Vaccination Programs: Immunization Information Systems

The CPSTF finding is based on evidence from a systematic review of 240 studies (108 published studies and 132 conference abstracts; search period January 1994 – April 2011). Included studies represented IIS-supported interventions (e.g., client reminder and recall systems) and described IIS program activities and experiences.

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing appropriate vaccination.

Immunization information systems now operate in all U.S. states. Most IIS serve all children, adolescents, and adults in the jurisdiction (CDC).

Minimum functional standards for the operation of immunization information systems were developed in the United States in 1997 by the Centers for Disease Control and Prevention, the National Vaccination Advisory Committee, and immunization program grantees. In 2012, CDC and the IIS community updated the IIS Functional Standards to be implemented from 2013-2017.

More details about study results are available in the CPSTF Finding and Rationale Statement.

The systematic review included 240 studies.

Studies were assigned to nine categories.

• Overall evidence on effectiveness
  • A published study from Australia reported an increase in vaccination rates following adoption of a national IIS. This change, however, was likely due to an increase in participation rates associated with incentive payments offered to families and vaccination providers.
  • A cross-sectional study from the United States reported that medical practices using IIS did not have significantly higher vaccination rates than did practices not using IIS.
• IIS-supported interventions to increase vaccination rates
  • Client reminder and recall systems
    • Vaccination rates: median increase of 6 percentage points (13 studies with 16 study arms)
    • Additional descriptive studies reported client reminder and recall activities (17 studies).
  • Provider assessment and feedback
    • Vaccination rates: median increase of 9 percentage points (5 studies)
    • Additional descriptive studies reported the use of IIS to support the conduct of these interventions (10 studies).
  • Provider reminders (also referred to as clinical decision support for immunizations, or CDSi)
    • Vaccination rates: increase of 14 percentage points (1 study)
    • Many IIS in the United States have built-in reminders that prompt vaccination providers when a client record is consulted.
• IIS use in vaccination-related decisions by clinicians, schools, and health care systems
  • No studies evaluated the use of IIS by vaccination providers at the clinic level.
  • Studies described use of IIS in school settings (10 studies).
  • Studies described use of a state IIS by a health care system (4 studies). Of these studies, three described using IIS data for quality measurements, including HEDIS (Healthcare Effectiveness Data and Information Set).
• IIS use in public health response
  • Studies described use of IIS to respond to outbreaks of vaccine-preventable disease (18 studies), including
    • Targeted recalls of unvaccinated patients
    • Retrospective review of vaccine uptake to monitor provider adoption of revised vaccination recommendations
    • Guiding decisions around 2009 H1N1 influenza vaccine distribution and client management
  • Studies described use of IIS to respond to a public health emergency situation (3 studies). Of these, two detailed the use of IIS to avoid administering unneeded vaccines to people displaced by Hurricane Katrina.
• IIS to support vaccine management
  • Studies described the use of IIS in the process of vaccine supply management, distribution, and accountability (14 studies). Of these, 10 involved doses distributed as part of the U.S. Vaccines for Children Program.
• IIS to assess vaccine safety and effectiveness
  • Studies described use of IIS in assessment of, or response to, vaccine safety issues or in evaluation of vaccine effectiveness (17 studies).
• IIS as a tool for public health decision support
  • Included studies described a range of IIS surveillance capabilities
    • Coverage assessments for specific vaccines (51 studies)
    • Investigations of vaccination rates among high risk subsets of the population (32 studies)
    • Ability to monitor uptake of new vaccines (16 studies)
• IIS integrated with other child health information systems
  • Studies discussed integration of additional child health data (e.g. blood-lead levels, early hearing detection) into existing IIS (8 studies).
• IIS contributing to change in documentation
  • Studies compared the completeness of individual IIS vaccination records with some other immunization data source (e.g. medical records, parental report; 24 studies).

More details about study results are available in the CPSTF Finding and Rationale Statement.

The economic review is based on evidence from 14 studies (12 published papers and 2 government reports; search period January 1994 March 2012).

• Included studies evaluated the cost of IIS (9 studies; 7 assessed system costs, and 2 assessed the cost of exchanging immunization data), benefits of IIS (9 studies), and cost-benefit ratios (4 studies).
• Program costs
  • Estimated total costs ranged from $205,077 to $108 million.
  • Estimated annual cost per child ranged from $5.40 to $60.82.
  • Estimated cost per vaccination record ranged from $0.11 to $12.88.
• Benefits evaluated in the included studies were mostly specific to savings associated with administrative efficiency and decreased over-vaccination.
• Cost-Benefit
  • One study modeled cost and benefits of a nationwide IIS and indicated a benefit-cost ratio of 3.5:1, meaning $3.50 in savings for every dollar invested.
  • A state-level study modeled anticipated yearly benefits and found that compared with annual IIS costs to the state, the benefit-cost ratio was 1.59:1.
  • At the city level, one evaluation based on a single year found that using an IIS compared with manually performing immunization activities resulted in net savings of $36,815.
  • Among health care systems, a managed care organization estimated a return of $8 for every $1 spent after linking to a state IIS for electronic data reporting versus manually retrieving claims data.
• All studies provided information about IIS implemented in the United States and focused on pediatric immunizations.
• Variability in costs might be attributable to the scale of the IIS and the target population size.
• Of the seven studies that assessed system costs, six evaluated systems implemented from 1997 to 2002. Cost and benefit data from these studies may be less applicable today owing to changes in system technology, data exchange methods, availability of vendor support, and system functionalities.

Results of this review are broadly applicable to IIS implemented in the United States for use with the childhood vaccination series. This is especially true as systems achieve levels of provider and client participation demonstrated by Sentinel Site programs.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• What is the overall impact of IIS (or IIS activities) on vaccination rates in the general U.S. population or among target populations that have gaps in coverage?
• How useful is IIS for vaccination providers in clinical settings?
• How do participation rates and records capture vary based on demographic characteristics, such as race and ethnicity, household income, and insurance status?
• What is the frequency and reach of various IIS activities within the population?
• What are the costs of implementing present-day IIS, either with systems developed in-house or with systems supported by vendors?
• What are the economic returns associated with additional benefits (improved efficiencies and decreased time associated with conducting provider reminder/recall functions, provider assessment and feedback efforts, improved vaccine supply and management, and reduced morbidity and mortality)?
• What is the cost to connect between providers’ Electronic Health Records (EHRs) and central IIS?

• Studies evaluated systems in the United States (209 studies), Australia (2 studies), and other countries (5 studies).
  • Of the studies conducted in the United States (52% of the included studies), 108 described actions and capabilities of systems within the IIS Sentinel Site program.
  • Most U.S. studies considered children and vaccinations within the childhood series. Only 33 studies (20% of the included studies) that reported vaccination outcomes described the use of IIS for adolescents and 12 (7%) described the use of IIS for adult populations, with most studies focused on influenza vaccination.

