Communicable Diseases and Immunization Service 655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel 604.707.2548 Fax 604.707.2515 www.bccdc.ca Immunization Uptake in Children by the Seventh Birthday
Table of Contents Data Sources and Definitions...3 Data Sources... 3 Years... 3 Up-to-date for Age Definitions... 3 Caution... 3 Percent of Seven-year-olds with Up-to-date Immunizations...4 British Columbia... 4 Health Authorities... 5 Health Service Delivery Areas, Interior Health... 7 Health Service Delivery Areas, Fraser Health... 8 Health Service Delivery Areas, Vancouver Coastal Health... 9 Health Service Delivery Areas, Vancouver Island Health... 10 Health Service Delivery Areas, Northern Health... 11 Figures... 12 Notes... 21 Minimum Intervals Between Eligible Doses... 24 Effect of activating Panorama records for clients who primarily receive immunizations from First Nations Health Services Organizations on 7-year old immunization coverage rates... 25 2
Data Sources and Definitions Data Sources 1. Panorama, BC Centre for Disease Control (2014 onward) 2. Integrated Public Health Information System (iphis), BC Centre for Disease Control (2012-2013) 3. Primary Access Regional Information System (PARIS), Vancouver Coastal Health Authority (VCHA) 4. BC Ministry of Education (BC MoE), school enrollment data Years Coverage reported on any given year reflects uptake among children who turned 7 years old during the previous calendar year (i.e., 2018 results are for children born in 2010 and who turned 7-years old in 2017). Data last updated October 3, 2018. Up-to-date for Age Definitions Only doses given prior to the seventh birthday are included in this assessment. Up to date for age D/T/aP/IPV D/T/aP Hepatitis B Measles Mumps Rubella Varicella Meningococcal C conjugate Children who met the up-to-date requirements for D/T/aP/IPV, measles, mumps, rubella, varicella, and hepatitis B, as defined below. In 2012-2017 meningococcal-c conjugate vaccine was included in this measure. 4th or 5th dose of diphtheria/acellular pertussis/tetanus and 3rd or 4th dose of polio after the fourth birthday 4th or 5th dose of diphtheria/acellular pertussis/tetanus after the fourth birthday 3 doses hepatitis B vaccine 2 doses measles-containing vaccine 2 doses mumps-containing vaccine At least 1 dose rubella-containing vaccine 1 (to 2014) or 2 (2015 onward) doses of varicella vaccine, or recorded exemption for varicella due to previous disease or protective antibody levels. These children are only considered protected if disease or immunization occurred on or after the first birthday. At least 1 dose of Meningococcal C conjugate on or after 12 months of age (assessed until 2017) All analyses were conducted using business rules which calculated ages and time intervals at receipt of immunization. Each dose was counted as a valid dose only if given at or after the earliest eligible age, or at a time interval equal to or greater than the shortest recommended interval. See Minimum Intervals Between Eligible Doses. Caution Data in this report should be interpreted with caution. Please refer to the Notes for additional information. 3
Percent of Seven-year-olds with Up-to-date Immunizations British Columbia Province British Columbia BC Vaccination Details Year 2012 2013 2014 2015 2016 2017 2018 Up-to-date for age 70% 71% 72% 63% 66% 68% 70% D/T/aP/IPV 79% 79% 78% 77% 76% 76% 77% D/T/aP n/a n/a n/a n/a n/a n/a 78% Hepatitis B 90% 91% 91% 89% 89% 89% 90% Measles 89% 91% 90% 90% 90% 88% 82% Mumps 89% 91% 90% 90% 90% 88% 82% Rubella 95% 96% 95% 96% 95% 95% 95% Varicella 89% 91% 92% 69% 72% 74% 76% Meningococcal C conjugate 89% 91% 92% 93% 94% 93% n/a 4
