Wendy Wang

A middle school immunization law rapidly and substantially increases immunization coverage among adolescents.

OBJECTIVES This study assessed the effectiveness of a middle school vaccination requirement for raising second-dose measles, mumps, and rubella vaccine and hepatitis B vaccine coverage among adolescents. METHODS Random-digit-dialed telephone surveys were conducted before (1998) and after (1999) the implementation of a vaccination requirement for entry into the seventh grade in San Diego, Calif. RESULTS Vaccination coverage was higher among children subject to the vaccination requirement (seventh-grade students; 60%) than among fifth- and sixth-grade students 1 year before the requirement (13%, P <.001), and 8th- through 12th-grade students not subject to the requirement (27%, P <.0001). CONCLUSIONS Middle school-entry vaccination requirements can rapidly and substantially raise vaccination coverage among students subject to the law.

Protecting Newborns by Immunizing Family Members in a Hospital-Based Vaccine Clinic: A Successful Tdap Cocooning Program During the 2010 California Pertussis Epidemic

Objective. Infants are at greatest risk for mortality from pertussis infection. Since 2005, the Advisory Committee on Immunization Practices has recommended a cocooning strategy of vaccinating all close contacts of infants with tetanus, diptheria, and acellular pertussis (Tdap) vaccine to reduce the risk of transmitting pertussis. Difficulties in establishing a complete cocoon have been reported in the literature. We determined whether families of newborns could be fully immunized against pertussis, thereby providing a complete cocoon of protection. Methods. Tdap vaccine was offered during visiting hours to contacts aged 7 years and older and to postpartum patients who had not received Tdap vaccine during pregnancy. We then conducted retrospective phone interviews with randomly selected mothers (or other family members) to assess vaccination rates. We compared household vaccination rates during intervention and control periods and the demographic factors associated with Tdap vaccination of all members within the households. Results. During the intervention period, 243 postpartum patients and 1,287 other family members of newborns were immunized, with 84.8% of all family members receiving Tdap vaccination. Seventy-six percent of households reported a complete cocoon. In the control group, 52.2% of all family members received Tdap vaccination, and 29.3% of households had a complete cocoon. In the control group, fewer family members completed Tdap vaccination in the larger households than in the smaller households (p=0.008). Conclusion. A cocooning strategy can be successfully implemented, such that the majority of newborns leave the hospital with their families fully immunized against pertussis.

Comparing telephone and written surveys to assess local adolescent immunization coverage rates.

To identify adolescent hepatitis B coverage levels, a survey was conducted of seventh grade parents in San Diego County, California, using a random digit-dial telephone survey. A written survey was fielded also that was distributed at selected schools. Results were validated using data from a mandated report from all schools. Both survey methods overestimated the proportion completing the hepatitis B series by about 10%. Parents accurately reported immunization shot dates from the childs parent-held immunization shot record on the telephone and written surveys. The written survey, in addition to having a somewhat lower cost, may be useful when focusing on a localized area, whereas the telephone survey permits a more representative sample of a larger county-wide population.

A public health initiative to increase annual influenza immunization among hospital health care personnel: The San Diego Hospital Influenza Immunization Partnership

BACKGROUND A public health department-supported intervention to increase influenza immunization among hospital-based health care practitioners (HCPs) in San Diego County took place between 2005 and 2008. The study included all major hospitals in the county, with a population of approximately 3.5 million. METHODS Information on hospital activities was collected from before, during and after initiative activities. Vaccination status and demographics were collected directly from HCP using hospital-based and random-dialed telephone surveys. RESULTS Between 2006 and 2008, hospitals increased promotion activities and reported increases in vaccination rates. Based on the random-dialed surveys, HCP influenza vaccination coverage rates did not increase significantly. Vaccination rates were significantly higher in HCPs who reported that employers provided free vaccination and those who believed that their employers mandated influenza vaccination. CONCLUSIONS This local public health initiative and concurrent state legislation were effective in increasing employer efforts to promote influenza vaccination; however, population-based surveys of HCPs did not show significant increases in influenza vaccination. Overall, this study suggests that public health leadership, intensive employer promotion activities, and state-required declinations alone were not sufficient to significantly increase HCP influenza vaccination. Policymakers and employers should consider mandates to achieve optimal influenza vaccination among HCPs.

