Electronic Immunization Registry Research Articles

Hepatitis A Exposure Response and Outbreak Prevention in a Large Urban Jail - Los Angeles County, California, May-July 2023.

Correctional settings provide a high-risk environment for hepatitis A transmission because of the high proportion of homelessness and injection drug use among persons who are incarcerated. On May 30, 2023, Los Angeles County Department of Public Health informed the Communicable Disease Surveillance and Control (CDSC) unit of the Los Angeles County Jail system that a symptomatic incarcerated person had received a positive test result for acute hepatitis A. Upon learning the next day that the patient was a food handler, CDSC staff members identified 5,830 potential contacts of the index patient, 1,702 of whom had been released from the jail. During June 1-12, a total of 2,766 contacts who did not have a documented history of hepatitis A serology or vaccination that could be confirmed from the electronic health record or state immunization registry were identified. These persons were offered hepatitis A vaccination as postexposure prophylaxis; 1,510 (54.6%) accepted vaccination. Contacts who were food handlers without confirmed evidence of immunity and who declined vaccination were removed from food-handling duties for the duration of their potential incubation period. No additional cases were identified. Identifying contacts promptly and using immunization and serology records to ensure rapid delivery of postexposure prophylactic vaccine can help prevent hepatitis A transmission during exposures among incarcerated populations.

Need for open data on COVID-19 vaccine uptake among pregnant people in the Caribbean: a call to action.

Pregnant people with coronavirus disease 2019 (COVID-19) have a higher risk of adverse maternal and fetal outcomes compared with pregnant people without COVID-19. In 2021, large increases in maternal mortality were reported in Jamaica, almost half of which were attributable to COVID-19. COVID-19 vaccination has been shown to reduce these risks, but low- and middle-income countries lack free, publicly available data, known as open data, on COVID-19 vaccine uptake for their pregnant populations. The objectives of this paper were to: review how high-income countries use open data to detect trends in COVID-19 vaccine uptake among pregnant people and develop vaccination distribution strategies; outline barriers to making open data available for maternal COVID-19 vaccination in the Caribbean; and propose a multipronged strategy that would increase the availability of open data on maternal COVID-19 vaccination in the Caribbean. A multipronged strategy to fill the data void would involve: (i) utilizing existing Caribbean maternal immunization data collection entities; (ii) adapting digital software tools to establish maternal electronic immunization registries; and (iii) collaborating with local partners skilled in data analytics. Making open data available for COVID-19 vaccine uptake among pregnant people in the Caribbean could offer substantial benefits, including the development of measurable maternal COVID-19 vaccination goals and the facilitation of vaccine decision-making discussions between providers and pregnant people.

Methodological changes implemented over time to support accurate and timely COVID-19 vaccine coverage estimates: Ontario, Canada.

The COVID-19 vaccination program implementation in Ontario, Canada has spanned multiple years and is ongoing. To meet the challenges of the program, Ontario developed and implemented a new electronic COVID-19 immunization registry, COVaxON, which captures individual-level data on all doses administered in the province enabling comprehensive coverage assessment. However, the need for ongoing COVID-19 vaccine coverage assessments over a multi-year vaccination program posed challenges necessitating methodological changes. This paper describes Ontario's COVID-19 immunization registry, the methods implemented over time to allow for the ongoing assessment of vaccine coverage by age, and the impact of those methodological changes. Throughout the course of the vaccination program, four different methodological approaches were used to calculate age-specific coverage estimates using vaccination data (numerator) obtained from COVaxON. Age-specific numerators were initially calculated using age at time of first dose (method A), but were updated to the age at coverage assessment (method B). Database enhancements allowed for the exclusion of deceased individuals from the numerator (method C). Population data (denominator) was updated to 2022 projections from the 2021 national census following their availability (method D). The impact was most evident in older age groups where vaccine uptake was high. For example, coverage estimates for individuals aged 70-79years of age for at least one dose decreased from 104.9% (method B) to 95.0% (method D). Thus, methodological changes improved estimates such that none exceeded 100%. Ontario's COVID-19 immunization registry has been transformational for vaccine program surveillance. The implementation of a single registry for COVID-19 vaccines was essential for comprehensive near real-time coverage assessment, and enabled new uses of the data to support additional components of vaccine program surveillance. The province is well positioned to build on what has been achieved as a result of the COVID-19 pandemic and expand the registry to other routine vaccination programs.