Health Authorities Province Interior Health IHA Fraser Health FHA Vancouver Coastal Health VCHA Vancouver Island Health VIHA Vaccination Details Year 2012 2013 2014 2015 2016 2017 2018 Up-to-date for age 70% 73% 74% 64% 64% 62% 65% D/T/aP/IPV 79% 81% 82% 76% 73% 68% 71% D/T/aP n/a n/a n/a n/a n/a n/a 71% Hepatitis B 86% 88% 88% 84% 84% 81% 83% Measles 89% 89% 89% 86% 87% 80% 76% Mumps 89% 89% 89% 86% 87% 80% 76% Rubella 92% 93% 93% 90% 91% 86% 87% Varicella 88% 89% 89% 69% 69% 66% 71% Meningococcal C conjugate 87% 88% 89% 88% 90% 85% n/a Up-to-date for age 66% 68% 69% 59% 64% 67% 70% D/T/aP/IPV 75% 77% 76% 76% 75% 75% 77% D/T/aP n/a n/a n/a n/a n/a n/a 77% Hepatitis B 90% 93% 93% 89% 91% 91% 93% Measles 89% 91% 90% 91% 91% 90% 83% Mumps 89% 91% 90% 91% 91% 90% 83% Rubella 96% 97% 97% 98% 97% 98% 97% Varicella 89% 92% 93% 66% 71% 73% 75% Meningococcal C conjugate 90% 92% 93% 95% 95% 95% n/a Up-to-date for age 75% 76% 75% 69% 73% 76% 76% D/T/aP/IPV 82% 81% 80% 80% 82% 84% 82% D/T/aP n/a n/a n/a n/a n/a n/a 83% Hepatitis B 90% 89% 89% 90% 87% 90% 89% Measles 88% 90% 88% 89% 89% 90% 86% Mumps 87% 89% 87% 88% 89% 89% 86% Rubella 94% 93% 93% 93% 93% 94% 94% Varicella 88% 90% 90% 73% 79% 82% 82% Meningococcal C conjugate 86% 90% 91% 91% 92% 92% n/a Up-to-date for age 71% 69% 71% 62% 65% 68% 68% D/T/aP/IPV 79% 76% 77% 75% 75% 75% 75% D/T/aP n/a n/a n/a n/a n/a n/a 75% Hepatitis B 91% 91% 93% 91% 90% 91% 92% Measles 92% 92% 93% 92% 91% 90% 80% Mumps 92% 91% 93% 92% 91% 90% 80% Rubella 96% 96% 98% 98% 97% 96% 97% Varicella 91% 92% 94% 68% 70% 72% 73% Meningococcal C conjugate 93% 92% 95% 96% 96% 95% n/a 5
Province Northern Health NHA Vaccination Details Year 2012 2013 2014 2015 2016 2017 2018 Up-to-date for age 75% 77% 76% 72% 62% 72% 73% D/T/aP/IPV 85% 85% 84% 84% 72% 82% 81% D/T/aP n/a n/a n/a n/a n/a n/a 81% Hepatitis B 92% 94% 92% 92% 92% 93% 94% Measles 93% 94% 92% 94% 93% 92% 85% Mumps 93% 94% 92% 94% 93% 92% 85% Rubella 96% 98% 95% 97% 98% 97% 96% Varicella 91% 93% 92% 77% 67% 77% 77% Meningococcal C conjugate 92% 95% 93% 96% 97% 96% n/a 6
Health Service Delivery Areas, Interior Health Province East Kootenay EK Kootenay Boundary KB Okanagan OK Thompson Cariboo Shuswap TCS Vaccination Details Year 2012 2013 2014 2015 2016 2017 2018 Up-to-date for age 66% 74% 73% 63% 69% 68% 72% D/T/aP/IPV 79% 85% 83% 81% 79% 76% 80% D/T/aP n/a n/a n/a n/a n/a n/a 80% Hepatitis B 86% 89% 87% 84% 85% 82% 84% Measles 91% 92% 91% 89% 90% 82% 83% Mumps 91% 91% 91% 89% 90% 82% 83% Rubella 95% 94% 94% 93% 93% 87% 90% Varicella 90% 90% 90% 73% 75% 72% 79% Meningococcal C conjugate 86% 87% 87% 89% 91% 86% n/a Up-to-date for age 60% 61% 61% 48% 52% 52% 63% D/T/aP/IPV 73% 71% 70% 66% 67% 63% 72% D/T/aP n/a n/a n/a n/a n/a n/a 72% Hepatitis B 77% 77% 76% 70% 72% 69% 76% Measles 80% 79% 80% 76% 77% 71% 75% Mumps 80% 79% 80% 76% 77% 71% 75% Rubella 84% 83% 83% 82% 84% 76% 83% Varicella 75% 77% 78% 56% 57% 58% 69% Meningococcal C conjugate 79% 78% 79% 79% 80% 74% n/a Up-to-date for age 69% 72% 74% 63% 64% 60% 62% D/T/aP/IPV 78% 81% 81% 74% 73% 67% 68% D/T/aP n/a n/a n/a n/a n/a n/a 68% Hepatitis B 86% 87% 88% 84% 85% 81% 82% Measles 89% 89% 88% 85% 87% 79% 73% Mumps 89% 89% 88% 85% 87% 79% 73% Rubella 92% 93% 93% 90% 91% 85% 85% Varicella 88% 89% 90% 68% 70% 64% 68% Meningococcal C conjugate 87% 88% 89% 88% 90% 84% n/a Up-to-date for age 76% 80% 81% 70% 67% 65% 68% D/T/aP/IPV 82% 85% 86% 79% 74% 70% 73% D/T/aP n/a n/a n/a n/a n/a n/a 73% Hepatitis B 90% 92% 92% 89% 88% 85% 86% Measles 91% 93% 93% 89% 89% 83% 78% Mumps 91% 93% 93% 89% 89% 83% 78% Rubella 94% 95% 95% 92% 92% 89% 90% Varicella 91% 93% 92% 73% 70% 68% 73% Meningococcal C conjugate 91% 93% 93% 91% 92% 88% n/a 7
