1. Impact of Outreach Activities on Childhood Immunization Coverage in Philadelphia, PA
Philadelphia Department of Public Health
Abbey Mahady, Andrew Chilkatowsky,
Michael Eberhart, Bruce Barlow
National Immunization Program
Maureen Kolasa, Yuan Kong,
Katie Endress, Lindsay Newcomb

2. Background
Many infants don’t receive vaccinations on time during their first year.
Increased susceptibility to disease
Impacts coverage rates at months
Outreach targets children at 9 months, not up-to-date (NUTD) for age-appropriate immunizations according to the KIDS Immunization Registry.

3. Setting 20,000 - annual birth cohort in Philadelphia
98.7% in registry
82% of children <1 are VFC eligible
Philadelphia Department Public Health (PDPH) contracts with two community-based outreach organizations:
Supportive Child Adult Network (SCAN)
Council of Spanish-Speaking Organizations, Inc. (CONCILIO)
65% of Philadelphia children live in areas served by outreach organizations.

4. Outreach Methods
Every month, PDPH uses the KIDS Immunization Registry to identify children, 9 months, NUTD, and living in an “outreachable zipcode”.
Outreachable zipcodes:
Lower socio-economic status
High density of minority populations

5. Outreach Interventions
Outreach workers
Check KIDS Registry for updates.
Contact last immunization provider listed in registry for child’s history.
Enter missing immunizations into KIDS Registry.
If the child is UTD, the case is closed.

6. Outreach Interventions
For children still NUTD
Outreach worker contacts parents by telephone and/or home visit.
Encourages vaccination at the medical home.
Makes the appointment.
Assists with transportation, if needed.
Outreach activities include locating a new or alternate address.

7. Objectives
Determine the impact of outreach on increasing immunization coverage by 13 and 19 months of age.
Assess the impact of outreach across different racial and ethnic groups.
Assess the impact by outreach organization.

8. Up-to-Date Definitions
UTD 9 months:
3 DTaP, 2 Polio, 2 Hib, 2 HepB
UTD 13 months:
UTD 19 months:
4 DTaP, 3 Polio, 3 Hib, 2 HepB, 1 MMR, 1 Varicella
2 HepB – accounts for missing birth dose

9. Inclusion Criteria Children born April 1, 2003 - Feb 28, 2004
All 19 months by Sept 30, 2005
Received outreach from SCAN\Concilio =6854
Removed from analysis because no outreach completed = 918
Moved from Philadelphia (85)
Died (0)
Unable to locate (833)

10. Children referred to outreach
because NUTD at 9 months
according to Registry
N = 5936
Received additional
outreach through
another PDPH
initiative N=1444
(24%)
UTD at 9 months
after chart review
N = (25%)
NUTD at 9 months
N = 3034 (51%)
Chart reviews:
Concilio 871
SCAN 587
Outreach done:
Concilio 2,131
SCAN 903

11. Race of Outreached Children
White
Black
API
O\U
Total
Concilio
215
16%
757
56%
222
17%
152
11%
1346
64%
SCAN 60 8%
642
84% 42 6% 16 2%
760
36%
275
13%
1399
66%
264
168
2106
API = Asian\ Pacific Islander; O\U = Other\Unknown

12. Ethnicity of Outreached Children
Hispanic
Non-Hispanic
Unknown
Total
Concilio
222
21%
664
64%
152
15%
1038
69%
SCAN 23 5%
419
88% 32 7%
474
31%
245
16%
1083
72%
184
12%
1512

13. 2004
CONCILIO
SCAN

14. Black and Hispanic Population Philadelphia 2000

15. Asian and White Population Philadelphia 2000

16. Among children NUTD at 9 months, UTD coverage at 13 & 19 months,
86%
35%

17. Among children NUTD at 9 months, UTD coverage at 13 & 19 months by outreach organization, N = 3034%

18. Comparison of NIS Immunization coverage of children 19 months (2004) to Coverage among children receiving outreach Jan 1, 2004 – Sept 30, at 19 months %

19. Philadelphia NIS Immunization coverage for 4:3:1:3:3:1 among children months in 2004 by Race/Ethnicity %

20. Among children NUTD at 9 months, UTD coverage at 13 & 19 months by race, N = 2106%
API = Asian\ Pacific Islander; O\U = Other\Unknown

21. Among children NUTD at 9 months, UTD coverage at 13 & 19 months by ethnicity, N = 1512%

22. Conclusions
Outreach is effective at bringing NUTD children UTD by 19 months.
86% UTD by 19 months (2609 children)
Outreach is effective at bringing NUTD children UTD by 13 months.
35% brought UTD between 9 and 13 months (1062 children)
Many others likely needed more than one immunization visit to get them UTD.

23. Conclusions
UTD coverage at 19 months similar among all races\ethnicities.
UTD coverage at 13 months lower among API (Asian-Pacific Islanders) than other races\ethnicities.
Outreach efforts initiated for children already UTD.
1,458 children (25% of those thought NUTD at 9 months) truly were UTD.
Referred to outreach because NUTD in registry (registry data incomplete).
Review of charts is helpful to complete registry data.

24. Recommendations
Improve quality of registry data to decrease staff time conducing outreach on UTD children.
Provider-based outreach initiative.
Prevent immunization delay in the first year to achieve a larger impact at 13 months.
Address late starters.
Consider initiating recall intervention or outreach at an earlier age.

25. Recommendations
Low coverage among API at 13 months suggests need to engage API population.
Seek opportunities to collaborate with other city agencies to locate children.
Transient children may be more likely to be NUTD.