Using geographic information system to track children and optimize immunization coverage and equity in Karachi, Pakistan.

Despite the potential of geospatial technologies to track and monitor coverage, they are underutilized for guiding immunization program strategy and implementation, especially in low-and-middle-income countries. We conducted geospatial analysis to explore the geographic and temporal trends of immunization coverage, and examined the pattern of immunization service access (outreach and facility based) by children. We extracted data to analyze coverage rates across different dimensions (by enrolment year, birth year and vaccination year) from 2018 till 2020 in Karachi, Pakistan using the Sindh Electronic Immunization Registry (SEIR). We conducted geospatial analysis to assess variation in coverage rates of BCG, Pentavalent (Penta)-1, Penta-3, and Measles-1 vaccines using Government targets. We also analyzed the proportion of children receiving their routine vaccinations at fixed centers and outreach and examined whether children received vaccinations at the same or multiple immunization centers. A total of 1,298,555 children were born, enrolled or vaccinated from 2018 till 2020. At the district level, analysis by enrollment and birth year showed coverage increased between 2018 and 2019 and declined in 2020, while analysis by vaccination year showed consistent increase in coverage. However, micro-geographic analysis revealed pockets where coverage persistently declined. Notably 27/168, 39/168 and 3/156 Union councils showed consistently declining coverage when analyzing by enrollment, birth and vaccination year respectively. More than half (52.2%, 678,280/1,298,555) of the children received all their vaccinations exclusively through fixed centers and, 71.7% (499,391/696,701) received all vaccinations from the same centers. Despite overall improving vaccination coverage between 2018 and 2020, certain geographic areas have consistently declining coverage rates, which is detrimental for equity. Making immunization inequities visible through geospatial analysis is the first step to ensure resources are allocated optimally. Our study provides impetus for immunization programs to develop and invest in geospatial technologies, harnessing its potential for improved coverage and equity.

Leveraging Electronic Immunization Registry to monitor the two-year impact of COVID-19 on uptake of routine immunizations in children under 2 years of age in Sindh, Pakistan: insights from big data analysis with > 6.9 million children

Leveraging Electronic Immunization Registry to monitor the two-year impact of COVID-19 on uptake of routine immunizations in children under 2 years of age in Sindh, Pakistan: insights from big data analysis with > 6.9 million children

Usability and Acceptability of Electronic Immunization Registry Data Entry Workflows From the Health Care Worker Perspective in Siaya, Kenya (Part 3): Pre-Post Study.

Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate the challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health and the International Training and Education Center for Health Kenya implemented an EIR system in 161 immunizing clinics in Siaya County between 2018 and 2019. The successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the health care workers (HCWs) using the EIR. This study aimed to evaluate HCWs' perceptions of the usability and acceptability of multiple clinic workflows using the new EIR. We performed a mixed methods pre-post study using semistructured interviews with HCWs at 6 facilities in Siaya County, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after the implementation of 3 different workflow modifications (n=24 interviews). The baseline state was dual data entry with paper records and the EIR. We then implemented 3 workflow modifications for 1 full day each: fully paperless data entry, preparation of an appointment diary before patient visits for the day, and a combination of the 2 workflows. We compared ratings and themes across interviews after each of the 4 workflows to understand the changes in the usability and acceptability of the EIR. HCWs considered the EIR clinic workflows to be usable and acceptable. Of the modified workflows, HCWs perceived the fully paperless workflow most favorably. In all workflows, HCWs' perceived benefits included ease of clinical decision-making using the EIR, reduced mental burden of data entry when using the EIR, and ease of identification of errors. Perceived barriers to the workflow included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors in saving records and missing fields, and workflow challenges such as the dual data entry burden of using paper and digital tools simultaneously. Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon the presence of supporting contextual clinic factors and the resolution of system performance and design challenges. Rather than trying to identify a singular best workflow, future efforts should provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Future EIR implementation stands to benefit from continued monitoring of EIR adoption acceptability during implementation, both for Siaya's program and for other efforts around the globe, as digital health interventions become more widely used.