Health Service Delivery Areas, Fraser Health Province Fraser East FE Fraser North FN Fraser South FS Vaccination Details Year 2012 2013 2014 2015 2016 2017 2018 Up-to-date for age 72% 75% 75% 71% 72% 76% 75% D/T/aP/IPV 79% 81% 80% 82% 80% 82% 81% D/T/aP n/a n/a n/a n/a n/a n/a 81% Hepatitis B 93% 98% 96% 97% 95% 96% 96% Measles 91% 96% 94% 96% 94% 93% 86% Mumps 91% 96% 94% 96% 94% 93% 86% Rubella 96% 100% 98% 100% 99% 99% 100% Varicella 92% 96% 95% 75% 76% 79% 79% Meningococcal C conjugate 93% 98% 96% 100% 98% 98% n/a Up-to-date for age 67% 69% 69% 60% 66% 66% 70% D/T/aP/IPV 77% 78% 76% 77% 77% 75% 78% D/T/aP n/a n/a n/a n/a n/a n/a 78% Hepatitis B 95% 95% 96% 90% 96% 93% 96% Measles 93% 94% 94% 94% 97% 92% 85% Mumps 93% 94% 94% 94% 96% 92% 85% Rubella 100% 100% 100% 100% 100% 100% 100% Varicella 94% 95% 98% 69% 73% 73% 76% Meningococcal C conjugate 94% 95% 96% 98% 100% 96% n/a Up-to-date for age 63% 65% 66% 53% 60% 64% 67% D/T/aP/IPV 73% 75% 74% 73% 72% 73% 76% D/T/aP n/a n/a n/a n/a n/a n/a 76% Hepatitis B 86% 89% 89% 86% 86% 88% 89% Measles 85% 87% 87% 87% 87% 88% 80% Mumps 85% 87% 86% 87% 86% 88% 80% Rubella 92% 95% 94% 96% 94% 95% 95% Varicella 85% 88% 89% 61% 67% 70% 73% Meningococcal C conjugate 87% 88% 89% 91% 90% 92% n/a Note: Coverage rates approaching 100% in FHA, VIHA and NHA are likely over-estimates resulting from the use of different data sources for numerators and denominators (see Notes). 8
Health Service Delivery Areas, Vancouver Coastal Health Province Richmond RICH Vancouver VAN North Shore / Coast Garibaldi NSCG Vaccination Details Year 2012 2013 2014 2015 2016 2017 2018 Up-to-date for age 81% 85% 87% 82% 83% 86% 87% D/T/aP/IPV 87% 89% 91% 89% 88% 91% 91% D/T/aP n/a n/a n/a n/a n/a n/a 91% Hepatitis B 95% 94% 95% 96% 93% 95% 95% Measles 91% 95% 94% 95% 95% 94% 93% Mumps 90% 93% 93% 94% 94% 94% 93% Rubella 96% 97% 97% 97% 97% 97% 97% Varicella 93% 95% 95% 84% 87% 89% 90% Meningococcal C conjugate 88% 93% 95% 95% 95% 96% n/a Up-to-date for age 78% 78% 76% 69% 73% 75% 75% D/T/aP/IPV 83% 82% 81% 80% 82% 82% 81% D/T/aP n/a n/a n/a n/a n/a n/a 81% Hepatitis B 90% 90% 90% 90% 87% 90% 89% Measles 90% 91% 90% 89% 89% 90% 85% Mumps 89% 90% 89% 88% 88% 89% 85% Rubella 94% 94% 94% 94% 93% 94% 94% Varicella 89% 91% 91% 72% 80% 81% 81% Meningococcal C conjugate 88% 91% 92% 92% 91% 91% n/a Up-to-date for age 63% 63% 63% 61% 66% 73% 73% D/T/aP/IPV 76% 71% 71% 75% 78% 82% 80% D/T/aP n/a n/a n/a n/a n/a n/a 81% Hepatitis B 85% 82% 83% 84% 83% 86% 86% Measles 81% 84% 81% 84% 86% 87% 83% Mumps 81% 84% 81% 83% 86% 87% 83% Rubella 92% 90% 88% 89% 91% 92% 92% Varicella 83% 85% 84% 66% 74% 79% 79% Meningococcal C conjugate 81% 86% 87% 89% 90% 91% n/a 9
Health Service Delivery Areas, Vancouver Island Health Province South Vancouver Island SVI Central Vancouver Island CVI North Vancouver Island NVI Vaccination Details Year 2012 2013 2014 2015 2016 2017 2018 Up-to-date for age 72% 71% 73% 63% 67% 70% 69% D/T/aP/IPV 80% 77% 78% 75% 76% 77% 76% D/T/aP n/a n/a n/a n/a n/a n/a 76% Hepatitis B 92% 91% 94% 88% 89% 91% 92% Measles 93% 92% 94% 91% 91% 90% 80% Mumps 93% 91% 94% 91% 91% 90% 80% Rubella 97% 95% 97% 96% 97% 96% 96% Varicella 93% 91% 94% 69% 72% 74% 73% Meningococcal C conjugate 93% 92% 95% 94% 95% 94% n/a Up-to-date for age 70% 69% 69% 60% 62% 67% 70% D/T/aP/IPV 76% 75% 74% 75% 73% 74% 77% D/T/aP n/a n/a n/a n/a n/a n/a 77% Hepatitis B 91% 92% 92% 92% 90% 93% 95% Measles 90% 91% 92% 93% 89% 90% 81% Mumps 90% 91% 92% 93% 89% 90% 81% Rubella 95% 95% 97% 99% 96% 98% 100% Varicella 90% 92% 93% 65% 68% 71% 75% Meningococcal C conjugate 92% 92% 94% 97% 95% 97% n/a Up-to-date for age 72% 65% 71% 63% 66% 64% 62% D/T/aP/IPV 81% 75% 79% 77% 76% 71% 70% D/T/aP n/a n/a n/a n/a n/a n/a 71% Hepatitis B 90% 91% 95% 92% 93% 88% 88% Measles 93% 93% 96% 94% 94% 88% 77% Mumps 93% 93% 96% 94% 94% 88% 77% Rubella 96% 99% 100% 100% 100% 95% 95% Varicella 90% 93% 96% 69% 71% 68% 67% Meningococcal C conjugate 93% 93% 97% 98% 99% 94% n/a Note: Coverage rates approaching 100% in FHA, VIHA and NHA are likely over-estimates resulting from the use of different data sources for numerators and denominators (see Notes). 10
