Shot or Not Shot?

Adult ImmTrac Would Know

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Public Health Feature – November 2010

Tex Med. 2010;106(11):43-46.

By Crystal Conde
Associate Editor

"How many of us can confidently say that we know exactly where our immunization record is and whether we are up-to-date on our recommended vaccinations?" Jason Terk, MD, asked this pertinent question of the Senate Committee on Health and Human Services during the last legislative session.

The Keller pediatrician asked that question as he appealed to committee members to support Senate Bill 346 by committee Chair Sen. Jane Nelson (R-Flower Mound). The legislation expanded ImmTrac, the statewide immunization registry operated by the Texas Department of State Health Services (DSHS), to permit retention of immunization information in the immunization registry after a person turns 18.

Testimony from Dr. Terk and other physicians and the efforts of medical organizations paid off. The law authorizing an adult opt-in ImmTrac registry took effect Sept. 1, 2009. The adult registry will be fully operational by December, says DSHS Assistant Commissioner for Prevention and Preparedness Services Adolfo Valadez, MD, MPH.

Dr. Terk felt compelled to address the legislature because he wanted to help doctors and public health officials protect patients.

"I think public health is a shared responsibility," he said. "That includes having a robust immunization registry so that in times of public health crisis or natural disaster, the public can be protected better by consulting a reliable data source."

Dr. Terk is a member of the Texas Medical Association's Council on Science and Public Health and Be Wise — ImmunizeSM Advisory Committee. The TMA Foundation provides funding for the Be Wise — Immunize program.

Before the law's passage, a child's ImmTrac data was expunged when he or she turned 18. Dr. Terk says perfectly good immunization information was deleted because there was no way to retain adults' immunization information in the registry.

Not only does an adult registry allow Texans to keep up with their immunization records, Dr. Terk adds, it also will prevent adults from receiving unnecessary vaccines when their records can't be located, saving the patient and the state money.

Dr. Terk encourages physicians to educate their adolescent and adult patients about the adult registry.

"Adults of all ages have to give consent for their immunization records to be preserved in the ImmTrac registry. If a physician submits data to ImmTrac on a patient for which DSHS has no recorded consent, by law that patient's electronic immunization record won't be populated," he said.

At press time, ImmTrac could receive and store adult immunization records. Dr. Valadez says physicians will be able to access the records by December. For information about the adult registry, to register to participate in ImmTrac, and for adult consent forms, For additional help, call ImmTrac toll-free at (800) 348-9158.

Education Key to Success

DSHS worked with the Texas Education Agency to inform students and parents about the adult registry. According to Dr. Valadez, DSHS has collaborated with school nurses since last spring to establish a process to collect consent forms from graduating high school seniors. As of September, ImmTrac had received about 3,100 consent forms from adults.

"We'll continue that campaign annually to work with the school nurses to get student consent and move that vaccine data into ImmTrac," Dr. Valadez said.

He'd like DSHS to work with TMA and other health care associations to develop resources and training opportunities to educate health care professionals about the registry and to let them know that adults may consent to retaining their shot records in ImmTrac.

He acknowledges that an opt-in consent process has inherent benefits and challenges.

"The clear benefit to the patient is the ability to have control over protected health information. By giving informed consent, essentially, patients feel assured of their protection of privacy and confidentiality of their medical information," he said.

But attaining consent requires extra legwork, he says.

"Children who had their information stored in ImmTrac now have to consent again to make sure their records continue to be entered in the system as adults," he said. "That means more effort from physicians, other health care professionals, DSHS staff, and the individuals themselves."

Dr. Valadez says physicians can encourage their adolescent and adult patients to opt into the registry. As Dr. Valadez explains, when a child turns 18, DSHS has one year to work with the physician to obtain that patient's consent or erase the information from ImmTrac when the child reaches his or her 19th birthday.

Dr. Valadez says DSHS plans to work with TMA, the Texas Pediatric Society, and other stakeholders to develop a consent process for older adults to allow retention of their records in ImmTrac, as well.

Once an adult's immunization information is entered in ImmTrac, it can be accessed by:  

  • A Texas physician or other health care professional legally authorized to administer vaccines for treatment of the individual as a patient;
  • A Texas school (kindergarten through grade 12 or institution of higher education) in which the individual is enrolled;
  • A Texas public health district or local health department for public health purposes within its jurisdiction;
  • A state agency that has legal custody of the individual; and
  • A payer authorized by the Texas Department of Insurance to operate in Texas for immunization records relating to the specific individual covered under the payer's policy.

According to Dr. Valadez, patients cannot currently access the ImmTrac adult registry.