Of the included studies, 47 evaluated or described one or more of the following interventions supported directly by an IIS or population-based vaccination database:

• Client reminder and recall notices
• Provider assessment and feedback activities
• Provider reminder systems

Studies evaluated IIS used in various settings for different reasons:

• U.S. studies evaluated or described use of IIS by vaccination providers, schools and day cares, or health care systems (14 studies).
• U.S. studies described IIS interactions with schools and day cares (10 studies).
• U.S. studies evaluated or described use of IIS in responses to outbreaks of vaccine-preventable disease or other public health emergencies (18 studies).
• Studies described use of a state IIS by a health care system (4 studies).
• Studies described IIS use to facilitate vaccine ordering, inventory monitoring, and vaccine-related accountability (14 studies).
• Studies (12 from the U.S.) described IIS use to assess or respond to vaccine safety issues or to evaluate vaccine effectiveness (17 studies).

Groom H, Hopkins DP, Pabst LJ, et al. Immunization information systems to increase vaccination rates: a Community Guide systematic review. Journal of Public Health Management & Practice. 2015;21(3):227-248. Available at: http://journals.lww.com/jphmp/Fulltext/2015/05000/Immunization_Information_Systems_to_Increase.2.aspx.

Patel M, Pabst L, Chattopadhyay S, et al. Economic review of immunization information systems to increase vaccination rates: a Community Guide systematic review. Journal of Public Health Management & Practice. 2015;21(3):253-262. Available at: http://journals.lww.com/jphmp/Fulltext/2015/05000/Economic_Review_of_Immunization_Information.4.aspx.

Community Preventive Services Task Force. Recommendation for use of immunization information systems to increase vaccination rates. Journal of Public Health Management & Practice. 2015;21(3):249-252. Available at: http://journals.lww.com/jphmp/Fulltext/2015/05000/Recommendation_for_Use_of_Immunization_Information.3.aspx.

Novick LF. Immunization information systems (Editorial). Journal of Public Health Management & Practice. 2014:1-2. Available at: http://journals.lww.com/jphmp/Citation/publishahead/Immunization_Information_Systems_.99828.aspx.

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

No content is available for this section.

Effectiveness Review

No content is available for this section.

Economic Review

Summary Evidence Table – Economic Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Adamkiewicz TV, Silk BJ, Howgate J, Baughman W, Strayhorn G, Sullivan K, et al. Effectiveness of the 7-valent pneumococcal conjugate vaccine in children with sickle cell disease in the first decade of life. Pediatrics 2008;121(3):562-9.

Adams WG, Conners WP, Mann AM, Palfrey S. Immunization entry at the point of service improves quality, saves time, and is well-accepted. Pediatrics 2000;106(3):489-92.

Ali H, Zwar N, Wild J. Improving childhood immunisation coverage rates evaluation of a divisional program. Aust Fam Physician 2009;38(10):833-5.

Allison MA, Crane LA, Beaty BL, Davidson AJ, Melinkovich P, Kempe A. School-based health centers: improving access and quality of care for low-income adolescents.Pediatrics 2007;120(4):e887-94.

Allison MA, Daley MF, Barrow J, Crane LA, Beaty BL, Allred N, et al. High influenza vaccination coverage in children with high-risk conditions during a vaccine shortage. Arch Pediatr Adolesc Med 2009;163(5):426-31.

Allison MA, Daley MF, Crane LA, Barrow J, Beaty BL, Allred N, et al. Influenza vaccine effectiveness in healthy 6- to 21-month-old children during the 2003-2004 season. J Pediatr 2006;149(6):755-62.

Allred NJ, Stevenson JM, Kolasa M, Bartlett DL, Schieber R, Enger KS, et al. Using registry data to evaluate the 2004 pneumococcal conjugate vaccine shortage. Am J Prev Med 2006;30(4):347-50.

Andersen AD. Accuracy of documented immunization status in pediatric emergency department patients. Paper presented at: Pediatric Academic Societies annual meeting; May 3-6, 2008; Honolulu, HI.

Bailowitz A. Pediatric influenza immunization in Baltimore city, 1999-2004. National Immunization Conference; 2006.

Baker J. Idaho’s immunization reminder information systems (IRIS) annual data quality audit. 45th National Immunization Conference; Washington (DC); 2011.

Balog JL. School nurses and immunization registries: A partnership for success. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

Bardi J. Vaccine ordering and accountability system: integration with the CHILD Profile immunization registry (CPIR). Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Bartlett DL. Uptake of human papillomavirus vaccine by age group – IIS sentinel sites, August 2006-2007. Paper presented at: Pediatric Academic Societies annual meeting; May 3-6, 2008; Honolulu, HI.

Bartlett DL. Assessing the number of vaccines received per visit and frequency of vaccination visits among fully vaccinated and partially vaccinated children 16-19 months of age, IIS Sentinel Sites 2004-8. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Beaudrault S. AFIX and Managed Care in Oregon: Applying the AFIX model in a non-traditional setting. Paper presented at: 43rd National ImmunizationConference; March 30-April 2, 2009; Dallas, TX.

Bond L, Davie G, Carlin JB, Lester R, Nolan T. Increases in vaccination coverage for children in child care, 1997 to 2000: an evaluation of the impact of government incentives and initiatives. Aust NZ J Public Health 2002;26(1):58-64.

Boom JA, Dragsbaek AC, Nelson CS. The success of an immunization information system in the wake of Hurricane Katrina. Pediatrics 2007;119(6):1213-7.

Boom JA, Tate JE, Sahni LC, Rench MA, Hull JJ, Gentsch JR, et al. Effectiveness of pentavalent rotavirus vaccine in a large urban population in the United States. Pediatrics 2010;125(2):e199-207.

Botham SJ, Poulos RG, McFarland KJ, Ferson MJ. Getting it right–the Australian Childhood Immunisation Register and immunisation rates in south-eastern Sydney. Aust NZ J Public Health 2004;28(1):68-71.

Boulton ML, Grossman AM, Potter R, Vranesich PA, Clayton J. Assessing the relationship between seasonal and H1N1 influenza vaccination status in Michigan children, 2009-2010. Public Health Rep 2011;126(Suppl 2):70-7.

Boyd TD, Linkins RW, Mason K, Bulim I, Lemke B. Assessing immunization registry data completeness in Bexar County, Texas. Am J Prev Med 2002;22(3):184-7.

Bronson-Lowe D, Gosney K, Goodykoontz S, Fredrickson K, Anderson S. Effects of recommending a minimum interval schedule for DTaP during a statewide pertussis outbreak in Arizona. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

Bronson-Lowe D, Anderson SM. Effects of a minimum interval immunization schedule for diphtheria and tetanus toxoids and acellular pertussis vaccination during a pertussis outbreak. Arch Pediatr Adolesc Med 2009;163(5):417-21.

