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Abstract
Vaccination cards are useful health records that contain information about vaccination dates and dosage. This information is helpful for parents, vaccination providers, and public health researchers. However, as they currently are structured, many vaccination cards are very difficult to read by non-experts, like parents, and even by health-care providers. Many families also lose these vaccination cards; among the top 10 countries with the most unvaccinated children, the proportion of families who were able to find their vaccination cards and give them to researchers was low, ranging from 20.7% in the Democratic Republic of the Congo to 69.2% in South Africa. Moreover, some families report that not having a vaccination card during a vaccination visit resulted in them being unable to obtain a vaccine (8% in one study in Ethiopia and 16% in one study in Bangladesh). This commentary provides recommendations about how vaccination cards should be used by parents, health-care providers, and researchers, and comments on their continued relevance in an era with increased use of electronic registries.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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Danovaro-Holliday MC, Contreras MP, Pinto D, Molina-Aguilera IB, Miranda D, García O, Velandia-Gonzalez M. Assessing electronic immunization registries: the Pan American Health Organization experience. Rev Panam Salud Publica 2019; 43:e28. [PMID: 31093252 PMCID: PMC6519664 DOI: 10.26633/rpsp.2019.28] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/13/2018] [Indexed: 11/24/2022] Open
Abstract
Objective. To develop a methodology to assess electronic immunization registries (EIRs) in low- and middle-income countries (LMICs) in Latin America and the Caribbean. Methods. A team from the Immunization Unit at the Pan American Health Organization (PAHO) reviewed existing methodologies to evaluate health information systems, particularly the Performance of Routine Information System Management (PRISM) framework and methodologies used to assess information systems. In 2014, the PAHO team convened a small working group to develop an evaluation approach to be added to the existing World Health Organization immunization data quality self-assessment (DQS) tool. The resulting DQS with an added EIR component was named “DQS Plus.” The DQS Plus methodology was used in Panama in May 2014 and in Honduras in November 2015. Results. The DQS Plus tool proved feasible and easy to implement in Panama and Honduras, including by not adding much time or resources to those needed for a usual DQS. The information obtained from the DQS Plus assessment was practical and helped provide health authorities with recommendations to update and improve their EIR, strengthen the use of the registry, and enhance the data the assessment produced, at all levels of the health system. These recommendations are currently being implemented in the two countries. Conclusions. The DQS Plus proved to be a practical and useful approach for assessing an EIR in an LMIC and generating actionable recommendations. Further work on defining operational and related EIR functional standards in LMICs will help develop an improved EIR assessment tool for Latin America and the Caribbean, and potentially elsewhere.
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Affiliation(s)
- M Carolina Danovaro-Holliday
- World Health Organization Department of Immunization, Vaccines and Biologicals Expanded Programme on Immunization Strategic information Group Geneva Switzerland Strategic information Group, Expanded Programme on Immunization, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Marcela P Contreras
- Comprehensive Family Immunization Unit Comprehensive Family Immunization Unit Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Comprehensive Family Immunization Unit, Washington, D.C., United States of America
| | - Dalys Pinto
- Programa Ampliado de Inmunización Programa Ampliado de Inmunización Ministerio de Salud de la República de Panamá Panamá Panamá Ministerio de Salud de la República de Panamá, Programa Ampliado de Inmunización, Panamá, Panamá
| | - Ida Berenice Molina-Aguilera
- Centro Nacional de Biológicos Centro Nacional de Biológicos Secretaría de Salud de Honduras TegucigalpaFrancisco Morazán Honduras Secretaría de Salud de Honduras, Centro Nacional de Biológicos, Tegucigalpa, Francisco Morazán, Honduras
| | - Diana Miranda
- Región de San Miguelito - San Miguelito Salud Región de San Miguelito - San Miguelito Salud Panamá Panamá Región de San Miguelito - San Miguelito Salud, Panamá, Panamá
| | - Odalys García
- Pan American Health Organization Pan American Health Organization Tegucigalpa Honduras Pan American Health Organization, Tegucigalpa, Honduras
| | - Martha Velandia-Gonzalez
