

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

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

15. “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?”

16. “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

17. “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?”

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

19. More Results (1)
% of adolescents surveyed had some type of health insurance
% had dental insurance
% 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

20. 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

21. 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

22. 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

23. Limitations
Telephone survey
Volunteer bias
Recall bias

24. 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

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Contact Information
Wendy Wang, MPH
Evaluation Manager
(619)
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