The digital immunization system of the future: imagining a patient-centric, interoperable immunization information system

Systematic documentation of the introduction of COVID-19 vaccines in Latin America and the Caribbean

Objective

To document the process of introducing COVID-19 vaccines in a selection of Latin American and Caribbean countries, including the lessons learned and the strengths and weaknesses, and similarities and differences among programs.

Methods

This descriptive study is based on a systematic evaluation of the process of introducing COVID-19 vaccines in Argentina, Belize, Brazil, Costa Rica, Panama and Peru. Data were collected through a questionnaire distributed to key stakeholders. Six informants from each of the included countries participated in this study. The period of the study was from December 2021 through September 2022.

Results

The main strengths reported by countries were health workers' commitment to delivering vaccinations, evidence-based decision-making, the development of plans for vaccine introduction, the participation of national immunization technical advisory groups, the availability of economic resources and positive actions from the respective Ministry of Health. The main challenges were the actions of antivaccination groups, problems with electronic immunization registries, a lack of vaccines, delays in the delivery of vaccines and the scarcity of health personnel at the local level.

Conclusions

Commitment, the participation of multiple sectors, the availability of resources and preparedness planning were some of the many strengths shown by countries introducing COVID-19 vaccines. Weaknesses included third parties' interests, the lack of information systems and difficulty in accessing vaccines and vaccine services. There is a window of opportunity for countries to maintain the good practices that allowed for the processes' strengths and to assess the identified weaknesses to invigorate immunization programs and prepare for future health crises.

A global blockchain for recording high rates of COVID-19 vaccinations

Blockchain has been recently proposed to securely record vaccinations against COVID-19 and manage their verification. However, existing solutions may not fully meet the requirements of a global vaccination management system. These requirements include the scalability required to support a global vaccination campaign, like one against COVID-19, and the capability to facilitate the interoperation between the independent health administrations of different countries. Moreover, access to global statistics can help to control securing community health and provide continuity of care for individuals during a pandemic. In this paper, we propose GEOS, a blockchain-based vaccination management system designed to address the challenges faced by the global vaccination campaign against COVID-19. GEOS offers interoperability between vaccination information systems at both domestic and international levels, supporting high vaccination rates and extensive coverage for the global population. To provide those features, GEOS uses a two-layer blockchain architecture, a simplified byzantine-tolerant consensus algorithm, and the Boneh-Lynn-Shacham signature scheme. We analyze the scalability of GEOS by examining transaction rate and confirmation times, considering factors such as the number of validators, communication overhead, and block size within the blockchain network. Our findings demonstrate the effectiveness of GEOS in managing COVID-19 vaccination records and statistical data for 236 countries, encompassing crucial information such as daily vaccination rates for highly populous nations and the global vaccination demand, as identified by the World Health Organization.

Challenges of vaccination information system implementation: A systematic literature review

Globally, healthcare services have begun to show interest in switching from paper-based to electronic-based vaccination records through Vaccination Information Systems (VIS). VIS have been implemented in various countries, but the study on the challenges of implementing VIS in these countries is still limited. The challenges of implementing VIS need to be understood to become a subject of discussion and anticipation by other countries that are just starting to implement VIS. We analyzed 32 selected publications from 634 initially retrieved. Fourteen challenges were successfully identified when implementing VIS, including interoperability, data quality, security and privacy, standardization, usability, internet connectivity, infrastructure, workflow, funding, government regulations, awareness, skeptical response, computer literacy, and staff-related challenges. The challenges of interoperability and data quality were found to be the most widely discussed by previous studies. In addition to identifying the challenges, this study includes a series of solutions that can be applied to overcome each challenge.

