Immunization registry use and progress--United States, 2001

Immunization registries are confidential, population-based, computerized information systems that collect vaccination data about all children within a geographic area. Registries are key tools used to increase and sustain high vaccination coverage by providing complete and accurate information on which to base vaccination decisions. Registries consolidate vaccination records of children from multiple healthcare providers, identify children who are due or late for vaccinations, generate reminder and recall notices to ensure that children are appropriately vaccinated, and identify provider sites and geographic areas with low vaccination coverage. One of the national health objectives for 2010 is to increase to 95% the proportion of children aged <6 years who participate in fully operational population-based immunization registries (objective 14-26). CDC analyzed data from 50 states and the District of Columbia (DC) from the calendar year 2000 Immunization Registry Annual Report (CY 2000 IRAR) to assess current registry activity. This report summarizes the results of those analyses, which indicate that 32 (63%) of the 51 grantees are operating population-based immunization registries (Figure 1). These 32 projects represent 49% of the U.S. population aged <6 years.     

Immunization registry progress--United States, 2002

Immunization registries are confidential, population-based, computerized information systems that collect vaccination data about all children within a geographic area. By providing complete and accurate information on which to base vaccination decisions, registries are key tools to increase and sustain high vaccination coverage. Registries consolidate vaccination records of children from multiple health-care providers, identify children who are due or late for vaccinations, generate reminder and recall notices to ensure that children are vaccinated appropriately, and identify provider sites and geographic areas with low vaccination coverage. One of the national health objectives for 2010 is to increase to 95% the proportion of children aged <6 years who participate in fully operational, population-based immunization registries (objective 14.26). This report summarizes data from the calendar year 2001 Immunization Registry Annual Report (CY 2001 IRAR), a survey of registry activity among immunization programs in the 50 states and the District of Columbia (DC) that receive grant funding under Public Health Service Act 317b. Although these data indicate that approximately half of U.S. children aged <6 years are participating in a registry, achieving the national health objective will require increased immunization provider participation.     

Immunization registry progress--United States, January-December 2002

Immunization registries are confidential, computerized information systems that collect vaccination data within a geographic area. By consolidating vaccination records from multiple health-care providers, generating reminder and recall notifications, and assessing clinic and vaccination coverage, registries serve as key tools to increase and sustain high vaccination coverage. One of the national health objectives for 2010 is to increase to 95% the proportion of children aged <6 years who participate (i.e., have two or more vaccinations recorded) in fully operational, population-based immunization registries. This report summarizes data from CDC's 2002 Immunization Registry Annual Report (2002 IRAR), a survey of registry activity among immunization programs in the 50 states and the District of Columbia (DC) that receive grant funding under section 317b of the Public Health Service Act. These data indicate that approximately 43% of children aged <6 years are enrolled in a registry; achieving the national health objective will require increased implementation of functional standards to improve data quality.     

Progress in development of immunization registries--United States, 1999

Community-based and state-based immunization registries are confidential, population-based, computerized information systems that contain data about children's vaccinations and represent an important tool to increase and sustain high vaccination coverage. Immunization registries consolidate vaccination records for children from multiple providers, provide a vaccination needs assessment for each child, generate reminder and recall vaccination notices, produce an official vaccination record, and provide practice-specific and community-based vaccination coverage assessments. One of the Healthy People 2010 national objectives is to increase to 95% the proportion of children aged <6 years who are enrolled in a fully operational population-based immunization registry. To assess the status of immunization registry development, CDC analyzed data from the 1999 Immunization Registry Annual Report (IRAR) of 64 jurisdictions (grantees) that receive federal immunization funds under section 317d of the Public Health Service Act. Findings from this analysis indicate that substantial progress has been made in the United States in developing and implementing community-based and state-based immunization registries.     

Immunization information system progress--United States, 2003

One of the national health objectives for 2010 is to increase to at least 95% the proportion of children aged <6 years who participate in fully operational, population-based immunization registries (objective 14-26). Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and interoperability with electronic medical records (EMRs), is called an immunization information system (IIS). This report summarizes data from CDC's 2003 Immunization Registry Annual Report (IRAR), a survey of IIS grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. The findings of the 2003 IRAR indicate that approximately 44% of U.S. children aged <6 years participated in an IIS. In addition, 76% of public vaccination provider sites and 36% of private vaccination provider sites submitted immunization data to an IIS during the last 6 months of 2003. Increasing health-care provider participation by linking EMRs to IISs is vital to meeting the national health objective.     