Health Service Delivery Areas, Northern Health Province Northwest NW Northern Interior NI Northeast NE Vaccination Details Year 2012 2013 2014 2015 2016 2017 2018 Up-to-date for age 68% 73% 70% 59% 61% 62% 65% D/T/aP/IPV 78% 83% 78% 77% 76% 74% 73% D/T/aP n/a n/a n/a n/a n/a n/a 73% Hepatitis B 87% 89% 85% 84% 82% 83% 83% Measles 87% 90% 85% 86% 86% 82% 76% Mumps 87% 89% 85% 86% 86% 82% 76% Rubella 92% 94% 88% 91% 92% 89% 88% Varicella 85% 89% 83% 66% 69% 68% 70% Meningococcal C conjugate 86% 90% 85% 90% 91% 88% n/a Up-to-date for age 79% 82% 80% 81% 72% 78% 79% D/T/aP/IPV 88% 90% 88% 90% 81% 86% 86% D/T/aP n/a n/a n/a n/a n/a n/a 86% Hepatitis B 93% 98% 94% 95% 95% 96% 95% Measles 94% 97% 94% 97% 96% 95% 90% Mumps 94% 97% 94% 96% 96% 95% 90% Rubella 97% 100% 97% 99% 100% 99% 98% Varicella 91% 95% 94% 85% 75% 81% 83% Meningococcal C conjugate 93% 98% 94% 98% 98% 98% n/a Up-to-date for age 73% 70% 74% 67% 47% 70% 68% D/T/aP/IPV 86% 78% 84% 81% 54% 80% 78% D/T/aP n/a n/a n/a n/a n/a n/a 78% Hepatitis B 95% 92% 95% 94% 96% 96% 101% Measles 98% 93% 97% 95% 95% 95% 82% Mumps 98% 93% 97% 95% 95% 95% 82% Rubella 100% 99% 100% 100% 100% 100% 100% Varicella 96% 93% 98% 74% 51% 75% 73% Meningococcal C conjugate 97% 93% 98% 99% 100% 100% n/a Note: Coverage rates approaching 100% in FHA, VIHA and NHA are likely over-estimates resulting from the use of different data sources for numerators and denominators (see Notes). 11
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Note: Coverage rates approaching 100% in FHA, VIHA and NHA are likely over-estimates resulting from the use of different data sources for numerators and denominators (see Notes). 19
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Notes 1. Numerators: Number of children with active records in Panorama/iPHIS/PARIS who were up-to-date for the specified agent(s) by their seventh birthday. As of 2018 for the Interior Health Authority (IHA), only those that also had Panorama records indicating that they were enrolled in school as of June 30 of the most recent school year. 2. Denominators: For VCHA - All children with active records in PARIS. For IHA in 2012-2017- All children with active records in iphis/panorama. For IHA as of 2018 - All children with active records in Panorama indicating that they were enrolled in school as of June 30 of the most recent school year. For all other health authorities/years - All children in the specified birth cohort and health region in the BC MoE enrollment data. 3. Changes in data sources can impact coverage rates. In 2018, IHA changed their data sources to count children in the birth cohort of interest with active records in Panorama whose records indicated they were enrolled in school during the previous school year. While this definition is anticipated to more accurately reflect the population of these regions, the change in definition may explain some of the differences observed in coverage rates, when compared to previous years. When compared to the numbers that would have been used if the previous methods had been continued, in 2018, this change in method resulted in a 16% decrease in the number of children counted in IHA (14%-19% decrease in each of IHA's HSDAs). An analysis of a sample of the records that were excluded identified that approximately 90% of the sample were inadvertently missing a school record possibly due to administrative error, missing First Nation school records and inactive/old records. 