describe operational and financial objectives of the systems. In addition, a technical work group was established to develop approaches to measuring performance of the systems against 12 functional standards (Hinman et al., 2007). There are also plans to develop an IIS certification process.

As the state and community IISs develop, they are increasingly used for broader purposes, such as emergency preparedness and response (Boom et al., 2007), monitoring the impact of vaccine shortages (Allred et al., 2006), and monitoring the use of new vaccines. There have also been calls to integrate IISs with other child-information systems—such as vital registration, newborn dried-blood spot screening, and early hearing detection and intervention (Saarlas et al., 2004)—and to expand the systems to include adolescents and adults. The NVAC reported that as of 2005, 87% of CDC grantees included adolescents in their IISs, and 75% included information on persons 50 years old and older (Hinman et al., 2007).

In 2009, the NVAC issued new recommendations for federal adult immunization programs (HHS, 2009).One recommendation was that CDC and the Health Resources and Services Administration (HRSA) devote resources to the inclusion of adult immunization records in all grantee IISs, and another was that all grantees be required to implement adult immunization activities and adopt ACIP recommendations for routine adult immunization.

Recommendation 4-4. States should be encouraged to expand immunization-information systems to include adolescents and adults.

  • Systems should allow the sharing of information between states so that immunization status can be tracked when people move from state to state.

  • Vaccine registries should include adult populations, such as incarcerated persons, IDUs, and people who have STDs.

  • Data sharing on vaccination status should be established between correctional facilities and public-health departments.

Barriers to Hepatitis B Vaccination

Mistrust of Vaccination

Like other childhood vaccinations, hepatitis B vaccination is sometimes refused because patients or parents of children have concerns about the safety of a vaccine (Allred et al., 2005; Gust et al., 2008; Smith et al., 2006a). The committee is unaware of credible evidence of serious harms caused by the hepatitis B vaccine in its many forms. In a 2002 scientific review by the Institute of Medicine, the hepatitis B vaccine was not found



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