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Niklas Danielsson

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  1. Electronic immunisation registers – Making a difference Electronic immunisation registers are not panacea to measles elimination but they could make a difference. Measles incidence fell 73% worldwide between 2000 and 2014, from 146 to 40 cases per million population, and eradication now looms in the distance. But for decades, measles control has stalled here in Europe and we just missed yet another elimination target date. The truth is that we are in desperate need of innovation, renewed commitments and a change of tactics when it comes to measles control in Europe. Unless we do some things better and others differently, Europe is unlikely to break the chain of domestic transmission any time soon. More of the same will not graduate Europe to join the measles-free part of the world. Data for decision-making is critical and timely, accurate and detailed information on vaccination uptake over time and place is of the essence for responsive immunisation programme management. Electronic Immunisation Registers (EIR) and Immunisation Information Systems (IIS) are two commonly used terms for computerised systems that record individual vaccinations. Such systems allow managers to monitor vaccine uptake at high resolution (i.e. uptake in smaller administrative areas), rapidly investigate signals of adverse events from vaccination, and study changes in vaccine effectiveness. Web-based EIR and IIS allow for real-time recording of individual vaccinations, including bar-code identification of the unique vaccine vial that was administered to a particular recipient. The advantages for parents and others are substantial: they no longer have to safe-guard paper records of vaccinations, they can receive verified transcripts of register records on request when required by schools and employers, and they have access to a trusted source of information on vaccines and vaccination schedules. If electronic immunisation registers offer such clear benefits to both parents and programme managers, then why do not all countries in Europe invest in them? Is it because national immunisation programmes have become complacent as a result of their historic successes? Are public health managers a conservative community that worries about rocking the boat? Or are there other, more palpable challenges of a financial, technical or legislative nature that have delayed these digital developments? I would like to learn more about your opinions on this matter. And I encourage you to explore the Norwegian electronic immunisation register as an example of what a register can deliver. This database has national coverage, operates with unique personal identifiers, and covers all children in the country. Immunisation registers such as the Norwegian that are populated from birth registration and migration records produce near complete denominators, an invaluable asset for surveillance of vaccine safety and effectiveness, and a fantastic resource for programme managers. The immunisation register in Norway is called SysVak. Click on the link to find out what SysVak offers to parents and individual vaccine recipients (information available in English). Uptake of the childhood vaccination programme is reported in absolute numbers and percentage fully vaccinated children at ages 2, 9 and 16 years, and down to the level of communes. Check out the interactive database on vaccination uptake by place, year and vaccine: http://www.norgeshelsa.no/norgeshelsa/ Systems similar to the Norwegian are in operation in other European countries, including Denmark, Finland, UK, and the Netherlands. The European Centre for Disease Prevention and Control (ECDC) recently started a project aimed at sharing experiences and expertise on IIS, and to provide technical support to countries with plans to set up electronic immunisation registries. If you want to learn more about this project please send an email to info@ecdc.europa.eu. To share your thoughts on electronic immunisation registers you can join the conversation by posting a comment here.
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