Statewide Immunization Information System Research Articles

COVID-19 pandemic vaccination preparedness strategies for independent community pharmacies

ObjectiveThis study aimed to determine independent community pharmacist preparedness for coronavirus disease 2019 (COVID-19) vaccination and to identify strategies for COVID-19 pandemic vaccination implementation in Pennsylvania. MethodsThis study used a complementary mixed-methods approach to recruit independent community pharmacists to participate in an electronic survey and 2 virtually conducted focus groups before the availability of the first COVID-19 vaccine. Information was gathered and compiled into 5 topic areas: (1) workflow, (2) resources, (3) staff and patient safety, (4) communication, and (5) documentation and training. Data collection occurred between October and December 2020. Survey data were analyzed using descriptive statistics. Focus group discussions were audiorecorded and transcribed. A directed, content analysis was conducted to identify strategies for each topic area, and supporting quotes were selected. ResultsA total of 88 and 11 independent community pharmacists participated in the survey and focus groups, respectively. Because of the small size of most independent pharmacies, participants recommended working with community partners to support off-site mass vaccination clinics. Leveraging partnerships with community organizations and universities could be used to support staffing for vaccination efforts. Using an appointment-based immunization model was identified as one tool to optimize patient and staff safety during the pandemic. Pharmacists suggested using existing scheduling tools and text messaging and automated phone calls for second-dose reminders. Finally, independent pharmacists recommended further training and process improvements to support vaccine documentation and transmission to the Pennsylvania Statewide Immunization Information System. ConclusionRecommendations from this study were used to support planning and preparation for COVID-19 vaccinations across Pennsylvania. Incorporation of pharmacists’ ideas and recommendations on pandemic vaccination implementation is an important strategy to efficiently expand vaccination administration during pandemics.

Increasing Human Papillomavirus Vaccination in a Federally Qualified Health Center Organization Using a Systems-Based Intervention Integrating EHR and Statewide Immunization Information System

Public acceptance of the HPV vaccine has not matched that of other common adolescent vaccines, and HPV vaccination rates remain below the Healthy People 2020 target of 80% compliance. The purpose of this study was to evaluate the capacity of nine pediatric clinics in a Federally Qualified Health Center organization to implement a systems-based intervention targeting office staff and providers using EHRs and a statewide immunization information system to increase HPV vaccination rates in girls and boys, ages 11 to 16 over a 16-month period. System changes included automated HPV prompts to staff, postcard reminders to parents when youths turned 11 or 12 years old, and monthly assessment of provider vaccination rates.During the intervention, 8960 patients (11–16 yo) were followed, with 48.8% girls (n = 4370) and 51.2% boys (n = 4590). For this study period, 80.5% of total patients received the first dose of the HPV vaccine and 47% received the second dose. For the first dose, 55.5% of 11 year old girls and 54.3% of 11 year old boys were vaccinated. For ages 12 to 16, first dose vaccination rates ranged from the lowest rate of 84.5% for 14 yo girls up to the highest rate of 90.5% for 13 yo boys. Logistic regression showed age was highly significantly associated with first dose completion (OR 1.565, 95% CI 1.501, 1.631) while males did not have a significant association with first dose completion compared to females. The intervention increased overall counts of first and second HPV vaccination rates.

Increasing Equity in Tdap Vaccination in Pregnancy: Using Data to Drive a Quality Improvement Project [15F

INTRODUCTION: National guidelines recommend the Tdap vaccine during 27-36 weeks gestation to confer immunity to the neonate. At the University of New Mexico, Title V-funded clinics that provide prenatal care for uninsured women do not provide on-site Tdap, but refer women to the Department of Health (DOH) for vaccination. Other university clinics stock the vaccine on-site. We sought to compare rates at Title V clinics to university-based obstetrical and family medicine clinics. METHODS: A retrospective review of electronic health records was performed for women who received prenatal care at Title V, obstetric, and family medicine clinics in 2018. Patients were crossed checked in the New Mexico Statewide Immunization Information System to include DOH records. Statistical significance was assessed using two-sample tests of proportion and a logistic regression. RESULTS: Results from 372 charts revealed the rate for Title V clinics (31.94%) was significantly lower than the rates for obstetrical clinics (71.91%, P<.02) and family medicine clinics (90%, P<.001). Controlling for demographic factors, women at Title V clinics were 80% less likely to get a Tdap vaccine than women who went to obstetric clinics (P<.001). CONCLUSION: Title V clinic patients are less likely to receive Tdap than patients who receive care at clinics with Tdap on-site. Providing on-site Tdap vaccination for uninsured pregnant women is a matter of health equity. Advocating for change by addressing specific barriers is ongoing. The results of this study have guided a comprehensive quality improvement project, resulted in the donation of on-site vaccines, and inspired a larger DOH study.

