Robert W. Linkins

The Impact of Computer-Generated Messages on Childhood Immunization Coverage

Introduction: Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life.Design: Randomized, controlled trial.Setting: County health department in the Denver metropolitan area.Study Participants: Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines.Intervention: Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s).Main Outcome Measure: Immunization series completion at 24 months of age.Results: Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = 1.21; CI [confidence interval] =1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was

A review of state legislation related to immunization registries1

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Assessing immunization registry data completeness in Bexar County, Texas

79 after start-up costs were discounted). Conclusion: Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.

A World Without Polio

BACKGROUND Since the early 1990s, a concerted effort has been made to develop community- and state-based immunization registries. A 1995 survey showed that nine states had laws specifically authorizing immunization registries. This survey was conducted to describe the current status of legislation and policies addressing immunization registries and the sharing of immunization information. METHODS A telephone survey was administered from September 1997 to February 1998 to immunization program managers and/or their designees within the state health department of each of the 50 states and the District of Columbia. Some of the survey items were later updated through follow-up interviews and informal communications. Copies of legislation, administrative rules and regulations, and immunization registry policies were collected for review. RESULTS As of October 2000, 24 of 51 states (47%) had laws (21) or rules (3) specifically authorizing an immunization registry. Nine additional states (18%) have laws specifically addressing the sharing of immunization information. CONCLUSIONS Over half of the states have enacted legislation or rules addressing registries or the sharing of immunization information. Further research should be conducted to assess the impact of this legislation on immunization registries.

Support for immunization registries among parents of vaccinated and unvaccinated school-aged children: a case control study

BACKGROUND Immunization information systems (or registries) are increasingly being used to promote and sustain high levels of vaccination coverage. However, the perception among many providers that registry data are too incomplete to be relied on when making immunization decisions has impeded the acceptance of registries. METHODS To evaluate registry completeness, immunization coverage levels from the San Antonio Immunization Registry System (SAIRS) were compared with coverage levels derived from immunization records from 77 (37%) of the 210 clinics participating in the Vaccines for Children (VFC) program in 1998, 44 (21%) clinics in 1999, and 10 (5%) clinics in 2000. RESULTS Clinic data indicated an average immunization coverage level for the 4:3:1 series of 39.8%. The overall coverage level for these clinics based on registry data was 64.1%. Registry-coverage levels for these clinics were < or =65% above the coverage levels based on clinic records. CONCLUSIONS Immunization coverage levels based on SAIRS data were the same or higher than coverage levels based on clinic records. These data suggest that San Antonios registry data were more complete than clinic records and may assist in changing provider perceptions regarding registry data completeness.

The impact of computer-generated messages on childhood immunization coverage21In the article entitled “The Impact of Computer-Generated Messages on Childhood Immunization Coverage” by Eugene F. Dini et al., several errors occurred. Below is the text as it should have appeared. COMP: p/u from article 319, see hard copy22Publisher’s note: The publisher regrets the errors in the text.

Stephen L. Cochi, Hamid S. Jafari, Gregory L. Armstrong, Roland W. Sutter, Robert W. Linkins, Mark A. Pallansch, Olen Kew, and R. Bruce Aylward Global Immunization Division, and Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Polio Operations and Research Department, and Office of the Assistant Director-General, Polio and Emergencies, World Health Organization, Geneva, Switzerland

Optimal schedule for the administration of oral poliovirus vaccine

BackgroundImmunizations have reduced childhood vaccine preventable disease incidence by 98–100%. Continued vaccine preventable disease control depends on high immunization coverage. Immunization registries help ensure high coverage by recording childhood immunizations administered, generating reminders when immunizations are due, calculating immunization coverage and identifying pockets needing immunization services, and improving vaccine safety by reducing over-immunization and providing data for post-licensure vaccine safety studies. Despite substantial resources directed towards registry development in the U.S., only 48% of children were enrolled in a registry in 2004. Parental attitudes likely impact child participation. Consequently, the purpose of this study was to assess the attitudes of parents of vaccinated and unvaccinated school-aged children regarding: support for immunization registries; laws authorizing registries and mandating provider reporting; opt-in versus opt-out registry participation; and financial worth and responsibility of registry development and implementation.MethodsA case control study of parents of 815 children exempt from school vaccination requirements and 1630 fully vaccinated children was conducted. Children were recruited from 112 elementary schools in Colorado, Massachusetts, Missouri, and Washington. Surveys administered to the parents, asked about views on registries and perceived utility and safety of vaccines. Parental views were summarized and logistic regression models compared differences between parents of exempt and vaccinated children.ResultsSurveys were completed by 56.1% of respondents. Fewer than 10% of parents were aware of immunization registries in their communities. Among parents aware of registries, exempt children were more likely to be enrolled (65.0%) than vaccinated children (26.5%) (p value = 0.01). A substantial proportion of parents of exempt children support immunization registries, particularly if registries offer choice for participation. Few parents of vaccinated (6.8%) and exempt children (6.7%) were aware of laws authorizing immunization registries. Support for laws authorizing registries and requiring health care providers to report to registries was more common among parents of vaccinated than exempt children. Most parents believed that the government, vaccine companies or insurance companies should pay for registries.ConclusionParental support for registries was relatively high. Parental support for immunization registries may increase with greater parental awareness of the risks of vaccine preventable diseases and utility of vaccination.

Hepatitis A and hepatitis B infection prevalence and associated risk factors in men who have sex with men, Bangkok, 2006–2008

INTRODUCTION Recent evaluations of computer-generated reminder/recall messages have suggested that they are an inexpensive, labor-saving method of improving office visitation rates of childhood immunization providers. This study assesses the sustained impact of computer-generated messages on immunization coverage during the first two years of life. DESIGN Randomized, controlled trial. SETTING County health department in the Denver metropolitan area. STUDY PARTICIPANTS Children (n = 1227) 60 to 90 days of age who had received the first dose of diphtheria-tetanus-pertussis (DTP) and/or poliovirus vaccines. INTERVENTION Households of children were randomized into four groups to receive: telephone messages followed by letters (Group A); telephone messages alone (Group B); letters only (Group C); or no notification (Group D). Households in the intervention groups (A, B, and C) received up to five computer-generated telephone messages and/or up to four letters each time their children became due for immunization(s). MAIN OUTCOME MEASURE Immunization series completion at 24 months of age. RESULTS Children whose families were randomized to receive any of the interventions were 21% more likely to have completed the immunization series by 24 months of age than were children randomized into the control group (49.2% vs 40.9%; RR [rate ratio] = .21; CI [confidence interval] = 1.01, 1.44). While not statistically significant, children in Group A were 23% more likely to complete their immunization series by 24 months of age than those in the control group (50.2% vs 40.9%; RR = 1.23; CI = 1.00, 1.52). No differences were detected among the intervention groups. The costs per additional child completing the series by 24 months of age in Group A was

Prevalence of Asymptomatic Poliovirus Infection in Older Children and Adults in Northern India: Analysis of Contact and Enhanced Community Surveillance, 2009

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Poliovirus vaccine formulations

79 after start-up costs were discounted). CONCLUSION Computer-generated contacts, either by phone or by mail (or both combined), used each time vaccines become due, are efficacious in increasing immunization coverage of children under 2 years of age.