Callahan JM, Reed D, Meguid V, Wojcik S, Reed K. Utility of an immunization registry in a pediatric emergency department. Pediatr Emerg Care 2004;20(5):297-301.

CDC. Pertussis outbreak in an Amish community Kent County, Delaware, September 2004-February 2005.MMWR 2006;55(30):817-21.

CDC. Influenza vaccination coverage among children aged 6-59 months six immunization information system sentinel sites, United States, 2006-07 influenza season.MMWR 2007;56(37):963-5.

CDC. Influenza vaccination coverage among children aged 6-59 months eight immunization information system sentinel sites, United States, 2007-08 influenza season. MMWR 2008;57(38):1043-6.

CDC. Influenza vaccination coverage among children aged 6 months-18 years eight immunization information system sentinel sites, United States, 2008-09 influenza season. MMWR 2009;58(38):1059-62.

CDC. Seasonal influenza vaccination coverage among children aged 6 months-18 years eight immunization information system sentinel sites, United States, 2009-10 influenza season. MMWR 2010;59(39):1266-9.

CDC. Rotavirus vaccination coverage among infants aged 5 months immunization information system sentinel sites, United States, June 2006-June 2009. MMWR 2010;59(17):521-4.

Chamberlain A. Improving communication during a vaccine shortage: Lessons learned from the 2008-2009 Haemophilus Influenzae Type B (Hib) Shortage. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Chamberlain A. Use of immunization information systems by VFC provider sites in Oregon and Louisiana in planning for and managing the 2009-2010 influenza vaccination campaign. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Cherry Kreger L. Just in time marketing and training for H1N1 allows providers to test drive registry software. Paper presented at: National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Cherry Kreger L. Reminder postcards vs. reminder recall/broadcast telephone technology as a cost saving alternative. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Cherry LD. Using immunization registry reminder-recall reports to improve CASA audit results. Paper presented at: 39th National Immunization Conference; March 20-24, 2005; Washington, DC.

Cierzniewski A. Impact of state immunization registry on immunization rates of sixth grade students. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Copeland KA. Comparison of vaccination coverage estimates: National Immunization Survey (NIS) Vs. immunization information systems (IIS). Paper presented at: 45th National Immunization Conference; Washington (DC); 2011.

Cordon A CB, Sheon A. Watching the weight of the community: use an IIS for BMI tracking and intervention. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Cortese MM, Leblanc J, White KE, Jerris RC, Stinchfield P, Preston KL, et al. Leveraging state immunization information systems to measure the effectiveness of rotavirus vaccine. Pediatrics 2011;128(6):e1474-81.

Crielly AS. Improving mass immunizations using a web-based registry. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Cugley K, Crawford N, Royle J, Elia S, Massie J. Immunisation rates of children with cystic fibrosis using the Australian Childhood Immunisation Register. J Paediatr Child Health 2010;46(12):768-71.

Cullen K. Simultaneous administration among females of HPV4 vaccine and other vaccines recommended for adolescents- IIS sentinel sites, United States, 2008-2009. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Cullen K. Factors associated with reporting a child’s vaccination history to an immunization information system, National Immunization Survey 2006-2008. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Cullen K. Newborn Hepatitis B vaccination coverage among children aged 3, 5, and 19-35 months – IIS sentinel sites, United States 2008-9. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Cushon J. Improving coverage rates and tackling disparities: A Canadian immunization intervention. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Czaja C, Crossette L, Metlay JP. Accuracy of adult reported pneumococcal vaccination status of children.Ann Epidemiol 2005;15(4):253-6.

Daley MF, Barrow J, Pearson K, Crane LA, Gao D, Stevenson JM, et al. Identification and recall of children with chronic medical conditions for influenza vaccination.Pediatrics 2004;113(1 Pt 1):e26-33.

Daley MF, Steiner JF, Brayden RM, Xu S, Morrison S, Kempe A. Immunization registry-based recall for a new vaccine. Ambul Pediatr 2002;2(6):438-43.

Daskalaki I. Implementation of the 2-dose Varicella vaccination regimen among children aged 4-6 years in Philadelphia: a good start but a long way to go. Paper presented at: Pediatric Academic Society annual meeting; May 2-5, 2009; Baltimore, MD.

Daskalaki I, Spain CV, Long SS, Watson B. Implementation of rotavirus immunization in Philadelphia, Pennsylvania: high levels of vaccine ineligibility and off-label use. Pediatrics 2008;122(1):e33-8.

Davidson AJ, Melinkovich P, Beaty BL, Chandramouli V, Hambidge SJ, Phibbs SL, et al. Immunization registry accuracy: improvement with progressive clinical application. Am J Prev Med 2003;24(3):276-80.

Dawson V. Ensuring data quality, New Jersey Statewide QA initiative. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Denious A. Impact of registry data during a mass immune globulin vaccination clinic. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta,GA.

DeVries OE, Knobloch MJ, Garlitz W, Gruber R, Wolfe J, Kenitzer R, et al. Using an Internet-based registry to link school immunization records with community records. J Sch Health 2003;73(5):201-2.

Dombkowski KJ. Centralized immunization recall in a large urban area. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Dombkowski KJ. Pandemic preparedness: identifying and reaching priority cases using an IIS. Papers presented at: 45th National Immunization Conference; Washington (DC); 2011.

Dombkowski KJ. Strategies to leverage IIS capabilities to improve outreach to children with chronic conditions. Papers presented at: 45th National Immunization Conference; Washington (DC); 2011.

Dombkowski KJ. Effectiveness of population-based immunization recall in a large urban area. Papers presented at: 45th National Immunization Conference; Washington (DC); 2011.

Dombkowski KJ, Harrington LB, Dong S, Clark SJ. Seasonal influenza vaccination reminders for children with high-risk conditions: a registry-based randomized trial. Am J Prev Med 2012;42(1):71-5.

Eberhart M. Impact of outreach activities on childhood immunization coverage in Philadelphia. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Enger KS. Replacement of Td with Tdap in Michigan in 2006, measured using the MCIR. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

Enger KS. Immunization exemptions in Michigan, 2005-2006 and 2006-2007 school years. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008;Atlanta, GA.

Enger KS, Stokley S. Meningococcal conjugate vaccine uptake, measured by Michigan’s immunization registry. J Adolesc Health 2007;40(5):398-404.

Erhart LM. Uptake of Tdap during a statewide outbreak of pertussis, Arizona 2005. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta,GA.

Ernst KC, Pogreba-Brown K, Rasmussen L, Erhart LM. The effect of policy changes on hepatitis A vaccine uptake in Arizona children, 1995-2008. Public Health Rep 2011;126(Suppl 2):87-96.

