The Role of the Immunization Registry in a Measles Outbreak, New York City

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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_at_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
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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

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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

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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

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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

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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

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Number of Children Exposed by Site n64
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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

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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 childrens records with
  over 15 million immunizations
• Contains contact information of all NYC providers
  who immunize children

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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

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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

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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 lt 1 y/o
were also exposed but not eligible for an MCV
11 (44) were found in the CIR 7 (28)
children received IG
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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

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Areas affected in NYC
Pediatrician Office
Hospital A
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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

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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