4. Ideally, numerators and denominators should be taken from the same data source. In order to maintain accurate denominators in an immunization registry, the health authorities need to be aware of every child who moves into and out of the health region. As not all health regions have been able to fully establish these processes, Vancouver Island Health Authority (VIHA), Fraser Health Authority (FHA) and Northern Health Authority (NHA) felt that the BC MoE enrollment data were more accurate estimates of the number of children in each health region than iphis/panorama. School district boundaries do not directly line up with health region boundaries. As such, the BC MoE enrollment data are based on a process of identifying the schools that lie within each health service delivery area (with health authority input). The BC MoE enrollment data exclude youth custody, continuing education, early learning and summer schools. Using different data sources for numerators and denominators can result in inaccurate results, including coverage results that appear to be greater than 100%. When this occurred, the coverage rates were adjusted to 100%. Immunization coverage rates approaching 100% in the Fraser, Vancouver Island and Northern Health Authorities are likely over-estimates resulting from the use of different data sources for numerators and denominators. 5. In January 2012, the BC immunization schedule changed to introduce a second dose of varicella vaccine as combined measles/mumps/rubella/varicella (MMRV) at school entry (4-6 years of age), replacing the 18-month measles/mumps/rubella (MMR) dose. The first group of children affected by this change in schedule was those born in July 2010, or those receiving their second dose of MMR-containing vaccine in 2012 or later. The change in immunization schedule may have resulted in fewer opportunities to provide the second dose of MMRcontaining vaccine prior to the seventh birthday, explaining the drop in measles and mumps coverage in 2018. 6. Assessment of uptake of Meningococcal-C conjugate vaccine at the 7-year old milestone was stopped in 2018. This vaccine is routinely offered at 12 months of age; uptake is assessed as part of the 2-year old immunization coverage analysis. 21
7. In 2016 (2008 birth cohort), the in-panorama coverage report was used to assess immunization coverage, because the routine method (analysis using an external analysis program) could not be applied. The in- Panorama reports allow for doses to be counted as adequate even if these do not meet the minimum age/interval criteria through a manual validation process at the user and record level. An assessment of the differences between estimates produced by the two reporting methods indicated that these produce very similar results. For the 2007 birth cohort, the differences in coverage results between the two reporting methods were less than 0.7% for all measure at the provincial level. 8. In July 2013, Northern Health Authority began using the Community Medical Office Information System (MOIS) to record immunizations at point of care, with secondary data entry into Panorama. As of 2016, Northern Health Authority has also been undergoing changes to the delivery of publicly funded immunization programs. It is unclear whether the fluctuations seen in coverage in NHA are data artefacts or true changes in uptake; if they are true changes, the root cause is unknown. Northern Health Authority continues to monitor the situation. 9. In 2015 (2007 birth cohort), the varicella requirement changed from requiring one to two doses of varicella for a child to be considered up-to-date. As a result of this change, the percent of children born in 2007 who were considered up-to-date for varicella decreased considerably when compared to previous years. If only one dose of varicella vaccine had been required for the 2007 birth cohort, the percent of children up-to-date for varicella would have been 24% higher (93%) and the percent of up-to-date for age would have been 6% higher (69%). 