Fairbrother G, Simpson LA. It is time! Accelerating the use of child health information systems to improve child health. Pediatrics 2009;123(Suppl 2):S61-3.

Fath J, Hicks-Thomson J, Hoyle T, Williams W. Interfacing external information systems with VTrckS – Lesson learned from the 2010 pilot test. Paper presented at: 45th National Immunization Conference; Washington (DC); 2011.

Federico S. Overcoming immunization disparities: A retrospective analysis of school-based health center immunization delivery. Paper presented at: Pediatric Academic Society annual meeting; May 2-5, 2009; Baltimore, MD.

Feemster KA, Spain CV, Eberhart M, Pati S, Watson B. Identifying infants at increased risk for late initiation of immunizations: maternal and provider characteristics.Public Health Rep 2009;124(1):42-53.

Fernandez K. Implementation of immunization assessments using and IIS in NYC. Paper presented at: Vaccine University; May 28-30, 2008; Baltimore, MD.

Findley S. Use of an immunization registry to enhance outreach and tracking by community organizations. Immunization Registry Conference of CDC; October 28-30, 2002; Philadelphia, PA.

Findley SE, Irigoyen M, Sanchez M, Stockwell MS, Mejia M, Guzman L, et al. Effectiveness of a community coalition for improving child vaccination rates in New York City. Am J Public Health 2008;98(11):1959-62.

Flenner M. Utilizing registry functionality and data for statewide school and childcare reporting – First year results. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

Fowler L. New avenues for promoting pediatric immunizations: Advice for implementing and autodialer awareness campaign. Paper presented at: 43rdNational Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Francis-Crick P. Restructuring AFIX and VFC program to improve the quality of site visits. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Fu LY. Improving immunization rates of underserved children. Paper presented at: Pediatric Academic Societies annual meeting; May 2-5, 2009; Baltimore, MD.

Gaudino JA. Do providers listen to local public health? Evaluating the efficacy of accelerated DTaP immunization recommendations during 2003 pertussis outbreaks in Oregon Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Gaudino JA. Monitoring new adolescent immunization uptake using IIS: Early trends from Oregon’s CDC sentinel IIS surveillance population. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008; Atlanta, GA.

Giraudon I, Permalloo N, Nixon G, Charlett A, Cohuet S, Mandal S, et al. Factors associated with incomplete vaccination of babies at risk of perinatal hepatitis B transmission: a London study in 2006. Vaccine 2009;27(14):2016-22.

Gold M, Dugdale S, Woodman RJ, McCaul KA. Use of the Australian Childhood Immunisation Register for vaccine safety data linkage. Vaccine 2010;28(26):4308-11.

Goldstein ND. A Brief Review of Vaccination Coverage in Immunization Registries. Online J Public Health Informatics 2011;3(1):1-7.

Gosney K. Use of a registry to measure the uptake of an accelerated schedule for DTaP immunization in response to state recommendation during the 2005 pertussis outbreak in Arizona. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Gosney K. Comparison of immunization completion rates between American Indian/Alaska Native (AI/AN) and non-AI/AN children in the Arizona sentinel site study region. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008; Atlanta, GA.

Groom H. Adolescent vaccination uptake among students participating in Tdap-only clinics in Deschutes County, Oregon. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Gubernick RS. Continuing to achieve, sustain, and spread improvements in immunization delivery. Paper presented at: 41st National Immunization Conference; March 5-8, 2007;Kansas City, MO.

Guh AY, Hadler JL. Use of the state immunization information system to assess rotavirus vaccine effectiveness in Connecticut, 2006-2008. Vaccine 2011;29(37):6155-8.

Hadler J. Effectiveness of one dose of 2009 monovalent H1N1 vaccine at preventing hospitalization with pandemic H1N1 influenza in children 7 months to 9 years of age, New York City. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington DC.

Halsell C. Implementation of online vaccine ordering in Washington state. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Hambidge SJ, Davidson AJ, Phibbs SL, Chandramouli V, Zerbe G, LeBaron CW, et al. Strategies to improve immunization rates and well-child care in a disadvantaged population: a cluster randomized controlled trial. Arch Pediatr Adolesc Med 2004;158(2):162-9.

Hambidge SJ, Phibbs SL, Chandramouli V, Fairclough D, Steiner JF. A stepped intervention increases well-child care and immunization rates in a disadvantaged population. Pediatrics 2009;124(2):455-64.

Hamstra S. Comparing vaccine providers: effect on 43133 immunization rates for AI/AN children in Arizona. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

Hanna JN. An assessment of the implementation of the Pneumococcal Conjugate Vaccination Program for Aboriginal and Torres Strait Aboriginal and Torres Strait Intants in North Queensland. Commun Dis Intell 2002;26(4):262-6.

Hanna JN, Bullen RC, Andrews DE. The acceptance of three simultaneous vaccine injections recommended at 12 months of age. Commun Dis Intell 2004;28(4):493-6.

Hanna JN, Hills SL, Humphreys JL. Impact of hepatitis A vaccination of Indigenous children on notifications of hepatitis A in north Queensland. Med J Aust 2004;181(9):482-5.

Hanna JN, Morgan AK, McCulloch BG. Uptake of influenza vaccine among Aboriginal and Torres Strait Island adults in north Queensland, 2003. Commun Dis Intell 2004;28(1):80-2.

Hanna M. Evaluation of the delivery of immunizations to children under supervision of the department of children and family services in southern Los Angeles county. Paper presented at: Pediatric Academic Societies annual meeting; May 2-5, 2009; Baltimore, MD.

Hansen MA. Preparing for VTrckS: implementing an online ordering and management tool in an IIS. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Happe LE, Lunacsek OE, Marshall GS, Lewis T, Spencer S. Combination vaccine use and vaccination quality in a managed care population. Am J Manag Care 2007;13(9):506-12.

Harris RS. Streamlining AFIX and VFC site visit processes using an IIS. Paper presented at: Vaccine University; May 28-30, 2008; Baltimore, MD.

Health Protection Agency. October to December 2008: quarterly vaccination coverage statistics for children aged up to five years in the United Kingdom [COVER programme]. Health Protection Rep. March 27, 2009;6(12).

Hicks-Thompson J. Washington VTrckS ExIS Integration: partnership and implementation. Paper presented at: 45th National Immunization Conference; March 28-31, 2011;Washington, DC.

Hinman AR, Atkinson D, Diehn TN, Eichwald J, Heberer J, Hoyle T, et al. Principles and core functions of integrated child health information systems. J Public Health Manag Pract 2004;Suppl:S52-6.

Hopfensperger DJ. Using IIS and performance based contracts to improve childhood immunization rates. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008; Atlanta, GA.

Hoyle T. What information should be integrated with the childhood immunization registry? Mich Med 2005;104(1):18-9.

Hoyle T, Swanson R. Assessing what child health information systems should be integrated: the Michigan experience. J Public Health Manag Pract 2004;Suppl:S66-S71.

