ABSTRACT
This study used data from the population database through which the province of Manitoba, Canada, administers its universal health insurance plan. Enrollment, hospitalization, and immunization files from children born in the 1987-1989 period were linked using the unique identification number assigned to each population member. Analysis of these linked data successfully identified serious potential adverse events in the first year of life and the timing of events around immunization. Not only is population-based active surveillance for immunization-related events feasible, but the techniques described, applied to years of data accumulated through surveillance, offer powerful research tools. Baseline population incidences of adverse events were calculated, temporal relationships between events and immunization assessed, and incidences for events showing true temporal associations determined. Eventual goals are the quantification of vaccine-related risk and the gathering of evidence concerning casual associations. The approach could be used readily by several other Canadian provinces and by health maintenance organizations in the United States.
Subject(s)
Diphtheria Toxoid/adverse effects , Diphtheria-Tetanus-Pertussis Vaccine , Pertussis Vaccine/adverse effects , Poliovirus Vaccine, Inactivated/adverse effects , Population Surveillance , Tetanus Toxoid/adverse effects , Vaccination/adverse effects , Cohort Studies , Diphtheria/epidemiology , Diphtheria/prevention & control , Diphtheria Toxoid/administration & dosage , Female , Fever of Unknown Origin/etiology , Hospitalization/statistics & numerical data , Humans , Immunization/statistics & numerical data , Immunization Schedule , Incidence , Infant , Infant, Newborn , Male , Manitoba/epidemiology , Pertussis Vaccine/administration & dosage , Poliomyelitis/epidemiology , Poliomyelitis/prevention & control , Poliovirus Vaccine, Inactivated/administration & dosage , Seizures/epidemiology , Seizures/etiology , Tetanus/epidemiology , Tetanus/prevention & control , Tetanus Toxoid/administration & dosage , Vaccines, Combined/administration & dosage , Vaccines, Combined/adverse effects , Whooping Cough/epidemiology , Whooping Cough/prevention & controlABSTRACT
In Manitoba, Canada, a centralized, computerized childhood immunization monitoring system serves a population with insured medical coverage; each individual has a unique identification number. All physicians bill a single payer, and specific billing codes are used to identify immunizations given by physicians and by public health nurses. Together with dates of service, this information is used to construct immunizations-to-date and age-at-immunization profiles for individuals and groups. Reminders seeking missing information are built into the system and executed at strategic ages. The quality of input data has been assessed as high. The approach could be used readily by health maintenance organizations in the United States.