10. Historically, health regions using the iphis immunization registry inactivated the records of clients receiving the majority of their immunizations from First Nations Health Services Organizations (FNHSOs) that did not use the iphis immunization registry. The reason for inactivation was because the iphis records were likely incomplete as their immunizations were recorded in other systems. Inactivated records were excluded from coverage analyses. Three FNHSOs used the iphis immunization registry, and the records of children immunized by these FNHSOs remained active. Between June 2015 and January 2018 the Panorama records of children born in 2008-2013 that had been inactivated because they received the majority of their immunizations from FNHSOs were reactivated. These records were activated to facilitate the use of Panorama by the FNHSOs that have adopted Panorama. See: Effect of Activating Panorama Records for clients who primarily receive immunizations from First Nations Health Services Organizations. 11. Starting in 2015, for varicella assessment, only exemptions for previous disease that were effective at the time of the 7th birthday were considered as proof of immunity, while in previous years all recorded exemptions for previous disease in Panorama were considered as proof of immunity. This change only applied to a small number of children and did not have an appreciable effect on overall coverage rates. 12. Starting in 2015, doses marked invalid in Panorama due to vaccine interactions and manual invalidation were excluded from counts, while in previous years these invalid doses in Panorama had been counted. At the provincial level, this change resulted in a decrease in coverage rates that ranged 0.0% to 0.5% for all measures. 13. Data need to be interpreted with caution for the following reasons: a. To be considered up-to-date for age, documentation of every dose in an immunization registry (iphis/panorama/paris) is required. Some children may have received doses that have not been documented. All regions make their best efforts to obtain vaccination records pertaining to immunizations given by providers other than BC public health. b. There can be a delay in obtaining immunization records, which can result in delay of data entry. c. First Nations children may not be completely captured in the registries. On-reserve birth records and immunizations may not be reported to the regional health authorities. 14. Reporting History Seven-year old coverage assessment became an official measure in 2012 (for the 2004 birth cohort). Prior to 2012, assessment of school-entry immunization coverage was conducted at the end of Kindergarten. Kindergarten assessment did not allow for complete capture of on-time immunizations since "school-entry" doses 22
are recommended at 4-6 years of age. Kindergarten assessment does not capture doses administered after Kindergarten but prior to the seventh birthday. Due to the use of different data sources, 7-year old coverage results cannot be directly compared to Kindergarten coverage results. 15. Abbreviations Health Authorities: FHA Fraser Health Authority VCHA Vancouver Coastal Health Authority IHA Interior Health Authority VIHA Vancouver Island Health Authority NHA Northern Health Authority Health Service Delivery Areas: EK East Kootenay VAN Vancouver KB Kootenay Boundary NSCG North Shore / Coast Garibaldi OK Okanagan SVI South Vancouver Island TCS Thompson Cariboo Shuswap CVI Central Vancouver Island FE Fraser East NVI North Vancouver Island FN Fraser North NW Northwest FS Fraser South NI Northern Interior RICH Richmond NE Northeast For an explanation of BC Health Authorities, please visit: http://www.health.gov.bc.ca/socsec/index.html 23