Hull B, McIntyre P. Mapping immunisation coverage and conscientious objectors to immunisation in NSW. NSW Public Health Bull 2003;14(1-2):8-12.

Hull BP, Deeks SL, McIntyre PB. The Australian Childhood Immunisation Register a model for universal immunisation registers? Vaccine 2009;27(37):5054-60.

Hull BP, Lawrence GL, MacIntyre CR, McIntyre PB. Immunisation coverage in Australia corrected for under-reporting to the Australian Childhood Immunisation Register. Aust NZ J Public Health 2003;27(5):533-8.

Hull BP, McIntyre PB. A re-evaluation of immunisation coverage estimates from the Australian Childhood Immunisation Register. Commun Dis Intell 2000;24(6):161-4.

Hull BP, McIntyre PB. Immunisation coverage reporting through the Australian Childhood Immunisation Register–an evaluation of the third-dose assumption. Aust NZ J Public Health 2000;24(1):17-21.

Hull BP, McIntyre PB. What do we know about 7vPCV coverage in Aboriginal and Torres Strait Islander children? Commun Dis Intell 2004;28(2):238-43.

Hull BP, McIntyre PB. Timeliness of childhood immunisation in Australia. Vaccine 2006;24(20):4403-8.

Hull BP, McIntyre PB, Sayer GP. Factors associated with low uptake of measles and pertussis vaccines an ecologic study based on the Australian Childhood Immunisation Register. Aust NZ J Public Health 2001;25(5):405-10.

Irigoyen M. Point of service versus real time registry-based coverage assessment. Immunization Registry Conference of CDC; October 28-30, 2002; Philadelphia, PA.

Irigoyen M. Registry-based simulation of chart audits for immunization practice assessments. Paper presented at: Pediatric Academic Societies annual meeting; May 3-6, 2003;Seattle,WA.

Irigoyen MM, Findley S, Wang D, Chen S, Chimkin F, Pena O, et al. Challenges and successes of immunization registry reminders at inner-city practices. Ambul Pediatr 2006;6(2):100-4.

Johnson AL. Auditing techniques for ensuring quality data in a registry. Paper presented at: Immunization Registry Conference of CDC; October 28-30, 2002; Philadelphia, PA.

Jones KL, Hammer AL, Swenson C, Appel A, Phibbs S, Hill F, et al. Improving adult immunization rates in primary care clinics. Nurs Econ 2008;26(6):404-7.

Joyce CJ. Using registries to improve employee health immunization management. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Kelly J. Assessing variability among IIS vaccine forecasting algorithms. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Kempe A, Beaty BL, Steiner JF, Pearson KA, Lowery NE, Daley MF, et al. The regional immunization registry as a public health tool for improving clinical practice and guiding immunization delivery policy. Am J Public Health 2004;94(6):967-72.

Kempe A, Daley MF, Barrow J, Allred N, Hester N, Beaty BL, et al. Implementation of universal influenza immunization recommendations for healthy young children: results of a randomized, controlled trial with registry-based recall. Pediatrics 2005;115(1):146-54.

Kempe A, Steiner JF, Renfrew BL, Lowery E, Haas K, Berman S. How much does a regional immunization registry increase documented immunization rates at primary care sites in rural Colorado? Ambul Pediatr 2001;1(4):213-6.

Khare M, Piccinino L, Barker LE, Linkins RW. Assessment of immunization registry databases as supplemental sources of data to improve ascertainment of vaccination coverage estimates in the national immunization survey.Arch Pediatr Adolesc Med 2006;160(8):838-42.

Kleyman Z, Aveni K. Expanding IIS to EHR: Tracking and reporting early hearing detection and intervention. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008; Atlanta, GA.

Kolasa M. Provider chart audits and outreach to parents: Impact in improving childhood immunization coverage and immunization information system completeness. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Kolasa MS, Cherry JE, Chilkatowsky AP, Reyes DP, Lutz JP. Practice-based electronic billing systems and their impact on immunization registries. J Public Health Manag Pract 2005;11(6):493-9.

Korten LZ. Sharing immunization data with health systems. Paper presented at: Immunization Registry Conference of CDC; October 28-30, 2002; Philadelphia, PA.

Kurilo MB. Using Oregon’s IIS to recall children who received subpotent DTaP vaccine. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Kurilo MB. Oregon’s ALERT Immunization information system: striving to meet the needs of school law. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Kurilo MB. Measuring adolescent data capture in Oregon’s IIS sentinel region. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Lawrence GL, Hull BP, MacIntyre CR, McIntyre PB. Reasons for incomplete immunisation among Australian children. A national survey of parents. Aust Fam Physician 2004;33(7):568-71.

Lawrence GL, MacIntyre CR, Hull BP, McIntyre PB. Measles vaccination coverage among five-year-old children: implications for disease elimination in Australia.Aust NZ J Public Health 2003;27(4):413-8.

Lawrence GL, MacIntyre CR, Hull BP, McIntyre PB. Effectiveness of the linkage of child care and maternity payments to childhood immunisation. Vaccine 2004;22(17-18):2345-50.

LeBaron CW, Starnes DM, Rask KJ. The impact of reminder-recall interventions on low vaccination coverage in an inner-city population. Arch Pediatr Adolesc Med 2004;158(3):255-61.

LeBeau T. VFC vaccine accountability through a statewide registry: South Dakota’s experience. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

LeBeau T. Utilizing a statewide immunization information system and GIS mapping software to determine pockets of need. Paper presented at: Vaccine University; May 28-30, 2008; Baltimore, MD.

Ledezma E. Characteristics of populations delaying scheduled immunizations within Bexar County, Texas. Paper presented at: 39th National Immunization Conference; March 20-24, 2005; Washington, DC.

Lister S, McIntyre PB, Burgess MA, O’Brien ED. Immunisation coverage in Australian children: a systematic review 1990-1998. Commun Dis Intell 1999;23(6):145-70.

LoMurray K. Assessing vaccination coverage of American Indian children using the North Dakota immunization information system. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

LoMurray K, Sander M. Using the North Dakota Immunization Information System to determine adolescent vaccination rates and uptake. Public Health Rep 2011;126(Suppl 2):78-86.

Ma KK, Schaffner W, Colmenares C, Howser J, Jones J, Poehling KA. Influenza vaccinations of young children increased with media coverage in 2003. Pediatrics 2006;117(2):e157-63.

Maerz TR. Streamlining vaccine ordering and improving VFC accountability the role of registries. Paper presented at: 39th National Immunization Conference; March 20-24, 2005; Washington, DC.

Mahon BE, Shea KM, Dougherty NN, Loughlin AM. Implications for registry-based vaccine effectiveness studies from an evaluation of an immunization registry: a cross-sectional study. BMC Public Health 2008;8:160.

