Influenza Immunization Data: Can We Make Order Out of Chaos?
Jennifer A. Pereira, Christine L. Heidebrecht, Susan Quach, Sherman D. Quan, Michael Finkelstein, Julie A. Bettinger, Shelley L. Deeks, Maryse Guay, David L. Buckeridge, Larry Chambers, Natasha S. Crowcroft, Beate Sander, Donna Kalailieff, Stephanie Brien and Jeffrey C. Kwong
The 2009 H1N1 pandemic vaccination campaign was an excellent opportunity to witness the many benefits of collecting individual-level immunization data at the point of vaccination. Most provinces and territories required the reporting of at least partial demographic vaccination data from their local public health agencies, so timely vaccine coverage data were available to inform operational planning and infection prevention activities.
Many provincial and local public health agencies are now building on this momentum and are incorporating similar data-collection approaches into their seasonal influenza vaccination campaigns. However, our research has shown a disconcerting lack of uniformity across the country in the collecting and reporting of data elements. We have reviewed related literature and consulted with various provincial and territorial ministries and healthcare professional organizations, and our findings confirm that this issue is even more pronounced in non-public health settings, where provincial and territorial standards mandating the systematic collection and central reporting of immunization data from physicians' offices, hospitals, pharmacies and private clinics are either absent or not enforced. Further, where physicians report immunization data to their local public health agencies, these do not typically extend beyond the number of doses administered (Carolyn Sanford, Prince Edward Island's Department of Health and Wellness, personal communication, August 23, 2010).
In jurisdictions where pharmacists have authorization to administer vaccines, immunization information (date, vaccine name/lot number) must be documented in each client's profile (Alberta College of Pharmacists 2009), but there are a lack of provincial standards around reporting to health authorities (Cheryl McIntyre, BC Centre for Disease Control, personal communication, April 19, 2011). In other pharmacy-based and workplace clinics across the country, privately funded vaccines are administered by nurses who report aggregate dose data to the employer and retain the client records (Nan Cleator, Victorian Order of Nurses Canada, personal communication, April 20, 2011). Where vaccines are publicly funded for these clinics, specific provincial and territorial reporting requirements vary broadly, ranging from an extensive list of data elements to aggregate counts for specific risk groups (Nan Cleator, Victorian Order of Nurses Canada, personal communication, August 9, 2010).
As well, we have observed substantial variation in the collection of immunization data for hospital-based healthcare workers, ranging again from aggregate counts of total immunizations to individual-level records containing medical history and immunization data (Russell and Henderson 2003). Therefore, it remains nearly impossible to ascertain whether vaccine coverage estimates are truly representative, particularly where vaccines are primarily delivered by community-based providers; without accurate and timely coverage data, it is immensely challenging to understand the nature of infection spread and mount a coordinated response.
Over the next five years, several provinces and territories will adopt Panorama, a public health application whose need was identified in the aftermath of the outbreak of severe acute respiratory syndrome (SARS). This initiative will support the collection, analysis and dissemination of immunization and surveillance data for the management of infectious diseases (KPMG 2009). At the same time, an increasing number of physicians are adopting electronic medical records, recognizing the advantages of storing client information electronically (Canadian Medical Association 2009). It is expected that infrastructure to link information from these two sources will ultimately be developed, providing an opportunity for the benefits of collecting comprehensive individual-level data to be realized at a population level.
In order to capitalize on these advancements, federal and provincial public health authorities must become actively engaged in discussions around these clinical data system functionalities to ensure they address present and future public health needs. The benefits of accurate vaccine coverage data can only be realized through the development of systematic data collection processes for common data elements at all public and non-public health vaccination settings across the country or, at the very least, the establishment of provincial-level immunization data collection standards.
The 2009 H1N1 pandemic reinforced the value of comprehensive and timely immunization data availability. Making changes to optimize data collection and the reporting of immunization information during seasonal campaigns across all vaccination settings will allow us not only to make better decisions about seasonal influenza control but also to strengthen our capacity to respond to the next public health emergency.
About the Author(s)
Jennifer A. Pereira, Christine L. Heidebrecht, Susan Quach, Shelley Deeks, Natasha Crowcroft and Beate Sander are members of the Department of Surveillance and Epidemiology, Public Health Ontario, in Toronto, Ontario.
Sherman D. Quan is a member of the University Health Network, in Toronto.
Michael Finkelstein is a member of Toronto Public Health, in Toronto.
Julie A. Bettinger is a member of the Vaccine Evaluation Center, University of British Columbia, in Vancouver, British Columbia.
Maryse Guay is a member of the Département des sciences de la santé communautaire, Université de Sherbrooke, in Longueuil, Québec.
David L. Buckeridge and Stephanie Brien are members of the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, in Montreal, Quebec.
Larry Chambers is a member of the Elisabeth Bruyère Research Institute, in Ottawa, Ontario.
Donna Kalailieff is a member of the Niagara Regional Public Health Department, in Thorold, Ontario.
Jeffrey C. Kwong is a member of the Department of Family and Community Medicine, University of Toronto; Dalla Lana School of Public Health, University of Toronto; and Institute for Clinical Evaluative Sciences, in Toronto.
Alberta College of Pharmacists. 2009. Alberta Influenza Immunization Program Resource Guide for Alberta Pharmacists. Edmonton, AB: Author. Retrieved September 7, 2010. <https://pharmacists.ab.ca/Content_Files/Files/InfluenzaImmunizationResourceDocument_Dec01.pdf>.
Canadian Medical Association. 2009. Information Technology and Health Care in Canada: 2009 Status Report. Ottawa, ON: Author.
KPMG. 2009. Final Report: 2009 Performance Evaluation of the Canada Health Infoway Public Health Surveillance Program. Ottawa, ON: Author. Retrieved March 15, 2011. <https://www2.infoway-inforoute.ca/documents/Infoway-PHS%20Evaluation-Final-March%202009%20-%20EN.pdf>.
Russell, M.L. and E.A. Henderson. 2003. "The Measurement of Influenza Vaccine Coverage among Health Care Workers." American Journal of Infection Control 31: 457–61.
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