1. 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:
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

2. 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

3. 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

4. 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 million (US Census Bureau, 2000)
Standard outbreak control measures were undertaken

5. 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

6. 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

7. Number of Children Exposed by Site: n=64

8. 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

9. 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

10. 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

11. 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

12. 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; (44%) were found in the CIR; 7 (28%) children received IG
National Immunization Conference, Chicago, IL, March 17-20, 2003

13. 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

14. Areas affected in NYC
Pediatrician Office
Hospital A

15. 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

16. 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