Malcolm RL, Ludwick L, Brookes DL, Hanna JN. The investigation of a ‘cluster’ of hepatitis B in teenagers from an indigenous community in North Queensland.Aust NZ J Public Health 2000;24(4):353-5.

Markey P, Krause V, Boslego JW, Coplan PM, Dargan JM, Kaplan KM. The effectiveness of Haemophilus influenzae type b conjugate vaccines in a high risk population measured using immunization register data. Epidemiol Infect 2001;126(1):31-6.

McCall WW. The easy button: collaborating with statewide immunization information systems to reduce the stress of the ‘back to school’ rush. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

McIntyre PB, Heath TC, O’Brien ED, Hull BP. National immunisation coverage interpreting the first three quarterly reports from the ACIR. Commun Dis Intell 1998;22(6):111-2.

Melinkovich P, Hammer A, Staudenmaier A, Berg M. Improving pediatric immunization rates in a safety-net delivery system. Jt Comm J Qual Patient Saf 2007;33(4):205-10.

Mennito SH DP. Impact of practice policies on pediatric immunization rates. J Pediatr 2010;156:618-22.

Metroka A. Accounting for H1N1 vaccine using the NYC IIS. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Metroka AE, Hansen MA, Papadouka V, Zucker JR. Using an immunization information system to improve accountability for vaccines distributed through the Vaccines for Children program in New York City, 2005-2008. J Public Health Manag Pract 2009;15(5):E13-21.

Mickle-Hope MA. Using an IIS to assess immunization coverage: the NYC experience. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Mosquera MC. Evaluating immunization coverage in NYC by geographic area. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Muhammad RD. Using IIS to evaluate effectiveness of pneumococcal conjugate vaccine among children Paper presented at: 59th EIS Conference; April 19-23, 2010; Atlanta, GA.

Muscoplat M. Patient follow-up in high risk areas using IIS. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Nguyen M. Mapping immunization rates. Paper presented at: Pediatric Academic Societies annual meeting; May 3-6, 2008; Honolulu, HI.

Niedner D. Using a state immunization registry to identify parents with invalid vaccinations. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

O’Connor AC, Layton CM, Osbeck TJ, Hoyle TM, Rasulnia B. Health plan use of immunization information systems for quality measurement. Am J Manag Care 2010;16(3):217-24.

O’Hallahan J, McNicholas A, Galloway Y, O’Leary E, Roseveare C. Delivering a safe and effective strain-specific vaccine to control an epidemic of group B meningococcal disease. NZ Med J 2009;122(1291):48-59.

Olson JJ, Mannenbach MS, Moore BR, Smith VD, Rosekrans JA, Jacobson RM. A reexamination of the feasibility of the administration of routine childhood vaccines in emergency departments in the era of electronic vaccine registries. Pediatr Emerg Care 2005;21(9):565-7.

Ortega AN, Stewart DC, Dowshen SA, Katz SH. The impact of a pediatric medical home on immunization coverage. Clin Pediatr (Phila) 2000;39(2):89-96.

Pabst L. Achieving full vaccination coverage with influenza vaccine among children 6-59 months IIS sentinel sites, 2007-8 influenza season. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Papadouka V. Accuracy and completeness of immunization registry data: a comparison with chart data. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Papadouka V. Impact of childhood hepatitis A vaccination. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

Papadouka V, Metroka A, Zucker JR. Using an immunization information system to facilitate a vaccine recall in New York City, 2007. J Public Health Manag Pract 2011;17(6):565-8.

Papadouka V, Schaeffer P, Metroka A, Borthwick A, Tehranifar P, Leighton J, et al. Integrating the New York citywide immunization registry and the childhood blood lead registry. J Public Health Manag Pract 2004;Suppl:S72-80.

Pati S. Does maternal health literacy predict immunization status? Paper presented at: Pediatric Academic Societies annual meeting; May 3-6, 2008; Honolulu, HI.

Phibbs SL, Hambidge SJ, Steiner JF, Davidson AJ. The impact of inactive infants on clinic-based immunization rates. Ambul Pediatr 2006;6(3):173-7.

Philbrick T. Accountability thorough technology: Making every dose count. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Pierce A. Matching school immunization records to NDIIS Data. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Pitman JP. Linking immunization registries and geographic information systems (GIS) to detect areas of low immunization coverage (PON). Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Placzek H, Madoff LC. The use of immunization registry-based data in vaccine effectiveness studies. Vaccine 2011;29(3):399-411.

Potter R. An IIS and provider education partnership: results of a pilot study. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Powers ME. Immunization rates among children of adolescent mothers. Paper presented at: Pediatric Academic Societies annual meeting; May 5-8, 2007; Toronto, Canada.

Rasmussen L. Use of the Arizona State IIS (ASIIS) during the Pima county (Tucson, Arizona) measles outbreak. In: SnapShots; NewYork, NY: American Immunization Registry Association; 2008:8.

Rasmussen L. Using Arizona’s IIS to collect Hepatitis A/B immunizations given to vulnerable populations. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Rasulnia B. Using IIS data to assess clinical and operational processes for improving immunization coverage among 19-35 month olds. Paper presented at: Pediatric Academic Societies annual meeting; May 3-6, 2008; Honolulu, HI.

Reader-Jolley D. Statewide rollout of online vaccine ordering: lessons learned and best practices. Paper presented at: 45th National Immunization Conference; March 28-31, 2011;Washington, DC.

Renfrew BL, Kempe A, Lowery NE, Chandramouli V, Steiner JF, Berman S. The impact of immunization record aggregation on up-to-date rates implications for immunization registries in rural areas. J Rural Health 2001;17(2):122-6.

Robison SG. A practical method of estimating county and local immunization rates from the Oregon ALERT registry. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Robison SG. Enhancing state and local immunization surveillance by partnering with payors: an example from Oregon and the Oregon health plan. Paper presented at: 44th National Immunization Conference April 19-20; 2010; Atlanta, GA.

Robison SG, Kurosky SK, Young CM, Gallia CA, Arbor SA. Immunization milestones: a more comprehensive picture of age-appropriate vaccination. J Biomed Biotechnol2010;2010:916525.

Rosen D. A quality improvement system to reduce the rate of invalid immunizations. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008; Atlanta, GA.

Rucinski D. Improving data quality of electronic registries. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Ryan MA, Smith TC, Sevick CJ, Honner WK, Loach RA, Moore CA, et al. Birth defects among infants born to women who received anthrax vaccine in pregnancy. Am J Epidemiol 2008;168(4):434-42.

Sabnis SS. Improving influenza vaccination rates: the effectiveness of intervention at an inner-city academic practice. Paper presented at: Pediatric Academic Societies annual meeting; April 29-May 2, 2006; San Francisco, CA.

