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Immunization UpdateMOBI Train-the-Trainer
Tami Yates, RN, BSNImmunization ProgramBureau of Infectious Diseases Ohio Department of Health
How is CDC & ODH involved with MOBI and TIES?
• CDC provides federal funds to improve and maintain immunization rates
• ODH budgets $3.4 million in these federal funds for grant projects to encourage timely infant and adolescent immunizations
• Ohio AAP receives $375,000 to oversee MOBI and TIES – includes help to non-IAP counties
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Why MOBI and TIES?
• Inform immunization providers about best practices
• Encourage timely immunization
• Fully immunized children = less disease
• Less disease = good for everyone
3
Immunization Best Practices
• Assessment, Feedback, Incentives, eXchange (AFIX)
• Use best record keeping practices
• Full use of immunization information systems
• Keep parents on the ACIP schedule
• How and when to remind/recall children (parents)
• Methods providers can use to reinforce vaccines
• Reduce missed opportunities and barriers
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Best Practices
• See the 2013 Pink Book (13th Edition) Chapter 3 “Immunization Strategies for Health Care Practices and Providers”
Webpage is found at: http://www.cdc.gov/vaccines/pubs/pinkbook/strat.html
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What are the immunization levels in Ohio?
Data available from multiple sources for immunization rates…
• National Immunization Survey
• AFIX
• ImpactSIIS registry – needs more data to be used for evaluation of rates
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National Immunization Survey (NIS) • Since 1994, the National Immunization Survey (NIS) is overseen by
the National Centers for Immunization and Respiratory Diseases (NCIRD) and the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC).
• The NIS is conducted for the CDC by the National Opinion Research Center (NORC) at the University of Chicago.
• NIS target population is children between the ages of 19 and 35 months living in the United States at the time of the interview.
• Data from the NIS are used to produce timely estimates of vaccination coverage rates for all childhood vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP).
2015 NIS Information
• Children in the 2015 NIS were born January 2012-May 2014
• Uncertainty in ranking states can be quite large because confidence intervals can occur between + or – 5 to 10%.
• Ranking each state from best to worst should be interpreted with caution.
• National sample size for 2015 was 15,167.
• Ohio sample size for 2015 was approximately 250.
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Ohio NIS Rankings
2006 74.9% 33rd (4:3:3:1:3:1)2007 77.7% 22nd (4:3:3:1:3:1)2008 81.8% 3rd (4:3:3:1:3:1)2009 74.8% 27th (4:3:3:1:3:1)2010 77.6% 20th (4:3:3:1:3:1)2011 74.7% 6th (4:3:3:1:3:1:4) FS2012 66.8% 32nd (4:3:3:1:3:1:4) FS2013 61.7% 48th (4:3:3:1:3:1:4) FS 2014 68.1% 37th (4:3:3:1:3:1:4) 2015 68.3% 40th (4:3:3:1:3:1:4) (±7.9)
Ohio NIS Rankings - MMR
2011 93.3% 14th (1 MMR)
2012 90.3% 30th (1 MMR)
2013 86.0% 50th (1 MMR)
2014 95.6% 4th (1 MMR)
2015 88.1% 48th (1 MMR)
2015 National Immunization Survey (4:3:1:3:3:1:4 Series)
U.S. and Ohio, Up To Date by 19-35 Months
68.463.6
70.273.3
68.472.7 71.6 72.2
90
71.5 68.873.8 76.4
66.863.4
68.1 68.3
90
0
10
20
30
40
50
60
70
80
90
100
2008 2009 2010 2011 2012 2013 2014 2015 Goal
US NIS
Ohio NIS
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2015 NIS - Ohio v. U.S.Select Antigens by 19-35 months
84.6
93.7 91.9
82.7
91.8
80.9
91.888.1
78.6
86.2
0
10
20
30
40
50
60
70
80
90
100
4+ DTaP 3+ Polio 1+ MMR 3+ Hib 1+ Var
US NIS
Ohio NIS
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2015 NIS - Ohio v. U.S.Select Antigens by 19-35 months
92.6
84.1
59.6
73.2
50.9
92.3
79.1
53.1
71.8 73.2
0
10
20
30
40
50
60
70
80
90
100
3+ Hep B 4+ PCV 2+ Hep A Rotavirus HepB Birth
US NIS
Ohio NIS
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2015 NIS - OhioAll Antigens by 19-35 months – Low to High
53.1
71.8
78.6 79.1 80.986.2 88.1
91.8 92.3
0
10
20
30
40
50
60
70
80
90
100
2+ Hep A Rota 3+ Hib 4+ PCV 4+ DTaP 1+ Var 1+ MMR 3+ Polio 3+ Hep B
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2015 NIS - Ohio v. U.S.Select Antigens Adolescents 13-17 Years of Age
86.481.3
62.8
49.8
41.9
28.1
86.7
76.1
61
43.737.8
21
0
10
20
30
40
50
60
70
80
90
100
1 Tdap 1 Men ACWY 1 HPV Female 1 HPV Male 3 HPV Female 3 HPV Male
US NIS
Ohio NIS
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AFIX Levels - Ohio
• AFIX is a CDC sponsored quality assurance method used in Ohio to assist health care providers understand and improve their own immunization rates.