Accuracy of Parental-Reported Tetanus Vaccination Status for Children With Lacerations.

The aim of this study was to determine whether emergency department (ED) providers are able to accurately assess whether a child with a laceration needs tetanus prophylaxis. We conducted an 8-month prospective cross-sectional study of children presenting with a laceration to a pediatric ED. We asked ED providers whether tetanus prophylaxis was necessary. An ED pharmacist accessed the Utah Statewide Immunization Information System (USIIS), and we assessed the accuracy of the ED provider's determination of necessary tetanus prophylaxis compared with USIIS records. Among 375 patients aged 5 months to 17 years, ED providers made an inaccurate assessment of necessary tetanus prophylaxis in 33 cases (8.8%; 95% confidence interval [CI], 6.3%-12.1%). Emergency department providers would have inappropriately administered tetanus prophylaxis in 5 cases (1.3%; 95% CI, 0.5%-3.2%) and would have missed the need for tetanus prophylaxis in 28 cases (7.5%; 95% CI, 5.2%-10.6%). Emergency department providers were more likely to provide an inaccurate recommendation in older children (8.3 vs 4.8 years; P < 0.001), in patients with a dirty wound (45.5% vs 11.7%; P < 0.001), and in children who had fewer than 3 vaccines recorded in the USIIS (54.5% vs 1.2%; P < 0.001). Emergency department providers may inaccurately assess the need for tetanus prophylaxis in children. Special attention should be paid to cases of dirty wounds and cases in which fewer than 3 tetanus-containing vaccines have been given.

An appointment-based model to systematically assess and administer vaccinations

ObjectivesTo incorporate the assessment of vaccination status and administration of vaccines in an appointment-based model (ABM) and measure the impact on vaccinations administered and patient and pharmacist satisfaction with the appointment-based model. Practice descriptionAn ABM was implemented to systematically assess vaccination status and administer vaccines. Patients made an appointment to pick up synchronized prescriptions, and pharmacists assessed vaccination histories and administered vaccinations during the appointment. In addition, pharmacists could access the statewide immunization information system to objectively determine vaccination histories and document administered vaccines. Settings and participantsThis project was conducted at 24 Kroger Pharmacies in the Cincinnati-Dayton Area. Any patient filling more than 1 maintenance medication was eligible for the ABM program. Pharmacists were encouraged to target patients at high risk for medication problems and vaccine-preventable diseases, including patients 60 years of age or older with more than 5 medications and high-risk disease states such as diabetes, asthma, and chronic obstructive pulmonary disease. EvaluationPharmacies were randomized, and an a priori analysis was conducted to ensure that the 24 intervention and 78 control stores were similar at baseline. Postimplementation data on the mean number of vaccines per store were compared between the intervention stores and the control stores from September 2014 through December 2015. Patient and pharmacist satisfaction with the ABM was assessed via surveys. ResultsThe pharmacist vaccine assessment as part of the ABM program showed higher overall mean vaccinations per store compared with the control group during the project period (1810.71 ± 500.88 vs. 1455.09 ± 754.43; P = 0.01). Patients and pharmacists felt that the ABM program facilitated vaccine discussions. ConclusionThe ABM program with a focus on vaccinations allowed pharmacists to systematically assess patient vaccination histories and administer vaccines in the pharmacy. Patients and pharmacists appreciated the dedicated time to discuss vaccinations.

Statewide analysis of missed opportunities for human papillomavirus vaccination using vaccine registry data

