This document provides information from a train-the-trainer presentation on Ohio's MOBI and TIES programs for improving childhood immunization rates. It discusses how CDC and ODH support these programs, why they were created to encourage timely immunization using best practices, and current immunization levels and challenges in Ohio based on National Immunization Survey and AFIX data. Providers are encouraged to focus on antigens and practices with the lowest rates, like DTaP dose 4 and standing orders, in order to increase rates and reach a 90% immunization level goal.

1. Immunization Update
MOBI Train-the-Trainer
Tami Yates, RN, BSN
Immunization Program
Bureau of Infectious Diseases
Ohio Department of Health

2. 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
2

3. Why MOBI and TIES?
• Inform immunization providers about best
practices
• Encourage timely immunization
• Fully immunized children = less disease
• Less disease = good for everyone
3

4. 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
4

5. 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/st
rat.html
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6. 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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7. 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).

8. 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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9. 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) FS
2012 66.8% 32nd (4:3:3:1:3:1:4) FS
2013 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)

10. 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)

11. 2015 National Immunization Survey
(4:3:1:3:3:1:4 Series)
U.S. and Ohio, Up To Date by 19-35 Months
68.4
63.6
70.2
73.3
68.4
72.7 71.6 72.2
90
71.5 68.8
73.8 76.4
66.8
63.4
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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12. 2015 NIS - Ohio v. U.S.
Select Antigens by 19-35 months
84.6
93.7 91.9
82.7
91.8
80.9
91.8
88.1
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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13. 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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14. 2015 NIS - Ohio
All Antigens by 19-35 months – Low to High
53.1
71.8
78.6 79.1 80.9
86.2 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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15. 2015 NIS - Ohio v. U.S.
Select Antigens Adolescents 13-17 Years of Age
86.4
81.3
62.8
49.8
41.9
28.1
86.7
76.1
61
43.7
37.8
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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16. 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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17. 2014 - 2016 AFIX Levels - Ohio
Childhood (24-35 months of age)
75.4
92 89 93.7 90.6 87.4 85.8
74.6
91.1 89.1
93.1
90.3
87.7
83.174.3
90.8 90.1
92.9
89.6 89.1
83.3
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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18. 2015 NIS Results Compared to
2015 AFIX Levels - Ohio
18
74.6
91.1 89.1 90.3 93.1
87.7 85.8
80.9
91.8
88.1
92.3
78.6
86.2
79.1
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

19. Select Antigens: 2015 NIS, 2015
AFIX & 2015 K Entry - Ohio
19
80.9
91.8
88.1
92.3
86.2
78.6 79.1
74.6
91.1 89.1 90.3 87.7
93.1
85.8
92.1 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

20. 2015 NIS vs. Ohio 2016 AFIX Levels
Select Antigens Adolescents 13-17 Years of Age
86.7
76.1
61
43.7
37.8
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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21. 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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22. 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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23. 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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24. 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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25. 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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26. 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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27. Comments?
Questions?
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