Immunization Gender Inequity in Pakistan: An Analysis of 6.2 Million Children Born from 2019 to 2022 and Enrolled in the Sindh Electronic Immunization Registry

Gender-based inequities in immunization impede the universal coverage of childhood vaccines. Leveraging data from the Government of Sindh's Electronic Immunization Registry (SEIR), we estimated inequalities in immunization for males and females from the 2019-2022 birth cohorts in Pakistan. We computed male-to-female (M:F) and gender inequality ratios (GIR) Tfor enrollment, vaccine coverage, and timeliness. We also explored the inequities by maternal literacy, geographic location, mode of vaccination delivery, and gender of vaccinators. Between 1 January 2019, and 31 December 2022, 6,235,305 children were enrolled in the SEIR, 52.2% males and 47.8% females. We observed a median M:F ratio of 1.03 at enrollment and at Penta-1, Penta-3, and Measles-1 vaccinations, indicating more males were enrolled in the immunization system than females. Once enrolled, a median GIR of 1.00 indicated similar coverage for females and males over time; however, females experienced a delay in their vaccination timeliness. Low maternal education; residing in remote-rural, rural, and slum regions; and receiving vaccines at fixed sites, as compared to outreach, were associated with fewer females being vaccinated, as compared to males. Our findings suggeste the need to tailor and implement gender-sensitive policies and strategies for improving equity in immunization, especially in vulnerable geographies with persistently high inequalities.

Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study of Modified User Workflows.

Digital health interventions have the potential to improve the provision of health care services through digitized data collection and management. Low- and middle-income countries are beginning to introduce electronic immunization registries (EIRs) into their routine immunization services to better capture and store childhood vaccination information. Especially in Africa, where 25% of children remain unimmunized or underimmunized, technologies that can help identify children due for a vaccination are particularly important for improving vaccination coverage. However, an improved understanding of the effectiveness of these systems is needed to develop and deploy sustainable EIRs in low- and middle-income countries. We conducted an interventional pretest-posttest design study that sought to improve time efficiency through workflow modifications in Kenyan immunization clinics. Our aim was to describe how activity times differed after introducing workflow modifications that could potentially reduce the time needed to perform routine data entry activities. Our intent was to demonstrate changes in efficiency when moving from the existing dual-data entry workflow to a future paperless workflow by health facility size and experience length of health care workers (HCWs). We tested how 3 workflow modifications would affect time utilization among HCWs using the EIR at the point of care compared with baseline immunization clinic workflows. Our outcome of interest was the time taken to complete individual activities and a patient's total time in the clinic where we compared the time spent during the baseline workflow with that during the modified workflow. We used a standardized tool to observe and document the immunization clinic workflow. To estimate differences in time utilization, we used bivariate analyses and fit multivariate linear mixed-effects models. Our study found that for HCWs using an EIR, the introduction of modified workflows decreased the amount of time needed to provide services to children seen in the immunization clinic. With a baseline mean time of 10 minutes spent per child, this decreased by about 3 minutes when the preparation modification was introduced and almost 5 minutes for the paperless and combined modifications. Results pertaining to the EIR's performance and ability to connect to the internet were particularly insightful about potential causes of delays. We were able to conduct a concise clinical simulation exercise by introducing modified workflows and estimating their impact on time utilization in immunization clinics using an EIR. We found that the paperless workflow provided the largest time savings when delivering services, although this was threatened by poor EIR performance and internet connectivity. This study demonstrated that not only should digital health interventions be built and adapted for particular use cases but existing user workflows also need to adapt to new technology.

Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability.

In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries. In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry's usability. Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers. Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1-ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2-confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3-identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4-make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality. We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users' workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users' needs and again after scale-up to ensure that interventions are suitable for all user settings.

Design, Development, and Deployment of an Electronic Immunization Registry: Experiences From Vietnam, Tanzania, and Zambia.

