Concept: Childhood Immunizations

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Concept Description

Last Updated: 2007-05-15

Introduction

This concept provides information on childhood immunizations, including how to work with immunization tariff codes and how to identify the codes for DPT , Polio , HiB , and MMR .

In Manitoba, the three levels of government - municipal (City of Winnipeg), provincial, and federal - and two types of providers - physicians (approximately 80%) and public health nurses (20%)- are involved in the delivery of immunizations. Immunizations are provided through a longstanding provincial program. The Manitoba Immunization Monitoring System (MIMS) records all immunizations of provincial registrants (as of Jan 1, 1980) and provides monitoring and reminders to families.

MIMS files contain:


• registry information
• a code that identifies the vaccine administered and its sequence in the immunization schedule
• service date
• provider identifiers-to distinguish physician administered immunizations from those given by public health nurses


Comparisons between physician and MIMS records have shown data quality for the non-aboriginal population to be high. Two percent or fewer immunizations or service dates are coded incorrectly, while physician failure to bill has been estimated at between 0.2% (urban) and 6.6% (rural).

Data

Martens et al. (2003) calculated immunization rates for each Regional Health Authority (RHA) and for each RHA District in Manitoba. The following three Excel spreadsheets are available to download:


• 1 Year Immunization Rates By RHA and RHA Districts
  
  
• 2 Year Immunization Rates By RHA and RHA Districts
  
  
• 7 Year Immunization Rates By RHA and RHA Districts

Immunization Schedule

In order for a child to be considered completely immunized, a minimum number of doses of each type of vaccine must be received within the first few months. The table below presents the:

Current immunization schedule for infants and children in Manitoba, in the first 2 years of life.



Age at vaccination	DPT	Polio	HiB 1	MMR
2 months 4 months 6 months 12 months 18 months	X X X X	X X (X)* X	X X X X	X

* This dose is not needed routinely, but can be included for convenience.

¹ Hemophilus influenza B vaccine added mid-1992

Source: Martens et al. (2003)


Hepatitis B has been offered to all Grade IV students since Fall of 1998, but there is not currently any schedule for children.

Changes over time in recommended schedule:


• In 1984 the recommended childhood immunization schedule was:
  • DPT (diphtheria, pertussis and tetanus) at 2, 4, 6 and 18 months
    
  • OPV (oral polio vaccine) at 2, 4, 6 and 18 months
    
  • MMR (measles, mumps and rubella) at 12 months
  
  
• In 1992, Hib (haemophilus influenza B) vaccine was added at 2, 4, 6 and 18 months
  
  
• In 1997, OPV was replaced with IPV (inactivated polio vaccine). This was combined with the DPT vaccine as a quadravalent vaccine. Hib was also added to form a pentavalent vaccine.
  
  
• In 2004, three vaccines applicable to this age group were introduced
  • influenza for infants age 6 - 23 months
  • pneumococcal conjugate at 2, 4, 6 and 18 months of age
  • varicella at age 12 months

Working with Immunization Tariff Codes

Tariff codes for immunizations have responded to changes in vaccine technology over the last several years. Not only are vaccines being improved in terms of efficacy and reduction of adverse effects, but the trend has been toward combining several antigens into one vaccine. The greater convenience of these combined doses makes them easier for the health care provider to administer, making it more likely that the required number of doses of each will be given on time.

Tariff Codes

Counting immunizations is equivalent to a search for tariff codes. The date of the immunization must also be checked to see if it falls within the specified time period. Any doses outside of this time period (i.e. too late) are not counted. For example, to be complete at one year a child requires three DPT, two Polio, and three Hib in the first 12 months of life.

The MMR at 12 months is not usually counted in this first 12 month period. The Canadian Immunization Guide 1998 states this dose should be given "shortly after the first birthday." Tables for subsequent periods, such as 13 months or 18 months, should count the MMR.

The following list of tariff codes has been used to search for immunizations from 1987 up to 1999.

Note: Validity beyond these years should be verified by checking for code additions/deletions before any runs outside this time period are attempted.


DPT

TARIFF CODES	DOSE	DESCRIPTION
8601, 8602, 8603, 8609	DPT	Diphtheria, pertussis, tetanus
In 1992 the above codes were replaced with the following series, which adds the HiB component:
8781, 8782, 8783, 8789	DPT/HiB	Diphtheria, pertussis, tetanus, HiB
In 1997 these codes were replaced with the following series:
8802, 8804, 8806, 8807	DaPTP/HiB	Diphtheria, pertussis, tetanus, inactivated polio virus(IPV), HiB
A small proportion of doses come from other combinations of vaccines:
8641, 8642, 8643, 8649	DT	Diphtheria, tetanus (for those who cannot receive pertussis vaccine)
8921, 8922, 8923, 8929	DPTP	Diphtheria, pertussis, tetanus, IPV
8798	DTP	Diphtheria, tetanus, IPV, for children under 7 years (for those who cannot receive pertussis vaccine)
8805	TdP	Tetanus, diphtheria, IPV, for children over 7 years. Code is not for infants, but is found in a very small number of cases.
8924	DaPTP	Diphtheria, acellular pertussis, tetanus, IPV


