use of nominal records for closing gaps in immunization

Measles control in ChileUse of nominal records for closing gaps in immunization

de 2016

Fernando Munoz, MD, MSCHead, Department of Immunizations

Ministry of Health, ChileSiena, May 2016

2

ChileAdministrative Organization:• 15 regions• 346 municipalities

• Ministry of Health• 15 SEREMI (Regional Health

Authorities)• 29 Health Services

(Governmentally managed)

• Population:18.006.407

2016Vaccination schedule: 12 months 1°dose In certified public

and private facilities

6 years First grade in basic schools (publicand private)

Vaccines (Programmatic and Campaigns) aremandatory. The program is managed by theMOH. Provision of vaccines to public andprivate facilities is free of charge and is fundedwith governmental resources.

History of Vaccination

1963 1983 –1985 1980 - 1981

Measlesvaccine at 9 months

Vaccine at 12 and 18 months

Vaccine at First grade (6 yearsold)

1992 - 2015

Campaigns in different agegroups (mostlyin children)

Measles Mortality

Chile 1951 - 2006

0

2

4

6

8

10

12

51 55 59 63 67 71 75 79 83 87 91 95 99 '03 2006

1963 Vaccine in National Program

Tasas por 100 casos Fuente. DEIS. Depto. de Epidemiología

Campaigns

Campaigns

Measles morbidity

Chile 1951 - 2006

0

100

200

300

400

500

600

51 55 59 63 67 71 75 79 83 87 91 95 99 2003

Tasas por 100.000 habitantes. Fuente. DEIS. Depto. de Epidemiología

1963:Vaccine in national program

Campaigns

Campaigns

Coverage in campaigns

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Year Campaign Coverage

1992

Puesta al día, Campaña Masiva, 9 meses- 15

años 99.6%

1996 2da. Puesta al día, Campaña Masiva 1 -15 años 100,0%

2001 1ra. Campaña de Seguimiento 1- 5 años 99,0%

2005 2da. Campaña de Seguimiento 1- 5 años (SR) 93,2%

2010 3ra. Campaña de Seguimiento 1- 5 años (SRP) 75,2%

2015 82.5 %

8

2010Implementation ofRNI for the InfluenzaCampaign

2011

Implementation ofthe programaticvaccines module,BCG in maternitywards and travelers

2011Nominal and traditional register in parallel

2013 RNI is the official source of data concerning vaccines

Nominal Record (RNI)

• Nominal Record for vaccines provided to public and private health centers.

• Timely information for monitoring vaccine coverage.

• Allows tracing people vaccinated and products used.

• Information management: Attendance, rejection to vaccines, stock control, planning

acquisitions.

9

Modules

Program

Campaigns

Maternities

Outbreaks/Contingencies

Cordination with the Health Statistics and Informatics departments.

Over 10 million people already registered in RNI.

1.196 Health Facilities already using RNI.

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National Record of Immunizations (RNI)

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Interoperation

RNI

Data Warehouse

12

www.saludteprotege.cl

www.deis.cl

• History

• Manuals

• Report

• Monitoring:

- Ocurrence

- Residence

Report: Reporte Vacunas Programáticas

Reporte Vacunas Campañas

http://www.saludteprotege.cl/

http://www.deis.cl/

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Report

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Coverage with different denominators

