Sharing Immunization Data between IHS/Tribal Facilities and the Arizona State Immunization Information System Scott Hamstra, MD (IHS) Kimiko Gosney, MS (AZ DHS) John Parker, RN (IHS) Michael Conklin (AZ DHS) Amy Groom, MPH (CDC & IHS) ASIIS Program March 23, 2005

ASIIS Program Systems Background  The Arizona State Immunization Information System (ASIIS) is populated by birth records  IHS and tribal facilities maintain local immunization registries using the Resource and Patient Management System (RPMS)  Historically, immunization records from the RPMS immunization registries were not included in ASIIS

ASIIS Program Reporting Background  American Indians/Alaska Natives (AI/AN) make up 7% of Arizona’s population  Immunization coverage rates for this population are limited to data from RPMS immunization registries which are community-based  Lack of statewide immunization coverage data on the AI/AN population causes under-estimation of true coverage levels

ASIIS Program AI/AN Population Percent by County 2000 Census

ASIIS Program Objectives  To improve immunization data on AI/AN children in ASIIS  Using ASIIS data : Compare 4:3:1:3:3 coverage levels in 2 counties for AI/AN and non-AI/AN populations Examine hepatitis A vaccine coverage and hepatitis A incidence in Arizona

ASIIS Program Methods  Using HL7 batch uploads, immunization data exchange between the RPMS immunization registries and ASIIS was implemented Vaccinations from IHS and tribal RPMS immunization registries were exported to ASIIS Vaccinations from ASIIS missing in the IHS/tribal registries were exported back to the sites to update the RPMS immunization registries

ASIIS Program 4:3:1:3:3 Coverage Total No Month olds No. with 4:3:1:3:3 (%) Apache County (60.4%) Navajo County (46.7%)

ASIIS Program 4:3:1:3:3 by Race AI/AN months AI/AN 4:3:1:3:3 (%) Non- AI/AN months Non- AI/AN 4:3:1:3:3 (%) RR (95% CI) Apache County (73.5%) (28.5%) 2.58 ( ) Navajo County (66.3%) (38.1%) 1.74 ( )

ASIIS Program 4:3:1:3:3 Coverage Conclusions  4:3:1:3:3 coverage for these 2 counties was relatively low  AI/AN had significantly higher coverage than non AI/AN  Apache County AI/AN were 2.58 times more likely to have complete 4:3:1:3:3 coverage than non-AI/AN  Navajo County AI/AN were 1.74 times more likely to have complete 4:3:1:3:3 coverage than non-AI/AN

Hepatitis A

ASIIS Program Hepatitis A Incidence in the United States, source:

ASIIS Program Hepatitis A vaccination in Arizona  ACIP recommends routine vaccination for AI/AN children. Program in Arizona targets 2-12 year old AI/AN children.  1998 – Arizona immunization reporting law passed. Maricopa county (includes Phoenix metropolitan area) requires Hepatitis A vaccination for all children in licensed childcare. Hepatitis A vaccine made available by State for all 2-5 year old children.  1999 – ACIP recommendation for routine vaccination of children 2 years of age and older in states with average annual incidence >= 20 cases / 100,000 during

ASIIS Program Hepatitis A Cases per 100,

ASIIS Program

yr old Arizona Population Percentage With 1 or More Hepatitis A Vaccinations

ASIIS Program Hepatitis A Cases per 100,000 MAP OF 1994 Hep A Incidence MAP OF 2004 Hep A Incidence

ASIIS Program Conclusion  Hepatitis A vaccine recommendations were effectively implemented by public health services (IHS and county) in Arizona

ASIIS Program Contact Information Arizona Immunization Program Office (AIPO): ASIIS Help Line: or ASIIS Web Site: ASIIS Web Application: Kimiko Gosney MS Michael Conklin Indian Health Service Scott Hamstra MD Amy Groom MPH

ASIIS Program Additional slides

ASIIS Program

4:3:1:3:3 : Effect of data exchange % 4:3:1:3:3 before exchange % 4:3:1:3:3 using combined data County A County B 46.8