• AFIX stands for: Assessment, Feedback, Incentive and eXchange.
• ODH staff and local health department staff conduct AFIXs
• 464 were conducted in 2014 and 411 in 2015
• 284 completed thus far in 2016 (childhood & adolescent)
• Provider offices voluntarily allow assessors access to immunization records
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2014 - 2016 AFIX Levels - OhioChildhood (24-35 months of age)
75.4
92 89 93.7 90.6 87.4 85.8
74.6
91.1 89.193.1
90.387.7
83.174.3
90.8 90.192.9
89.6 89.183.3
0
10
20
30
40
50
60
70
80
90
100
4+ DTaP 3+ Polio 1+ MMR 3+ Hib 3 Hep B 1+ Var 4 PCV
2014
2015
2016
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2015 NIS Results Compared to 2015 AFIX Levels - Ohio
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74.6
91.1 89.1 90.3 93.187.7 85.8
80.9
91.888.1
92.3
78.6
86.279.1
0
10
20
30
40
50
60
70
80
90
100
4+ DTaP 3+ Polio MMR 3+ Hep B 3 + Hib Varicella 4+ PCV
AFIX Data
Ohio NIS
Select Antigens: 2015 NIS, 2015 AFIX & 2015 K Entry - Ohio
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80.9
91.888.1
92.386.2
78.6 79.174.6
91.1 89.1 90.3 87.793.1
85.892.1 92.4 92.1 95.1
91.5
0
10
20
30
40
50
60
70
80
90
100
4+ DTaP 3+ Polio MMR 3+ Hep B Varicella 3+ Hib 4 PCV
Ohio NIS Ohio AFIX K Entry
2015 NIS vs. Ohio 2016 AFIX LevelsSelect Antigens Adolescents 13-17 Years of Age
86.7
76.1
61
43.737.8
21
94.4
80.8
0 0 0 0
37.3
0
10
20
30
40
50
60
70
80
90
100
1 Tdap 1 Men ACWY 1 HPV Female 1 HPV Male 3 HPV Female 3 HPV Male 3 HPV All
Ohio NIS
Ohio AFIX
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How do we reach 90% Immunization Levels?
Q: How can public health make changes?
Q: How can providers improve vaccine rates?
Q: How can we better encourage parents?
Q: What are the immunization barriers in your county?
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Encourage Best Practices
• Assessment, Feedback, Incentives, eXchange (AFIX)
• Best recordkeeping practices
• How to use immunization information systems
• When parents need to return (ACIP)
• How and when to remind/recall children (parents)
• Methods providers can use to reinforce vaccines
• Reduce missed opportunities and barriers
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Focus on the Weakest Links
Average Aggregate AFIX Results - 2015
Worst Antigen = DTP #4 74.6%
2nd Worst Antigen = PCV13 #4 83.1%
4:3:1:3:3:1:4 = 64% Public
4:3:1:3:3:1:4 = 68% Private
Missed Opportunities = 14%
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Focus on the Weakest Links
AFIX Assessment Questionnaire Lowest Results:
Childhood AFIX Aggregate Results – 2015
Recall / Reminder System in Place? 81%
Contact in 3-5 days if no show? 76%
Standing orders to give all vaccines? 66%
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Focus on the Weakest Links
AFIX Assessment Questionnaire Lowest Results:
Adolescent AFIX Aggregate Results – 2015
Recall / Reminder System in Place? 75%
Contact in 3-5 days if no show? 75%
Standing orders to give all vaccines? 63%
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Learning Opportunities
• Learn to solve low vaccine rates at your HD.
• Assure best practices at your HD.
• Perform MOBIs, TIES and AFIXs well in your counties.
• Use AFIX data to encourage improvement.
• Take advantage of all opportunities to encourage timely immunizations.
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Comments?Questions?
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