Sahni LC, Boom JA, Patel MM, Baker CJ, Rench MA, Parashar UD, et al. Use of an immunization information system to assess the effectiveness of pentavalent rotavirus vaccine in US children. Vaccine 2010;28(38):6314-7.

Salmon DA, Akhtar A, Mergler MJ, Vannice KS, Izurieta H, Ball R, et al. Immunization-safety monitoring systems for the 2009 H1N1 monovalent influenza vaccination program. Pediatrics 2011;127 Suppl 1:S78-86.

Sanchez SJ. Integrating IIS with AFIX to improve feedback and follow-up. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Sander M. Lessons learned: billing insurance at local public health units in North Dakota. 45th National Immunization Conference; Washington (DC); 2011.

Sandler M. An effective early childhood immunization program: One community’s fifteen year experience. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008; Atlanta. GA.

Sans D. Using incentive programs to improve private provider participation in registry programs. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Santilli L. Bringin’ them out of the woodworks: H1N1 and NYSIIS participation. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Sathya B. Vaccination coverage of children in the city of Philadelphia shelter system. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Saville AW, Albright K, Nowels C, Barnard J, Daley MF, Stokley S, et al. Getting under the hood: exploring issues that affect provider-based recall using an immunization information system. Acad Pediatr 2011;11(1):44-9.

Sawyer M. What’s going on out there? Measuring the use of alternative immunization schedules. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Sayer N. Keeping Track of Idaho’s TOTS. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Schauer SL. Evaluation of the impact of rotavirus vaccine on acute care visits, hospitalizations and laboratory testing in Wisconsin, 2002-2008. Washington, DC: APHA; 2009.

Schauer SL, Maerz TR, Hurie MB, Gabor GW, Flynn JM, Davis JP. The use of an immunization information system to establish baseline childhood immunization rates and measure contract objectives. J Public Health Manag Pract 2009;15(5):E6-12.

Scholz S. Increasing childhood immunization rates. Milwaukee, WI: Aurora Health Care; 2000.Schwarz K, Garrett B, Lamoreux J, Bowser YD, Weinbaum C, Alter MJ. Hepatitis B vaccination rate of homeless children in Baltimore. J Pediatr Gastroenterol Nutr 2005;41(2):225-9.

Scott JW. The river center shelter mass vaccination clinic. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Shinall MC Jr PE, Poehling KA. Validity of parental report of influenza vaccination in children 6 to 59 months of age. Paper presented at: Pediatric Academic Societies annual meeting; April 29-May 2, 2006; San Francisco, CA.

Siegler PA. Increasing adult pneumococcal immunization rates through innovative software applications and collaborative efforts. Paper presented at: 40th National Immunization Conference; March 6-9, 2006; Atlanta, GA.

Skiles MP. Improving immunization rates among WIC clients: how an immunization registry helped. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008; Atlanta, GA.

Slater S. Timely immunization in Texas and barriers parents face. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Stecher DS, Adelman R, Brinkman T, Bulloch B. Accuracy of a state immunization registry in the pediatric emergency department. Pediatr Emerg Care 2008;24(2):71-4.

Stille CJ, Christison-Lagay J. Determining immunization rates for inner-city infants: statewide registry data vs medical record review. Am J Public Health 2000;90(10):1613-5.

Stockwell MS. How parents’ experiences at immunization visits affects child immunization status. Paper presented at: Pediatric Academic Societies annual meeting; May 2-5, 2009; Baltimore, MD.

Stockwell MS. Integrating electronic information to improve documentation of immunization rates for a low-income, minority population. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Stockwell MS. Text4Health: Effectiveness of immunization registry-linked text message reminders on adolescent immunization coverage. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Stockwell MS. FluText: using text messaging to promote timely flu vaccination in an undeserved child population. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Stockwell MS, Brown J, Chen S, Vaughan RD, Irigoyen M. Is underimmunization associated with child maltreatment? Ambul Pediatr 2008;8(3):210-13.

Suh CA, Saville A, Daley MF, Glazner JE, Barrow J, Stokley S, et al. Effectiveness and net cost of reminder/recall for adolescent immunizations. Pediatrics 2012;129(6):e1437-45.

Swanson R. Michigan’s Experience implementing VTrckS using EXIS. Papers presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Tatley MV, Kunac DL, McNicholas A, Zhou L, Ballantyne S, Ashton J, et al. The Intensive Vaccines Monitoring Programme (IVMP): an electronic system to monitor vaccine safety in New Zealand. Vaccine 2008;26(22):2746-2752.

Therrell BL, Jr. Data integration and warehousing: coordination between newborn screening and related public health programs. Southeast Asian J Trop Med Public Health 2003;34 Suppl 3:63-8.

Thomas C. Evaluating and decreasing disparities using an IIS in a sentinel site school-age population. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

Tichy K. An integrated approach to a statewide IIS. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008; Atlanta, GA.

Torvaldsen S, Hull BP, McIntyre PB. Using the Australian Childhood Immunisation Register to track the transition from whole-cell to acellular pertussis vaccines. Commun Dis Intell 2002;26(4):581-3.

Tropper J. Monitoring Influenza A (H1N1) Monovalent vaccine doses administered using CDC’s countermeasure and response administration system: Lessons learned. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Urquhart GA, Williams W, Tobias J, Welch FJ. Immunization information systems use during a public health emergency in the United States. J Public Health Manag Pract 2007;13(5):481-5.

Vlack S, Foster R, Menzies R, Williams G, Shannon C, Riley I. Immunisation coverage of Queensland indigenous two-year-old children by cluster sampling and by register. Aust NZ J Public Health 2007;31(1):67-72.

Wake L. Comparing school immunization records to provider records. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

Wake L. Comparing school immunization exemptions to registry records. Paper presented at: 44th National Immunization Conference; April 19-20, 2010; Atlanta, GA.

Wells WH. Utilizing links to improve immunization status of children admitted to the children’s hospital of LSUHSC-Shreveport. Paper presented at: Pediatric Academic Societies annual meeting; May 3-6, 2008; Honolulu, HI.

Wester R. Streamlining school immunization compliance reporting through an IIS. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington,DC.

White KE, Anderson J, Stanley M, Ehresmann K. Evaluating hepatitis B universal birth dose vaccination at Minnesota birthing hospitals by utilizing immunization information systems, birth certificates, and chart reviews, 2007-2008. J Public Health Manag Pract 2009;15(6):464-70.

White KE, Pabst LJ, Cullen KA. Up-to-date Haemophilus influenzae type b vaccination coverage during a vaccine shortage. Pediatrics 2011;127(3):e707-12.

Wolicki J. Using IIS to educate immunization providers on safe and effective vaccine administration. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Yawn BP, Schroeder C, Wollan P, Rocca L, Zimmerman R, Bardenheier B. Immediate and longer term impact of the varicella shortage on children 18 and 24 months of age in a community population. BMC Fam Pract 2006;7:51.

