Iowa’s Statewide Immunization Registry
John Warming, Project Coordinator
ISIIS Implementation Team, Bureau of Immunization
Iowa Department of Public Health
Summer 1999

In 1993, the Iowa Department of Public Health (IDPH) began developing the Iowa State Immunization Information System (ISIIS), a statewide immunization registry. This registry establishes a computerized network of public and private health care providers. It enables the sharing of immunization records and creates a permanent repository for individual vaccination histories in a central registry database.

IDPH selected a computer software application called ADIOS-IIS. Participating providers use this software to manage patient immunization records and vaccine inventories. The software also has recall and reminder capabilities. In addition, ADIOS-IIS allows participants to interface with the statewide registry.

Participating providers can search the central registry for records on patients who have been previously immunized by another caregiver. A participant communicates with the central registry from his or her personal computer or network via modem, using toll-free phone lines established for ISIIS.

The security of immunization records is a key requirement of the ISIIS network. Security is assured through several processes. First, log-in and password procedures at provider sites control access to the software. These assist participants in protecting their computers from unauthorized use. Tampering with the central registry is prevented by similar means.

Second, an elaborate, encrypted authentication process protects the transmission of immunization records between provider sites and the state registry. This process is activated each time someone attempts to connect to the registry.

ISIIS and the public sector

Since its beginnings in 1993, the ISIIS network has passed several important milestones. This summer also promises to be an exciting time. In March 1998 the ISIIS project completed the implementation of the registry for Iowa’s public sector immunization provider sites. Today, more than 130 locations statewide participate in the immunization registry. The central database has grown to include the immunization histories of more than 250,000 individuals, from newborns to 94-year-olds. More than 2.5 million vaccination dates are now part of the state’s permanent record of this critical preventive health care activity.

Starting in June 1999, the ISIIS project will begin upgrading the ADIOS-IIS software <%=Application("")%> This upgrade will provide several eagerly anticipated new features, including the ability to view immunization records from the central registry without having those records become part of the participant’s local database. It will also significantly improve communication protocols.

ISIIS and the private sector

When upgrades to existing, public sector ISIIS network sites are completed, IDPH will develop the implementation plan for expanding the network to include private health care providers. All health care providers practicing in Iowa will be eligible to enroll in the registry. ADIOS-IIS software will be given to providers, who will also be trained in its use.

One of the more exciting goals for the future of the ISIIS network is the deployment of a web browser-based interface with the registry. IDPH is exploring several possibilities that would allow participating providers to interact with the registry without needing to run a separate software application on their computers.

Health care providers who have questions about the ISIIS network are encouraged to contact project staff at 1-800-374-3958.

Recommended childhood immunization schedule, 1999

Colored bars indicate the optimal age range for immunization. If a child does not receive an immunization during the recommended period, a "catch up" dose should be given at a subsequent visit. Green areas indicate a vaccine that should be given if an immunization was missed, or was given earlier than the recommended age. The Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) approve these recommendations.

Hepatitis B (Hep B)
Infants born to mothers with unknown HbsAg status should receive hep B vaccine within 12 hours of birth. Maternal blood should be drawn at the time of delivery to determine mother’s HbsAg status. If positive, infant should receive hep B immune globulin (HBIG) as soon as possible (no later than 1 week of age).

Infants born to HbsAg-positive mothers should receive the hep B vaccine and 0.5 mL HBIG at separate sites within 12 hours of birth. Give the 2^nd of hep B at 1-2 months of age; the 3^rd at 6 months of age.

Infants born to HbsAg-negative mothers should get the 2^nd dose of hep B vaccine at least 1 month after the first dose. They should get the 3^rd dose at least 4 months after the 1^st and at least 2 months after the 2^nd dose, but not before the child is 6 months old.

Children and adolescents younger than 19 may begin the hep B series during any visit. Special effort should be made to immunize children who were born in, or whose parents were born in, areas with moderate to high rates of HBV infection.

Diphtheria, tetanus, pertussis (DTaP)

DTaP (diphtheria and tetanus toxoids and acellular pertussis) vaccine is preferred for all doses in the immunization series, including completion of the series in children who have received one or more does of whole-cell DTP vaccine. Whole-cell DTP is an acceptable alternative to DTaP. If a child is unlikely to be seen at 15-18 months, the 4^th dose (DTP or DTaP) may be administered as early as 12 months of age, provided 6 months have elapsed since the 3^rd dose. Td (tetanus and diphtheria toxoids) are recommended at 11-12 years of age if at least 5 years have elapsed since the last dose of DTP , DTaP, or DT, with routine Td boosters every 10 years.

H. influenzae type b (Hib)

Three h. influenzae type b (Hib) conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB and COMVAX [Merck]) is administered at 2 and 4 months of age, a dose at 6 months is not required. DTaP/Hib combination products should not be used for primary immunization at 2, 4, or 6 months of age unless FDA-approved for these ages. Clinical studies in infants show that some combination products may induce a lower immune response to the Hib vaccine component.

Polio (IPV, OPV)

Two polio vaccines, inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV), are currently licensed in the U.S. The first two doses of poliovirus vaccine, at 2 months and at 4 months, should be IPV. ACIP recommends that this be followed by two doses of OPV, at 12-18 months and 4-6 years. Use of IPV for all doses is acceptable, and is recommended for immuno-compromised persons and their household contacts.

OPV is not recommended for a child’s first two doses except when:

• Parents do not accept the recommended number of injections
• Late initiation of immunization would require an unacceptable number of injections
• Imminent travel will take the child to areas where polio is widespread
• Vaccination is part of a mass immunization campaign to control an outbreak of wild poliovirus

Rotavirus (Rv)

Health care providers are just beginning to provide the new rotavirus (Rv) vaccine. Parents should discuss its use with health care providers. Give the first dose of Rv vaccine after the child is 6 weeks old. The minimum interval between doses is 3 weeks, and all doses should be completed by the first birthday. Do not begin the Rv vaccine series after a child is 7 months old.

Measles, mumps, rubella (MMR)

Give the first dose of MMR when the child is a year old, and the second dose at least 4 weeks after the first dose. Children who have not previously received the second dose should receive it prior to their 13^th birthday.

Varicella (Var)

Varicella vaccine is recommended at any visit on or after the first birthday for children who have not had chickenpox (diagnosed by a health care provider) and who have not been immunized. Susceptible children 13 years or older should receive 2 doses, given at least 4 weeks apart.