mapping the colorado immunization information system in the denver area

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© 2014 Denver Public Health

Mapping the Colorado Immunization Information System in

the Denver Area

Lauren Elizabeth Snyder, MPH Denver Public Health

Applied Public Health Fellowship Program

Sept. 25, 2014

GeCo in the Rockies


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• Key terms

• Why CIIS?

• Applications

• The challenges

– Rates and deciding on a denominator

• Next steps

Agenda


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Key terms

• Immunization Information Systems

• Vaccine Schedule

• Healthy People 2020

• Antigen

• Incidence


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Why CIIS?

CIIS Mapping

Spatial Visualization

Informatics

Public Health


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© 2014 Denver Public Health Source: http://www.vaccines.gov/basics/protection/

Public Health

http://www.vaccines.gov/basics/protection/


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© 2014 Denver Public Health Source: http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

Informatics

http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html




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Spatial Visualization


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Estimated Vaccination Coverage,*† with Individual Vaccines and

Selected Vaccination Series Among Children Aged 19-35 Months§ by

State -- National Immunization Survey, United States, 2013

Antigen 3+DTa

P¶

4+DTa

P**

3+Polio††

1+MMR§§

3+Hib¶¶ Hib-

PS***

Hib-

FS†††

3+Hep

B§§§

HepB

Birth

dose¶¶¶

1+Var**

**

3+PCV†

†††

4+PCV§

§§§

1+Hep

A¶¶¶¶

2+Hep

A*****

Rotavir

us†††††

4:3:1§§§

§§

4:3:1:3¶¶¶¶¶

US

National 94.1±0.

9

83.1±1.

3

92.7±1.

0

91.9±0.

9

92.8±0.

9

93.7±0.

9

82.0±1.

3

90.8±1.

0

74.2±1.

4

91.2±0.

9

92.4±1.

0

82.0±1.

3

83.1±1.

2

54.7±1.

6

72.6±1.

5

81.5±1.

3

81.1±1.

3

Colorado 91.7±4.

5

81.2±6.

0

90.3±4.

7

86.0±5.

5

90.1±4.

8

90.8±4.

8

82.8±5.

8

84.1±5.

6

60.2±7.

3

84.8±5.

6

91.0±4.

6

84.0±5.

6

73.2±6.

6

47.6±7.

4

73.8±6.

6

79.7±6.

1

78.9±6.

2

Antigen 4:3:1:3-

PS******

4:3:1:4-

FS††††††

4:3:1:3:3§§§§§§

4:3:1:3:3

-PS¶¶¶¶¶¶

4:3:1:4:3

-

FS*******

4:3:1:3:3

:1†††††††

4:3:1:0:3

:1§§§§§§§

4:3:1:3:3

:1-

PS¶¶¶¶¶¶¶

4:3:1:4:3

:1-

FS*******

*

4:3:1:3:3

:1:4†††††††

†

4:3:1:0:3

:1:4§§§§§§§

§

4:3:1:3:3

:1:4-

PS¶¶¶¶¶¶¶

¶

4:3:1:4:3

:1:4-

FS*******

**

US

National 81.2±1.3 77.1±1.4 78.7±1.3 78.8±1.3 75.0±1.4 77.7±1.4 77.9±1.4 77.7±1.4 74.0±1.4 72.6±1.5 72.7±1.5 72.7±1.5 70.4±1.5

Colorado 78.9±6.2 77.4±6.3 73.4±6.7 73.4±6.7 72.2±6.7 72.1±6.8 72.9±6.7 72.1±6.8 71.0±6.8 70.3±6.9 70.3±6.9 70.3±6.9 69.2±6.9

*Highlighted indicates below national average; red font indicates below healthy people 2020 target


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Estimated Vaccination Coverage,*† with Individual Vaccines and

Selected Vaccination Series Among Children Aged 19-35 Months§ by

State -- National Immunization Survey, United States, 2013

Antigen 3+DTa

P¶

4+DTa

P**

3+Polio††

1+MMR§§

3+Hib¶¶ Hib-

PS***

Hib-

FS†††

3+Hep

B§§§

HepB

Birth

dose¶¶¶

1+Var**

**

3+PCV†

†††

4+PCV§

§§§

1+Hep

A¶¶¶¶

2+Hep

A*****

Rotavir

us†††††

4:3:1§§§

§§

4:3:1:3¶¶¶¶¶

US

National 94.1±0.

9

83.1±1.

3

92.7±1.