There is growing interest among low- and middle-income countries to introduce electronic immunization registries (EIRs) that capture individual-level vaccine data. We compare the design, development, and deployment of EIRs in Vietnam, Tanzania, and Zambia. Through desk review and the authors' firsthand implementation experiences, we describe experiences related to timeline, partnerships, financial costs, and technology and infrastructure. The country cases highlight the multi-year timeline required to implement an EIR at scale and the benefit of multiple iterative cycles to pilot and redesign the system before achieving scale. Of the 3 countries, only Vietnam has achieved nationwide scale of the EIR, which took 7 years. In all 3 countries, national government leadership as part of an interdisciplinary team (with experience in leadership, technology, and immunization) was important to ensure country ownership and sustainability. Where international software developers were contracted, partnering with a local software company helped improve responsiveness and sustainability. Across all 3 countries, governments contributed significant in-kind time in addition to investments from donors. Cost savings were observed in Tanzania and Zambia, largely driven by health worker time savings from using the EIR. All 3 case countries underscore the need to understand the local technology and infrastructure context and design the EIR to fit the context. In Vietnam, an initial landscape assessment was conducted to assess technology and infrastructure, whereas in Tanzania and Zambia, user advisory groups provided insights. Existing infrastructure informed EIR design decisions, such as choosing a system with offline functionality in Tanzania and Zambia. All 3 countries have a local partner to provide ongoing technical support. Comparing implementation factors across these cases highlights practical experience and recommendations that complement existing EIR guidance documents. The findings and recommendations from this study can inform other countries considering or in the process of implementing an EIR.

Introduction and implementation of an immunization information system in the Indonesian province of Daerah Istimewa Yogyakarta: lessons for scaling-up

BackgroundImmunization is critical to saving children from infections. To increase vaccination coverage, valid and real-time data are needed. Accordingly, it is essential to have a good report system that serves as defaulter tracking to prevent children's immunization failure. The Daerah Istimewa Yogyakarta (DIY) Health Office introduced an electronic immunization registry and successfully implemented it for more than five years. It is the only individual-based record system in Indonesia that has been sustainably operated for a long time. Yet, no systematic assessment of this system has been conducted to date. This study examines the Sistem Informasi Imunisasi Terpadu (SIMUNDU) introduction and implementation process with a view to extracting lessons that could inform scalability and sustainability across the country.MethodsThis study used an explanatory sequential mixed-method design, which collected quantitative data from 142 participants and qualitative data from nine participants. The data entry clerk at a health facility was systematically selected to participate in the survey, while in the key informant interview, the informant was selected based on the survey result. A descriptive and thematic approach was adopted to analyze the quantitative and qualitative data. Results from across the two approaches were integrated for comparison and contrast.ResultsFindings are presented according to three core themes that emerged from the data: system strengths, potential threats, weakness and opportunities for scaling-up. Strengths, i.e., factors contributing to the success of SIMUNDU, include management, system performance, people’s behavior, and resources. Potential threats to sustaining the system include individual capacity, technical or system issues, and high workload. Opportunities – i.e., a promising factor that influences the SIMUNDU ability to operate sustainably – such as continuity, expectation, and the possibility of scaling up.ConclusionsSIMUNDU is a promising innovation for Indonesia, beyond DIY. There is agreement about the potential for scaling up this IIS to other provinces. The experience of implementing this system in DIY over the past five years has shown that the benefits outweigh the challenges, and SIMUNDU has grown into a robust yet user-friendly system.

Vaccination coverage and immunization safety among children with special health status in Chongqing, China

ABSTRACT Vaccination of children with special health status has become one of the most urgent issues in China. We aim to evaluate vaccination coverage and safety as well as its associated factors among children with special health status in China during 2016‒2020. We conducted a retrospective cohort review of all children with special health status recorded in the Electronic Immunization Registries System in Chongqing, China, between 2016 and 2020. Univariate and multivariate logistic regression analyses were used to analyze the influence factors. Among the 2,175 children with special health status enrolled in the study, the overall vaccination coverage rate was lower than that among the general population, and the incidence of adverse event in them following immunization was very rare. Children with congenital heart disease were better vaccinated (aOR = 1.508–6.331), while most of the jaundice children had missed vaccination (aOR = 0.441‒0.556). The purchase of vaccine compensation insurance was associated with higher completion rate of basic immunization for Bacillus Calmette-G vaccine (aOR = 1.706, 95% CI: 1.249‒2.329) and rotavirus vaccine (aOR = 1.346, 95% CI: 1.061‒1.708). Children with special health status can be safely vaccinated. However, the vaccination coverage in these huge and vulnerable group is too low to protect them from vaccine-preventable diseases through immunization. More researches and interventions should be conducted to ensure a higher vaccination rate among the children with special health status.

