Scott Stafford-Veale

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

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

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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+DTaP¶
4+DTaP**
3+Polio††
1+MMR §§
3+Hib¶¶
Hib- PS***
Hib- FS†††
3+HepB§§§
HepB Birth dose¶¶¶
1+Var** **
3+PCV† †††
4+PCV§ §§§
1+HepA¶¶¶¶
2+HepA*****
Rotavirus†††††
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

9. © 2014 Denver Public Health
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+DTaP¶
4+DTaP**
3+Polio††
1+MMR §§
3+Hib¶¶
Hib- PS***
Hib- FS†††
3+HepB§§§
HepB Birth dose¶¶¶
1+Var** **
3+PCV† †††
4+PCV§ §§§
1+HepA¶¶¶¶
2+HepA*****
Rotavirus†††††
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.

11. © 2014 Denver Public Health
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
Timeliness/growth

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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

16. © 2014 Denver Public Health
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

17. © 2014 Denver Public Health
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.

18. © 2014 Denver Public Health
Questions?
Lauren.snyder@dhha.org
303.602.3680