1. 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

2. 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

3. 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

4. ASIIS Program AI/AN Population Percent by County 2000 Census

5. 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

6. 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

7. ASIIS Program 4:3:1:3:3 Coverage Total No. 19-35 Month olds No. with 4:3:1:3:3 (%) Apache County 20061213 (60.4%) Navajo County 27101268 (46.7%)

8. ASIIS Program 4:3:1:3:3 by Race AI/AN 19-35 months AI/AN 4:3:1:3:3 (%) Non- AI/AN 19-35 months Non- AI/AN 4:3:1:3:3 (%) RR (95% CI) Apache County 14241047 (73.5%) 582166 (28.5%) 2.58 (2.26-2.94) Navajo County 834553 (66.3%) 1876715 (38.1%) 1.74 (1.61-1.88)

9. 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

10. Hepatitis A

11. ASIIS Program Hepatitis A Incidence in the United States, 1980-2002 source: http://www.cdc.gov/ncidod/diseases/hepatitis/slideset/hep_a/slide_41.htm

12. ASIIS Program Hepatitis A vaccination in Arizona  1996 - 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 1987-1997.

13. ASIIS Program Hepatitis A Cases per 100,000 1994

14. ASIIS Program

15. 19972004 2- 14 yr old Arizona Population Percentage With 1 or More Hepatitis A Vaccinations

16. ASIIS Program Hepatitis A Cases per 100,000 MAP OF 1994 Hep A Incidence MAP OF 2004 Hep A Incidence 19942004

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

18. ASIIS Program Contact Information Arizona Immunization Program Office (AIPO): 602-364-3630 ASIIS Help Line: 602-364-3899 or 1-877-491-5741 ASIIS Web Site: www.hs.state.az.us/phs/asiis/index.htmwww.hs.state.az.us/phs/asiis/index.htm ASIIS Web Application: www.asiis.state.az.uswww.asiis.state.az.us Kimiko Gosney MS gosneyk@azdhs.govgosneyk@azdhs.gov Michael Conklin conklim@azdhs.govconklim@azdhs.gov Indian Health Service Scott Hamstra MD scott.hamstra@ihs.hhs.govscott.hamstra@ihs.hhs.gov Amy Groom MPH amy.groom@ihs.govmy.groom@ihs.gov

19. ASIIS Program Additional slides

20. ASIIS Program

25. 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 859.2 County B 46.8