Immunization information system progress--United States, 2004

One of the national health objectives for 2010 is to increase to at least 95% the proportion of children aged <6 years who participate in fully operational, population-based immunization registries (objective no. 14-26). Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and linkages with electronic data sources, is called an immunization information system (IIS). This report summarizes data from CDC's 2004 IIS Annual Report, a survey of 56 grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. The findings indicate that approximately 48% of U.S. children aged <6 years participated in an IIS. Moreover, 76% of public vaccination provider sites and 39% of private vaccination provider sites submitted immunization data to an IIS during the last 6 months of 2004. Overcoming challenges and barriers to increasing the number of provider sites and the percentage of children aged <6 years participating in an IIS is critical to achieving the national health objective. CDC has developed a plan of action to address those challenges. Major components of the plan include, but are not limited to, a multiyear IIS business plan for each grantee and enhanced technical assistance to grantees with unresolved challenges.     

Immunization information systems progress - United States, 2005

Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and linkages with electronic data sources, is called an immunization information system (IIS). This report summarizes data from CDC's 2005 Immunization Information System Annual Report (IISAR), a survey of grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. These data indicated that approximately 56% of U.S. children aged <6 years participated in an IIS, an increase from 48% in 2004. Moreover, 75% percent of public vaccination provider sites and 44% of private vaccination provider sites submitted vaccination data to an IIS during July-December 2005. These findings underscore the need to increase the number of participating children, from the current 13 million to approximately 21 million, to assure 95% participation of children aged <6 years and improve the effectiveness of U.S. immunization programs.     

Progress in immunization information systems --- United States, 2009

An immunization information system (IIS) is a confidential, computerized, population-based system that collects and consolidates vaccination data from vaccine providers and provides tools for designing and sustaining effective immunization strategies at the provider and program levels. Among the capabilities of an IIS are the capacity to inform vaccine providers of upcoming patient vaccination needs; generate vaccination coverage reports, patient reminders, or recalls for past due vaccinations; and interoperate with electronic health record (EHR) systems. In 2010, the Task Force on Community Preventive Services recommended that immunization information systems be used to increase vaccination coverage after showing strong evidence of their effectiveness. A Healthy People 2020 objective is to increase to 95% the percentage of children aged <6 years whose immunization records are housed in a fully operational IIS. To assess IIS progress toward meeting the Healthy People objective, CDC analyzed data from the 2009 Immunization Information Systems Annual Report (IISAR) survey (completed by 53 of 56 federal grantees with IIS sites), which indicated that 77% of all U.S. children aged <6 years participated in an IIS, an increase from 75% in 2008. In addition, 59% of grantees reported being able to send and receive vaccination data using Health Level Seven (HL7) messaging standards, and 73% reported that some vaccine providers with EHR systems in their geographic area were providing vaccination data directly to an IIS from EHRs. Enhancing IIS and EHR with standards such as HL7 will provide greater consistency in data exchange and likely help to improve the quality and timeliness of IIS data.     

Progress in immunization information systems - United States, 2010

Immunization information systems (IIS) are confidential, computerized, population-based systems that collect and consolidate vaccination data from vaccination providers and provide important tools for designing and sustaining effective immunization strategies at the provider and immunization program levels. These tools include clinical decision support, vaccination coverage reports, interoperability with electronic health record systems, vaccine inventory management, and the ability to generate reminder and recall messages. In 2010, based on strong evidence of effectiveness, the Task Force on Community Preventive Services recommended IIS use as a means of increasing vaccination rates. A?Healthy People 2020 target (IID-18) is to increase to 95% the proportion of children aged <6 years whose immunization records are in fully operational, population-based IIS. To monitor progress toward program goals, CDC annually surveys 56 immunization program grantees (50 states, five cities, and the District of Columbia) using the IIS Annual Report (IISAR). Results from the 2010 IISAR (completed by 54 grantees) indicate that 82% (18.8 million) of U.S. children aged <6 years participated in IIS, as defined by having at least two recorded vaccinations, an increase from 78% (18.0 million) in 2009. Among 52 grantees who responded to questions about the Vaccine Tracking System (VTrckS), CDC's new national vaccine ordering and inventory management system for publicly purchased vaccine, 38 (73%) indicated their intention to use the IIS in their state or city to interface with VTrckS. Use of IIS to interface with VTrckS might provide additional incentive for vaccination providers to participate in IIS and enhance IIS utility by supporting efficient and effective methods for providers to order vaccine and track inventory and by promoting greater accountability of publicly purchased vaccine.     