BackgroundHuman papillomavirus (HPV) vaccine 3-dose completion rates among adolescent females in the US are low. Missed opportunities impede HPV vaccination coverage. MethodsA population-based secondary data analysis of de-identified vaccination and demographic data from the Utah Statewide Immunization Information System (USIIS) was conducted. Records were included from 25,866 females ages 11–26 years at any time during 2008–2012 who received at least one of the following adolescent vaccinations documented in the USIIS: Tdap (Tetanus, Diphtheria, Pertussis), meningococcal, and/or influenza. A missed opportunity for HPV vaccination was defined as a clinical encounter where the patient received at least one adolescent vaccination, but not a HPV vaccine. ResultsOf 47,665 eligible visits, there were 20,911 missed opportunities (43.87%). Age group, race/ethnicity, and rurality were significantly associated with missed opportunity (p<0.0001). In a multivariable mixed-effects logistic regression model that included ethnicity, location and age, as fixed effects and subject as a random effect, Hispanics were less likely to have a missed opportunity than whites OR 0.59 (95% CI: 0.52–0.66), small rural more likely to have a missed opportunity than urban youth OR 1.8 (95% CI: 1.5–2.2), and preteens more likely than teens OR 2.4 (95% CI: 2.2–2.7). ConclusionMissed clinical opportunities are a significant barrier to HPV vaccination among female adolescents. Interventions targeted at providers who serve patient groups with the highest missed opportunities are needed to achieve adequate protection from HPV-associated illnesses. ImpactThis is one of the first studies to utilize state immunization information system data to assess missed opportunities for HPV vaccination.

Statewide Vaccine Registry Data Indicate High Number of Missed Opportunities for the HPV Vaccine Among Eligible Girls

Abstract This study investigates the rate of missed opportunities for the HPV vaccine among eligible girls using statewide vaccine registry data. Methods: Using data from the Utah Statewide Immunization Information System (USIIS) from 2008–2012 for approximately 55,000 girls ages 11–18, we assessed the frequency of missed opportunities (receipt of other recommended vaccinations such as TDap, MCV4, and/or flu and not the HPV vaccine) among eligible female patients for the HPV vaccine. USIIS is a free, confidential, web-based information system that contains immunization histories for Utah residents of all ages. Records of all persons born in Utah since 1998 are in USIIS. USIIS is designed to help enrolled healthcare providers track immunization records for patient care by consolidating immunizations from enrolled providers into one centralized record. Vaccine administration from 86% of healthcare providers in Utah is reported to USIIS. USIIS data used for the study include date of birth, age, gender, ethnicity and race, zip code, and date and type of vaccine received. Descriptive statistics and chi- square tests were used to assess rate of missed opportunities for the HPV vaccine and associated demographic factors. Results: Approximately 65% of preteens (ages 11–12; N = 2,593) and 32% of female teens (ages 13–18; N = 4,937) had a missed opportunity for the HPV vaccine between years 2008–2012 in Utah (P &amp;lt; 0.001). Race and ethnicity related to rates of missed opportunities for the HPV vaccine among all girls ages 11–18 (Whites = 36%, N = 2,454; Hispanics = 21%, N = 254) (P &amp;lt; 0.001). Rural and urban locations were also associated with rates of missed opportunities for the HPV vaccine (urban = 31%, N = 4,448; large rural town = 42%, N = 202) (P &amp;lt; 0.001). Conclusions: For more than eight years, a vaccine to prevent cervical and other HPV-related cancers has been available, yet receipt of the 3-dose HPV vaccine in the United States is far below national goals for girls (33% vs. 80%; actual vs. target). Using statewide vaccine registry data, our study demonstrates that administering the HPV vaccine when providing other recommended adolescent vaccinations may dramatically improve rates of HPV vaccination among girls in a state with low HPV vaccine uptake. In addition, targeting rural communities and non-Hispanic White patients may further reduce missed opportunities.

Adolescent Immunization Coverage and Implementation of New School Requirements in Michigan, 2010

We examined the effect of Michigan's new school rules and vaccine coadministration on time to completion of all the school-required vaccine series, the individual adolescent vaccines newly required for sixth grade in 2010, and initiation of the human papillomavirus (HPV) vaccine series, which was recommended but not required for girls. Data were derived from the Michigan Care Improvement Registry, a statewide Immunization Information System. We assessed the immunization status of Michigan children enrolled in sixth grade in 2009 or 2010. We used univariable and multivariable Cox regression models to identify significant associations between each factor and school completeness. Enrollment in sixth grade in 2010 and coadministration of adolescent vaccines at the first adolescent visit were significantly associated with completion of the vaccines required for Michigan's sixth graders. Children enrolled in sixth grade in 2010 had higher coverage with the newly required adolescent vaccines by age 13 years than did sixth graders in 2009, but there was little difference in the rate of HPV vaccine initiation among girls. Education and outreach efforts, particularly regarding the importance and benefits of coadministration of all recommended vaccines in adolescents, should be directed toward health care providers, parents, and adolescents.