Changes in on-time vaccination following the introduction of an electronic immunization registry, Tanzania 2016-2018: interrupted time-series analysis

BackgroundDigital health interventions (DHI) have the potential to improve the management and utilization of health information to optimize health care worker performance and provision of care. Despite the proliferation of DHI projects in low-and middle-income countries, few have been evaluated in an effort to understand their impact on health systems and health-related outcomes. Although more evidence is needed on their impact and effectiveness, the use of DHIs among immunization programs has become more widespread and shows promise for improving vaccination uptake and adherence to immunization schedules.MethodsOur aim was to assess the impact of an electronic immunization registry (EIR) using an interrupted time-series analysis to analyze the effect on proportion of on-time vaccinations following introduction of an EIR in Tanzania. We hypothesized that the introduction of the EIR would lead to statistically significant changes in vaccination timeliness at 3, 6, and > 6 months post-introduction.ResultsFor our primary analysis, we observed a decrease in the proportion of on-time vaccinations following EIR introduction. In contrast, our sensitivity analysis estimated improvements in timeliness among those children with complete vaccination records. However, we must emphasize caution interpreting these findings as they are likely affected by implementation challenges.ConclusionsThis study highlights the complexities of using digitized individual-level routine health information system data for evaluation and research purposes. EIRs have the potential to improve vaccination timeliness, but analyses using EIR data can be complicated by data quality issues and inconsistent data entry leading to difficulties interpreting findings.

An Improved Immunization Record to Support Vaccination During the COVID-19 Pandemic at a University Hospital in Argentina.

WHO and UNICEF highlight vaccination as the most cost-effective method of prevention of infectious diseases. An effective public health strategy requires efficient tracking of vaccination to assess coverage, safety, and efficacy of these vaccines. Paper-based immunization records are still being used in most low and middle-income countries. Adequate Electronic Logistic Management Information Systems, Immunization Registries and Records are crucial for proper data collection and analysis, and for making better decisions at an individual and at a population level. In this paper we share our experience in the redesign of an interoperable immunization record to track vaccination, including the recently developed vaccines for the novel coronavirus SARS-CoV-2 (COVID-19).

Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania

BackgroundThere is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions.ObjectiveThe aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study.MethodsThis study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs.ResultsThe analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine–1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine–1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10% of facilities, indicating the potential for EIRs to target quality improvement efforts.ConclusionsEIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses.

Mobile-based Vaccine Registry to Improve Collection and Completeness of Maternal Immunization Data

Immunization during pregnancy and infancy significantly reduces morbidity and mortality of mothers, unborn fetuses, and young infants. Several studies show the merits of getting complete, quality, and accurate data on time to enhance policy and decision-making for society or country development. Despite the efforts by nations to ensure the success of maternal immunization through electronic immunization registries, limited resources such as poor internet access, shortage of electricity, and digital illiteracy in developing countries hinder the goal of full immunization of mothers and infants. Since 2015, immunization programs in Tanzania use internet-based information systems to collect immunization data from health facilities and submit them to the responsible authority for further decision-making such as the allocation of vaccines to health facilities. The internet-based media is not fully achieved in developing countries due to its cost and resource setting, thus, the responsible authority does not receive instant data to update its vaccine inventory and management activities which often results in partial immunization due to the unavailability of vaccines in some facilities. This challenge can be solved by having an affordable system that instantly incorporates and transmits vaccination details such as the utilization of vaccines and demands from each health facility to responsible authority with less resources. The present study proposes a USSD platform to enhance the receipt of real-time data by immunization authorities from both health facilities with poor and good internet connectivity at a lesser cost. A greater number of health facilities in Tanzania prefer to use both online and offline platforms for collecting and recording immunization data. As electronic immunization registry has been introduced in areas with limited resources, it is recommended the use online and offline platforms for data collection so that they can submit immunization data in real-time without the delays caused by poor resource setting.