Immunization information systems progress--United States, 2006

A CDC program goal for 2010 is to achieve >95% participation in an immunization information system (IIS) (defined as having two or more recorded vaccinations) among children aged <6 years. IISs, previously known as immunization registries, are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area. Most IISs have additional capabilities, such as vaccine management, adverse event reporting, maintenance of birth-to-death vaccination histories, and interoperability with other health information systems. IISs can provide accurate data on which to make informed vaccination decisions and better protect against vaccine-preventable diseases. This report highlights selected data from CDC's 2006 Immunization Information System Annual Report (IISAR), a survey of grantees in 50 states, five cities, and the District of Columbia that receive funding under the Public Health Service Act. The data indicated that 65% of all U.S. children aged <6 years (approximately 15 million children) participated in an IIS in 2006, an increase from 56% in 2005. The majority of grantees (70%) reported that their IISs have the capacity to track vaccinations for persons of all ages. Data on vaccinations were entered within 30 days of vaccine administration for 69% of children aged <6 years. However, results for certain data completeness measures were low. These findings underscore the need to continue to address challenges to full IIS participation and ensure high-quality information.     

Immunization registries: progress and challenges in reaching the 2010 national objective.

Immunization registries are confidential, population-based, computerized information systems that contain data about children's immunizations and have been described as the cornerstone of immunization delivery in the 21st century. Work to ensure the privacy of registry participants and the confidentiality of their information, recruit provider participation, overcome technical and operational challenges, and identify sustainable funding streams has resulted in 24 percent of children less than 6 years of age currently in an immunization registry in the United States. New solutions will be needed before reaching the national health objective of increasing the proportion of children to 95 percent in a fully operational immunization registry by 2010.     

Influenza vaccination coverage among children aged 6-59 months--six immunization information system sentinel sites, United States, 2006-07 influenza season

In June 2006, the Advisory Committee on Immunization Practices (ACIP) expanded its 2004 recommendation for routine influenza vaccination of children aged 6-23 months to include children aged 24-59 months. The 2006 ACIP recommendations also reemphasized that previously unvaccinated children aged <9 years should receive 2 doses of influenza vaccine administered at least 1 month apart to be fully vaccinated. In 2007, using data from six immunization information system (IIS) sentinel sites, CDC conducted the first assessment of influenza vaccination coverage among children aged 6-59 months during the 2006-07 influenza season. The findings demonstrated that, at all six sites, <30% of children aged 6-23 months and <20% of children aged 24-59 months were fully vaccinated. Vaccination coverage data from national and state surveys for an influenza season generally are not available until the next influenza season. Rapid assessment of influenza vaccination coverage can help direct activities of state and local public health agencies aimed at increasing the number of children fully vaccinated against influenza.     

Assessing immunization registry data completeness in Bexar County, Texas

BACKGROUND: Immunization information systems (or registries) are increasingly being used to promote and sustain high levels of vaccination coverage. However, the perception among many providers that registry data are too incomplete to be relied on when making immunization decisions has impeded the acceptance of registries. METHODS: To evaluate registry completeness, immunization coverage levels from the San Antonio Immunization Registry System (SAIRS) were compared with coverage levels derived from immunization records from 77 (37%) of the 210 clinics participating in the Vaccines for Children (VFC) program in 1998, 44 (21%) clinics in 1999, and 10 (5%) clinics in 2000. RESULTS: Clinic data indicated an average immunization coverage level for the 4:3:1 series of 39.8%. The overall coverage level for these clinics based on registry data was 64.1%. Registry-coverage levels for these clinics were < or =65% above the coverage levels based on clinic records. CONCLUSIONS: Immunization coverage levels based on SAIRS data were the same or higher than coverage levels based on clinic records. These data suggest that San Antonio's registry data were more complete than clinic records and may assist in changing provider perceptions regarding registry data completeness.     

Influenza vaccination coverage among children with asthma--United States, 2004-05 influenza season

In 2005, approximately 8.9% (6.5 million) of U.S. children aged <18 years were reported to have current asthma. Children with asthma are at high risk for complications from influenza, and influenza vaccination has been determined to safely and effectively reduce rates of influenza in these children. Since its establishment in 1964, the Advisory Committee on Immunization Practices (ACIP) has recommended that all children with asthma aged > or =6 months receive vaccination with inactivated influenza vaccine during each influenza season; however, national influenza vaccination coverage rates specifically for children with asthma have not been determined. Previous studies have assessed influenza vaccination rates in children with asthma at the local level using health maintenance organization and clinician group-practice information, with estimates ranging from 10% to 43% for various influenza seasons. Another study used Behavioral Risk Factor Surveillance System (BRFSS) data to estimate influenza vaccination coverage in children aged 2-17 years with one or more conditions putting them at high risk for complications from influenza (including asthma, although asthma was not assessed separately); in that study, the national rate was estimated at 34.8% for the 2004-05 influenza season (based on a sample size of 685, which included all states and the District of Columbia [DC]). To estimate national influenza vaccination coverage rates among children aged 2-17 years with current asthma, CDC analyzed data from the 2005 National Health Interview Survey (NHIS). This report describes the results of that analysis and provides the first national estimates of influenza vaccination coverage among children with asthma. The findings indicated that although children with current asthma were more likely to receive influenza vaccination than children without current asthma, the vaccination coverage rate among children with asthma was low, at 29.0% (95% confidence interval [CI] = 24.5-33.9). These findings underscore the need to increase influenza vaccination coverage in children with asthma aged 2-17 years by identifying and overcoming barriers to vaccination.     