- Comprehensive Family Immunization Unit Comprehensive Family Immunization Unit Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Comprehensive Family Immunization Unit, Washington, D.C., United States of America
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Immunization information systems: a decade of progress in law and policy. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 21:296-303. [PMID: 24402434 PMCID: PMC4671281 DOI: 10.1097/phh.0000000000000040] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article reports on a study of laws, regulations, and policies governing Immunization Information Systems (IIS, also known as "immunization registries") in states and selected urban areas of the United States. The study included a search of relevant statutes, administrative codes and published attorney general opinions/findings, an online questionnaire completed by immunization program managers and/or their staff, and follow-up telephone interviews.The legal/regulatory framework for IIS has changed considerably since 2000, largely in ways that improve IIS' ability to perform their public health functions while continuing to maintain strict confidentiality and privacy controls. Nevertheless, the exchange of immunization data and other health information between care providers and public health and between entities in different jurisdictions remains difficult due in part to ongoing regulatory diversity.To continue to be leaders in health information exchange and facilitate immunization of children and adults, IIS will need to address the challenges presented by the interplay of federal and state legislation, regulations, and policies and continue to move toward standardized data collection and sharing necessary for interoperable systems.
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Wolf E, Rowhani-Rahbar A, Duchin J, DeHart MP, Opel D. The Challenges in Measuring Local Immunization Coverage: A Statewide Case Study. Pediatrics 2016; 137:peds.2015-3755. [PMID: 27244807 PMCID: PMC4845875 DOI: 10.1542/peds.2015-3755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/24/2022] Open
Abstract
There are many forms of existing immunization surveillance in the United States and Washington state, but all are limited in their ability to provide timely identification of clusters of unimmunized individuals and assess the risk of vaccine-preventable diseases. This article aims to: (1) describe challenges to measuring immunization coverage at a local level in the United States using Washington State as a case study; and (2) propose improvements to existing surveillance systems that address the challenges identified.
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Affiliation(s)
- Elizabeth Wolf
- Departments of Pediatrics, and Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia;
| | | | - Jeffrey Duchin
- Epidemiology, University of Washington, Seattle, Washington;,King County Department of Public Health, Seattle, Washington; and
| | | | - Douglas Opel
- Departments of Pediatrics, and,Seattle Children’s Research Institute, Seattle, Washington
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Robison SG. Addressing immunization registry population inflation in adolescent immunization rates. Public Health Rep 2015; 130:161-6. [PMID: 25729105 PMCID: PMC4315857 DOI: 10.1177/003335491513000209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE While U.S. adolescent immunization rates are available annually at national and state levels, finding pockets of need may require county or sub-county information. Immunization information systems (IISs) are one tool for assessing local immunization rates. However, the presence of IIS records dating back to early childhood and challenges in capturing mobility out of IIS areas typically leads to denominator inflation. We examined the feasibility of weighting adolescent immunization records by length of time since last report to produce more accurate county adolescent counts and immunization rates. METHODS We compared weighted and unweighted adolescent denominators from the Oregon ALERT IIS, along with county-level Census Bureau estimates, with school enrollment counts from Oregon's annual review of seventh-grade school immunization compliance for public and private schools. Adolescent immunization rates calculated using weighted data, for the state as a whole, were also checked against comparable National Immunization Survey (NIS) rates. RESULTS Weighting individual records by the length of time since last activity substantially improved the fit of IIS data to county populations for adolescents. A nonlinear logarithmic (ogive) weight produced the best fit to the school count data of all examined estimates. Overall, the ogive weighted results matched NIS adolescent rates for Oregon. CONCLUSION The problem of mobility-inflated counts of teenagers can be addressed by weighting individual records based on time since last immunization. Well-populated IISs can rely on their own data to produce adolescent immunization rates and find pockets of need.
