Date of Award
Open Access Thesis
Master of Public Health (MPH)
School of Public Health
Daniel M. Weinberger
Melinda M. Pettigrew
Streptococcus pneumoniae is an important human pathogen with more than 92 identified serotypes of varying invasiveness. Asymptomatic colonization of the nasopharynx can later cause diseases such as sinusitis, AOM, or IPD. Children under age five are the major reservoirs of infection. Pediatric conjugate vaccines effectively reduce vaccine-type carriage and disease. Vaccinating children can have indirect effects on adults.
Materials and Methods:
This paper used CIRTS to describe patterns of three- and four-dose PCV uptake throughout Connecticut in 2000 to 2009 birth cohorts. Spatial cluster analysis was used to detect any clusters with higher than expected proportions of unvaccinated children. Log-binomial regression models were used to assess unadjusted and adjusted associations between variables from the 2000 U.S. Census and proportions of unvaccinated children in ZCTAs. These factors describe the racial and socioeconomic composition, age distribution, population density, and housing characteristics of ZCTAs.
There were 315,628 children across 266 ZCTAs in the registry. Across all cohorts and ZCTAs, 91 percent of children received three doses of PCV and 74 percent received all four doses. Vaccination rates varied across cohorts and by poverty level. Cluster analysis revealed several significant clusters. All selected community-level variables were independently associated with a high proportion of unvaccinated children in ZCTAs. All but three variables comprise a final multivariate model.
Connecticut enjoys a robust uptake of both three and four doses of PCV. Areas near Groton, New Haven, and parts of Windham, Tolland, Hartford, and New London counties would benefit from increased vaccine delivery efforts. Socioeconomic variables were consistently related to risk of ZCTAs having a high proportion of unvaccinated children.
AIC= Akaike information criterion
APIC=Advisory Committee on Immunization Practices
AOM=acute otitis media
CDC=Centers for Disease Control and Prevention
CIRTS=Connecticut Immunization Registry and Tracking System
HMO=health maintenance organization
IAP=Immunization Action Plan
IPD=invasive pneumococcal disease
PCP=primary care physician
PCV=pneumococcal conjugate vaccine
PCV7=heptavalent pneumococcal vaccine
PCV13=13-valent pneumococcal conjugate vaccine
PPV23=23-valent plain polysaccharide vaccine
CHIP=Children's Health Insurance Program
VFC=Vaccines for Children
ZCTA=zip code tabulation area
Mead, Aimee Marie, "Predictors Of Patterns In Pediatric Pneumococcal Vaccine Uptake In Connecticut, 2000-2009" (2014). Public Health Theses. 1193.