Universal Vaccination Program Mexico: Lessons Learned from National Registry System November 2014

1804 Dr.Balmis introduced smallpox vaccine 1926 Compulsory vaccination against samllpox by Presidential decree Mass vaccination campaigns 1948 Difteria and pertusis 1951 BCG 1956 Poliomielytis (SALK) 1962 Oral polio (OPV) 1973 National Immnization Program (NIP) 4 VACCINES, 6 DISEASES Tuberculosis (BCG) Poliomielitis (Sabin) Difteria, Pertusis and tétanus (DPT) Measles 1990 Coverage was low Measles outbreak More than 68,000 cases Over 6,000 deaths reported National Immunization Council (CONAVA) and the Universal Vaccination Program are created Objective: vaccination of all children under 5 Background

Diseases Diseases Diseases Diseases Diseases Diseases Diseases BCG Sabin DPT MeaslesMMR Pentavalent (Diphtheria, whole cell pertussis, tetanus, hep B and Hib) Pentavalent (Diphtheria, acellular pertussis, tetanus, IPV, Hib) Seasonal Influenza Hepatitis B Rotavirus Pneumococcal HPV Evolution of the vaccination scheme

History of the Vaccination Registry 1926 Smallpox vaccination card 1978 National vaccination card 1991 Creation of the Universal Vaccination Program Creation of a nominal system (PROVAC)

Computer system with a structured language SQL (Standard Query Language) and PHP (Hypertex Preprocessor) Works at the local level (on each national health system center wit vaccination activities) Created in 1991 when only four vaccines were recorded Nominal System: PROVAC

Achievements Since 1998, population data for children under 8 was added The identification and localization of unvaccinated children was possible Challenges Different versions were used throughout the country The system could not work with more than 18 million entries Problems The system was not updated in accordance with the Program changes Coverage formulas were altered

LOCAL CAMPAIGNS BLOCKING VACCINE PERMANENT PROGRAM PROVAC INSTITUTIONAL SYSTEM APPLIED DOSE REGISTRY SISPA, SUI, SII NATIONAL HEALTH WEEK CENSUS NOMINALRATE TOTAL REGISTERED CARD NATIONAL IMMUNIZATION COVERAGE

LOCAL CAMPAIGNSBLOCKING VACCINE PERMANENT PROGRAM PROVAC NATIONAL HEALTH WEEK CENSUS NOMINALRATE TOTAL REGISTERED CARD NATIONAL IMMUNIZATION COVERAGE INSTITUTIONAL SYSTEM APPLIED DOSE REGISTRY SISPA, SIS, SIAIS, SIEMP Allowed to record doses administered national health weeks on administrative registers Allowed to check the consistency of the dose of administrative systems with nominal registration system Missed the official population targeted for coverage exclusively concentrating on nominal data Allowed to record doses administered national health weeks on administrative registers Allowed to check the consistency of the dose of administrative systems with nominal registration system Missed the official population targeted for coverage exclusively concentrating on nominal data

LOCAL FIELED IDENTIFY TO ALLOW PEOPLE OF MUNICIPAL LIABILITY NOT IDENTIFY UNIT COVERS SATATE LACK OF ASSESSMENT ADMINISTRATIVE REGISTER IGNORANCE OF THE SOURCE OF DATA FOR MEASUREMENT OF COVERAGE NATIONAL HANDLING OF FORMULAS FOR CONSTRUCTION COVERAGE DOSAGE FOR DISTRIBUTED COVERAGE A LACK OF ADEQUATE DOSE APPLIED RECORDS

DETERMINATION OF COVERAGE BY COHORT OF LESS THAN ONE YEAR, ONE YEAR, FOUR YEARS, AND SIX YEARS ACCORDING TO VACCINATION SCHEME GRAPHICS USE COVERAGE FOR MEDICAL UNIT, MONTHLY MEASUREMENT OF NATIONAL HEALTH SYSTEM 2013 Decisions Do not use PROVAC Use administrative data Have workshops to determine denominators at the local level

Challenges in a future Implementation of an electronic record Use of administrative data Accurate determination of denominators Determination of vaccination coverage Use of graphics at the local level

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