Interim results: state-specific influenza vaccination coverage--United States, August 2010-February 2011

The 2010--11 influenza season was unusual because it followed the 2009 influenza A pandemic (H1N1) season and it was the first season the Advisory Committee on Immunization Practices (ACIP) recommended influenza vaccination of all persons aged ≥6 months. The season also was notable because a record number of seasonal influenza vaccine doses (approximately 163 million) were distributed in the United States. To provide preliminary state-specific influenza vaccination coverage estimates, CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) data for adults aged ≥18 years and National Immunization Survey (NIS) data for children aged 6 months-17 years collected September 2010 through March 2011. By February 28, the preliminary national vaccination coverage estimate was 49.0% for children aged 6 months-17 years; among 43 states and the District of Columbia (DC), coverage ranged from 30.2% for adults aged 18-49 years to 68.6% for adults aged ≥65 years. The record high seasonal vaccination coverage achieved during 2009-10 (41.3%) among persons aged ≥6 months in 43 states and DC was sustained during the 2010--11 season (42.8%). Coverage for Hispanic and non-Hispanic black children increased by 11-12 percentage points from 2009-10 levels. Opportunity exists to improve coverage in all age groups, particularly among adults. To accomplish that, health departments and other nonoffice-based vaccination providers can increase access to vaccination at work and school locations, pharmacies and stores, and other nonmedical sites. In addition, physicians and clinics should implement proven strategies for improving vaccination coverage (e.g., office-based protocols, including reminder/recall notification and standing orders).     

Public health and aging: influenza vaccination coverage among adults aged > or =50 years and pneumococcal vaccination coverage among adults aged > or =65 years--United States, 2002

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy in preventing morbidity and mortality in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or =65 years. In 1998, an estimated 3,400 adults aged > or =65 years died as a result of invasive pneumococcal disease. One of the national health objectives for 2010 is to achieve 90% coverage of noninstitutionalized adults aged > or =65 years for both influenza and pneumococcal vaccinations (objective no. 14.29). In 2000, the Advisory Committee on Immunization Practices (ACIP) broadened the universal recommendations for influenza vaccination to include adults aged 50-64 years in addition to adults aged > or =65 years. To assess progress toward achieving the 2010 national health objective and implementing the ACIP recommendations, CDC analyzed data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that influenza and pneumococcal vaccination levels among adults aged > or =65 years and influenza vaccination levels among adults aged 50-64 years varied widely among states/areas and racial/ethnic populations. Innovative approaches are needed to increase vaccination coverage, particularly among certain populations.     

Immunization registries in the EMR Era

Background: The CDC established a national objective to create population-based tracking of immunizations through regional and statewide registries nearly 2 decades ago, and these registries have increased coverage rates and reduced duplicate immunizations. With increased adoption of commercial electronic medical records (EMR), some institutions have used unidirectional links to send immunization data to designated registries. However, access to these registries within a vendor EMR has not been previously reported.Purpose: To develop a visually integrated interface between an EMR and a statewide immunization registry at a previously non-reporting hospital, and to assess subsequent changes in provider use and satisfaction.Methods: A group of healthcare providers were surveyed before and after implementation of the new interface. The surveys addressed access of the California Immunization Registry (CAIR), and satisfaction with the availability of immunization information. Information Technology (IT) teams developed a “smart-link” within the electronic patient chart that provides a single-click interface for visual integration of data within the CAIR database.Results: Use of the tool has increased in the months since its initiation, and over 20,000 new immunizations have been exported successfully to CAIR since the hospital began sharing data with the registry. Survey data suggest that providers find this tool improves workflow and overall satisfaction with availability of immunization data. (p=0.009).Conclusions: Visual integration of external registries into a vendor EMR system is feasible and improves provider satisfaction and registry reporting.Key Words: Electronic Medical Records, Immunization Registries, EMR integration, HITECH, Meaningful Use     

Vaccination coverage in the US Commonwealth of the Northern Mariana Islands, 2005.

