Vaccination Coverage of American Indian Children Using the North Dakota Immunization Information System (NDIIS)

Background:  American Indian (AI) children are at greater risk for death than non-AI infants and have higher morbidity rates due to infectious diseases, including vaccine preventable diseases. Vaccines have been shown to be a successful tool to reduce the morbidity and mortality of vaccine preventable diseases in the AI population. It is important to monitor immunization rates of AI children to determine whether there is a disparity compared to white children and to help reduce vaccine preventable diseases. The NDIIS is a useful tool in monitoring vaccination coverage.

Objectives:  To describe the immunization rates of AI children and compare them to white children in North Dakota using the NDIIS.

Methods:  Providers record vaccine doses administered in the NDIIS. The North Dakota Department of Health extracted data from the NDIIS in November 2010 for children born between October 1, 2007 and February 28, 2009. All data was screened for illogical values. The immunization rates for AI children were generated at immunization milestones and compared to the immunization rate for white children.

Results:  Of the 12,862 children with an NDIIS record during the assessment period, 1,359 (10.6%) were AI children and 9,149 (71.1%) were white children. Beginning at the three month milestone, AI children were less likely to be up-to-date (UTD) than white children for all vaccines, except Hepatitis B. At 19 to 35 months, 918 (67.5%) of AI children were UTD for the 4:3:1:X:3:1:4 series compared to 6,958 (76.1%) of white children.

Conclusions:  In North Dakota, AI children are less likely than white children to have received all recommended vaccines and, by the first well child visit, are more likely to have delay initiation of immunizations. Healthcare providers and immunization stakeholders need to focus efforts on AI children to remove racial disparities in immunization rates.