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Hedden EM, Jessop AB, Field RI. An education in contrast: state-by-state assessment of school immunization records requirements. Am J Public Health 2014; 104:1993-2001. [PMID: 25122033 PMCID: PMC4167093 DOI: 10.2105/ajph.2014.302078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We reviewed the complexities of school-related immunization policies, their relation to immunization information systems (IIS) and immunization registries, and the historical context to better understand this convoluted policy system. METHODS We used legal databases (Lexis-Nexis and Westlaw) to identify school immunization records policies for 50 states, 5 cities, and the District of Columbia (Centers for Disease Control and Prevention "grantees"). The original search took place from May to September 2010 (cross-referenced in July 2013 with the list on http://www.immunize.org/laws ). We describe the requirements, agreement with IIS policies, and penalties for policy violations. RESULTS We found a complex web of public health, medical, and education-directed policies, which complicates immunization data sharing. Most (79%) require records of immunizations for children to attend school or for a child-care institution licensure, but only a few (11%) require coordination between IIS and schools or child-care facilities. CONCLUSIONS To realize the full benefit of IIS investment, including improved immunization and school health program efficiencies, IIS and school immunization records policies must be better coordinated. States with well-integrated policies may serve as models for effective harmonization.
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Affiliation(s)
- Erika M Hedden
- Erika M. Hedden and Amy B. Jessopare are with the Department of Health Policy and Public Health, University of the Sciences, Philadelphia, PA. Robert I. Field is with the School of Law and School of Public Health, Drexel University, Philadelphia, PA
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7
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Immunization information systems: a decade of progress in law and policy. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE : JPHMP 2014. [PMID: 24402434 DOI: 10.1097/phh.0000000000000040.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reports on a study of laws, regulations, and policies governing Immunization Information Systems (IIS, also known as "immunization registries") in states and selected urban areas of the United States. The study included a search of relevant statutes, administrative codes and published attorney general opinions/findings, an online questionnaire completed by immunization program managers and/or their staff, and follow-up telephone interviews.The legal/regulatory framework for IIS has changed considerably since 2000, largely in ways that improve IIS' ability to perform their public health functions while continuing to maintain strict confidentiality and privacy controls. Nevertheless, the exchange of immunization data and other health information between care providers and public health and between entities in different jurisdictions remains difficult due in part to ongoing regulatory diversity.To continue to be leaders in health information exchange and facilitate immunization of children and adults, IIS will need to address the challenges presented by the interplay of federal and state legislation, regulations, and policies and continue to move toward standardized data collection and sharing necessary for interoperable systems.
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8
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Hull BP, Deeks SL, McIntyre PB. The Australian Childhood Immunisation Register-A model for universal immunisation registers? Vaccine 2009; 27:5054-60. [PMID: 19576945 DOI: 10.1016/j.vaccine.2009.06.056] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Revised: 06/09/2009] [Accepted: 06/14/2009] [Indexed: 11/18/2022]
Abstract
The Australian Childhood Immunisation Register (ACIR) was established in 1996 as an opt-out register built on the platform of Medicare, the universal national health insurance scheme. Introduction of financial incentives for providers and parents, linked to the ACIR, followed from 1998. Over the subsequent decade, national levels for receipt of all vaccines by 12, 24 and 72 months of age have risen to 91%, 93%, and 88%, respectively. Conscientious objection to immunisation can be registered, with retention of eligibility for incentives. The ACIR has been important in implementation of a range of measures to improve childhood immunisation coverage in Australia. Linkage of a universal childhood immunisation register to national health insurance schemes has potential applicability in a variety of settings internationally.
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Affiliation(s)
- Brynley P Hull
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney, NSW, Australia.
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Riva A, Mandl KD, Oh DH, Nigrin DJ, Butte A, Szolovits P, Kohane IS. The personal internetworked notary and guardian. Int J Med Inform 2001; 62:27-40. [PMID: 11340004 DOI: 10.1016/s1386-5056(00)00136-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this paper, we propose a secure, distributed and scaleable infrastructure for a lifelong personal medical record system. We leverage on existing and widely available technologies, like the Web and public-key cryptography, to define an architecture that allows patients to exercise full control over their medical data. This is done without compromising patients' privacy and the ability of other interested parties (e.g. physicians, health-care institutions, public-health researchers) to access the data when appropriately authorized. The system organizes the information as a tree of encrypted plain-text XML files, in order to ensure platform independence and durability, and uses a role-based authorization scheme to assign access privileges. In addition to the basic architecture, we describe tools to populate the patient's record with data from hospital databases and the first testbed applications we are deploying.