0

91.9±0.

9

92.8±0.

9

93.7±0.

9

82.0±1.

3

90.8±1.

0

74.2±1.

4

91.2±0.

9

92.4±1.

0

82.0±1.

3

83.1±1.

2

54.7±1.

6

72.6±1.

5

81.5±1.

3

81.1±1.

3

Colorado 91.7±4.

5

81.2±6.

0

90.3±4.

7

86.0±5.

5

90.1±4.

8

90.8±4.

8

82.8±5.

8

84.1±5.

6

60.2±7.

3

84.8±5.

6

91.0±4.

6

84.0±5.

6

73.2±6.

6

47.6±7.

4

73.8±6.

6

79.7±6.

1

78.9±6.

2

Antigen 4:3:1:3-

PS******

4:3:1:4-

FS††††††

4:3:1:3:3§§§§§§

4:3:1:3:3

-PS¶¶¶¶¶¶

4:3:1:4:3

-

FS*******

4:3:1:3:3

:1†††††††

4:3:1:0:3

:1§§§§§§§

4:3:1:3:3

:1-

PS¶¶¶¶¶¶¶

4:3:1:4:3

:1-

FS*******

*

4:3:1:3:3

:1:4†††††††

†

4:3:1:0:3

:1:4§§§§§§§

§

4:3:1:3:3

:1:4-

PS¶¶¶¶¶¶¶

¶

4:3:1:4:3

:1:4-

FS*******

**

US

National 81.2±1.3 77.1±1.4 78.7±1.3 78.8±1.3 75.0±1.4 77.7±1.4 77.9±1.4 77.7±1.4 74.0±1.4 72.6±1.5 72.7±1.5 72.7±1.5 70.4±1.5

Colorado 78.9±6.2 77.4±6.3 73.4±6.7 73.4±6.7 72.2±6.7 72.1±6.8 72.9±6.7 72.1±6.8 71.0±6.8 70.3±6.9 70.3±6.9 70.3±6.9 69.2±6.9

*Highlighted indicates below national average; red font indicates below healthy people 2020 target

Take away message is that CO is behind national immunization

levels for young children and not currently on track to meet the

healthy people 2020 target


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Background

Colorado Immunization Information System:

• Statewide, confidential, computerized

• Maintains records for children & adults

• Financial incentive (through Meaningful Use), but not required to report to CIIS

• Patients and providers can opt out

• As of May 2014, CIIS held approximately 45.3 million immunization services for 4.2 million individuals.


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Applications

• Overall vs. antigen specific penetration

• Up to date/ not up to date

• Incidence

• Protecting confidentiality

Confirmed Pertussis Cases, 0-18 years, Denver County, 2012


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Rates

• Important and difficult

– Number affected, infected, immune

– Choosing a denominator is tricky

• In and out movement of people

• Young and old age groups especially of interest

• Differing data sources locate people differently


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•Federally administered

•Collected every ten years

•Attempts to sample everyone 2010 Census

•Small sample collected every year, 5 yr average

•5 year age groupings

•Not recommended for population estimates

American Community Survey

5 year estimate

•Associated cost, new data pulls each year and age groups, concern for public health

•Less institutional knowledge about methodology

Commercial 2013 estimate

•New data source

• Issues with patient and provider opt out, data cleanliness

CIIS counts

Deciding on a Denominator

Trust

Time

line

ss/grow

th


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Differences with Denominators


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Suggestions/Recommendations

• Know your data, know your audience

• Make logic clear on maps

• Series of maps can be helpful to end users

• Generally, ACS is not recommended for population estimates


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Next steps

• Spatial analysis:

– Immunization status and disease incidence correlation, other factors and models

• Ordinary Least Squares and Moran’s I

– Mapping in a business intelligence context

– Regional mapping

– Bivariate mapping


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Acknowledgements: (DPH Team)

Arthur Davidson, MD, MSPH Dean McEwen, MBA Moises Maravi, MSc

Judy Shlay, MD, MSPH Christie Mettenbrink, MSPH Theresa Mickiewicz, MSPH Kaylynn Aiona, MPH Kelly Gerard, MS Lourdes Yun, MD, MSPH Kathryn DeYoung, MS

This study/report was supported in part by an appointment to the Applied Public Health Informatics Fellowship Program administered by CSTE and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement 3U38HM000414-04W1.


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Questions?

[email protected]

303.602.3680

mailto:[email protected]

mapping the colorado immunization information system in the denver area

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