Evaluation And Monitoring Of Children Immunization Coverage Based On Immunization Information System Of Shandong,China

[Background]Vaccination is the most specific,the most effective,the safest and the most economical primary preventive measure to control infectious diseases.The National Immunization Programme(NIP)in China has attracted worldwide attention.Since the implementation of Expanded Immunization Programme(EPI)for children began in 1978,the goal of Universal Childhood Immunization was achieved,with a child immunization coverage rate reached 85%at the provincial,county and township levels in 1988,1990 and 1995,respectively.Since China entered the period of NIP from 2000,especially the expanded NIP was implemented in 2007,the free vaccinations against diseases provided by government has increased from 4 vaccines against 6 diseases in 1978 to 14 vaccines against 15 diseases,greatly ensured the health of the people.As the number of vaccinations increased,the traditional methods of establishing vaccination records by hand and routine immunization rate monitoring gradually showed disadvantages.There are many problems in manual filing,such as heavy workload,incomplete record of vaccination information,repeated filing of floating children,etc.However,the report of routine immunization rate is manually counted and filled by doctors from vaccination unit,which often has data omission,false reporting and filling error.Although vaccination rate sampling surveys can play a supplementary role in reporting vaccination rates,household surveys are becoming more and more difficult due to factors such as population flow and urbanization,and restricted by manpower and material resources,the age group of the survey is limited,the survey object has certain selection bias,it is difficult to obtain the accurate vaccination data of all age groups.With the rapid development of computer and network information technology,it is possible to manage vaccination cases through information technology.As early as the 1960s,computers were applied to children's health services in developed countries.The United Kingdom,the United States,Australia and other developed countries started to use the computer system for children's vaccination management,the main functions include vaccination registration,vaccination appointments,vaccination notification,the generation of coverage reports,and new vaccine application monitoring.Since 2000,some provinces in China began to explore the establishment of Immunization Information System(IIS).The traditional manual registration of child immunization cases has been transformed into the use of computer management to improve work efficiency.After the introduction of relevant national policies in 2006,the IIS system construction mushroomed everywhere.By 2010,eight provinces including Shandong,Beijing,Shanghai,Zhejiang,Jiangsu,Hubei,Anhui and Hainan had established provincial platforms.Other provinces had made positive progress.By 2017,23 provinces(autonomous regions and municipalities directly under the central government)had established provincial-level platforms for regional information sharing.However,because there is no unified national construction standard and indicator system,the functions of the established provincial platforms are quite different.Most of the provincial platforms were limited to the collection of vaccination cases and the exchange of vaccination data of floating children,so the use of the platform's mass case data is not sufficient.In addition,some of the algorithms of vaccination rate are still inaccurate and inconsistent,and the substitution rules of non-NIP vaccines for NIP vaccines are not clear,all of which cause great interference to the data evaluation results.Therefore,although the IIS has been established,most provinces have not really played an effective role in the real-time monitoring and evaluation of population access rates in immunization work.[Objectives]According to the work requirements of NIP and the work requirements of EPI and vaccination in Shandong province,this study intends to further improve the IIS provincial platform function program based on the work of IIS in Shandong province,to tentatively establish the method of quality control,real-time monitoring and evaluation of vaccination data for children based the IIS in Shandong province,which is applied to the practical work to realize the full utilization of vaccination information in the whole province.The main objectives of this study are:(1)to establish the quality control index system and algorithm rules of vaccination information,to develop the program software for the evaluation of children's vaccination data quality,and to realize the quality analysis of vaccination information.(2)to establish the index system and algorithm rules for the monitoring and evaluation of vaccination information,to develop the program software for the real-time monitoring and evaluation of the coverage rate of children,and to realize the real-time monitoring and evaluation of the coverage rate based on the birth cohort.(3)to apply the above two rules and methods to the practical monitoring and evaluation of NIP vaccine for children in Shandong province.By using the vaccination record database of IIS system in Shandong province,and according to NIP,the data quality and vaccination rate of the current school-age children's routine immunization were monitored and evaluated in real-time,children who have not been immunized are promptly identified and targeted measures are taken to vaccinate them in a timely manner in order to achieve the goal of increasing and maintaining a high level of coverage.