Comparison of immunization information systems, electronic medical records, and self-report to ascertain RSV vaccination status among US adults aged ≥60 years, 2023-2024.

BACKGROUND

Respiratory syncytial virus (RSV) vaccines were recommended for US adults aged ≥60 years in 2023. Immunization information systems (IISs) are important sources of RSV vaccination data; however, the completeness of documented RSV vaccinations in IISs is unknown.

METHODS

The IVY network prospectively enrolled hospitalized adults with acute respiratory illness aged ≥60 years at 26 hospitals in 20 states during October 1, 2023-April 30, 2024. At enrollment, RSV vaccination history was abstracted from jurisdictional IISs, inpatient electronic medical records (EMRs), and through patient (or proxy) interviews with final RSV vaccination status adjudicated from all three sources. Frequencies and proportions of RSV vaccinations identified by IISs, EMRs, and self-report were compared to each other and to adjudicated RSV vaccination status using an unweighted Cohen's kappa coefficient (κ), sensitivity, and specificity. RSV vaccinations documented in IISs were compared by jurisdictional consent policies. Statistical significance was determined using Wilcoxon rank sum or Pearson's chi-squared tests, with a 2-sided P value <0.05.

RESULTS

Among 7219 enrolled patients, 749 (10.4 %) had received RSV vaccination adjudicated from all sources, 613 (8.5 %) RSV vaccinations were detected by IISs, 439 (6.1 %) by self-report, and 334 (4.6 %) by EMRs. Self-report had the highest frequency of missing RSV vaccination history (30.1 %). Among 4422 patients with non-missing RSV vaccination data, agreement with adjudicated RSV vaccination status was highest for self-report (κ = 0.90) followed by IISs (κ = 0.88) and EMRs (κ = 0.55). Among 6208 patients with IIS data, the sensitivity of detecting RSV vaccinations was higher in states with mandatory inclusion of vaccination data in IISs than in those that required explicit consent (92 % vs. 65 %, P < 0.001).

CONCLUSIONS

In this multicenter analysis, IISs detected more RSV vaccinations than self-report or EMRs, especially in jurisdictions with mandatory inclusion policies. Combining multiple data sources remains the optimal approach to ascertain RSV vaccination status in the US.