Age-specific strategies for immunization reminders and recalls: a registry-based randomized trial.

Although previous studies have found reminder/recall to be effective in increasing immunization rates, little guidance exists regarding the specific ages at which it is optimal to send reminder/recall notices. To assess the relative effectiveness of centralized reminder/recall strategies targeting age-specific vaccination milestones among children in urban areas during June 2008-June 2009. Three reminder/recall strategies used capabilities of the Michigan Care Improvement Registry (MCIR), a statewide immunization information system: a 7-month recall strategy, a 12-month reminder strategy, and a 19-month recall strategy. Eligible children were randomized to notification (intervention) or no notification groups (control). Primary study outcomes included MCIR-recorded immunization activity (administration of ≥1 new dose, entry of ≥1 historic dose, entry of immunization waiver) within 60 days following each notification cycle. A total of 10,175 children were included: 2,072 for the 7-month recall, 3,502 for the 12-month reminder, and 4,601 for the 19-month recall. Immunization activity was similar between notification versus no notification groups at both 7 and 12 months. Significantly more 19-month-old children in the recall group (26%) had immunization activity compared to their counterparts who did not receive a recall notification (19%). Although recall notifications can positively affect immunization activity, the effect may vary by targeted age group. Many 7- and 12-month-olds had immunization activity following reminder/recall; however, levels of activity were similar irrespective of notification, suggesting that these groups were likely to receive medical care or immunization services without prompting.

Statewide Pandemic Influenza Vaccination Reminders for Children with Chronic Conditions

We evaluated the use of a statewide immunization information system (IIS) to target influenza vaccine reminders to high-risk children during a pandemic. We used Michigan's IIS to identify high-risk children (i.e., those with ≥ 1 chronic condition) aged 6 months to 18 years with no record of pH1N1 vaccination among children currently or previously enrolled in Medicaid (n = 202,133). Reminders were mailed on December 7, 2009. We retrospectively assessed children's eligibility for evaluation and compared influenza vaccination rates across 3 groups on the basis of their high-risk and reminder status. Of the children sent reminders, 53,516 were ineligible. Of the remaining 148,617 children, vaccination rates were higher among the 142,383 high-risk children receiving reminders than among the 6234 high-risk children with undeliverable reminders and the 142,383 control group children without chronic conditions who were not sent reminders. Midseason reminders to parents of unvaccinated high-risk children with current or past Medicaid enrollment were associated with increased pH1N1 and seasonal influenza vaccination rates. Future initiatives should consider strategies to expand targeting of high-risk groups and improve IIS reporting during pandemic events.

Epidemiologic and Laboratory Features of a Large Outbreak of Pertussis-Like Illnesses Associated With Cocirculating Bordetella holmesii and Bordetella pertussis—Ohio, 2010–2011

During 9 May 2010-7 May 2011, an outbreak of pertussis-like illness (incidence, 80 cases per 100 000 persons) occurred in Franklin County, Ohio. The majority of cases were identified by IS481-directed polymerase chain reaction (PCR), which does not differentiate among Bordetella species. We sought to determine outbreak etiology and epidemiologic characteristics. We obtained demographic, clinical, and vaccination-related data from the Ohio Disease Reporting System and Impact Statewide Immunization Information System. We tested sera from 14 patients for anti-pertussis toxin (PT) antibodies and used species-specific PCR on 298 nasopharyngeal specimens. Reported cases totaled 918. IS481 results were available for 10 serologically tested patients; 5 of 10 had discordant anti-PT antibody and IS481 results, suggestive of Bordetella holmesii, which lacks PT and harbors IS481. We identified specific Bordetella species in 164 of 298 specimens tested with multitarget PCR; B. holmesii and Bordetella pertussis were exclusively detected among 48 (29%) and 112 (68%), respectively; both were detected in 4 (2%). Among 48 patients with B. holmesii infections, 63% were aged 11-18 years, compared with 35% of 112 patients with B. pertussis infections (P = .001). Symptoms were similar among B. holmesii- and B. pertussis-infected patients. Adolescent pertussis ("Tdap") booster vaccinations were more effective against B. pertussis than B. holmesii (effectiveness: 67% and 36%, respectively; 95% confidence intervals, 38%-82% and -33% to 69%, respectively). We report the first documented mixed outbreak of B. pertussis and B. holmesii infections. Bordetella holmesii particularly affected adolescents. Although laboratory capacity limitations might inhibit routine use of multitarget PCR for clinical diagnosis, focused testing and enhanced surveillance might improve understanding the burden of B. holmesii infection.