"Right now, patients will have to go through physicians or other health care professionals to access their immunization records. But, ideally, in the future we'd like the individual to be able to access the records directly," he said.

Recently, ImmTrac updated its immunization scheduler, which allows physicians to generate up-to-date immunization recommendations for patients with records in ImmTrac. (See "ImmTrac Updates Shot Scheduler.")

Adult Registry Has Many Benefits  

Dr. Valadez says the ImmTrac adult registry's primary goal is to increase and improve adult immunization levels by ensuring that adults receive the recommended vaccines on schedule. Immunization schedules are posted on the DSHS website.

According to 2007 and 2008 data from the Texas Behavioral Risk Factor Surveillance System, the state's adult immunization rates vary by vaccine and age group.

The hepatitis B immunization rate for adults 18 and older is 31 percent. Influenza vaccination ranges from about 26 percent for 18- to 49-year olds, to 42 percent among 50- to 64-year-olds, to 71 percent for those 65 and older. Data show 62 percent of adults 65 and older have received the pneumococcal vaccine, and about 51 percent of those 18 and older have had the tetanus, diphtheria, and pertussis (Tdap) or tetanus-diphtheria (Td) vaccine.

Only 12 percent of Texas adults aged 18 to 26 have been vaccinated against human papillomavirus.

In the long term, Dr. Valadez says, DSHS can use adult immunization data to make sure certain populations are receiving immunizations. The information in the adult registry also will allow the department to determine any vaccine coverage disparities by race, ethnicity, and socioeconomic status.

"DSHS can review information on vaccine coverage levels and allocate resources more efficiently. For instance, there may be certain areas of the state that have low coverage levels for certain vaccines. Once we've identified that problem, we can launch media campaigns to educate physicians and the public, and we can distribute resources to increase coverage levels in those parts of the state," he said.

Currently, 10,241 active sites routinely report immunization information to ImmTrac. These include physician offices, school districts, clinics, and pharmacies. ImmTrac also has 13,582 active users, including physicians, nurses, and other health care professionals who enter data into the system.

Dr. Terk says the adult immunization registry potentially can benefit public health in many ways. He points to a number of immunizations now recommended and required for adults.

Texas law now requires new or transfer students entering college to be vaccinated against meningococcal disease if they plan to live on campus. Dr. Terk says an adult immunization registry will not only be helpful and convenient for college students to consult but will also be a valuable resource to colleges.

"If a college has a localized outbreak of meningococcal virus, that school can address the outbreak by using the registry to determine who has received the vaccine, and it will not waste money repeating vaccinations," he said.

An adult registry also will allow easy access to immunization records for adults wishing to enter graduate education programs or the military or hoping to study or travel abroad.

Another vaccine-preventable disease of concern, he says, is pertussis, which is much more common than meningitis. Although it doesn't typically cause serious illness and death in adults, it does in infants.

"When children grow up and decide to have babies, they'll want to know whether they've had the Tdap vaccine. They can use the registry to check," he said. "Tdap is important for the health of future generations who are more vulnerable to pertussis."

Dr. Terk also says that the ImmTrac registry will take the guesswork out of hospitals and physicians having to determine whether a new mother has received the Tdap vaccine.

"Health care professionals and hospitals won't need to guess and won't have to give the vaccine when it's not needed," he said.

Additionally, an adult immunization registry can help public health officials manage a disease outbreak, such as an H1N1 influenza pandemic.

"Adults will want to know whether they had the H1N1 vaccine last year. Data going into the registry will allow us to have a reliable resource to consult for that information," Dr. Terk said.

And health professionals can consult adult ImmTrac records for vaccination information on first responders in the event of a natural disaster.

"When a natural disaster or disease pandemic occurs, and we have first responders who need to know if they're covered with vaccines, it's important for the state to be able to allocate those resources to those individuals who really need them," Dr. Terk said.

Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by e-mail at Crystal Conde.


ImmTrac Updates Shot Scheduler

The Texas Department of State Health Services (DSHS) has updated ImmTrac to make it easier for physicians to generate up-to-date immunization recommendations for patients with records in ImmTrac. ImmTrac is the statewide immunization registry operated by DSHS.

The new version of the immunization scheduler recognizes combination vaccines. It also adds vaccines not included in the previous scheduler, such as human papillomavirus, seasonal influenza, and rotavirus.

The feature follows the Advisory Committee on Immunization Practices (ACIP) recommended schedule. The recommendations are calculated on the basis of the immunizations stored in the patient's ImmTrac record, essentially creating a customized schedule for each ImmTrac client.

DSHS has posted a Frequently Asked Questions document [PDF] on its website. Call (800) 348-9158 or e-mail if you need more information.

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