Georgia Immunization Rates Medicaid Medical Care Advisory Meeting    November 17th 2010 Anil T. Mangla

Anil T. Mangla, MS., PhD., MPH., FRIPH Acting State Epidemiologist Director of Infectious Diseases and Immunizations Adjunct Assistant Professor University of Georgia Department of Public Health Community Assistant Professor Mercer University School of Medicine

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% Coverage / Ranking 1

The Health People 2010 goal US Dept of HHS Healthy People 2020 goal is 90%) Achieving or maintaining vaccination coverage for children, 19-35 months, at 90 percent for specific antigens including 4 doses of DTaP, 3doses of Hep B, 3 doses of Hib, 1 dose of MMR, 3 doses of Polio, and 1 dose of Varicella.

4:3:1:3:3:1 (4 DTaP, 3 IPV, 1 MMR, 3 Hib, 3 HepB, 1 Varicella) Coverage Among 2 Year Olds in Georgia, 2000-2008

NIS pulls a sample of approximately 500 children from all over GA. The sample is found from random-digit dialing, so it excludes cell-phone only families. The random numbers are dialed and then polled to see how many of them have a child within the correct age bracket. Sample is around 2500 children Sample is randomly selected from birth records (certain # chosen from every district- based on response rate from previous year and population distribution) The children are all looked-up in GRITS and if they are incomplete on the 4:3:1:3:3:1:4 level, then they are sent to the district Immunization Coordinators. analyze children were complete at 2 years of age and how many children became complete by the end of the study.

IPV Coverage Among 2 Year Olds in Georgia, 2000-2008

MMR Coverage Among 2 Year Olds in Georgia, 2000-2008

Hib Coverage Among 2 Year Olds in Georgia, 2000-2008

HepB Coverage Among 2 Year Olds in Georgia, 2000-2008

Varicella Coverage Among 2 Year Olds in Georgia, 2000-2008

PCV Coverage* Among 2 Year Olds in Georgia, 2002-2008

DTaP Coverage Among 2 Year Olds in Georgia, 2000-2008

1 Vaccine 2009 NIS Nat’l (%+CI) 2009 GA Coverage (%+CI) 4+DTaP 83.9+1.0 82.8+5.5 79.0+6.7 3+Polio 92.8+0.7 94.3+3.2 93.1+3.5 1+MMR 90.0+0.8 91.3+4.2 92.7+3.7 3+Hib* 83.6+1.0 78.6+5.8 62.6+7.3 3+HepB 92.4+0.7 94.1+3.3 93.6+3.7 1+VAR 89.6+0.8 91.5+4.4 90.6+4.8 4+PCV 80.4+1.1 79.4+5.9 81.6+5.8 2+HepA 46.6+1.4 58.1+7.1 42.7+7.1 3+DTaP 95.0+0.6 95.9+3.0 96.1±2.6 431331 69.9+1.2 69.3+6.6 71.9+6.9 Nat’l Rank 22 37 Looking at the DTaP series, year 2005 through 2009, the 3rd dose of DTaP is routinely recommended and given at 6th months of age. These rates are all well above the 90 percent level. The fourth dose is routinely recommended and given between 15 and 18 months. As you can see from this chart, these rates fall below the 90 percent level and many of these children have not received the fourth dose of DTaP series by 35 months. The data shows we lose approximately 10 percent of children between 12 and 35 months of age. 1

RANKING

Decline in immunization rates: 4th dose of DTaP are dramatically lower than other vaccine rates; and this vaccine is given at age 15 months (after 1st year of Medicaid eligibility ends). Temporary national immunization shortages, especially HIB Vaccine distribution issues related to policies and procedures of McKesson Missed opportunities by providers Vaccine refusals by fearful parents Poor economy – parents difficulty with transportation to preventive visits

Solutions One year continuous eligibility and a single eligibility determination process for both Medicaid & PeachCare, (eliminate gaps in coverage) Require CMO’s to develop QI programs in child immunizations to meet goal above. (HEDIS) (The Healthcare Effectiveness Data and Information Set) NCQA (The National Committee for Quality Assurance) Study of best practices in private practices with high vaccine rates, and replicate these techniques Establish Advisory Committee on Childhood immunizations

Georgia’s vaccine monitoring and distribution system The Georgia VFC program uses a vaccine replenishment system to monitor and distribute vaccine product to each enrolled provider. This information is entered in the CDC VACMAN vaccine distribution software. The software tracks the number of doses of each vaccine distributed and sends message to the VFC staff entering the order if more vaccine has been allocated than recommended based on the population.

Each month the provider is required to submit a vaccine comprehensive report. The information from the comprehensive report is used to replenish the amount of vaccine that each provider has on hand in his or her office. The intent is for each provider to have between 60 to 90 days supply of vaccine on hand.

Immunization Program Staff also verify vaccine usage totals reported to the program each month via their bi-annual site visits and various other provider visits. Patient charts are reviewed to validate vaccine doses administered and vaccine supply is inventoried. If discrepancies are found in the number of doses administered versus the number of doses in inventory, the provider will be required to take necessary corrective action steps to return to full compliance with VFC. Providers may be temporary restricted from participating in VFC until corrective actions have been completed.

Georgia has been using 4:3:1:3:3:1 to measure our immunization coverage level. This has been the same measure used by the CDC for the last 5 years. With the 2009 NIS data a number of other measures have been included such as 4:3:1:3:3:1:4 which includes PCV as a measure. CDC began collecting this measure in 2007 4313314 National 2007 66.5%, 2008 68.4%, 2009 69.0% or (63.6%- with change in data definition) 4313314 GA 2007 65.9%, 2008 67.4%. 2009 70.3% or (62.9%- change in data definition)

Thank You Anil T. Mangla 404-463-0772 anmangla@dhr.state.ga.us