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Objective: To explore the utility of laboratory data and determine the validity of healthcare administrative data for describing the frequency of measles in Ontario., Methods: We linked Ontario healthcare utilization administrative data to Public Health Ontario (PHO) laboratory data from 01 January 2006 to 30 November 2012., Results: The sensitivity of the administrative data was 54% and the positive predictive value was 1% when compared with 50 cases identified in laboratory data as a gold standard., Conclusions: As measles is no longer endemic in Ontario, the high number of measles-coded healthcare visits found in Ontario health administration data exceeds the true number of cases. Great caution should be taken in using administrative data to calculate the incidence of measles in areas where it has been eliminated.

Objectives: Canada does not have a national immunization registry. Diverse systems to record vaccine uptake exist, but these have not been systematically described. Our objective was to describe the immunization information systems (IISs) and non-IIS processes used to record childhood and adolescent vaccinations, and to outline the strengths and limitations of the systems and processes., Methods: We collected information from key informants regarding their provincial, territorial or federal organization's surveillance systems for assessing immunization coverage. Information collection consisted of a self-administered questionnaire and a follow-up interview. We evaluated systems against attributes derived from the literature using content analysis., Results: Twenty-six individuals across 16 public health organizations participated over the period of April to August 2015. Twelve of Canada's 13 provinces and territories (P/Ts) and two organizations involved in health service delivery for on-reserve First Nations people participated. Across systems, there were differences in data collection processes, reporting capabilities and advanced functionality. Commonly cited challenges included timeliness and data completeness of records, particularly for physician-administered immunizations. Privacy considerations and the need for data standards were stated as challenges to the goal of information sharing across P/T systems. Many P/Ts have recently implemented new systems and, in some cases, legislation to improve timeliness and/or completeness., Conclusion: Considerable variability exists among IISs and non-IIS processes used to assess immunization coverage in Canada. Although some P/Ts have already pursued legislative or policy initiatives to address the completeness and timeliness of information, many additional opportunities exist in the information technology realm.

Objective: Premature children are at increased risk of complications from vaccine-preventable diseases and should be vaccinated with the routinely recommended childhood vaccines at the same chronological age as full-term infants with the exception of the hepatitis B vaccine for infants of HBsAg-positive mothers. We sought to compare on-time vaccination levels in premature children for recommended vaccinations to levels in children born at term., Methods: Using linked health administrative databases, we compared the proportion of term (37+ wks), near term (33-36 wks), very premature (28-32 wks) and extremely premature (≤27 wks) children who received at least one vaccination during the 2-, 4- and 6-month vaccination visits within the recommended time period in the province of Ontario., Results: When we excluded children who were hospitalized at any time during the vaccination window, we identified that vaccination rates were within 3% of each other in the 4 categories examined. However, when we included infants who may have been hospitalized at any point during the on-time window, we observed substantially lower rates in the extremely premature children at 2 and 4 months and in the very premature children at 2 months., Conclusion: Our study identifies the need to confirm whether vaccinations are given while premature children are in hospital during the time of their scheduled vaccinations.

Objective: To evaluate the implementation of Ontario's publicly-funded, school-based HPV immunization program through a process evaluation., Participants: The immunization program targets grade 8 females. Ontario vaccine-preventable disease managers were the key informants for this evaluation., Setting: Ontario, Canada., Intervention: Ontario's Public Health Units (HUs) are responsible for the local implementation of the immunization program. The process evaluation involved a telephone-based, semi-structured questionnaire which included questions on stakeholder engagement; school and school board participation; communication strategies; and processes for obtaining informed consent., Outcomes: All 36 HUs participated; 16 (44%) reported difficulties receiving agreement from local school boards to administer HPV vaccine in schools. Two Catholic school boards have not permitted HPV vaccine clinics in their schools: 1 only during the first year and 1 in the second and third years. All HUs request parental consent for students to receive the HPV vaccine and 5/36 also request or encourage student consent; 14 HUs indicated they would immunize a grade 8 girl at a school clinic, in the absence of parental consent, if the student requested immunization and was judged capable of providing informed consent., Conclusion: Many HUs reported challenges in receiving support from local school boards. Despite this, vaccine clinics have been offered in all but 2 public school boards since 2007. All HUs request parental consent before HPV immunization at school-based clinics; 39% would consider immunizing in absence of parental consent. The results of this process evaluation will inform the HPV immunization program evaluation that is currently underway in Ontario.

Objectives: A critical component of the 2009 H1N1 vaccination campaign was the collection of immunization data at the point of care. To meet reporting requirements and to ensure timely availability of coverage information, many jurisdictions across Canada employed new or modified approaches to vaccine data collection. The objective of this study was to observe and characterize the range of influenza immunization data collection approaches used across Canada., Methods: As part of a multi-stage observational study, the research team visited immunization clinics at which tasks related to data collection and management were observed. Tasks included registration, medical history collection and review, vaccine record-keeping, proof of vaccination preparation, and data entry. Field notes were analyzed in order to understand the data collection mechanisms that comprised each information system as a whole., Results: Data collection mechanisms were grouped into two categories: electronic systems (9/38), in which all data were captured on computer; and hybrid systems (29/38), comprised of computerized and paper-based data collection tasks. Observed systems included stand-alone databases, immunization registries, and electronic health records. Organizations incorporated magnetic card reader technology, telephone registration, and pre-populated fields into data collection approaches. Electronic systems captured a greater number of data elements., Conclusion: Canadian jurisdictions employed a range of data collection approaches during the H1N1 vaccination campaign. System characteristics can have important implications for on-site efficiency and organization as well as program planning and evaluation. The systems observed have been described in detail to allow vaccine providers and planners to learn from what has been done elsewhere.

Ontario initiated a universal hepatitis B immunization program for grade seven students in the fall of 1994. An ecological study was conducted within seven health units of the Greater Toronto Area to assess vaccine coverage. The study population consisted of all grade seven students enrolled within schools in the participating health units, on October 1, 1994. There were 39,935 students enrolled in 604 schools eligible for inclusion in the study. Consent to receive the vaccine series was obtained for 88% (range across health units from 81.5% to 96.3%) of the students. Among students for whom consent was obtained, an average of 95% (range 88.1% to 99.5%) completed the series. Therefore, the total vaccine coverage for the study population was 84% (range 77.5% to 89.5%). Series completion varied by school board, education provider and the use of Ministry of Health educational material. A limiting factor in achieving high vaccination coverage among grade seven students was obtaining consent to receive the vaccine series.