Public Provider Immunization Assessments in Indiana
2000 Assessment Results

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Results

Sampling Rates

Overall, 98.8 percent of all active two-year old patients of local health departments and 92.4 percent of active two-year old patients of the non-health department public providers were sampled (Table 1).
 

Table 1. Summary of two-year old population (1997 birth cohort), Indiana public immunization providers, 2000.
  Local Health
Departmentsa		 Non-health Department
Public Providersb
Estimated number of children from 1997 birth cohort seen by Indiana's public immunization providers. 23,947 5,864
Total number of children from 1997 birth cohort included in the 2000 immunization assessment 23,654 5,417
% of 2 year old patient population sampled 98.8% 92.4%
a Data for all 94 local health departments.
b Only those providers with at least 25 children aged 24-35 months of age were assessed.

 
Immunization Coverage Levels

To be considered completely immunized by age two, each child must receive 4 vaccinations for diphtheria, tetanus, and "cellular pertussis (DTaP), 3 vaccinations for polio, the first measles, mumps, and rubella vaccine (MMR), at least 3 vaccinations for Haemophilus influenzae type b (Hib), and 3 vaccinations for hepatitis B (HepB).

This assessment demonstrates that, statewide, the public immunization providers in Indiana have not yet met the national goal of 90% coverage among the two-year old population. In the local health departments, overall single antigen coverage levels among their two-year old patient population ranged from 81.2 to 94.8 percent whereas among the non-health department public providers overall single antigen coverage levels ranged from 69.9 to 91.2 percent (Table 2). For the 4:3:1:3 vaccination series (4DTaP:3 Polio: I MMR: 3 Hib), the overall completion rate was found to be 79.7 percent among children seen at local health departments and 63.2 percent among children seen at the non-health department public clinics (Table 2). The 4:3:1:3 vaccination series is commonly used as the standard for measuring immunization coverage across the country (see the summary of the National Immunization Survey in the appendix).
 

Table 2. Summary of individual antigen and vaccination series completion levels, by 24 months of age, Indiana public immunization providers, 2000.
  % Complete
Statewide		 % Complete Per
Provider (median)
Local Health
Departments		 Non HD Public
Providers a		 Local Health
Departments		 Non HD Public
Providers a
INDIVIDUAL ANTIGENS
  3 DTap (Diphtheria, Tetanus, Pertussis) 94.8b 91.2c 97.7b 96.0c
  4 DTap (Diphtheria, Tetanus, Pertussis) 81.2 69.9 98.8 76.5
  3 Polio (Oral and Inactivated) 89.5 77.7 95.4 88.6
  1 MMR (Measles, Mumps, Rubella) 89.9 78.5 95.9 85.7
  3 Hib (Haemophilus influenzae type b) 91.8 82.7 96.6 89.1
  3 HepB (Hepatitis B) 91.1 70.2 96.1 91.1
VACCINATION SERIES
  4 DTaP: 3 Polio: 1 MMR 81.8b 70.5c 88.0b 88.0c
  4 DTaP: 3 Polio: 1 MMR: 3 Hib 79.7 63.2 87.9 76.1
  4 DTaP: 3 Polio: 1 MMR: 3 Hib: 3 HepB 79.9b 68.2c 79.9b 86.5c
a Only those clinics with at least 25 children aged 24-35 months of age were assessed.
b Data for all local health departments except Marion County Health Department.
c Data for all non-health department public providers except those in Marion County.

 

Calculations of median coverage levels among the population of local health departments demonstrate that coverage levels for the single antigens ranged from 88.8 percent to 97.7 percent (Table 2). Nearly three-fourths (69 of 94) of the local health departments were found to have a coverage level greater than 80.0 percent for the 4:3:1:3 vaccination series. Almost one-third (16 of 52) of the non-health departments public providers included in the assessment were found to have coverage levels greater than 80.0 percent for this same series (Figure 1).
 

Figure 1. 4:3:1:3 coverage levels at 24 months of age, by provider type, Indiana, 2000.

 

When comparing public providers found in urban counties with those in non-urban counties, those in urban counties were found to have significantly lower coverage levels of two-year old children for the 4:3:1:3 vaccination series for both public provider populations (Table 3).
 

Table 3.  4:3:1:3 coverage levels by population base, Indiana public providers, 2000.
  # providers # two-year olds
assessed		 % up-to-date with
4:3:1:3 series
Local Health Departments
  Urban 8 5,493 57.1%
  Non-Urban 86 18,171 86.5%
Non-health department public providers
  Urban 23 4,036 59.7%
  Non-urban 29 1,381 73.4%

 
Patient tracking is an important feature of immunization programs. Providers utilize a variety of methods for assuring that their patients return to complete the immunization series. CASA software measures the drop in single antigen coverage for the DTaP and hepatitis B vaccines as a surrogate marker for evaluating the effectiveness of patient tracking.

Drops in coverage were found to be more severe for the DTaP vaccine than for the hepatitis B vaccine. The local health departments experienced a median drop in coverage of only 2.1 percent between the first and final hepatitis B vaccine, but experienced a median drop in coverage of 9.6 percent between the first and fourth DTaP vaccine. For the non-health department public providers, this discrepancy was even more marked: 4.0 percent drop for hepatitis B and 16.7 percent drop for DTaP (Table 4).
 

  Median % Drop Per Provider
Local Health
Departmentsa		 Other Public
Providersb
Drop in coverage between DTaP1 and 12 months of age and DTaP4 by 24 months of age 9.6% 16.7%
Drop in coverage between HepB1 by 12 months of age and HepB3 by 24 months of age 2.1% 4.0%
a Data for all local health departments except Marion County Health Department
b Data for all non-health department clinics except those in Marion County

  
Additional analysis was completed comparing the number of children receiving their first, third, and fourth DTaP at the local health departments and at non-health department public providers. In both provider types, statistically significant differences in the mean coverage levels for each successive vaccination were found (Figure 2).
 

Figure 2.  Mean coverage levels of successive DTaP vaccinations, by provider type, Indiana, 2000.

 
Data available for both the 1999 and 2000 assessments from each of the 94 local health departments (representing the 1996 and 1997 birth cohorts, respectively) demonstrates that 63.8% (60 of 94) showed improvement in their 4:3:1:3 coverage levels. Of 52 non-local health department providers who received an assessment in both 1999 and 2000, 50.0% (9 of 18) demonstrated improvement in their 4:3:1:3 coverage levels.

The impact of repeated assessments can be seen by looking at trends of immunization coverage levels over time. Bar charts (Figures 3 and 4) demonstrate the shifting of immunization coverage levels towards 90% from the 1999 to 2000 for both local health departments and non-health department clinics.
 

Figure 3.  Local health department 4:3:1:3 coverage levels, Indiana, 1999 and 2000.

 

Figure 4.  Non-health department public provider 4:3:1:3 coverage levels, Indiana 1999 and 2000.

 

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