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Affiliation(s)
- A Riva
- Children's Hospital Informatics Program, Division of Endocrinology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Abstract
BACKGROUND Immunization registries are tools to improve and sustain immunization coverage rates for our nation's preschool children. Developing a means of supporting registries over the long term requires information on costs to operate registries. METHODS To determine the annual cost per child to operate immunization registries for the 16 All Kids Count (AKC) II projects, some of the most developed registry projects in the United States, we projected a national figure for operating registries and compared the figure with a variety of potential cost offsets. RESULTS When the registries are fully operational, the average cost per child for the 16 AKC II projects will be $3.91 (range, $1.60 to $6.23; interquartile range, $2.91 to $4.81) per year. CONCLUSIONS Based on the AKC study, maintaining a nationwide network of registries for children aged 0 to 5 will require an estimated $78.2 million. Cost offsets include not having to manually retrieve records for school entry, child care, change in provider, and Health Plan Employer Data Information Set reports; not having to carry out the National Immunization Survey; and prevention of overimmunization. We estimate these offsets at $113.8 million annually.
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Affiliation(s)
- P R Horne
- All Kids Count National Program Office, The Task Force for Child Survival and Development, Decatur, GA 30030, USA
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Rask KJ, Wells KJ, Kohler SA, Rust CT, Cangialose CB. The cost to providers of participating in an immunization registry. Am J Prev Med 2000; 19:99-103. [PMID: 10913899 DOI: 10.1016/s0749-3797(00)00183-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The medical and public health communities advocate immunization registries as one tool to achieve national immunization goals. Although substantial resources have been expended to establish registries across the nation, minimal research has been conducted to evaluate provider participation costs. METHODS The objective of this study was to identify the direct costs to participate in an immunization registry. To estimate labor and equipment costs, we conducted interviews and direct observation at four sites that were participating in one of two immunization registries. We calculated mean data-entry times from direct observation of clinic personnel. RESULTS The annual cost of participating in a registry varied extremely, ranging from $6083 to $24,246, with the annual cost per patient ranging from $0.65 to $7. 74. Annual per-patient costs were lowest in the site that used an automated data-entry interface. Of the sites requiring a separate data-entry step, costs were lowest for the site participating in the registry that provided more intensive training and had a higher proportion of the target population entered into the registry. CONCLUSIONS Ease of registry interface, data-entry times, and target population coverage affect provider participation costs. Designing the registry to accept electronic transfers of records and to avoid duplicative data-entry tasks may decrease provider costs.
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Affiliation(s)
- K J Rask
- Division of General Medicine, Emory University School of Medicine Atlanta, GA, USA.
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Abstract
Public health nurses (PHNs) play critical roles in public health surveillance systems in the United States. Increased understanding of public health surveillance systems can help PHNs appreciate their role in surveillance and improve the quality and usefulness of surveillance data. This paper describes the National Immunization Survey, the public health surveillance system currently in place for tracking immunizations, as well as immunization registries and HEDIS performance indicators, two emerging approaches to immunization surveillance. The contributions of public health nursing to these systems and implications for public health nursing practice are discussed. High quality public health surveillance information is essential for monitoring the progress of disease trends and program effectiveness. PHNs can help assure the quality of surveillance data.
