1. Enrollment In And Use Of The Vaccine For Children Program Among Juvenile Residential Facilities
Beatriz E Builes, Cindy Weinbaum, Abigail Shefer,
Lisa Jacques-Carroll, Yuan Kong, Janet Chiancone,
Catherine Gallagher, Michael Washington,
Daniel Fishbein
National Immunization Program, CDC
Division of Viral Hepatitis, CDC
Office of Juvenile Justice and Delinquency Prevention, Department of Justice
George Mason University

2. Background Juvenile Justice System:
Each year, more than 1,200,000 adolescents are detained in >3,600 public and private Juvenile Residential Facilities (JRF)
Over 100,000 youth are detained for >30 days
JRFs can provide and coordinate vaccination programs
Most detained youth are eligible for vaccine from Vaccines for Children (VFC)
Patterns and amount of vaccine ordered is unknown

3. Background ACIP Recommends:
For all adolescents *
tetanus/diphtheria/acellular pertussis
meningococcal conjugate
Catch up
hepatitis B
measles/mumps/rubella
varicella†
* Some vaccines given only to adolescents of specific ages
† Those who have not had chickenpox

4. Background ACIP Recommends:
For adolescents in target groups
influenza
hepatitis A
pneumococcal polysaccharide

5. Objectives
Determine the proportion of state owned and operated facilities
enrolled and
actively participating in the VFC program
Determine patterns of vaccine ordering in relation to:
age of detainees
facility type
type of medical care
attend school

6. Methods
OJJ provided data for 177 facilities owned and operated by states
These facilities were chosen because they were most able to provide vaccine
Median facilities per state: 3 (Range: 1-15)
160 (90%) were long term-secure
Average bed capacity

7. Methods Based on the 2004 DOJ Census, the selected facilities
housed 25% of the US juvenile residential population (~25,000 juveniles)
represented 5% of all the US facilities
average length of stay 204 days (range: 3-971)
average bed capacity 109 (range: )
average age of juveniles 13.8 years (range: 10-21y)
Average bed capacity

8. Methods
State immunization program managers from 47 states were surveyed by .
Questions:
enrolled in VFC (as of January 2006)
date of enrollment?
VFC site visit in the previous two years?
number of doses ordered of hepatitis A, hepatitis B, MMR, Td, and varicella distributed between July 01 and December

9. Results (continue) 46/47 states completed the survey
135 (78%) enrolled in VFC:
17 (13%) provide vaccination through outside medical care
115 (85%) actively enrolled
88 (61%) had >1 one site visit in the last two years
79 (55%) enrolled between 1994 and 1998
there is one outlier which order more than 6000 doses, after taking it out:
outlier of 6220 doses was taken out

10. Number of Facilities Enrolled in VFC, by Year (n=135)
55% facilities were enrolled by 1998

11. Number (%) of facilities ordering
Vaccines Ordered by Actively VFC Enrolled Facilities (n=115), July-Dec 2005
Number (%) of facilities ordering
Doses ordered
median (range) *
HepA
33 (29)
80 (10-660)
HepB
107 (93)
50 (2-2540)
MMR
56 (49)
20 (10-400)
Varicella
23 (20)
10 (10-100)
Td/Tdap
96 (84)
33 ( )
n/115
*Facilities ordering 0 doses of any type of vaccine were excluded

12. Estimated Number of Doses Ordered per Detainee
Number of Facilities n=115
Median
Range
Hepatitis A 33
0.81
Hepatitis B
107
0.45
MMR 56
0.18
Varicella 23
0.15
Td/Tdap* 95
0.32
Certaily all detainees may not need a dose yet these numbers suggest need to learn if the coverage rate is high in the state we hope they are ordering appropiatelly
Among facilities that ordered vaccine
Outlier Hepatitis B 2540
Number of doses/(kids*180/average of stay days
Some facilities ordered more doses than need for the six months, maybe order for a whole year; may be wasted for future recommend a limited dose based on bed occupation per six months.

13. Summary VFC enrollment 80%
The two vaccines ordered most were Hepatitis B and Td/Tdap (73%, 69%)
There was NO relationship between doses ordered and:
type of medical care
school inside or outside
mean age in facility
sex of juvenile in facility

14. Limitations These data are limited to 5% of US juvenile facilities
The data represent 25% of juvenile population housed in long term facilities that are state owned and operated
Data for vaccine distribution was based on only last six months

15. Next Steps Site visits to selected facilities to evaluate:
vaccination policies
vaccine screening practices
actual vaccine coverage by chart review
barriers to vaccination

16. Disclaimer
The findings and conclusions in this report are those of the authors and do not necessarily represent the view of the Centers for Disease and Prevention, US Department of Health and Human Services

17. VFC Coordinators and Immunization Program Managers in 47 states
Acknowledgements
VFC Coordinators and Immunization Program Managers in 47 states
NIP: Lance Rodewald, Nancy Fasano, Gary Edgar, Brad Prescott, Harry McKnight, Gary Buckett, Gayle Daniels, Lewis Anderson, Julie Orta, Steve Weems, and Jack Nemecek
Harold D. Margolis
All the staff and adolescents in JRF