Young CM. Immunization rates among Oregon Medicaid and WIC participants. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Zimmerman CM, Mickle-Hope MA, Papadouka V, et al. Validation of an immunization information system against the National Immunization Survey and improvement of Hepatitis B birth dose coverage in New York City. Paper presented at: 42nd National Immunization Conference; March 17-20, 2008; Atlanta, GA.

Zimmerman CM. The epidemiology of measles in New York City (NYC) in 2008 and the use of an immunization information system (IIS) in outbreak control. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Zimmerman L. Assessing extra immunization among children using IIS. Paper presented at: 41st National Immunization Conference; March 5-8, 2007; Kansas City, MO.

Zucker JR. Use of an IIS to facilitate timely recall of potentially contaminated vaccine. Paper presented at: 43rd National Immunization Conference; March 30-April 2, 2009; Dallas, TX.

Zucker JR. H1N1 Influenza vaccine distribution and reporting in NYC. Paper presented at: 45th National Immunization Conference; March 28-31, 2011; Washington, DC.

Economic Review

Bartlett DL. Cost savings associated with using immunization information systems for vaccines for children administrative tasks. J Public Health Manag Pract 2007;13(6):559.

Bartlett DL, Molinari NAM, Ortega-Sanchez IR, Urquhart GA. Economics of immunization information systems in the United States: assessing costs and efficiency. Cost Effectiveness and Resource Allocation 2006;4(1):15.

Boom JA, Dragsbaek AC, Nelson CS. The success of an immunization information system in the wake of Hurricane Katrina. Pediatrics 2007;119(6):1213-7.

Florida Bureau of Immunization. Florida SHOTS Time Savings Study results; 2009.

Fontanesi JM, Flesher Jr DS, De Guire M, Lieberthal A, Holcomb K. The cost of doing business: cost structure of electronic immunization registries. Health Serv Res 2002;37(5):1291-307.

Glazner JE, Beaty BL, Pearson KA, Lowery NE, Berman S. Using an immunization registry: effect on practice costs and time. Ambul Pediatr 2004;4(1):34-40.

Horne PR, Saarlas KN, Hinman AR. Costs of immunization registries: experiences from the All Kids Count II projects. Am J Prev Med 2000;19(2):94-8.

McKenna VB, Sager A, Gunn JE, Tormey P, Barry MA. Immunization registries: costs and savings. Public Health Rep 2002;117(4):386.

O’Connor AC, Layton CM, Osbeck TJ, Hoyle TM, Rasulnia B. Health plan use of immunization information systems for quality measurement-page 2. Health 2010;16:217-24.

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(2):99-103.

Rask KJ, Wells KJ, Kohler SA, Rust CT, Cangialose CB. Measuring immunization registry costs: promises and pitfalls. Am J Prev Med 2000;18(3):262-7.

Slifkin RT, Freeman VA, Biddle AK. Costs of developing childhood immunization registries: Case studies from four All Kids Count Projects. J Public Health Manag Pract 1999;5:67-81.

Urquhart GA, Williams W, Tobias J, Welch FJ. Immunization information systems use during a public health emergency in the United States. J Public Health Manag Pract 2007;13(5):481-5.

Virginia Department of Health. 12 VAC 5-115- Virginia Immumization Information System Economic Impact Analysis. Virginia Department of Planning and Budget. Virginia Register of Regulations 2012;29(6). Available at URL:http://register.dls.virginia.gov/details.aspx?id=3286.

The team conducted a broad literature search to identify studies evaluating the effectiveness of an IIS or population based vaccination database, or the effectiveness of an intervention generated from an IIS, or describe an IIS capability linked to increasing vaccination rates or reducing vaccine-preventable disease. The following 9 databases were searched during the period of January 1994 up to April 2011: CABI, CINAHL, TheCochrane Library, EMBASE, ERIC,MEDLINE, PsycINFO, Sociological Abstracts, andWeb of Science. Reference lists of articles reviewed as well as lists in review articles were also searched, and subject matter experts were consulted for additional references.

The team also included an assessment of unpublished US literature in the form of conference abstracts. Abstracts presented at 4 selected conferences (Immunization Registry Conference; National Immunization Conference, Pediatric Academic Society, Vaccine University) in the United States were searched during the period January 2002 to April 2011. To be included in the review, a study had to:

• Have a publication date of 1994-2011
• Evaluate vaccinations recommended for children, adolescents, and/or adults
• Meet the evidence review and Guide chapter development team’s definition of the interventions
• Be a primary research publication or US conference abstract with 1 or more outcomes related to the analytic frameworks
• Take place in a high-income country or countries
• Be written in English
• Report 1 or more quantitative outcomes (changes in vaccination rates, coverage, or uptake; reductions in missed opportunities) or describe system capabilities linked to increasing vaccinations or reducing vaccine-preventable disease

Effectiveness Review

Search Terms

MeSH (Medical SubjectHeadings) were exploded to include all related subject headings. British spelling variations, plurals, title, abstract, and keywords were searched in the non-MEDLINE databases as well.

1. Immunization
2. Vaccination
3. Immunization information system
4. Immunization registry
5. Vaccination registry

Economic Review

To examine the economic effectiveness of IIS in improving vaccination rates, a systematic review of the economic evidence was conducted. The search period of the economic literature was from January 1994 to March 2012.

In addition to the databases searched in the effectiveness review (i.e., The Cochrane Library; MEDLINE; CINAHL; PsycInfo; ERIC; Sociological Abstracts; Web of Knowledge; EMBASE; and CAB International), EconLit, Social Sciences Citations Index, JSTOR, and Google also were used.

Search Terms

Economic-specific keywords listed below were combined with effectiveness search terms.

1. Cost
2. Cost-benefit
3. Cost-effectiveness
4. Cost-utility

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

• Many systems rely on voluntary participation of vaccination providers. Accordingly, the completeness (and subsequent utility) of data are dependent on the extent and timeliness of provider reporting.
• Client participation and confidentiality requirements may limit the ways in which IIS data can be entered, retrieved, or used for clinical and public health purposes.
• Vaccination providers have expressed concerns over technological constraints, as well as time and staffing required to enter complete and timely reports into the system.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Increase the proportion of people with vaccination records in an information system — IID‑D02
• Reduce the proportion of children who get no recommended vaccines by age 2 years — IID‑02
• Maintain the vaccination coverage level of 1 dose of the MMR vaccine in children by age 2 years — IID‑03
• Maintain the vaccination coverage level of 2 doses of the MMR vaccine for children in kindergarten — IID‑04
• Increase the coverage level of 4 doses of the DTaP vaccine in children by age 2 years — IID‑06
• Increase the proportion of people who get the flu vaccine every year — IID‑09
• Increase the proportion of adults age 19 years or older who get recommended vaccines — IID‑D03