The information resources that are currently available cannot answer critical questions about the immunization status of individual children or overall immunization levels among groups of children. The committee observed that data collection at the national, state, and local levels often is not coordinated. National surveys, for example, can rarely provide state-level results. The population-based data, which are essential for public health assessments and public accountability for program performance, are often unavailable. Furthermore, data collection and analysis remain impractical for many providers because they must rely on time-consuming manual procedures.

The committee felt that the success of the United Kingdom's immunization program clearly demonstrated the value of having good information and using it effectively. Immunization coordinators, providers, and families all need to know about children's immunization status. By monitoring the performance of health districts and individual providers, the United Kingdom's immunization program has been able to identify problem areas and, by comparing districts and providers, promote improvements. Providers receive a complete list of children for whom they are responsible and information on whether those children have had the appropriate immunizations. The United Kingdom has also made careful use of a somewhat different kind of information—market research—to guide the development of their public information messages and to target the delivery of those messages. All of these pieces make essential contributions to the program's success.

In the United States, there is renewed interest in immunization information and information systems.1 Immunization questions added to the NHIS in 1991 have produced the first national data since the last round of the U.S. Immunization Survey in 1985. CDC's random-digit dialing surveys, mentioned earlier, are expected to begin producing data on immunization levels for the IAP areas (states and 24 cities and counties) by the end of 1994. Even though telephone surveys are not ideal (e.g., they cannot include families that do not have a telephone and may have difficulty including respondents who do not speak English), this new program will produce the country's most comprehensive information on immunization coverage. Planned validation


In the 1960s, birth records were used for immunization surveillance and tracking. The limitations of the technology of the time made the process time-consuming and inefficient, and it was eliminated in the 1970s. From 1959 to 1985, the U.S. Immunization Survey provided annual estimates of national immunization rates. Apparent success in controlling vaccine-preventable diseases led to discontinuation of the survey. See Johnson (1992) for a more detailed history.

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