The Transition to an Entirely Digital Immunization Registry in Ha Noi Province and Son La Province, Vietnam: Readiness Assessment Study.

BackgroundVietnam is one of the first low- to middle-income countries to develop and implement a national-scale electronic immunization registry. This system was finalized into the National Immunization Information System (NIIS) and scaled up to a national-level system in 2017. As a result, immunization coverage and the timeliness of vaccinations have drastically improved. The time spent on planning and reporting vaccinations has drastically reduced; as a result, vaccination planning and reporting has become more accurate and effective. However, to date, end users have been tasked with managing both the NIIS and paper-based systems in parallel until a formal assessment of the readiness to fully transition to the NIIS is conducted.ObjectiveThis study aims to evaluate the readiness to move to an entirely digital NIIS in 2 provinces of Vietnam—Ha Noi and Son La.MethodsAll health facilities were surveyed to assess their infrastructure, capacity, and need for human resources. NIIS end users were observed and interviewed to evaluate their NIIS knowledge and skill sets. Data from immunization cards and facility paper-based logbooks were compared with data from the NIIS, and vaccine stocks at selected facilities were tallied and compared with data from the NIIS.ResultsOf the 990 health facilities evaluated, most used the NIIS to enter and track immunizations (987/990, 99.7%) and vaccine stocks (889/990, 90.8%). Most had stable electricity (971/990, 98.1%), at least 1 computer (986/990, 99.6%), and ≥2 trained NIIS end users (825/990, 83.3%). End users reported that the NIIS supported them in managing and reporting immunization data and saving them time (725/767, 94.5%). Although many end users were able to perform basic skills, almost half struggled with performing more complex tasks. Immunization data were compiled from the NIIS and immunization cards (338/378, 89.4%) and paper-based logbooks (254/269, 94.4%). However, only 54.5% (206/378) of immunization IDs matched, 57% (13/23) of Bacillus Calmette-Guérin vaccination records were accurate, and 70% (21/30) of the facilities had consistent physical vaccine stock balances. The feedback received from NIIS end users suggests that more supportive supervision, frequent refresher training for strengthening their skill sets, and detailed standardized guides for improving data quality are needed.ConclusionsThe readiness to transition to a digital system is promising; however, additional resources are required to address the timeliness, completeness, and accuracy of the data.

1-year impact of COVID-19 on childhood immunizations in Pakistan: analysis of &amp;gt; 3.7 million children

 Covid-19 has universally disrupted primary health care, but routine childhood immunizations are one the most affected services. We analyzed big data in vaccines for measuring the 1-year impact of Covid-19 on outline childhood immunizations for the 48 million population in the Sindh province of Pakistan. We extracted and analyzed >3.7m real-time immunization records of 0-23 months old children from the Sindh Government's Electronic Immunization Registry (EIR). Using a 6-month baseline preceding the COVID-19 lockdown, we quantified the lockdown's (March 23-May 9, 2020) impact on daily immunization rates by geographical area and the change in coverage rates at the one-year mark since the lockdown. The lockdown resulted in 53% drop in the number of immunizations. The impact in rural areas as more than in urban areas (54.9% decline vs 47.5% decline from baseline), and slums had a slightly larger decrease in immunization coverage than non-slum areas (53.8% vs. 51.3%). Of 1,246,321 children who missed immunizations during first year of the pandemic, 76% of these children were eventually vaccinated by the end of March 2021. Similarly, of the 417,553 children who had dropped out during the initial 7-week national lockdown (March 23-May 10, 2020), 79% were immunized by March 2021. Our analysis of EIR data shows that the catch-up and recovery of coverage rates have primarily been driven through intensive outreach vaccination efforts instead of an increase in demand. One year since the onset of the pandemic, the average daily immunization doses administered through outreach increased by 121 percent above baseline estimates. In contrast, vaccines administered at immunization clinics were still 22 percent below baseline. The example of Pakistan shows LMICs can successfully deploy mitigation strategies to catch up with missed children during Covid-19 and sustain routine childhood immunizations to close immunity gaps.Key messages Although the lockdown resulted in a 53% drop in immunizations, at the 1-year mark since the pandemic started, 76% of children who missed immunizations are vaccinated.Pakistan data shows LMICs can rectify routine immunization coverage and immunity gaps and rebound successfully to their pre-COVID-19 coverage rates.

