Another newscast. Another case of measles. More than forty cases of measles were reported in Canada by the end of April 2019. According to the World Health Organization (WHO), measles has seen a 30% increase in cases globally. While the reasons for this are complex, two contributing factors are vaccine hesitancy and travel to countries where measles still exists by those who are unvaccinated.
Canada’s “herd immunity” is low
We know that vaccines are most effective when they provide “herd immunity,” which occurs when immunization levels are high enough that they also offer protection to those who are unvaccinated as disease outbreaks become less likely to occur. The standard herd immunity or community immunity for measles is 95%.
We have yet to reach the immunization levels required. The Childhood National Immunization Coverage Survey, 2015 showed that Canada’s average herd immunity rate was 89% – the lowest rate among the G7 countries, although there were some regional variations across the country. Meanwhile, preliminary results of the 2017 survey recently released indicate that 90% of two-year-old children have received at least one of the two required doses of the measles vaccine.
Provincial registries – our best shot at understanding vaccination rates
One of the challenges in tackling an outbreak of a disease like measles is obtaining a clear picture of vaccination coverage. Who has been vaccinated, and who has not? Which populations or areas have low vaccination rates and are at the greatest risk?
Currently, Canada does not have a countrywide immunization registry, despite cries from the healthcare community and the efforts of government. Financial, technical and provincial co-operation challenges continue to stand in the way, and this impacts our ability to obtain a precise view of Canada’s national vaccine coverage.
For now, the best shot for health officials to understand vaccination rates is by piecing together information from provincial vaccine registries. Thankfully, every province and territory in Canada, with the exception of New Brunswick and Nunavut, has an immunization registry – a central database that stores immunization events and patient vaccination profiles for access by healthcare providers.
However, the success of a provincial registry relies on the quality of data being fed to it and the information being continually updated. Dr. Michel Hébert, Medical Chief at TELUS Health says keeping the registry as accurate and current as possible is a public health law. “The healthcare community is mandated to upload each person’s vaccination history to the registry. When the registry is implemented in a province or territory, an individual’s vaccination history must also be added. In addition, every time someone is vaccinated, the administrator of the vaccine must report it to the registry.”
Dr. Hébert admits that the registry needs some fine-tuning. For example, new vaccines on the market or new groups given the authority to vaccinate, such as pharmacists, may not automatically be recognized. Also, the registry doesn’t capture vaccines that can be purchased by an individual with a doctor’s prescription and administered privately by a nurse, such as the Hepatitis A and B vaccine. However, Dr. Hébert maintains that in terms of having a complete picture of pediatric vaccinations, “we are there.”
EMR integration saves time and helps ensure registry accuracy
In some provinces, new functionality linking some EMRs (like Medesync and KinLogix in Quebec) to the provincial registry helps make accessing and updating patient vaccine files more efficient. When vaccines are administered, the information is entered into the EMR and saved in both the patient file and the provincial registry. To view a patient’s vaccination profile, physicians can access the provincial registry directly from the patient’s file within the EMR.
“If the EMR and registry are not connected, we have to log into the registry separately, and locate the correct patient’s file to find and update vaccine information. When the two are linked, the system opens the patient’s file automatically and displays it to the practitioner. We avoid potential errors and everything happens in real-time,” says Dr. Hébert.
Other EMR features can also help healthcare teams manage patient vaccinations. For example, Med Access and PS Suite have pediatric modules with immunization forms and vaccination schedules to assist doctors with keeping each child’s vaccinations up-to-date. Automated reminders can also be sent to parents and patients who have upcoming vaccinations or have missed their shots.
As the threat of superbugs and contagious diseases continue to loom, members of the healthcare community can work together to leverage digital technology to protect the health and well-being of Canadians.