The Role of the Immunization Registry in a Measles Outreak, New York City The Role of the Immunization Registry in a Measles Outbreak, New York City Ynolde Andrews-Gillan, MS, DrPH Toby Keller, MPH Jane R. Zucker, MD, MSc New York City Department of Health and Mental Hygiene Immunization Program Contact: yandrews@health.nyc.gov Vikki Papadouka, PhD, MPH Shirley Huie, MPH New York Citywide Immunization Registry 37th National Immunization Conference March 17-20, 2003 Chicago, IL National Immunization Conference, Chicago, IL, March 17-20, 2003

Background In the US, high vaccine coverage for recommended childhood immunizations has contributed to significant decreases in morbidity and mortality attributable to vaccine preventable diseases One of the strategies developed to achieve and maintain high immunization coverage is the use of immunization registries Immunization registries are also useful in assisting outbreak investigations

Objective To describe the role of the New York Citywide Immunization Registry (CIR) in facilitating an epidemiological investigation of a measles outbreak in New York City

Outbreak On April 9, 2002 the Immunization Program of the NYC Department of Health & Mental Hygiene (DOHMH) was notified of a measles case: A Pakistani-American infant who resided in Queens (one of the 5 boroughs of NYC) Queens is home to large immigrant and multi- ethnic communities, and has a population of 2.29 million (US Census Bureau, 2000) Standard outbreak control measures were undertaken

Outbreak An 11-month old female traveled from Pakistan to NYC on March 30, 2002; she developed a fever on April 1 and rash April 6 Blood drawn on April 9, tested positive for measles (IgM+, IgG-) Prior to and during her hospitalization, 64 children were exposed at 2 health care facilities

Outbreak Control The following steps had to be taken quickly: Contact parents of children exposed or their providers to verify immunization status Children with no confirmed MCV had to be immunized or given Measles IG Alert the medical community Available staff and resources were stretched and the assistance of CIR was sought

Number of Children Exposed by Site: n=64

The CIR assisted to: Identify whether the exposed children had received a prior dose of a measles- containing vaccine (MCV) Notify providers and clinics in the ZIP code areas of the outbreak and request that they maintain a high index of suspicion for 2° cases of measles

New York Citywide Immunization Registry Profile Deployed January 1997 Mandatory reporting of immunizations for children 0-7 y/o Populated with birth records Contains ~ 2.3 million children’s records with over 15 million immunizations Contains contact information of all NYC providers who immunize children

Method The names, DOBs, addresses, and other identifying information of the 64 exposed children were given to the CIR The geographical area where the index case presented and surrounding areas were identified

Identification of Children with an MCV Searched for records of all 64 children exposed using all available identifiers If more than one record was found for a child, records were merged The immunization history for each child was printed and given to the surveillance unit

Results: Number of children with an MCV in CIR The Role of the Immunization Registry in a Measles Outreak, New York City Results: Number of children with an MCV in CIR ** 18 children did not have a documented MCV as per CIR; contact investigations revealed that 10 children had at least one dose of MCV, the remaining 8 children were lost to follow-up * 25 children < 1 y/o were also exposed but not eligible for an MCV; 11 (44%) were found in the CIR; 7 (28%) children received IG National Immunization Conference, Chicago, IL, March 17-20, 2003

Results: Identification of Providers A total of 18 ZIP codes were considered potentially affected Using the CIR contact information, providers and hospitals in these 18 ZIP codes were sent broadcast faxes A total of 332 notifications were sent

Areas affected in NYC Pediatrician Office Hospital A

Summary 39 of the 64 exposed children were eligible for an MCV; 21 were identified by CIR as having had an MCV Volume of outreach was reduced by 33% The CIR helped to quickly identify all providers and clinics in the 18 affected ZIP codes and alerted them of the outbreak No secondary cases of measles identified

The Role of the Immunization Registry in a Measles Outreak, New York City Conclusions An immunization registry can help prioritize limited resources by identifying persons with an immunization and re-directing outreach to those without By saving time, an immunization registry can limit the extent of an outbreak Immunization registries can be useful in alerting providers of outbreaks Even “incomplete” registries can support public health actions requiring urgent response National Immunization Conference, Chicago, IL, March 17-20, 2003