KEYWORDS:
CASA, School Assessments, Community Assessments

BACKGROUND:
The state of Colorado currently has no means of systematically measuring community-level immunization rates. The state's Immunization Program wanted to look at whether the immunization histories of children enrolled in public pre-schools could serve as indicators of community immunization rates.

OBJECTIVE(S):
· Measure the 24 month immunization levels of all children enrolled in Denver public pre-school programs.
· Describe immunization levels by feeder school boundaries
· Test the effectiveness of CASA as a community assessment tool.

METHOD(S):
Colorado Department of Public Health and Environment Immunization Program staff visited 82 public elementary schools with Early Childhood Education (ECE) programs in Denver. In each school, staff pulled and reviewed required school entry immunization record cards. Staff entered complete immunization histories on over 2,600 three through four year olds enrolled in the ECE programs into CASA. We then merged data from individual schools into "feeder school" communities and retropectively analyzed the rates of the pre-school children when they were 24 months of age.

RESULT(S):
4:3:1:3 (4 DTaP, 3 Polio, 1 MMR, 3Hib) rates ranged from 52.3% to 70.2%, indicating significant differences among communities. All community rates were lower than the state NIS results from the corresponding year (1999).

CONCLUSIONS(S):
Children living in certain communities within the Denver Public School boundaries seem to have lower immunization levels than others. CASA can be a useful tool in identifying at-risk communities, but data entry is time consuming. The use of pre-school immunization data is associated with several limitations, including selection bias, delayed nature of retrospective analysis, and lack of socio-demographic information. The methodology may have more potential where electronic records are available.

LEARNING OBJECTIVES:
Participants should:
Understand the process of defining communities by schools.
Be able to plan a pre-school based assessment in their area.
Know the limitations of retrospective pre-school record analysis.