Data to Action – Using State and Local Data to Make a Difference Bob Swanson, MPH Director, Division of Immunization

IIS Coverage Levels

Immunization Coverage Levels by County

MCIR Workbooks   

Immunization Coverage by Region Updated quarterly Easily accessible

Workbook Examples

Disparities Workbooks for Immunization Coverage

County Report Cards

Background  Nationally, Michigan’s vaccination coverage is compared to other states

Flu Vaccination Coverage Estimates by State, 2012-13 Flu Season, All Persons 6mos+

 Identify areas for improvement  Motivation to improve coverage levels

 MCIR data provides opportunity to compare county level data  Presented report card concept to Michigan Association for Local Public Health (MALPH), Immunization Action Plan (IAP) coordinators

http://www.cdc.gov/flu/fluvaxview/index.htm

County Immunization Report Card

County Population Summary 2013 Census

MCIR

Difference (%)

Total Adults (20yrs+)

281,723 208,295

238,438 157,209

43,285 (15%) 51,086 (24%)

Children (0-19yrs)

73,428

81,229

-7,801 (-10%)

 Census and MCIR population data show how closely they align  Encourages updating MOGE status  Encourages entering adult immunization data

 MOGE parameters: removed “inactive MOGE”, “inactive – unspecified”, “inactive – permanent”  Counted persons with an assigned county jurisdiction regardless of their state code

County Immunization Providers Active MCIR Immunization Providers Reported in last 6 months Active VFC Providers Reported in the last 6 months Influenza Sentinel Sites (Reg. Reporters)

Count 118 88 (74.5%) 7 7 (100%) 2

 “Active” Immunizing providers  No read-only sites  Excludes child cares and schools

 Flu Sentinel sites: providers enrolled in the Outpatient Influenza-like Illness Network (ILINet)  Each jurisdiction is recommended to have at least one regularly reporting site  Regular reporter = submits a weekly report at least half of all weeks during the influenza season

Data Sources for Childhood Measures

 County & Health Dept: MCIR data used for numerator and denominator  MI Avg: statewide coverage  Includes kids assigned to Michigan who DO NOT have a county code (similar to profile reports).

 County rank:  1 is the best coverage and 84 is the worst  Ties: same rank

Childhood Immunization Measures

 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 HepB, 1 Varicella, 4 PCV  43133142: includes 2 Hepatitis A doses

Adolescent Immunization Measures

• 132321: 1 Tdap, 3 Polio, 2 MMR, 3 Hep B, 2 Varicella, 1

MCV4 • 1323213: addition of 3 HPV – Males & Females

• Healthy People 2020 Goals age group: • 13 through 15 year olds

Adult Immunization Measures

 Census denominators based on specified age group  No HP 2020 goal for adult Tdap

Influenza Vaccination Measures

 Age groups based on ability to compare to US Average  HP 2020 goals for adults**  70% for 18-64 year olds  90% for 65 and older

School and Child Care Completion

 School completion: percent of children in the county that are complete for a defined series based on the students age  Kids with waivers or provisional data are not considered complete

 New entrants (“O”) are included in the overall school waiver rate

Overall Measures

Positive Feedback  MDCH leadership  Health departments, Boards of Health  ~4000 website hits from March – June 30  Some concern from the upper peninsula

NIS and IIS Measures

National Immunization Survey (NIS) Coverage Estimates 4:3:1:3:3:1 Series Compared to MCIR Profile Report Children age 19 through 35 months Michigan, 2001-2013 100% 90%

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

95% Confidence Limits Point Estimate 83.6

80%

84.5

85.6

82.9

88.4

85.5 81

77.3 73.6

70%

73.9

75.6

72.9

69

66.1

64

60%

79.4

70

68

64

81.7 80%

78.4

74

72.1

72

90% 83.9

77.8

100%

75

70.1 65

64.2

75

70%

67.7 60%

61

57 50%

44

40% 30%

50%

49

40%

34

30%

20%

20%

10%

10%

0%

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

0%

National Immunization Survey (NIS) Coverage Estimates 4:3:1:3:3:1:4 Series Compared to MCIR Profile Report Children age 19 through 35 months Michigan, 2007-2013 100% 90%