Using Medicaid Claims to Identify Children With Asthma

To assess the accuracy of using administrative data from state-managed programs to identify children with asthma in a statewide immunization information system. We wished to understand the degree to which alternative asthma case definitions applied to administrative data influence the accuracy of cases identified in an immunization information system. Children aged 2 to 18 years were sequentially classified into 3-case definition groups on the basis of Michigan Department of Community Health administrative data (2005-2006): (1) children with a Children's Special Health Care Services (CSHCS) Program qualifying diagnosis of asthma (CSHCS cases); (2) those having 1 or more asthma medication claims (Rx cases); or (3) those without asthma medications having 1 or more health services claim reporting an asthma diagnosis code (Dx cases). Children were randomly selected from each asthma case definition group; parents were invited to participate in a telephone interview to document physician diagnosis of asthma, symptoms, activity limitations, medications, and asthma health services use. The positive predictive value of parent report of a physician diagnosis of asthma; asthma severity, based on National Asthma Education and Prevention Program criteria. : Of 440 completed interviews, 89% of parents confirmed the child's high-risk status, reporting physician diagnosis of asthma (83%), wheezy-cough (5%), or reactive airway disease (1%). The positive predictive value varied for CSHCS cases (100%), Rx cases (91%) and Dx cases (73%, P < .0001). Although reported asthma severity levels were similar among CSHCS and Rx cases (P = .9100), asthma severity was lower among Dx cases (P = .0218). Medicaid administrative data can be used to accurately identify children with asthma and represents a feasible approach for Medicaid programs and health plans to identify priority groups for targeted influenza vaccination reminders.

Feasibility of Initiating and Sustaining Registry-Based Immunization Recall in Private Practices

ObjectiveTo assess the feasibility of initiating and sustaining immunization recall by private practices, including the barriers and costs, using a statewide immunization information system (IIS). MethodsPrivate practices in southeast Michigan were recruited in 2007 to perform IIS-based immunization recalls. Enrolled practices were provided with training and asked to conduct 4 recalls during the course of 12 months of children 19 to 35 months of age. Each practice recorded the time they spent performing recall-related activities; labor costs were estimated. Formative and summative evaluations with semistructured interviews were conducted to identify barriers. ResultsOf 97 eligible pediatric and family medicine practices, 44 declined to participate, 32 did not respond to repeated contacts, and 20 agreed to enroll in the study (21%). A total of 56 recalls were conducted during the study period, with 9 practices completing at least 4 recalls and 7 practices completing 1 to 3 recalls; 4 practices conducted no recalls. Common barriers reported included time constraints and executing all steps of the recalls. Practice costs per patient recalled ranged from $0.05 to more than $6 and were primarily driven by the type of personnel who performed recalls. The costs of creating a roster of current patients comprised nearly one-half of total labor costs. ConclusionsFew private provider practices that we contacted were willing to participate in this study of IIS-based recall, and less than one-half of enrolled practices completed the desired 4 recall cycles in 12 months. Time constraints and other real-world problems should not be underestimated in determining the feasibility of practice-based immunization recall. Efforts to increase the use of a statewide IIS for recall in private practice settings should emphasize ongoing training and technical support to practice staff. Improved interoperability with electronic health record systems may foster practice-based recall by reducing the labor intensity of roster building and other recall activities.

Seasonal Influenza Vaccination Reminders for Children with High-Risk Conditions: A Registry-Based Randomized Trial

Children with chronic conditions have an increased risk of complications from influenza and have low influenza vaccination rates. To assess the feasibility and effectiveness of using a statewide immunization information system (IIS) for seasonal influenza vaccine reminders from local health departments (LHDs) targeting children with high-risk conditions. A randomized community intervention. The study was conducted in a population of 3618 children aged 24-60 months with a high-risk condition residing in three Michigan counties. Children were identified using a statewide IIS in October 2008. Children were randomized to intervention (reminder) or control (no reminder) groups. Reminders for seasonal influenza vaccination were mailed by LHDs in November 2008. Feasibility of notification (address validity, address deliverability) was assessed (November 2008-February 2009), and frequencies of notification feasibility measures were determined (analyses conducted in 2010). Effectiveness of notification (seasonal influenza vaccine receipt) was assessed using bivariate logistic regression. Among 3618 children with a high-risk condition, 2730 (75.5%) had not received a 2008-2009 influenza vaccination and were eligible at the time of notification. Among children assigned to the reminder group (n=1374), 42.6% had an address determined to be either invalid, undeliverable, or both. Among those with valid addresses (n=2001), a greater percentage of children with deliverable reminders received at least one influenza vaccination (30.8%) during the outcome observation period than did children assigned to no reminder (24.3%, OR=1.39, 95% CI=1.13, 1.72); children with an undeliverable reminder had an influenza vaccination rate (22.8%) similar to children assigned to no reminder. Receipt of a reminder was positively associated with seasonal influenza vaccination. However, more than 40% of children assigned to receive a reminder were determined to have an invalid or undeliverable address, emphasizing the need for increased quality of IIS contact information. This study is registered at www.ClinicalTrials.gov NCT01431183.