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Wood D, Saarlas KN, Inkelas M, Matyas BT. Immunization registries in the United States: implications for the practice of public health in a changing health care system. Annu Rev Public Health 1999; 20:231-55. [PMID: 10352858 DOI: 10.1146/annurev.publhealth.20.1.231] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although immunization rates among children are rising across the country, rates in inner-city areas have remained at approximately 50%-60%, < or = 30% lower than corresponding suburban or state immunization levels. The failure to raise immunization levels in poor, underserved populations is caused in part by the lack of timely and accurate child-specific immunization information for providers and parents. Immunization registries are a new tool in health care that can be used to address these and other barriers to effective immunization delivery. Moreover, immunization registries have the potential to help health care officials track and improve delivery for a broad range of important child health services. An immunization registry is a computerized database of information on children (usually preschool-age children) in a defined population (e.g. those enrolled in a health maintenance organization or living in a specific geographic area), which is used to record and track all immunizations received by each child. The registry receives the information primarily from public and private providers that administer immunizations, as well as from parents, schools, and other agencies. A fully functioning immunization registry can be used to identify individual children in need of immunizations and to report on immunization rates by population characteristics such as child age, assigned provider, or geographic area (e.g. neighborhood, city). Today, > 250 local public health departments have immunization registries that are in various stages of planning or development. Only a small number of these registries meet the minimum functional criteria of maintaining records on 95% of all eligible 2-year-old children in the target population and providing an electronic immunization record that is accessible to providers. Nascent immunization registries represent innovative technologic solutions to the challenge of monitoring health problems and health care access on a population basis. This is a fundamental activity of public health agencies, but one that is increasingly shared by large health maintenance organizations. The study of the development of immunization registries across the United States provides an important case study for how public health agencies will use the rapidly developing health information infrastructure to perform health assessment and health assurance activities in a managed care environment.
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Affiliation(s)
- D Wood
- Shriners Hospitals, Tampa, Florida, USA.
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Horner SD, Murphy L. Creating alternative immunization clinics to maintain and improve community immunization rates. J Community Health Nurs 1999; 16:121-32. [PMID: 10349822 DOI: 10.1207/s15327655jchn1602_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Immunization campaigns are among the most effective means for improving community health, yet underimmunized groups leave communities at risk for vaccine-preventable diseases. In 1993, the Childhood Immunization Initiative (CII) was implemented to address this risk. The goal of the CII, to achieve immunization coverage 90% or greater among 2-year-old children, was reached nationwide by 1996. However, individual states ranged from 81% to 99% for specific vaccines (Centers for Disease Control and Prevention, 1997b). The work of the CII is ongoing and was expanded in 1996 to address the immunization needs of adolescents. The purpose of this article is to present a model for providing immunization services in alternative sites, in which the community health nurse takes the service to the people. Building linkages with local communities, preparing the clinic site and supplies, arranging for staffing of an alternative clinic, and evaluation after service provision are key elements to a successful outreach clinic.
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Affiliation(s)
- S D Horner
- School of Nursing, University of Texas at Austin 78701-1499, USA.
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Easley RB. When you run the zoo: the need for residents to learn strategies for delivering childhood immunizations. Pediatr Ann 1998; 27:331-2. [PMID: 9648166 DOI: 10.3928/0090-4481-19980601-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- R B Easley
- Department of Child Health, University of Missouri Hospital and Clinics, Columbia 65212, USA
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Abstract
OBJECTIVE To determine the factors associated with unnecessary immunization during the pre-school years. METHODS Children were selected from birth certificates and their parents were interviewed to identify all immunizations to 72 months of age. The immunizations were verified. RESULTS Of 187 children studied 34 (18%) received unnecessary immunization. Unnecessary immunization was strongly associated with ever receiving immunization in a large system of public clinics (designated "Public A") (33%) compared with other providers (5%) (P < 0.00001). Among children immunized in Public A, unnecessary immunization was associated with the parent having an incomplete or no copy of the child's immunization record (P = 0.007) and with not being up to date for immunizations at 24 months of age (P = 0.04). Complete documentation of immunizations either in the Public. A record or in the parent's copy of the record was associated with a 4% rate of unnecessary immunization; incomplete or no documentation in both the Public A and the parent's record was associated with a 45% rate of unnecessary immunization (P = 0.001). CONCLUSIONS Access to a complete immunization record, be it the provider's, the parent's or ideally both, decreases substantially a child's risk of unnecessary immunization.
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Affiliation(s)
- T V Murphy
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, USA
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