2007

2008

2009

2010

2011

2012

2013

95% Confidence Limits Point Estimate

100% 90%

84.7 80% 74.4 70% 60%

69

76.6 72.8

68

62 63

59.4

73.3

79.2

78

77.4

80%

73

73

74

70%

64.4

63.4

62.6

60%

60

58.6

50%

50%

40%

40%

30%

30%

20%

20%

10%

10%

0%

2007

2008

2009

2010

2011

2012

2013

0%

NIS Coverage Estimates for Selected Vaccines and Series Compared to MCIR Workbooks Children age 19 through 25 months Michigan, 2013

100% 90%

4+DTaP

86.2

80%

81.2

70%

73

60%

3+Polio

1+MMR

95.4

94.3

91.6 86.2

88.65 84.1

Hib UTD

86.6 85.9

3+HepB

1+Var

93.1 91.2

92.8

82.7

4+PCV

88.08

86

82.2

78.9

73.4

2+HepA 4:3:1:3*:3:1:4*

90% 77.4

70% 59.1

62.6

52.1

50%

43.3

40%

80%

74

72.2

95% Confidence Limits, 2013 NIS, Michigan MCIR Workbooks, December 31, 2013

100%

60% 50% 40%

30%

30%

20%

20%

10%

10%

0%

4+DTaP

3+Polio

1+MMR

Hib UTD

3+HepB

1+Var

4+PCV

2+HepA 4:3:1:3*:3:1:4*

0%

Looking for Gaps

HPV Vaccination Rates in Michigan MCIR Data as of August 2014 1+ HPV-F

3+ HPV-F

60%

1+ HPV-M

3+ HPV-M

58.0%

50.7% 50% 43.6% 39.8%

40%

36.1% 33.8%

30%

29.4%

27.9%

26.6%

24.7% 20% 14.2% 10%

13.5%

7.9%

7.2%

5.7%

2.3% 0%

11-12y 2013 US Census used as Denominator.

13-15y

16-18y

19-26y

1+ and 3+ HPV Coverage, Males and Females 13-17 years of age, MCIR Data, August 2014

1+ HPV Coverage

2013 Census Data used for the Denominator.

3+ HPV Coverage

School Reporting

School Status Reports

www.michigan.gov/immunize click on “School Immunization Data” under heading Local Health Departments