Feasibility assessment of immunization carpool model for &amp;lt;2 years children in rural Pakistan

Abstract   Almost 20 million children globally do not get routine vaccines, 1.4 million of which reside in Pakistan. Immunization coverage in rural settings of Pakistan, comprising &amp;gt;60% population, is lower than their urban counterparts. Barriers such as distant-centers, lack of transportation, and restrictions on women to travel alone, exacerbate the problem. We introduced immunization carpool services in rural settings to facilitate vaccination of &amp;lt; 2 years children. Low-coverage immunization clinics were selected based on availability of vaccinators and vaccines in Shikarpur, a rural district in Pakistan. Local transport providers were identified and vehicles were rented-in. Community mobilization was done through awareness sessions and branding vehicles. Data was recorded on the number of round trips and immunization visits facilitated by each vehicle. Details of children transported and feedback on carpool services were captured from caregivers. Immunization coverage was calculated using the government's electronic immunization registry data. Between January to October 2020, 6 vehicles were deployed, which provided free transport services in 98 catchment areas of 4 immunization clinics. On average, each vehicle completed 420 (SD: 58.2) round trips and facilitated 781 (SD: 171) immunization visits. A total of 2,391 children were enrolled, 1,182 (49.7%) of them were females and 1,197 (50%) aged &amp;lt;6months. Enrolled children compared to non-enrolled at the same immunization clinic, showed 19.1% higher coverage rate for penta-3 (81% vs 68%, p &amp;lt; 0.00) and 23.6% for measles-2 (73% vs 57%, p &amp;lt; 0.00). Immunization timeliness among enrolled children increased by 4.8% for penta-3 (9% vs 4%, p &amp;lt; 0.00) and 18% for measles-2 (25% vs 7%, p &amp;lt; 0.00). Reported advantages of services include time-saving (92%), cost-saving (79%), and reduced dependence on family members (95%). Immunization carpool service is well-accepted by rural women and can improve immunization coverage and equity in rural areas. Key messages Provision of commuting options can overcome accessibility barriers and has the potential to improve immunization coverage and timeliness. Free transport services for rural women could aid in promoting gender equity and reducing urban-rural disparities.

Electronic Immunization Registry in Improving Vaccine Supply Chain Availability in Tanga City Council, Tanzania

BackgroundDespite the advantages of the electronic registry which has been explained in other areas of health and other parts of the world, there has been no empirical research conducted with the aim of assessing the impact of the electronic immunization registry practices on the availability of immunization commodities.ObjectivesTo assess the effect of electronic immunization registry practices on the availability of immunization commodities.MethodsA cross-sectional study was carried out to health facilities providing vaccination services in Tanga City Council. A total of 27 health care workers in 27 health facilities were interviewed for availability of vaccines and their experience in using electronic immunization system in supply chain system functioning using structured questionnaires. The data from the vaccines manual ledger and electronic TImR system were also collected administered in April-June, 2019 specifically for Bacillus-Calmette Guerin (BCG), Diphtheria-Pertussis-Tetanus-Hepatis B-Haemophilus influenza type b (DPT-HepB-Hib), bi-oral polio vaccine (bOPV), Measles-Rubella and Human Papilloma Virus Vaccine (HPV). These data were analyzed by statistical software SPSS using one sample T test and 95% confidence interval.ResultsThe study affirmed that the mean numbers of children registered at the health facilities using electronic immunization registry was 1.5-3 times higher than the target population for the three months preceding the study given by the National Bureau of Statistics (NBS). The number of doses for the studied vaccines (DPT-HepB-Hib, measles rubella, HPV, BCG and bOPV) were found to be different in the manual and electronic TImR systems. Also, the number of doses available at the health facilities increased significantly with the number of the electronic system registered children.ConclusionThis study found that the adoption of Electronic immunization registry has improved the health supply chain in terms of improving the vaccines availability. Rwanda J Med Health Sci 2021;4(2): 223-236