RNI/INE RNI/RNV2015

SRP

Región1a dosis

Administradas RNV Cobertura

Arica y Parinacota 3.092 3.499 88,4%

Tarapacá 5.224 5.722 91,3%

Antofagasta 8.554 10.031 85,3%

Atacama 4.577 4.942 92,6%

Coquimbo 10.736 11.408 94,1%

Valparaíso 22.789 23.751 95,9%

Metropolitana 98.565 101.616 97,0%

Lib. Bdo O'Higgins 12.284 12.221 100,5%

Maule 13.975 14.117 99,0%

BioBio 26.237 27.068 96,9%

Araucanía 13.031 13.114 99,4%

Los Ríos 4.848 4.994 97,1%

Los Lagos 10.679 11.214 95,2%

Aysén 1.508 1.522 99,1%

Magallanes 1.904 2.067 92,1%

Total 238.003 247.286 96,2%

2015

1a dosis

Administradas Pob. INE Cobertura

Arica y Parinacota 3.092 3.632 85,1%

Tarapacá 5.224 5.930 88,1%

Antofagasta 8.554 9.964 85,8%

Atacama 4.577 4.973 92,0%

Coquimbo 10.736 11.202 95,8%

Valparaíso 22.789 23.637 96,4%

Metropolitana 98.565 100.654 97,9%

Lib. Bdo O'Higgins 12.284 12.322 99,7%

Maule 13.975 13.589 102,8%

BioBio 26.237 27.386 95,8%

Araucanía 13.031 13.135 99,2%

Los Ríos 4.848 5.232 92,7%

Los Lagos 10.679 11.555 92,4%

Aysén 1.508 1.553 97,1%

Magallanes 1.904 2.131 89,3%

Total 238.003 246.895 96,4%

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Coverage

Año Vacunados Cobertura Vacunados Cobertura

2010 236.926 94,4 205.162 83,7

2011 231.208 92,0 193.970 79,0

2012 227.162 90,3 180.614 72,9

2013 223.321 90,0 184.913 77,6

2014 235.051 96,2 217.248 88,7

2015 238.003 96,4 226.605 88,6

Fuente 2010-2012 RNI INE 2002Fuente 2013-2015 RNI INE actualizado 2013-2020

12 months First Grade

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TOTAL PAIS Total

CHILE: total de dosis administradas 1024965

Sala cuna - 1 Año 19491

Sala cuna - 2 Años 20575

Sala cuna - Otros 4774

Jardin infantil - 3 Años 82966



Jardin infantil - Otros 49867

Colegio - 3 Años 11948



Colegio - Otros 18645

Extramural (plazas-parques) - 1 Año 4633

Extramural (plazas-parques) - 2 Años 5393




Extramural (plazas-parques) - Otros 242

Vacunatorio - 1 Año 174734

Vacunatorio - 2 Años 108071




Vacunatorio - Otros 3091

RECHAZOS 8357

Daily Report during campaign

Register of activityaccording to setting of thevaccination

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Record of rejection

In order to implement strategies for reaching this population

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Comunas Buin Cerro Navia Colina Conchalí El Bosque Estación Central Huechuraba La Florida La Granja La Pintana

Buin 4332 1 8 3 1 6 2

Cerro Navia 4632 3 5 10 49 2 11 6

Colina 1 4 7148 2 5 8 4 2 2

Conchalí 6 5 5204 12 4 14 8 2 5

El Bosque 2 3 1 1 7741 4 25 8 99

Estación Central 24 1 9 3376 3 19 6 12

Huechuraba 4 14 10 5 1 4792 4 2 5

La Florida 3 6 1 8 31 10 5 12063 73 71

La Granja 3 3 42 4 1 245 5224 228

La Pintana 2 10 1 363 3 9 90 197 7698

Ocurrence

Campaign: Follow up of doses administered according to residence and occurence

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Rescue of unvaccinated children

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Phone call

Adressed to people missing doses

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Standard message for the whole

population

Message for people with

missed vaccines

Text messages

22

Rapid coverage monitoring

RNI was used for rapid monitoring. Childrenfound at home can be check with the registerand ID

Towards Erradication. Risk Matrix for theCountry

Risk matrix for a region

CADENAS DE TRANSMISIÓN BROTE DE SARAMPIÓN ASOCIADO A IMPORTACIÓN (H1). CHILE,

RM, MAYO-JULIO 2015

Caso 1 Importación (12/05)

31 años-viajero_Hombre

Caso 3 (01/06) 31 años-Hombre Caso 4 (2/06)

44 años (médico)-Hombre

Caso 6 (13/06) 10 meses (Hijo)

Caso 7 (15/06) 32 años Mujer

Caso 8 (27/06) 12 años (tío menor)

Caso 9 (11/07) 28 años-Mujer

Caso 2 (25/05) 10 meses-Niño

Caso 5 (4/06) 20 años (tío)

02 Jul

05 Jul

08 Jul

11 Jul

12 mayo

15 mayo

18 mayo

21

mayo

24

mayo

27 mayo

30

mayo

29

junio

26 junio

23

junio

20

junio

17

junio

02 junio

05 junio

08

junio

11

junio

14 junio

Seroprevalence for Measles (Sera obtained in the NationalHealth Survey, 2009, analyzed in 2011)

0%

20%

40%

60%

80%

100%

Gráfico Nº 4:Seroprevalencia de Sarampión según Sexo y Grupo

Quinquenal. Chile, año 2011

Masculino

Femenino

Fuente: Departamento de Epidemiología - DIPLAS -MINSAL

use of nominal records for closing gaps in immunization

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