Understanding Diversity of Policies, Functionalities, and Operationalization of Immunization Information Systems and Their Impact: A Targeted Review of the Literature

The COVID-19 pandemic has focused attention on the use of immunization information systems (IIS) to record and consolidate immunization records from a variety of sources to generate comprehensive patient immunization histories. Operationalization of IIS in the United States is decentralized, and as such, there are over 60 different IIS with wide variations in enabling policies and functionalities. As such, the policies that inform the development and operation of those sub-national IIS exist at the state and sometimes city levels. A targeted literature review was conducted to identify IIS policies and functionalities and assess their impact. The authors identified articles published from 2012 to 2022 that discussed or evaluated IIS policies and functionalities and screened titles, abstracts, and full text for inclusion. When selected for inclusion, authors extracted IIS policy/functionality characteristics and qualitative or quantitative outcomes of their implementation, where applicable. The search terms yielded 86 articles, of which 39 were included in the analysis. The articles were heterogeneous with respect to study design, interventions, outcomes, and effect measures. Out of the 17 IIS policies and functional components identified in the targeted literature review, the most commonly evaluated were provider-based patient reminder/recall, IIS-based centralized reminder/recall, and clinical decision support. Patient reminder/recall had the most published research and was associated with increased vaccination rates and vaccine knowledge. Despite the lack of quantitative evidence, there is a consensus that immunization data interoperability is critical to supporting IIS data quality, access, and exchange. Significant evidence gaps remain about the effectiveness of IIS functionalities and policies. Future research should evaluate the impact of policies and functionalities to guide improved utilization of IIS, increase national interoperability and standardization, and ultimately improve vaccination coverage and population health.

Provider group type and Tdap coverage in pregnancy

INTRODUCTION

The Advisory Committee on Immunization Practices (ACIP) has focused on maternal Tdap immunization as an important means to protect neonates from pertussis infections. There is little published data on provider and/or clinic characteristics as predictors of maternal Tdap uptake. This study examined differences in maternal Tdap coverage in women delivering at a single academic institution, but cared for prenatally in different clinical settings, in 2013, 2014, and 2015. Additionally, the accuracy and utilization of Vermont's immunization information system (IIS) was assessed.

METHODS

This was a retrospective, multiple time-point cross-sectional analysis of annual maternal Tdap coverage in women delivering at a single academic institution in the 3 years following a fundamental change in national maternal Tdap vaccination guidelines. Tdap administration was examined across different obstetric groups using chart review and data from the state's IIS.

RESULTS

All obstetric care groups except the resident-staffed clinic significantly increased maternal Tdap coverage in 2014, compared to 2013 coverage, with no further increase in 2015. In contrast, there was no increase in maternal Tdap coverage in 2014 in the resident-staffed clinics, but then a statistically significant increase in 2015. Overall Tdap coverage in 2014 was 80.4%, with variation in Tdap coverage between clinics types. In the subset of women who were cared for by the University-based groups, there was significant variation in Tdap coverage between clinics, despite racial homogeneity, which persisted after adjustment for maternal age and insurance type. The state's IIS was found to be highly accurate, using individual chart review as the "gold standard."

DISCUSSION

While we demonstrated high maternal Tdap coverage in women delivering at our institution, differences in clinic type and provider training appeared to impact immunization rates, as well as how quickly evolving national recommendations were adopted. Additionally, the fidelity of the state's IIS data was verified.

Pharmacist immunization services evolving for multiple-dose series

OBJECTIVES

To discuss how pharmacists are prepared to deliver vaccines that require multiple doses in a series.

SUMMARY

Influenza, pneumococcal, and zoster vaccines are the most common vaccines that are administered in pharmacies. Routine recommendations often identify these vaccines to be administered 1 year apart. Other vaccines, and potential new vaccines, may require more immediate follow-up to complete a series. This article discusses if the reminder systems used by pharmacists are adequate for vaccine follow-up dosing. The Standards for Adult Immunization Practices and the Immunization Neighborhood discuss these issues. Medication synchronization policies may address a similar situation but may need to be refined to be applicable to immunizations.

CONCLUSION

Pharmacists need to anticipate an expanded immunization service. An ideal reminder system would be minimally different from current workflow but will ensure appropriate and timely follow-up for vaccine doses.

National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19-35 Months - United States, 2014

The reduction in morbidity and mortality associated with vaccine-preventable diseases in the United States has been described as one of the 10 greatest public health achievements of the first decade of the 21st century. A recent analysis concluded that routine childhood vaccination will prevent 322 million cases of disease and about 732,000 early deaths among children born during 1994-2013, for a net societal cost savings of $1.38 trillion. The National Immunization Survey (NIS) has monitored vaccination coverage among U.S. children aged 19-35 months since 1994. This report presents national, regional, state, and selected local area vaccination coverage estimates for children born from January 2011 through May 2013, based on data from the 2014 NIS. For most vaccinations, there was no significant change in coverage between 2013 and 2014. The exception was hepatitis A vaccine (HepA), for which increases were observed in coverage with both ≥1 and ≥2 doses. As in previous years, <1% of children received no vaccinations. National coverage estimates indicate that the Healthy People 2020 target* of 90% was met for ≥3 doses of poliovirus vaccine (93.3%), ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.5%), ≥3 doses of hepatitis B vaccine (HepB) (91.6%), and ≥1 dose of varicella vaccine (91.0%). Coverage was below target for ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP), the full series of Haemophilus influenzae type b (Hib) vaccine, hepatitis B (HepB) birth dose,† ≥4 doses pneumococcal conjugate vaccine (PCV), ≥2 doses of HepA, the full series of rotavirus vaccine, and the combined vaccine series.§ Examination of coverage by child's race/ethnicity revealed lower estimated coverage among non-Hispanic black children compared with non-Hispanic white children for several vaccinations, including DTaP, the full series of Hib, PCV, rotavirus vaccine, and the combined series. Children from households classified as below the federal poverty level had lower estimated coverage for almost all of the vaccinations assessed, compared with children living at or above the poverty level. Significant variation in coverage by state¶ was observed for several vaccinations, including HepB birth dose, HepA, and rotavirus. High vaccination coverage must be maintained across geographic and sociodemographic groups if progress in reducing the impact of vaccine-preventable diseases is to be sustained.