Evaluation of the seroprevalence of measles, rubella, mumps, and varicella and the requirement for additional vaccination based on the JSIPC guidelines among emergency medical technicians at eight fire stations in Narita, Japan: a project review

Limited data are available regarding the seroprevalence of measles, mumps, rubella, and varicella (MMRV) among emergency medical technicians (EMTs) in Japan. The present study aimed to review a project to evaluate adequate immunity against MMRV for the requirement of additional vaccination among EMTs in accordance with the Japanese Society for Infection Prevention and Control guidelines. A retrospective observational study was conducted as part of a vaccination program for EMTs. Each participant was evaluated for medical history, vaccination history, and serology using the criteria established by the Japanese Society of Infection Prevention and Control. In total, 85 EMTs (median age, 31 years; male, 92.9%) were included. Among the included EMTs, 32 (37.6%), 54 (63.5%), 46 (54.1%), and 84 (98.9%) were seropositive for measles, rubella, mumps, and varicella, respectively, whereas 1 (1.2%), 6 (7.1%), 5 (5.9%), and 0 (0%) were seronegative. Furthermore, 48 (56.5%), 27 (31.8%), 45 (52.9%), and 8 (9.4%) EMTs received an additional dose of vaccines for measles, rubella, mumps, and varicella, respectively. The present study suggests that EMTs are not fully immune to MMRV, which highlights the need for confirming the immune status and additional vaccination requirement to prevent occupational infections.

A scoping review of active, participant-centred, digital adverse events following immunization (AEFI) surveillance: A Canadian immunization research network study

BACKGROUND

Post-licensure adverse events following immunization (AEFI) surveillance is conducted to monitor vaccine safety, such as identifying batch/brand issues and rare reactions, which consequently improves community confidence. The integration of technology has been proposed to improve AEFI surveillance, however, there is an absence of description regarding which digital solutions are successfully being used and their unique characteristics.

OBJECTIVES

The objectives of this scoping review were to 1) map the research landscape on digital systems used for active, participant-centred, AEFI surveillance and 2) describe their core components.

METHODS

We conducted a scoping review informed by the PRISMA Extension for Scoping Reviews (PRSIMA-ScR) guideline. OVID-Medline, Embase Classic + Embase, and Medrxiv were searched by a medical librarian from January 1, 2000 to January 28th, 2021. Two independent reviewers determined which studies met inclusion based on pre-specified eligibility criteria. Data extraction was conducted using pre-made tables with specific variables by one investigator and verified by a second.

RESULTS

Twenty-seven publications met inclusion, the majority of which came from Australia (n = 15) and Canada (n = 6). The most studied active, participant-centred, digital AEFI surveillance systems were SmartVax (n = 8) (Australia), Vaxtracker (n = 7) (Australia), and Canadian National Vaccine Safety (CANVAS) Network (Canada) (n = 6). The two most common methods of communicating with vaccinees reported were short-message-service (SMS) (n = 15) and e-mail (n = 14), with online questionnaires being the primary method of data collection (n = 20).

CONCLUSION

Active, participant-centred, digital AEFI surveillance is an area actively being researched as depicted by the literature landscape mapped by this scoping reviewWe hypothesize that the AEFI surveillance approach herein described could become a primary method of collecting self-reported subjective symptoms and reactogenicity from vaccinees, complementing existing systems. Future evaluation of identified digital solutions is necessary to bring about improvements to current vaccine surveillance systems to meet contemporary and future public health needs.

How ready was the US vaccination infrastructure and network of immunization information systems for COVID-19 vaccination campaigns: Recommendations to strengthen the routine vaccination program and prepare for the next pandemic

Coronavirus disease 2019 (COVID-19) pandemic vaccination campaigns globally have been unlike any effort in history. In the United States, the success of these efforts, in part, has hinged on the timely capture and reporting of an unprecedented amount of data from a significantly greater number of administering providers than for routine vaccinations. The pandemic response has highlighted the need to explore the status and value of vaccination data as the critical glue that connects all aspects of the upstream US vaccine development and downstream vaccination delivery system. In this review, we examine immunization information systems and the role that data and staffing play in pandemic responses. We offer three strategic recommendations—regarding funding, expanded provider enrollment, and data reporting—informed by a literature review, a survey and focus group from a convenience sample of 22 immunization jurisdictions, and the vision for enhanced data flow to improve future pandemic responses and routine vaccination.