For children born in the first half of 1998, the frequency of each tariff code up to June 1999 was distributed as follows:



Tariff codes	Frequency
8802, 8804, 8806, 8807 8781, 8782, 8783, 8789 8921, 8922, 8923, 8929 8924 8601, 8602, 8603, 8609 8798 8641, 8642, 8643, 8649 8805	99.2% 0.3% 0.1% 0.1% 0.1% 0.1% <0.1% <0.1%


Polio


TARRIFF CODES	DOSE	DESCRIPTION
8611,8612,8613,8619	OPV	Oral polio virus
8931,8932,8933,8939	IPV	Inactivated polio virus
Both OPV and IPV are licensed for use, but currently only IPV is recommended for routine immunization in Canada. OPV almost completely stopped being used for kids born 1998 and on.
8802, 8804, 8806, 8807	DaPTP/HiB	Diphtheria, pertussis, tetanus, inactivated polio virus(IPV), HiB
8921, 8922, 8923, 8929	DPTP	Diphtheria, pertussis, tetanus, IPV
8798	DTP	Diphtheria, tetanus, IPV, for children under 7 years (for those who cannot receive pertussis vaccine)
8805	TdP	Tetanus, diphtheria, IPV, for children over 7 years. Code is not for infants, but is found in a very small number of cases.
8924	DaPTP	Diphtheria, acellular pertussis, tetanus, IPV


For children born in the first half of 1998, the frequency of each tariff code up to June 1999 was distributed as follows:



Tariff codes	Frequency
8802, 8804, 8806, 8807 8611, 8612, 8613, 8619 8924 8798 8931, 8932, 8933, 8939 8805	99.6% 0.2% 0.2% 0.1% <0.1% <0.1%


HiB
HiB was introduced in 1992. For purposes of calculating completion rates of immunization, anyone born after May 1, 1992 requires the recommended number of HiB doses to be considered complete.


TARIFF CODES	DOSE	DESCRIPTION
8781, 8782, 8783, 8789	DPT/HiB	Diphtheria, pertussis, tetanus, HiB
8802, 8804, 8806, 8807	DaPTP/HiB	Diphtheria, pertussis, tetanus, inactivated polio virus(IPV), HiB
8901, 8902, 8903, 8909	HiB	Hemophilus influenza B


For children born in the first half of 1998, the frequency of each tariff code up to June 1999 was distributed as follows:



Tariff codes	Frequency
8802, 8804, 8806, 8807 8781, 8782, 8783, 8789 8901, 8902, 8903, 8909	99.4% 0.4% 0.2%


MMR


TARIFF CODES	DOSE	DESCRIPTION
8670	MMR	Measels, mumps, rubella
8621	Measels	Measels



For children born in the first half of 1998, the frequency of each tariff code up to June 1999 was distributed as follows:



Tariff codes	Frequency
8670 8621	100% 0.0%

Related concepts 

• Manitoba Immunization Monitoring System (MIMS)

Related terms 

• Childhood Immunization
• Childhood Immunization Rates
• Immunization
• Immunization Schedule By Age

Links 

• Canadian Immunization Guide - Seventh Edition (2006) - Public Health Agency of Canada Web Site
• Canadian National Report on Immunization, 1996 - Public Health Agency of Canada Web Site
• Manitoba Health: Manitoba Immunization Schedules

References 

• Black C, Roos NP, Fransoo R, Martens PJ. Comparative Indicators of Population Health and Health Care use for Manitoba's Regional Health Authorities: A POPULIS Project. Winnipeg, MB: Manitoba Centre for Health Policy and Evaluation, 1999. [Full Report] [Summary] (View)
• Brisson M, Edmunds W, Gay N, Law B, DeSerres G. Modelling the impact of immunization on the epidemiology of varicella zoster virus. Epidemiology and Infection 2000;125(3):651-669. [Abstract] (View)
• Martens PJ, Fransoo R, The Need to Know Team, Burland E, Jebamani L, Burchill C, Black C, Dik N, MacWilliam L, Derksen S, Walld R, Steinbach C, Dahl M. The Manitoba RHA Indicators Atlas: Population-Based Comparison of Health and Health Care Use. Winnipeg, MB: Manitoba Centre for Health Policy, 2003. [Full Report] [Summary] [Data extras] (View)
• Roberts JD, Poffenroth LA, Roos LL, Bebchuk JD, Carter AO. Monitoring childhood immunizations: a Canadian approach. Am J Public Health 1994;84(10):1666-1668. [Abstract] (View)
• Roos LL, Traverse D, Turner D. Delivering prevention: the role of public programs in delivering care to high-risk populations. Med Care 1999;37(6 Suppl):JS264-JS278. [Abstract] (View)

Keywords 

• health status
• Immunization Schedule
• MIMS
• Vaccines