title: Monitoring county-level vaccination coverage during the 2004-2005 influenza season.
abstract: BACKGROUND
  During the 2004-2005 influenza season, the United States faced a sudden shortage of influenza vaccine. In response, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommended prioritizing vaccination for persons aged 65 and older and others at high risk. To monitor subsequent vaccination coverage, several questions about influenza vaccination were added to the ongoing Behavioral Risk Factor Surveillance System (BRFSS). This study provided real-time county-level estimates of influenza vaccination coverage from the BRFSS each month from October 2004 through January 2005.
  
  
  METHODS
  The methods used a variation of small area estimation procedures suitable for situations in which most small areas have few or no survey respondents, and rapid assessment is essential. Both model-based methods and nonparametric spatial-smoothing methods were used in a three-step procedure.
  
  
  RESULTS
  The highest vaccination rates during the 2004-2005 influenza season were seen in the upper Midwest and the Southeast. Areas with the lowest vaccination rates were the intermountain West, southern California, portions of Washington and Oregon, and various areas across the Eastern United States, often coinciding with urban areas. Intrastate variations were especially pronounced in the Eastern United States, particularly in Georgia, Florida, Tennessee, Kentucky, North Carolina, Virginia, and New York. These states all had areas with low immunization rates as well as areas with high rates.
  
  
  CONCLUSIONS
  The results showed that vaccination coverage varied significantly across states and substate regions. Our findings show that this methodology can provide estimates with reasonable reliability for planning during public health emergencies.
authors.affiliation: Department of Community Medicine, Mercer University School of Medicine, Macon, Georgia 31207, USA. haomia@yahoo.com
authors.forename: Haomiao
authors.initials: H
authors.lastname: Jia
authors.forename: Michael
authors.initials: M
authors.lastname: Link
authors.forename: James
authors.initials: J
authors.lastname: Holt
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.forename: Paul S
authors.initials: PS
authors.lastname: Levy
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000600:supply & distribution*; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D032541:Mass Vaccination / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D017062:Small-Area Analysis; D019371:Topography, Medical; D014481:United States / Q000453:epidemiology
chemical_list: D007252:Influenza Vaccines