School Status Reports Posted on our Website

Selected IIS Related Publications over the Years Appendix B: Selected MCIR Publications: Dombkowski, KJ, Harrington LB, Allred NJ, Hudson E, Clark SJ. Feasibility of initiating and sustaining registry-based immunization recall in private practices. Acad Pediatr. 2012;12(2):104109. Clark SJ, Lamarand K, Dombkowski KJ. Identifying children with chronic conditions for influenza vaccination using a statewide immunization registry: initial experiences of primary care providers. J Public Health Mgmt Pract 2012;18(3):204-208. Dombkowski, KJ, Harrington LB, Dong S, Clark SJ. Seasonal influenza vaccination reminders for children with high-risk conditions: A registry-based randomized trial. Am J Prev Med, 2012;42:71-75. Rees-Clayton E, Montgomery JP, Enger KS, Boulton ML. Trends in Michigan Early Adolescent Immunization: 2006-2008. American Journal of Public Health, 2012; 102: 1735-1741. Boulton M, Grossman A, Potter R, Vranesich P, Clayton J. Assessing the Relationship Between Seasonal and H1N1 Influenza Vaccination Status in Michigan Children, 2009-2010. Public Health Reports, 2011; 126 (Suppl 2): 70-77. Dombkowski, KJ, Reeves S, Dong S, Stevenson J, Clark SJ. Assessing the burden of undeliverable immunization reminder and recall notifications. Prev Med. 2011;53(6):424-426. Wells E, Blostein J, Kim C, Potter R, Boulton M. A Measles Cluster in Michigan: Challenges for Measles Diagnosis in Adults Case Series and Review. Infect Dis Clin Pract, 2010 18 (1): 3740. Weston AL, Enger KS. Factors associated with hepatitis A vaccination receipt in one-year-olds in the state of Michigan. Journal of Biomedicine & Biotechnology, 2010; Article ID 360652. Potter R, Pabst LJ, Fiore, AE. Influenza Vaccination Coverage Among Children Aged 6 Months – 18 Years – Eight Immunization Information System Sentinel Sites, United States, 2008-09 Influenza Season. Morbidity and Mortality Weekly Report 2009; 58: 1059-1062. Hunt E, Lurie P, Lute J, Moll M, Stafford H, Bart J, Gray A, Urdaneta V, Ostroff S, Blostein J, Potter R, Wells E, Kilborn C, Martinez D, Lowrey M, Espinoza R, Ferraro A, Kutty P, Barskey A, Payne D, Redd S, Lowe L, Rota J, Bellini W, Rota P, Seward J, Thorley M, Reef S, Kim C, Sinclair J, Dykewicz C, Averhoff F, Chen T, Nguyen M. Multistate Measles Outbreak Associated with an International Youth Sporting Event — Pennsylvania, Michigan, and Texas, August–September 2007. Morbidity and Mortality Weekly Report 2008; 57: 169-173. Omer S, Enger KS, Moulton LH, Halsey NA, Stokley S, Salmon DA. Geographical clustering of nonmedical exemptions to school immunization requirements and associations with geographical clustering of pertussis. American Journal of Epidemiology, 2008; 168(12):138996.

Enger KS, Stokley S. Meningococcal conjugate vaccine uptake, measured by Michigan's immunization registry. Journal of Adolescent Health 2007; 40(5):398-404. Zimmerman LA, Bartlett DL, Enger KS, Gosney K, Williams WG. Influenza vaccination coverage: findings from immunization information systems. BMC Pediatrics 2007 July 27; 7(28). Kelly JS, Zimmerman LA, Reed K, Enger KS. Immunization information systems national research and evaluation agenda. Journal of Public Health Management and Practice 2007; 13(1):35-38. Dombkowski KJ, Leung SW, Clark SJ. Provider attitudes regarding use of an immunization information system to identify children with asthma for influenza vaccination. J Public Health Manag Pract. 2007;13(6):567-571. Fredrickson K, McLaren RP, Enger KS, White K, Kirsch B, Canavan BC, Zimmerman LA, Bartlett DL, Williams WG. Influenza vaccination coverage among children aged 6-23 months six immunization information system sentinel sites, United States, 2005-06 influenza season. Morbidity and Mortality Weekly Report 2006; 55(49):1329-1330. Allred NJ, Stevenson JM, Kolasa M, Bartlett DL, Schieber R, Enger KS, Shefer A. Using registry data to evaluate the 2004 pneumococcal conjugate vaccine shortage. American Journal of Preventive Medicine 2006; 30(4):347-350. Wilkins MJ, Boulton ML, Stoltman GA, Bidol SA, Enger KS, Lai JJ, Uyeki T, Harper S, Fischer M, Reagan SP, Jones J, Terebuh P, Stonecipher SD. Severe morbidity and mortality associated with influenza in children and young adults—Michigan, 2003. Morbidity and Mortality Weekly Report 2003; 52(35):837-840.

Potential Cost Saving Using an IIS to Forecast Influenza Avg. weighted cost of VFC Flu Vaccine Possible doses spared Potential Cost Saving

2011-12

2012-13

2013-14

$11.47

$11.38

$12.14

70,323

126,076

81,635

$806,605

$1,434,745

$991,049

• 48% of Michigan children were eligible for the VFC program in 2013 • Cost of vaccine is higher for the private sector compared to VFC program

http://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html