Immunization milestones: a more comprehensive picture of age-appropriate vaccination.

A challenge facing immunization registries is developing measures of childhood immunization coverage that contain more information for setting policy than present vaccine series up-to-date (UTD) rates. This study combined milestone analysis with provider encounter data to determine when children either do not receive indicated immunizations during medical encounters or fail to visit providers. Milestone analysis measures immunization status at key times between birth and age 2, when recommended immunizations first become late. The immunization status of a large population of children in the Oregon ALERT immunization registry and in the Oregon Health Plan was tracked across milestone ages. Findings indicate that the majority of children went back and forth with regard to having complete age-appropriate immunizations over time. We also found that immunization UTD rates when used alone are biased towards relating non-UTD status to a lack of visits to providers, instead of to provider visits on which recommended immunizations are not given.

When the cat is out of the bag: a case study in public health rationing in Oregon during the 2004-2005 influenza vaccine shortage.

Whereas the annual influenza season in the United States is fairly predictable, the influenza vaccine supply is variable, leaving providers vulnerable to supply and demand fluctuations each season. During the 2004-2005 influenza vaccine shortage, Oregon invoked Oregon Revised Statute 433-030 to target vaccine supplies to protect persons at highest risk for complications from influenza. This case study describes Oregon's efforts to ration vaccine at the point of administration by limiting the number of individuals eligible for vaccination. An evaluation of this process found that providers responded positively to the mandatory prioritization of vaccine recipients; however, limitations in assessing and affecting redistribution of privately held vaccine supplies and challenges in enforcement of the plan were revealed.

Evaluation of Mass Vaccination Clinics in Response to a Serogroup B Meningococcal Disease Outbreak at a Large, Public University-Oregon, 2015.

PURPOSE: Between January and May 2015, seven people at a large, public university developed invasive serogroup B meningococcal disease. One case was fatal. Attack rates were highest among freshmen and members of sororities, and fraternities (Greek organizations). Mass vaccination clinics using newly licensed serogroup B vaccine were held in March, May, and October 2015. No cases occurred after the second mass vaccination clinic. METHODS: We surveyed vaccine recipients at each clinic from March to October 2015 to determine preferred methods for notification about vaccination clinics, assess motivations for attending, and evaluate the clinic attendee population. RESULTS: Vaccination rates were low; 15% of undergraduates received one vaccine dose. An additional 11% received two doses of the three-dose MenB-FHbp series, and 4% completed a serogroup B meningococcal vaccine series at a mass vaccination clinic. University freshmen were 2.3 times as likely (confidence interval: 2.2-2.9) and Greek members 1.3 times as likely (confidence interval: 1.2-1.4) to attend a mass vaccination clinic as nonfreshmen or non-Greek members, respectively. Attendees reported e-mail as their preferred communication method (90%). Concerns about developing meningococcal disease (66%) and parental request (56%) were the most commonly cited motivations for attending a vaccination clinic. CONCLUSIONS: The serogroup B meningococcal outbreak at this large, public university disproportionately affected freshmen and students affiliated with Greek organizations. Despite low overall vaccination rates, the vaccination campaign did reach the populations at risk. In future outbreaks at large universities, we recommend focusing vaccination efforts on specific at-risk populations to maximize vaccination of those most at risk for this deadly disease.

Use of claims data to estimate annual cervical cancer screening percentages in Portland metropolitan area, Oregon.

BACKGROUND: Human papillomavirus (HPV) vaccine should reduce cervical dysplasia before cervical cancer. However, dysplasia diagnosis is screening-dependent. Accurate screening estimates are needed. PURPOSE: To estimate the percentage of women in a geographic population that has had cervical cancer screening. METHODS: We analyzed claims data for (Papanicolau) Pap tests from 2008-2012 to estimate the percentage of insured women aged 18-39 years screened. We estimated screening in uninsured women by dividing the percentage of insured Behavioral Risk Factor Surveillance Survey respondents reporting previous-year testing by the percentage of uninsured respondents reporting previous-year testing, and multiplying this ratio by claims-based estimates of insured women with previous-year screening. We calculated a simple weighted average of the two estimates to estimate overall screening percentage. We estimated credible intervals using Monte-Carlo simulations. RESULTS: During 2008-2012, an annual average of 29.6% of women aged 18-39 years were screened. Screening increased from 2008 to 2009 in all age groups. During 2009-2012, the screening percentages decreased for all groups, but declined most in women aged 18-20 years, from 21.5% to 5.4%. Within age groups, compared to 2009, credible intervals did not overlap during 2011 (except age group 21-29 years) and 2012, and credible intervals in the 18-20 year group did not overlap with older groups in any year. CONCLUSIONS: This introduces a novel method to estimate population-level cervical cancer screening. Overall, percentage of women screened in Portland, Oregon fell following changes in screening recommendations released in 2009 and later modified in 2012.

Physician attitudes regarding school-located vaccination clinics.

BACKGROUND: School-located vaccination clinics offer an opportunity to target children for vaccination programs during communicable disease outbreaks. However, children in the United States are primarily vaccinated in the pediatrician's or family physician's office, and the concept of school-located vaccinations may be unfamiliar to some parents and guardians. Physician support could contribute to effective implementation of school-located vaccination clinics during outbreak situations. The primary objective of the study was to assess physician opinion of using school-located vaccination clinics to administer both outbreak-specific and routine vaccines. METHODS: A statewide mail and Internet survey was administered to 275 pediatricians and 275 family physicians in Oregon during July and August 2010. RESULTS: Ninety-one percent of physicians supported the use of school-located vaccination clinics as immunization delivery sites during outbreak situations. Sixty percent of physicians supported using school-located vaccination clinics to administer routine vaccinations. Only 57% of physicians had knowledge of school-located vaccination clinic availability to their patients. CONCLUSIONS: Pediatricians and family physicians expressed strong support of school vaccination clinics as sites for immunization delivery during outbreak situations but significantly less support for administering routine vaccinations. Increasing physician awareness of school-located vaccination clinic availability and establishing partnerships between physician practices and school vaccination clinics may improve access to immunizations for school-aged children and adolescents, particularly during large-scale communicable disease outbreaks.

Frequency of alternative immunization schedule use in a metropolitan area.

OBJECTIVES: Recent studies have described an increase in parental hesitancy regarding vaccines as well as increases in parental adoption of vaccine schedules that delay or limit receipt of recommended vaccines. This study quantifies potential prevalence and trends in alternative schedule compliance by measuring consistent shot-limiting in a metropolitan area of Oregon. METHODS: Retrospective cohort analysis using the Oregon ALERT Immunization Information System to track children born between 2003 and 2009 in the Portland metropolitan area. Joinpoint regression was used to analyze prevalence trends in consistent shot-limiting during that time period. The 2007-2009 Haemophilus influenzae type b vaccine shortage and increased availability of combination vaccines were also examined for their effects on shot-limiting rates. RESULTS: A total of 4502 of 97,711 (4.6%) children met the definition of consistent shot-limiters. The proportion of consistent shot-limiters in the population increased from 2.5% to 9.5% between 2006 and 2009. Compared with those with no or episodic limiting, consistent shot-limiters by 9 months of age had fewer injections (6.4 vs 10.4) but more visits when immunizations were administered (4.2 vs 3.3). However, only a small minority of shot-limiters closely adhered to published alternative schedules. CONCLUSIONS: The percentage of children consistently receiving 2 or fewer vaccine injections per visit between birth and age 9 months increased threefold within a 2-year period, suggesting an increase in acceptance of non-Advisory Committee on Immunization Practices vaccine schedules in this geographic area.