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Monday, March 6, 2006 - 11:05 AM
4

Do Providers Listen to Local Public Health?: Evaluating the Efficacy of Accelerated DTaP Immunization Recommendations during 2003 Pertussis Outbreaks in Oregon

Elisa A. Wilson1, James A. Gaudino2, Don Dumont3, Nichole Carlson4, and Martha Priedeman Skiles2. (1) Epidemiology and Biostatistics MPH track, Dept. of Public Health and Preventive Medicine, 4803 NE 31st Ave (home), Portland, Oregon, OR, USA, (2) Immunization Program, Office of Family Health, State of Oregon Dept of Human Services, 800 NE Oregon Street, Suite 370, Portland, OR, USA, (3) Oregon Health Services, Department of Human Resources, 800 NE Oregon, Suite 370, Portland, OR, USA, (4) Dept of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, CB-669, Portland, OR, USA


Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
-Understand methods and findings.
-Discuss registry usefulness.

Background:
In 2003, Oregon experienced a 30 year high in pertussis. In July, local officials recommended accelerated, minimum-dose interval DTaP vaccination schedules to providers in three southern outbreak counties

Objectives:
Since this control measure is not well evaluated, we evaluate its impact on DTaP timing in one neighboring and three outbreak counties.

Methods:
Initially, records (N= 35,689) for children born between April 1996 and early 2005 with residences in these counties were extracted from Oregon's ALERT immunization registry and are being linked to birth certificates. Algorithms selected the first 4 DTaP vaccinations from multiple reports. Analyses of mean interval differences using ANOVA GLM focused on two cohorts born 6 months before (4/1/02-1/31/03) and after recommendations (8/13/03-11/30/03), n=6,516 and 2,280, respectively.

Results:
Most (52.6%) were older than 18 months by July. Compared to pre-recommendation intervals, mean post-recommendation cohort intervals were significantly shorter by 1.87 weeks (95% confidence intervals (CI) 0.41-3.2) from birth to DTaP1; 1.82 weeks (95% CI 0.67-3.56) from DTaP1 to DTaP2; and 2.24 weeks (95% CI 0.28-4.20) from DTaP2 to DTaP3. Among children given shots by family physician practices, mean differences were not significant: 1.30 weeks (95% CI –1.90-4.49) from birth to DTaP1; 1.31 weeks (95% CI -2.25-4.87) from DTaP1 to DTaP2; and 1.51 weeks (95% CI –2.29-5.30) from DTaP2 to DTaP3. Among those given shots by pediatric practices, only the first post-recommendation interval was significantly shorter: 2.03 weeks (95% CI 0.26-3.81) from birth to DTaP1; 2.10 weeks (95% CI -0.24-4.43) from DTaP1 to DTaP2; and 2.34 weeks (95% CI –0.22-4.91) from DTaP2 to DTaP3.

Conclusions:
After recommendations, DTaP dosing significantly changed suggesting some providers adopted the schedule. Further analyses may identify additional characteristics influencing adoption.

See more of Use of Immunization Information Systems to Prevent and Control Pertussis
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