An Exploration:
- Using Oregon’s AFIX Data Evaluating
4th DTaP Administration
Justin Weisser, MPH; Nathan Crawford,
MPH; Mimi Luther, BA
Background:
Importance of the 4th DTaP Shot in 4:3:1:3:3
Series Completion
•Many have theorized that completion of the 4:3:1:3:3
series by 24 months of age is often contingent on the
receipt of the 4th shot in the DTaP series.
•In the past five years of AFIX assessments in Oregon,
absence of a 4th DTaP was the most common reason
children were found not to be up-to-date with the full
4:3:1:3:3 series.
Study Data
• Data were taken from 74 AFIX Assessments
conducted by Oregon’s VFC/AFIX program in
‘06
• Clinics varied by type, size and geographic
location
• Kids assessed from varied SES backgrounds and
insurance coverage
Study Data (Con’t)
• Only kids who had a 4th DTaP were
included
• Only kids at least 24 months old at time
of assessment were included
• A total of 9,316 kids were assessed in this
study
• ALERT Registry source of data
What Is ALERT?
• Oregon’s Award-Winning Registry!
– “data warehouse” model
– public-private partnership
– voluntary private participation
• Population-based registry with strong provider
participation
– 100% of public clinics
– 87% of private clinics
ALERT Registry
ALERT contains approximately 95% of kids
resident in Oregon between the ages of 0-36
months who have had two or more shots.
ALERT registry data are used by the AFIX
program to assess individual kid’s
immunization status for clinic assessments.
Study Methods
• Data were received from ALERT and entered
into CASA v2.6 at the time of clinic assessment
• Later, data were exported from CASA as
individual clinic data files
• Individual files were grouped into a single
database
• Merged database was de-duplicated
• Data were imported into SPSS v14.0
• Chi-square test showed an association between
the timing of DTaP administration and up-todate status at 24 months of age
Analysis Results
• Did receive by 14 months, and UTD: 88%
• Received after 14 months, and UTD: 81%
– p <.000
– OR= 1.7
95% CI 1.5-2.1
Conclusions
• Initial results seem to indicate that giving the 4th DTaP
before 14 months greatly increases chances of being upto-date by 2 years of age
• If correct spacing allows, co-administration of all
vaccines due at the 12 months visit.
Limitations & Strengths
• Shots not evaluated with valid-spacing criteria
• Participating clinics were self-selected
• Reasons for early immunization not
investigated
• Very well-populated registry
• Oregon AFIX data: Oregon specific, timely,
relevant, inexpensive (no chart pulls!)
Future Directions
1) Further explore data to find influencing
factors (clinic size, practice type, etc…)
including valid spacing methodology
2) Design and implement a study to
compare practices which switch to a
“early 4th DTaP shot” set of standing
orders vs. practices which continue with
the standard ACIP schedule
• Mimi Luther
• Oregon Public Health
Division, Immunization
Program
• 800 NE Oregon, #370
• Portland OR 97232
• 971-673-0296
• [email protected]
.us