A National Immunization Registry as a Digital Assessment Tool during Outbreaks

Background: Immunization registries assemble vaccinations data to one database, enabling monitoring and planning to sustain and increase vaccination coverage. Even in high coverage locations, “pockets” of unvaccinated children occur, limiting herd immunity against highly contagious pathogens, e.g. measles and expediting disease spread and outbreaks.

Objective: To outline the practical utilization of Israel’s national immunization registry as a digital public health tool during vaccine-preventable-diseases outbreaks.

Methods: Routine vaccinations are offered without charge to all children at community-based clinics for age birth to 6 years and by school health services - age 6 to 15 years. Vaccinations are not mandatory. The national population is 9.1 million, children (0-17 years) consist a third of the population; the annual birth cohort 184,370 (2018).

Results: The registry was launched in late 2009 and expanded to include routine vaccinations, from electronic health records in child health clinics and school health services nationally. The registry was first utilized in the polio vaccination campaign for children in 2013 (following wild poliovirus type 1 WPV1 isolation in sewage samples in southern Israel). The monitoring provided daily data on campaign coverage and performance. The WPV1 event control was successful. The registry was utilized in the 2018-2019 measles outbreak (n=4300 cases), 8-10% were hospitalized (the leading complication pneumonia/pneumonitis) with 3 fatalities. Most cases (75%) were under 15 years, 85% were unvaccinated. The vaccination campaign was conducted with online support by registry data and led to increase of the MMR1/MMRV1 coverage rates from 80% to 95% within 3 months in children in the affected regions and to a marked decline in measles incidence.

Conclusion: An ongoing childhood vaccination coverage monitoring, by a national registry, during regular circumstances prepares the basis for utilization in outbreaks and emergencies. The national immunization registry may become useful in the future implementation of the novel COVID-19 vaccines.