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

Lauren T Vanasse¹, Basmah Safdar², Wesley H Self³, Yuwei Zhu⁴, Adit A Ginde⁵, Ithan D Peltan⁶, Samuel M Brown⁶, Manjusha Gaglani⁷, Shekhar Ghamande⁷, Cristie Columbus⁸, Nicholas M Mohr⁹, Kevin W Gibbs¹⁰, David N Hager¹¹, Amira Mohamed¹², Nicholas J Johnson¹³, Jay S Steingrub¹⁴, Akram Khan¹⁵, Jennifer G Wilson¹⁶, Nida Qadir¹⁷, Steven Y Chang¹⁷, Christopher Mallow¹⁸, Laurence W Busse¹⁹, Jamie Felzer¹⁹, Jennie H Kwon²⁰, Matthew C Exline²¹, Ivana A Vaughn²², Mayur Ramesh²³, Jarrod M Mosier²⁴, Estelle S Harris²⁵, Adrienne Baughman³, Sydney A Cornelison⁴, Cassandra Johnson⁴, Paul W Blair²⁶, Natasha Halasa²⁷, Nathaniel Lewis²⁸, Sascha Ellington²⁸, Rachel E Rutkowski¹, Marietta S Cox²⁹, Fatimah S Dawood¹, Diya Surie³⁰; Investigating Respiratory Viruses in the Acutely Ill (IVY) Network

Affiliations

¹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
² Yale University School of Medicine, New Haven, CT, USA.
³ Vanderbilt Institute for Clinical and Translational Research, and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
⁴ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
⁵ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁶ Department of Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA.
⁷ Baylor Scott and White Health, Temple and Dallas, TX, USA; Baylor College of Medicine, Temple, TX, USA.
⁸ Baylor Scott and White Health, Temple and Dallas, TX, USA; Texas A&M University College of Medicine, Dallas, TX, USA.
⁹ University of Iowa, Iowa City, Iowa, USA.
¹⁰ Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
¹¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹² Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
¹³ Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
¹⁴ Department of Medicine, Baystate Medical Center, Springfield, MA, USA.
¹⁵ Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA.
¹⁶ Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA.
¹⁷ Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
¹⁸ Department of Medicine, University of Miami, Miami, FL, USA.
¹⁹ Department of Medicine, Emory University, Atlanta, GA, USA.
²⁰ Department of Medicine, Washington University, St. Louis, MO, USA.
²¹ Department of Medicine, The Ohio State University, Columbus, OH, USA.
²² Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA.
²³ Division of Infectious Diseases, Henry Ford Health, Detroit, MI, USA.
²⁴ Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA.
²⁵ Department of Medicine, University of Utah, Salt Lake City, UT, USA.
²⁶ Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁷ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁸ Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
²⁹ Immunization Services Division, National Center for Immunization and RespiratoryDiseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
³⁰ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. Electronic address: dsurie@cdc.gov.

PMID: 41275655
DOI: 10.1016/j.vaccine.2025.127946

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

Lauren T Vanasse et al. Vaccine. 2025.

. 2025 Nov 22:69:127946.

doi: 10.1016/j.vaccine.2025.127946. Online ahead of print.

Authors

Affiliations

¹ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
² Yale University School of Medicine, New Haven, CT, USA.
³ Vanderbilt Institute for Clinical and Translational Research, and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
⁴ Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
⁵ Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁶ Department of Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA.
⁷ Baylor Scott and White Health, Temple and Dallas, TX, USA; Baylor College of Medicine, Temple, TX, USA.
⁸ Baylor Scott and White Health, Temple and Dallas, TX, USA; Texas A&M University College of Medicine, Dallas, TX, USA.
⁹ University of Iowa, Iowa City, Iowa, USA.
¹⁰ Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
¹¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹² Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
¹³ Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
¹⁴ Department of Medicine, Baystate Medical Center, Springfield, MA, USA.
¹⁵ Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA.
¹⁶ Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA.
¹⁷ Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
¹⁸ Department of Medicine, University of Miami, Miami, FL, USA.
¹⁹ Department of Medicine, Emory University, Atlanta, GA, USA.
²⁰ Department of Medicine, Washington University, St. Louis, MO, USA.
²¹ Department of Medicine, The Ohio State University, Columbus, OH, USA.
²² Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA.
²³ Division of Infectious Diseases, Henry Ford Health, Detroit, MI, USA.
²⁴ Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA.
²⁵ Department of Medicine, University of Utah, Salt Lake City, UT, USA.
²⁶ Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁷ Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁸ Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
²⁹ Immunization Services Division, National Center for Immunization and RespiratoryDiseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
³⁰ Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. Electronic address: dsurie@cdc.gov.

PMID: 41275655
DOI: 10.1016/j.vaccine.2025.127946

Abstract

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.

Keywords: Adult RSV vaccination; Electronic medical records; Immunization information systems; Respiratory syncytial virus; Vaccination status; Vaccine registry.

Published by Elsevier Ltd.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest Manjusha Gaglani reports funding from CDC, CDC-Abt Associates, and CDC-Westat, outside the submitted work. Natasha Halasa reports grant support from Merck and serving on a one-time advisory board for CSL-Seqirus, outside the submitted work. Akram Khan received research support to his institution from Directbiologics, 4D Medical, Dompe Pharmaceuticals, NIH and NHLBI and Department of Defense, outside the submitted work. Ithan D. Peltan reports funding from NIH and research funding to his institution from Bluejay Diagnostics and Novartis, outside the submitted work. Ivana A Vaughn receives funding for unrelated projects through her institution from eMax Health, Pfizer, Evidera PPD, Boehringer Ingelheim, outside the submitted work.

LinkOut - more resources

Full Text Sources
- ClinicalKey
- Elsevier Science
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

LinkOut - more resources

Full Text Sources

Miscellaneous