INNOVATIVE APPLICATIONS OF IMMUNISATION REGISTRATION INFORMATION SYSTEMS: EXAMPLE OF IMPROVED MEASLES CONTROL IN TAIWAN

Sunday, 21st of December 2014

INNOVATIVE APPLICATIONS OF IMMUNISATION REGISTRATION INFORMATION SYSTEMS: EXAMPLE OF IMPROVED MEASLES CONTROL IN TAIWAN

Eurosurveillance, Volume 19, Issue 50, 18 December 2014

D P Liu^1,2, E T Wang³, Y H Pan³, S H Cheng ()²

1. Epidemic Intelligence Center, Centers for Disease Control, Ministry of Health and Welfare, Taiwan
2. Institute of Health Policy and Management, National Taiwan University, Taiwan
3. Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, Taiwan

Abstract and introduction below ; full text is at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20994

Citation style for this article: Liu DP, Wang ET, Pan YH, Cheng SH. Innovative applications of immunisation registration information systems: example of improved measles control in Taiwan. Euro Surveill. 2014;19(50):pii=20994.
Date of submission: 10 October 2013

Immunisation registry systems have been shown to be important for finding pockets of under-immunised individuals and for increasing vaccination coverage. The National Immunisation Information System (NIIS) was established in 2003 in Taiwan. In this perspective, we present the construction of the NIIS and two innovative applications, which were implemented in 2009, which link the NIIS with other databases for better control of measles. Firstly, by linking the NIIS with hospital administrative records, we are able to follow up contacts of measles cases in a timely manner to provide the necessary prophylaxis, such as immunoglobulin or vaccines. Since 2009, there have been no measles outbreaks in hospitals in Taiwan. Secondly, by linking the NIIS with an immigration database, we are able to ensure that young citizens under the age of five years entering Taiwan from abroad become fully vaccinated. Since 2009, the measles-mumps-rubella vaccine coverage rate at two years of age has increased from 96% to 98%. We consider these applications of the NIIS to be effective mechanisms for improving the performance of infectious disease control in Taiwan. The experience gained could provide a valuable example for other countries.

Introduction

Immunisation is the most effective and efficient way to prevent vaccine-preventable diseases. However, the appropriate coverage rate is still critical for a comprehensive immunisation programme, especially for highly contagious diseases such as measles. The World Health Organization (WHO) recommends that countries should achieve coverage greater than 95% for a two-dose measles-containing vaccine in every district to eliminate measles [1]. The WHO European Region has set 2015 as the target for interrupting transmission of measles and rubella [2]; however, according to the 2014 Assessment report of the global vaccine action plans [3], among the three WHO regions aiming for measles elimination by the end of 2015, the Eastern Mediterranean Region and the European Region are markedly off track. The WHO Western Pacific Region has made the most progress, but outbreaks in China, the Philippines and Vietnam in 2013 proved a setback. National coverage is above 95% in many countries in the three WHO regions, but just one weak district is enough for this highly contagious virus to continue circulating [3].

In many countries, comprehensive immunisation registry information systems are well established and have proved helpful in identifying pockets of under-immunised individuals and improving vaccination coverage [4]. This perspective aims to present innovative applications of the system used for measles prevention and control in Taiwan and to share the preliminary experiences. New concepts of immunisation database linkage could help to address the weakness in measles control in mobile populations and within medical settings, even in countries with comprehensive vaccination polices.

Taiwan is well known for its information technology industry, and technology advances have been readily adopted in health management for over 20 years. The Primary Health Information System (PHIS) was first established for public health stations in every township in the 1990s. The vaccination registry system was developed independently and was extended to a web-based system to fulfil the demand to keep up with the mobile population of Taiwan. The planning and construction of a new registry system, the National Immunisation Information System (NIIS), started in 2001. Since the end of 2003, the system has been operating online, running at all public health bureaus in 25 counties/cities and public health stations in all 373 townships. It took a year to train the users and to extend its use from government public health services to all of the 1,600 contract clinics and hospitals, covering all service points nationwide. Since 2005, all of the local health agencies have been participating in the NIIS and upload complete information to a central database. As several imported measles cases and clusters occurred from the end of 2008 to spring 2009 [5], NIIS data linkage was considered in 2009 to help to control the disease.