Factors Associated With Missed Opportunities for Influenza Vaccination Review of Medical Records in a Diverse Sample of Primary Care Clinics, San Diego County, 2010-2011

Objective: Annual influenza vaccination rates remain well below health objectives. Most primary care clinic visits present opportunities for vaccination. The purpose of this study was to quantify missed opportunities (MOs) during the entire influenza season. Patients and clinic characteristics associated with vaccination and MOs are identified. Methods: Influenza vaccinations recorded in random chart reviews of children 6 months to 5 years and of adults 50 years and older at 6 pediatric and 7 adult primary care clinics were assessed during the 2010-2011 influenza season. Patient-specific MOs accounted for variable timing and number of visits throughout the vaccination season. Data were assessed using descriptive, graphical, proportional hazards regression methods. Results: Data for 1136 children and 1329 adults were analyzed. By the end of the season, influenza vaccination coverage recorded in medical records reached 56% and 26% for children and adults, respectively. MOs are common throughout the season and rise sharply after December. By the end of the season, 30.2% of children and 44.9% of adults had 2 or more MOs. Characteristics associated with MOs included age, insurance type, number of visits, and type of medical practice. Conclusions: Missed opportunities abound, especially after December. Strategies targeting patients most likely to have MOs and encouraging the use standing orders, reminders, and monitoring in order to reduce them need to be sustained.

The San Diego Immunization Survey: a model for local vaccination coverage assessment.

Objectives. Assessing vaccination coverage as part of a comprehensive intervention has been demonstrated to result in increased coverage rates. The National Immunization Survey provides coverage estimates at the national level and selected urban areas. However, it is important for other localities to understand vaccination coverage in their areas. The San Diego Immunization Branch conducts the San Diego Immunization Survey (SDIS) to gather vaccination coverage information in San Diego County. This article describes the methodology and results of the SDIS. Methods. The SDIS is a two-phase immunization survey. The first phase is a random-digit-dialing survey in which vaccination information is obtained by phone. The second phase involves the verification of this information and/or obtaining vaccination information via the registry or the childs provider(s). Results. In 2005, the sample size included 839 respondents. From 1995 to 2005, coverage for the following individual vaccines increased: diphtheria and tetanus toxoids, and acellular pertussis (92.0% to 96.5% for ≥3 doses, and 75.0% to 89.0% for ≥4 doses), polio (83.0% to 94.7%), measles-mumps-rubella (85.0% to 95.8%), Haemophilus influenzae type b (87.0% to 93.2%), and hepatitis B (67.0% to 93.6%). Conclusion. The results of the SDIS demonstrate that San Diego County has exceeded the Healthy People 2010 goal to reach at least 80% coverage for the series of universally recommended vaccinations.

Voluntarily Reported Immunization Registry Data: Reliability and Feasibility to Predict Immunization Rates, San Diego, California, 2013:

Objectives: Accurate data on immunization coverage levels are essential to public health program planning. Reliability of coverage estimates derived from immunization information systems (IISs) in states where immunization reporting by medical providers is not mandated by the state may be compromised by low rates of participation. To overcome this problem, data on coverage rates are often acquired through random-digit-dial telephone surveys, which require substantial time and resources. This project tested both the reliability of voluntarily reported IIS data and the feasibility of using these data to estimate regional immunization rates. Methods: We matched telephone survey records for 553 patients aged 19-35 months obtained in 2013 to 430 records in the San Diego County IIS. We assessed concordance between survey data and IIS data using κ to measure the degree of nonrandom agreement. We used multivariable logistic regression models to investigate differences among demographic variables between the 2 data sets. These models were used to construct weights that enabled us to predict immunization rates in areas where reporting is not mandated. Results: We found moderate agreement between the telephone survey and the IIS for the diphtheria, tetanus, and acellular pertussis (κ = 0.49), pneumococcal conjugate (κ = 0.49), and Haemophilus influenzae type b (κ = 0.46) vaccines; fair agreement for the varicella (κ = 0.39), polio (κ = 0.39), and measles, mumps, and rubella (κ = 0.35) vaccines; and slight agreement for the hepatitis B vaccine (κ = 0.17). Conclusions: Consistency in factors predicting immunization coverage levels in a telephone survey and IIS data confirmed the feasibility of using voluntarily reported IIS data to assess immunization rates in children aged 19-35 months.