Karen Lewis, MD, Medical Director at Arizona Department of Health Services (ADHS)
Print - Spring 2022
Vaccination is one of 10 great public health developments of the 20th Century. The Arizona Immunization Program Office (AIPO) of the Arizona Department of Health Services (ADHS) oversees many state and national programs that support proper use of vaccines approved or authorized by the Food and Drug Administration (FDA).
The Arizona State Immunization Information System (ASIIS) is managed by AIPO. ASIIS is an electronic registry started in 1998 to record immunizations administered in Arizona. Healthcare providers are required under Arizona Revised Statute (ARS) §36-135 to report to ADHS all immunizations administered to children 18 years old and younger; this is done through ASIIS. ARS § 32-1974 requires pharmacists to report to ASIIS all vaccines that they administer regardless of the recipient’s age. In addition, healthcare providers of adult vaccines are also encouraged to enter data on adult vaccinations into ASIIS to provide a lifelong vaccine record. The ASIIS Help Desk assists providers with questions about ASIIS enrollment and use.
AIPO administers the Vaccines for Children (VFC) program in Arizona. VFC is a federally funded program established in 1994 when studies showed that a reason for vaccine-preventable disease outbreaks in the U.S. was that some parents could not afford vaccines for their children. Children are VFC-eligible if they are AHCCCS-eligible, uninsured, underinsured, or if they are American Indian or Alaska Native. Parents of VFC-eligible children are not charged for VFC vaccines. AIPO staff visits healthcare providers who participate in VFC to educate staff and to ensure that VFC vaccines are being properly handled and administered.
The laws and rules governing school immunization requirements are Arizona Revised Statutes §15-871-874 and Arizona Administrative Code, R9-6- 701-708. Children need to receive specified vaccines to attend childcare or schools. In turn, schools and childcare institutions are required to report yearly to ADHS as to how many children have received these state-required vaccines and how many have exemptions (religious exemptions for childcare; medical or personal belief exemptions for schools). AIPO collects these aggregate reports with no identifiable information, analyzes them, and displays them by state, county, and school.
AIPO educates county health departments, health care providers, and the general public as to the benefits of vaccines, how to properly use vaccines, and how to understand vaccine safety issues.
Vaccines have been carefully studied in clinical trials and in post-marketing surveillance. AIPO emphasizes that vaccines are very safe and are essential to protect against vaccine-preventable diseases. One way that vaccine safety is monitored through the Vaccine Adverse Events Reporting System (VAERS). VAERS data cannot show a cause-and-effect relationship between a vaccine and an adverse event. However, VAERS data can be used to look for rare adverse events that may not have been found during clinical trials. VAERS data is further analyzed using Vaccine Safety Datalink, a collaboration between CDC and nine health care organizations to use anonymous electronic health information in determining if there could be a relationship between a vaccine and specific serious adverse events.
AIPO promotes reporting to VAERS of adverse events after vaccination and of vaccine administration errors. Healthcare providers are required by law to report any adverse event listed in the VAERS Table of Reportable Events Following Vaccination that occurs within the specified time after vaccination. They are also required to report any adverse event listed by the vaccine manufacturer as a contra-indication to further doses of the vaccine. In addition, healthcare providers are encouraged to report to VAERS any significant adverse event that happens after vaccination, whether it is or is not clear that a vaccine caused the adverse event.
In response to the COVID-19 pandemic, ADHS and AIPO have been actively involved in organizing the distribution of COVID-19 vaccines in Arizona. Healthcare providers who want to administer COVID-19 vaccines need to enroll in the ADHS Pandemic Provider Onboarding process. Providers who give COVID-19 vaccines use ASIIS for ordering COVID-19 vaccines, recording administration of COVID-19 vaccines, and maintaining accurate vaccine inventory. COVID-19 vaccine safety is carefully monitored through VAERS, v-safe (a real-time cell phone tool to report adverse events after vaccination to CDC), and Vaccine Safety Datalink. AIPO reminds healthcare providers to use VAERS and to ask patients to participate in v-safe after COVID-19 vaccination.
Despite how well vaccines protect against vaccine-preventable diseases, some people are hesitant to receive vaccines, including COVID- 19 vaccines. Providers should emphasize to patients that COVID-19 vaccines are much safer than COVID-19 infections (see figure 4). Other vaccines are also very safe and their use has resulted in vaccine-preventable diseases to reach historic low levels.
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