Minimum Intervals Between Eligible Doses Antigen/Agent Minimum Age or Minimum Time Interval Between Eligible Doses Dose 1 A Dose 2 Dose 3 Dose 4 Diphtheria, Tetanus, acellular Pertussis (DTaP or Tdap) 42 days 28 days 28 days 24 weeks Polio B 42 days 28 days 24 weeks Hepatitis B received 3rd dose before June 2007 0 days 28 days 28 days received 3rd dose between June 2007 and May 2014 0 days 28 days 56 days C received 3rd dose in June 2014 or later 0 days 28 days 56 days C,D Measles 12 months 28 days Mumps 12 months 28 days Rubella E 12 months Varicella F 12 months 28 days Meningococcal C Conjugate G 12 months A. Dose 1 refers to the earliest age a child can receive the initial dose. B. Schedule for DTaP should be followed when poliomyelitis provided in combination vaccine. C. Dose 3 must be given at least 16 weeks (112 days) after dose 1. D. Dose 3 must be given on or after 24 weeks of age. E. Schedule for measles/mumps should be followed when rubella provided in combination vaccine with measles/mumps. F. To be counted as valid, varicella vaccine must be administered on or after 12 months of age. Guidelines also state that children with a history of varicella disease should only be considered protected if the illness occurred on or after 12 months of age. The date of varicella disease onset is not systematically entered into iphis/panorama. For the purposes of this assessment, any child with a past history if varicella disease recorded in iphis/panorama is considered protected, regardless of their age at the time of illness. G. Dose must be given at least 56 days after any previous meningococcal C conjugate dose (if previous dose given). 24
Effect of activating Panorama records for clients who primarily receive immunizations from First Nations Health Services Organizations on 7-year old immunization coverage rates Historically, British Columbia health regions using the iphis immunization registry inactivated the records of clients receiving the majority of their immunizations from First Nations Health Services Organizations (FNHSOs) that did not use the provincial immunization registry (iphis). The reason for inactivation was because the iphis records were likely incomplete as their immunizations were recorded in other systems. Inactivated records were excluded from coverage analyses. Between June 2015 and January 2016, the Panorama records of children born in 2007-2013 that had been inactivated because they received the majority of their immunizations from FNHSOs were reactivated. These records were activated to facilitate the use of the new provincial immunization registry (Panorama) by the FNHSOs that have adopted Panorama. Jurisdiction Effect on % Up-to-date for age 2015 2016 2017 2018 British Columbia 0.1% 0.0% 0.1% Interior Health Authority 0.3% -0.5% -0.2% East Kootenay 0.1% -0.2% 0.0% Kootenay Boundary 0.0% 0.0% 0.0% Okanagan 0.0% -0.3% -0.1% Thompson Cariboo Shuswap 0.9% -1.1% -0.5% Fraser Health Authority 0.0% 0.0% 0.0% Fraser East 0.1% 0.0% 0.0% Fraser North 0.0% 0.0% 0.0% Fraser South 0.0% 0.0% 0.0% Vancouver Island Health Authority 0.2% 0.4% 0.5% South Vancouver Island 0.2% 0.0% 0.2% Central Vancouver Island 0.4% 1.0% 1.1% North Vancouver Island 0.0% 0.1% 0.0% Northern Health Authority 1.3% 0.8% 1.5% Northwest 1.2% 0.7% 2.1% Northern Interior 1.6% 0.2% 1.0% Northeast 0.7% 0.3% 0.7% The overall effect of activating the Panorama records was an increase of 0.1% in the provincial immunization coverage estimate for children up-to-date for age in 2018 (2010 birth cohort). This ranged from a decrease of 0.2% to an increase of 1.5% at the Health Authority level and a decrease of 0.5% to an increase of 2.1% at the Health Service Delivery Area level. In the Fraser, Vancouver Island and Northern Health Authorities, the denominators used for the coverage calculations (based on school enrolment) remained the same. As such, any change in the proportion up-todate for age reflects the fact that additional children were being counted in the numerator. Panorama data were used for both the numerators and denominators for the Interior Health Authority. In this region, the inclusion of the records that had previously been inactivated resulted in small declines in coverage, likely due to the inclusion of children with incomplete Panorama records. 25