Assessing the burden of undeliverable immunization reminder and recall notifications

Purpose To assess the completeness and accuracy of parent contact information for the delivery of mailed reminder/recall notices using a statewide immunization information system (IIS). Methods The Michigan Care Improvement Registry (MCIR) was used to generate reminder and recall notifications for children ages 6 months–19 years in Michigan (2008–2009). Mailed notifications were classified as being undeliverable if they were returned to the local health department (LHD) by the US Postal Service. Results 20,377 notifications were mailed and 5182 (26%) were undeliverable. Undeliverable notification increased with age (reference, 6–18 months): 19–35 months (OR = 1.27), 36–71 months (OR = 3.03) and adolescents 11–19 years (OR = 4.94). Children enrolled in Medicaid (OR = 0.76) were less likely to have an undeliverable notification compared to their non-enrolled counterparts, but children who had previously received some (OR = 1.07) or all vaccinations (OR = 2.43) at an LHD were more likely to have an undeliverable notification. Conclusion Undeliverable reminder/recall notifications are most likely among adolescents. Efforts to identify alternate sources of parent contact information may be an important strategy to improve the successful delivery of reminder/recall notifications, especially for adolescents.

Cost Savings Associated With Using Immunization Information Systems for Vaccines for Children Administrative Tasks

Our objective was to investigate the potential cost savings of immunization information systems (IIS) in performing some administrative tasks associated with the federal Vaccines for Children (VFC) program at the state and practice levels. VFC is an entitlement program providing free vaccine to eligible children. We timed the staff of the Utah Department of Health (UDOH) and 72 private VFC practices for administrative VFC-related tasks from September 2003 through March 2004. Time measurements included time for practices to produce VFC reports and for UDOH staff to assess practice coverage levels and process VFC reports manually or via the Utah Statewide Immunization Information System (USIIS). Median cost savings to the state health department could be as much as $11 740 annually. Utah VFC practices could save up to a maximum of $446 annually per practice by using USIIS for VFC tasks. If applied to the 218 enrolled private practices statewide, this would result in a median total cost savings of $17,615 ($15,519 for reports and $2,096 for pulling medical charts).

Partnering to Improve Infant Immunizations:: The Arizona Partnership for Infant Immunization (TAPII)

The Arizona Partnership for Infant Immunization (TAPII) is a public-private partnership intended to achieve the year 2000 goal of 90% infant immunizations. Created in 1992 as a means to develop a statewide approach to improving infant immunization rates, TAPII is a broad-based partnership that includes public health departments, managed care plans, professional organizations, medical organizations, pharmaceutical companies, businesses, the faith community, the media, and many others. TAPII’s organizational structure includes a steering committee and five subcommittees: advocacy and policy, community awareness, provider awareness, survey and assessment, and strategic planning. A key accomplishment of TAPII has been the development of a statewide infant immunization registry known as the Arizona Statewide Immunization Information System (ASIIS). This registry will facilitate up-to-date immunizations of children and improve statewide immunization assessment capability. Since the advent of TAPII, infant immunization rates within private managed care plans have increased. However, significant improvement in statewide rates will require long-term strategic efforts in provider and community awareness and a fully operational statewide registry, ASIIS, which is set to begin in January 1998. TAPII has been a successful partnership for a number of reasons: private sector participation, a single and measurable goal, vision and leadership, a strong emphasis on assessment, a broad-based membership, community ownership, Governor’s Office participation, health plan involvement, and full-time project staffing. As resources to improve the health of communities diminish, public-private partnerships such as TAPII can effectively consolidate resources and expertise to improve the health of populations.