BACKGROUND: In July 2005, a house-to-house survey was conducted to determine vaccination coverage achieved through routine health services on the three inhabited islands (Saipan, Rota, and Tinian) of the US Commonwealth of the Northern Mariana Islands (CNMI). METHODS: A population-based cluster survey was conducted on Saipan; clusters and households were selected by systematic random sampling. On the smaller islands of Rota and Tinian, all households were visited. Vaccination histories and demographic information were obtained during household interview for all children aged 19-35 months, children aged 6 years, and adults aged 65 years and older. Vaccination histories for children were supplemented by hospital/clinic records and an electronic vaccination registry. RESULTS: Among 295 children aged 19-35 months, estimated coverage with the primary vaccination series was 80 percent; coverage with individual vaccines was generally higher. Among 193 children aged 6 years, coverage for vaccines required at school-aged was 83 percent. Among 226 adults aged 65 years and older, 52 percent received influenza vaccine during the previous season while 21 percent had ever received pneumococcal vaccine. CONCLUSIONS: The CNMI has achieved the US Healthy People 2010 objective of 80 percent coverage for the standard vaccination series among children aged 19-35 months. High coverage levels among 6-year-old children may reflect the benefit of school entry requirements. Influenza and pneumococcal vaccination among older adults remains low. Efforts to ensure that children and older adults throughout the CNMI are equally well-protected should continue. Strategies to address parental awareness of vaccinations that are due should be explored and may be facilitated by upgrading the electronic vaccination registry.     

Immunization registry accuracy: improvement with progressive clinical application

BACKGROUND: Healthcare systems have been challenged to ensure the timely administration of immunizations. Immunization registries have been proposed to improve the accuracy and completeness of immunization information and to promote effective practice. METHODS: Comparison of randomly selected samples from two birth cohorts (1993 and 1998) from Denver Health Medical Center. Chart review and immunization registry information for these groups were compared; a composite immunization was recorded and up-to-date (UTD) status established. Registry data were compared with this composite using a sensitivity measure to assess completeness and accuracy. RESULTS: Among 818 children in the 1993 cohort and 1043 children in the 1998 cohort, there were 6386 and 6886 valid immunizations, respectively. The registry recorded 71.4% and 97.7% of these for the 1993 and 1998 cohorts, respectively (p <0.001). The apparent UTD rate, as measured with registry data alone, improved from 37% to 79% between the two time frames (p <0.001). Composite UTD status was 83.1% and 78.9% (1993 vs 1998, respectively). Accurate registry-defined UTD status improved from 44.4% to 100% between the two intervals. CONCLUSIONS: Immunization registry accuracy improved dramatically for recorded immunizations and UTD status. However, after 3 years of registry use, the overall proportion of children who were UTD had not significantly improved. The mere presence of a registry does not ensure more complete vaccination coverage. Other registry-based strategies, including use of the data for reminder, recall, and audit, may further improve immunization coverage.     

Vaccination coverage among children in kindergarten--United States, 2009-10 school year

Healthy People 2020 objectives include maintaining vaccination coverage among children in kindergarten (IID-10) (1). The target is ≥95% vaccination coverage for the following vaccines: poliovirus; diphtheria and tetanus toxoids and acellular pertussis (DTP/DTaP/DT); measles, mumps, and rubella (MMR); hepatitis B (HepB); and varicella (1). Data from school assessment surveys are used to monitor vaccination coverage and vaccination exemption levels among children enrolled in kindergarten. This report summarizes data from school assessment surveys submitted to CDC by 48 federal immunization program grantees (including 47 states and the District of Columbia) for the 2009-10 school year to describe vaccination coverage and exemption rates (2). For that period, 17 grantees reported coverage of ?95% for four vaccines (poliovirus, DTP/DTaP/DT, MMR, and HepB) and four grantees reported coverage of ≥95% for 2 doses of varicella vaccine. Total exemption rates, including medical, religious, and philosophical exemptions, ranged from <1% to 6.2% across grantees, and 15 grantees reported exemption rates<1%. Survey methods for vaccination coverage and exemption rates varied among grantees, making comparisons difficult and limiting the use of school assessment surveys to report aggregate national rates. Further standardization of school assessment survey methods will generate comparable data between grantees to monitor and track progress in reaching national objectives, and allow development of best practice guidelines for grantees to more effectively use and report school coverage and exemption data. CDC will continue to monitor vaccination coverage and exemption levels and assist grantees in identification of local areas with low vaccination coverage or high exemption rates for further evaluation or intervention.