Effectiveness of COVID-19 Vaccines Against SARS-CoV-2 Infection During a Delta Variant Epidemic Surge in Multnomah County, Oregon, July 2021

Background: Coronavirus disease 2019 (COVID-19) vaccines have been shown to be highly effective in preventing SARS-CoV-2 infection within controlled trials and real-world vaccine effectiveness (VE) studies. Recent reports have estimated reduced VE with the emergence and dissemination of the B.1.617.2 variant (Delta variant). During July 2021, Multnomah County experienced an epidemic expansion coinciding with increased Delta variant prevalence. We assess COVID-19 VE during this time. Methods: A test-negative design (TND) matched case-control analysis was performed to estimate the effectiveness of vaccination against SARS-CoV-2 infection during July 2021. Cases included a random sample of individuals that tested positive for SARS-CoV-2 and were reported by electronic laboratory report, were >15 years of age, and had no prior known SARS-CoV-2 infections. Controls were age and postal code matched individuals that tested negative for SARS-CoV-2 during July 2021. Immunization status was assessed using the Oregon ALERT Immunization Information system (ALERT IIS). Results: 500 case-control pairs were matched (n=1000). Overall effectiveness of any completed COVID-19 immunization was 73% (95% Confidence Interval [CI] 49-86%) and 74% (95% CI 65-85%) for mRNA immunizations and 72% (95% CI 47-85%) for individuals that had started but not completed mRNA immunizations. Conclusions: Our findings estimate high, yet reduced, VE during Delta variant dissemination. These results highlight the importance of COVID-19 immunizations for reducing SARS-CoV-2 infection while juxtaposing the need for additional non-pharmaceutical interventions. Importantly, the reduced VE identified here may predict future reductions in vaccine performance in the context of ongoing viral genetic drift.

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.

Readiness assessment in the transition to an entirely digital immunization registry in Ha Noi and Son La provinces, Vietnam (Preprint)

BACKGROUND Vietnam is one of the first low-middle-income countries to develop and implement a national-scale EIR. 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 timeliness of vaccinations has drastically improved. The time spent on planning and reporting vaccinations has drastically reduced, and as a result is more accurate and effective. However, to date, end-users have been tasked with managing both NIIS and paper-based systems in parallel until a formal assessment on the readiness to fully transition to NIIS was conducted. OBJECTIVE This study evaluated the readiness to move entirely to a digital national immunization information system (NIIS), in two provinces in Vietnam, Ha Noi and Son La. METHODS All health facilities were surveyed to assess their infrastructure, capacity and need of 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 log-books were compared to data in NIIS, and vaccine stocks at selected facilities were tallied and compared with data in the NIIS. RESULTS Of the 990 health facilities evaluated, most used NIIS to enter and track immunizations (99.7%) and vaccine stocks (90.8%). Majority had stable electricity (98.1%), had at least one computer (99.6%) and had two trained NIIS end-users or more (83.3%). End-users reported that the NIIS supported them in managing and reporting immunization data and saving them time (90%). Although many end-users were able to perform basic skills, almost half struggled with more complex tasks. Immunization data is compiled from the NIIS and immunization cards (89%) and paper-based log-books (91%). However, only 54% of immunization IDs matched, 56.5% of BCG vaccinations were accurate, and 70% of the facilities had consistent physical vaccine stock balances. Feedback received from NIIS end-users suggests that more supportive supervision, frequent refresher trainings to strengthen their skill-sets, and detailed standardized guides to improve data quality are needed. CONCLUSIONS The readiness to transition to a digital system was promising. However, additional resources are required to address timeliness, completeness, and accuracy of the data.

Measles Outbreak in Minnesota (2017): Roles of an Immunization Information System

The Minnesota Department of Health used its Immunization Information System—the Minnesota Immunization Information Connection—to respond to an outbreak of measles in the state in 2017 by assisting with the exclusion of unvaccinated exposed individuals from public activities, providing members of the public with their immunization records, and monitoring measles, mumps, and rubella vaccine uptake. Use of the Immunization Information System was found to be an efficient and sustainable tool in responding to the outbreak.

Structural and procedural conditions in National Immunization Program Information System establishment

ABSTRACT Objectives: to analyze structural and process conditions in National Immunization Program Information System establishment. Methods: a cross-sectional study conducted in 307 vaccination rooms in the state of Minas Gerais in 2017. For data collection, a multidimensional questionnaire was used. Descriptive data analysis was performed. Results: vaccination rooms have basic inputs necessary for System establishment. The greatest problems relate to professional practice. Low enrollment of population, failures in the active search for absentees, vaccine scheduling and absence of reports to monitor vaccination coverage were identified. Training was considered insufficient and ineffective. Conclusions: Immunization Information System is an essential technological innovation for the management of immunization actions. However, the production of timely records and the use of information are still challenges. Investments in training are required to ensure System’s management and operationalization activities.