[Methods]The population data in this study were obtained from Shandong Statistical Yearbook from 2011 to 2017 compiled by Shandong Provincial Bureau of Statistics,and the vaccination record data were obtained from the IIS platform in Shandong province.The platform construction adopts the Web application platform based on J2EE technology,integrates project contents into the Web application platform through the basic platform integration technology,and provides an open standard interface based on XML technology.The requirements of this research project are formed through literature review and expert consultation,and data warehouse technology is adopted for data mining and analysis.In this study,the evaluation index and its algorithm of IIS data quality control rules,rules of vaccination status monitoring and evaluation index and its algorithm,is according to the requirements of such normative documents as the National Code of Practice for Prevention and Vaccination,the National Immunization Program Vaccine Immunization Procedure,the Vaccine Instruction Manual and the Code of Practice for the Management of Information Reporting on Childhood Immunization,at the same time,combined with the actual operational needs of child vaccination in Shandong province,in the expert argumentation and solicit opinions from the grass-roots workers,on the basis of formulating and gradually perfect;Finally,the software development and software testing are organized by the winning company and transferred by the research group to the provincial platform after the testing is completed.CDC in some cities,counties and vaccination units conduct trial use,the existing problems and the existing function proposed further modifications,after the summary again submitted to the winning company for system improvement and test release,form the final application software.This study is based on the city as an example to carry out a real-time monitoring and evaluation of children's vaccination data quality control and vaccination rate based on the IIS of Shandong province.The actual application of vaccination data statistics is completed on Dec.31,2017,which is automatically generated according to the research software installed on the IIS system platform of Shandong province.[Results]1.In this study,the functional standards and evaluation indicators of Shandong province vaccination information platform and the client management procedures of Shandong province IIS were established,and the data quality and vaccination status of the IIS were evaluated accordingly.2.Through the setting of quality evaluation index in IIS,the data management rate,upload rate,integrity and repetition rate of vaccination cases in Shandong province have been greatly improved.The data quality of IIS and status of vaccination were evaluated.The case management rate and data upload rate of IIS were close to 100%.The basic information except the ID number and inoculation information except the inoculation site reached more than 99%.The data modification rate,replacement rate and repetition rate were 2.74 ‰,7.46 ‰ and 0.58 ‰,respectively,which still had room for decline.3.As the quality of vaccination data in Shandong province is generally at a high level,testing and evaluation were conducted on the city-based vaccination results of children in the whole province.The single vaccination rate of children aged 1-7 in all age groups was mostly above 90%,and the vaccination dose of some children in large age groups was less than 90%.[Conclusions]1.The data quality of the IIS of Shandong province is generally high,with low data integrity in some regions and high modification rate,supplement rate and repetition rate.The immunization coverage of children in small age group is better than that in large age group,and the immunization coverage in eastern region is better than that in western region.2.The functional standards and evaluation indexes of the Shandong provincial IIS platform established in this study are applicable to the actual NIP work in Shandong province,and basically meet the requirements of data quality control and vaccination rate evaluation.3.The functions of the examination of vaccination certificate for admission and docking with the information system of vaccine syringes in this study have not been fully realized,which need to be further improved in the future work.[Suggestions]1.Further improve and maintain the data quality of the IIS.In the future,it is necessary to further increase the training of inoculating clinic staff,strengthen the sense of responsibility and enthusiasm,improve the quality of input of vaccine information and vaccination information,ensure the consistency of inoculating information system case information and inoculating certificate information,and ensure the data of IIS is true,accurate and reliable.2.The index system and algorithm rules of quality control and access rate monitoring and evaluation of the IIS established in this study are popularized and applied.The relevant units should regularly evaluate and feedback the results so as to perfect the index system and algorithm rules.At the same time,the program software developed for real-time monitoring and evaluation of children's vaccination rate should be further upgraded to gradually realize real-time monitoring and evaluation of children's vaccination rate,so as to meet the needs of the practical NIP work.3.Actively explore the establishment of linkage mechanism with other big data management departments,such as household registration management departments.A shared database based on Shandong Health Cloud Platform will be established to realize the interconnection between household registration information of children and basic information of children in IIS,strengthen the synchronous management of floating children and permanent children within the jurisdiction,and improve the vaccination rate of children.4.Timely expand the functions and applications of the IIS in Shandong province.According to the requirements of the new Vaccine Management Law and relevant national standards,the functional modules of the IIS in Shandong province should be further expanded on the existing basis.For example,the information system of vaccine injectors should be added as soon as possible to connect with the vaccination case system,so as to effectively implement the electronic traceability system for the whole course of vaccines.As soon as possible,the enrollment certificate will be incorporated into the IIS and connected with relevant units of the education department.The cold chain temperature electronic monitoring and recording system will be incorporated into the IIS as soon as possible to further improve the whole process of vaccine transportation and temperature automatic monitoring to ensure the quality of vaccine.