2003
Primary Health Care Policy Fellowship

Immunization Registries: Protecting the Nation

Kathryn Atchison, DDS, MPH
American Association of Public Health Dentistry

Cynthia Grubbs, RN, JD
Health Resources and Services Administration

Anne Hume, PharmD, FCCP
American Association of Colleges of Pharmacy

Robert McNellis, MPH, PA-C
American Academy of Physician Assistants

Christopher Rizzo, MD
American Academy of Pediatrics

Izzat Sbeih, MPH
American Public Health Association

Immunization Registries: Protecting the Nation

Proposal:

This policy proposes to integrate, and expand to all Americans, the fragmented networks of childhood immunization and bioterrorism (BT) registries through the use of public health funds designated to support BT preparedness.

Recommendations:

It is recommended that the Secretary and Department of Health and Human Services:

• Identify as a critical capacity within the HHS Public Health Preparedness and Response for Bioterrorism Program the expansion of immunization registries to include adults and vaccinations for BT agents;
• Provide financial incentives through the Centers for Medicare and Medicaid Services to encourage healthcare providers to enter patient data into registry systems;
• Support the use of Vaccines For Children funds to establish demonstration programs to expand immunization registries.

Benefits of Creating a Population-Based Immunization Registry:

An integrated population-based system facilitates easy exchange of:

1. Data regarding smallpox and other BT vaccinations of health care providers and first responders, as well as all Americans;
2. Immunization data for tracking all preventable and potentially epidemic illnesses for which effective vaccines are available and;
3. Syndromic surveillance data to alert the public health system, including providers, of potential disease outbreaks.

It would also:

• Decrease public health risk in the event of a BT attack by facilitating rapid differential diagnosis of illness.
• Assist in coordinating an effective and timely response during a BT attack or an infectious disease outbreak.
• Attain and sustain high immunization coverage for all Americans.
• Better manage the vaccine stockpile distribution and help avert shortages.
• Reduce hospitalization rates and costs especially in elderly.
• Assist in improving and monitoring vaccine safety.
• Create immunization histories to prevent administering unnecessary doses of vaccine.

Conclusion:

Currently, the United States has a fragmented and incomplete system for tracking the immunization status of Americans that leaves us vulnerable in the event of an emergency. Immunizations are the foundation for preparedness against infections, whether naturally occurring or the result of a BT agent. A comprehensive and integrated system is crucial to protecting the public's health and safety.

Background:

The Centers for Disease Control and Prevention (CDC) has 64 immunization registry programs which collect and track data on the immunization status of children from birth to 6 years of age in the U.S. including the 50 states, some large cities and the U.S. territories. These programs are in various stages of development resulting in significant differences in enrollments. At this point, registries are about halfway to reaching the Healthy People 2010 goal of having 95% of children less than six years of age fully enrolled in registries.

Another objective of Healthy People 2010 is to increase immunization rates among both children and the elderly, however most registries do not track adult immunizations. Registries can help ensure adults are protected against vaccine preventable diseases such as influenza and pneumococcal pneumonia. This can decrease preventable morbidity and mortality leading to reduced hospitalizations and healthcare costs, especially in elderly adults.

Since September 11, 2001 all states have been required to develop BT preparedness programs. A priority of these programs is smallpox preparedness through the Pre-Event Vaccination System (PVS) or other CDC-certified tracking system. The emphasis of these systems is on tracking the immunization status of health care workers and first responders. Lessons learned from the rapid implementation of the PVS can be translated to preparedness for other current or emerging infectious diseases.

In the event of an outbreak, the nation must be prepared to quickly identify vulnerable and protected individuals whether it is smallpox, another BT agent, or a common preventable infection such as influenza. Although some current immunization registries are certified for both smallpox and routine vaccination tracking, the systems differ and are not able to communicate with each other in the event of a national emergency. An integrated, population-based immunization registry system is essential to accomplish this goal.

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