Immunization Uptake in Children by the Seventh Birthday

Immunization Programs & Vaccine Preventable Diseases Service 655 West 12th Avenue Vancouver, BC V5Z 4R4 Tel 604.707.2548 Fax 604.707.2515 www.bccdc.ca Immunization Uptake in Children by the Seventh Birthday 2012-2017

Table of Contents Measure Specifications 2 Table 1. Percent of Seven-year-olds with Up-to-date Immunizations, British Columbia and Health Authorities 3 Table 2. Percent of Seven-year-olds with Up-to-date Immunizations by Health Service Delivery Area 5 Figure 1. Percent of Seven-year Olds with Up-to-date Immunizations: Up to Date for Age 10 Figure 2. Percent of Seven-year Olds with Up-to-date Immunizations: D/T/aP/IPV 11 Figure 3. Percent of Seven-year Olds with Up-to-date Immunizations: Hepatitis B 12 Figure 4. Percent of Seven-year Olds with Up-to-date Immunizations: Measles 13 Figure 5. Percent of Seven-year Olds with Up-to-date Immunizations: Mumps 14 Figure 6. Percent of Seven-year Olds with Up-to-date Immunizations: Rubella 15 Figure 7. Percent of Seven-year Olds with Up-to-date Immunizations: Varicella (Chickenpox) 16 Figure 8. Percent of Seven-year Olds with Up-to-date Immunizations: Meningococcal C 17 Appendix 1: Minimum Intervals Between Eligible Doses, Seven-year Olds with Up-to-date Immunizations 18 Appendix 3: Explanatory Notes 19 1

Measure Specifications Measure: Years: Data Sources: Measure Specification: Percent of seven-year olds with up-to-date immunizations 2012-2017 Data last updated November 6, 2017. Coverage reported on any given year reflects uptake among children who turned 7 years old during the previous calendar year (i.e., 2016 results are for children born in 2008). Panorama, BC Centre for Disease Control (2014 onward) Public Health Information System (iphis), BC Centre for Disease Control (2012-2013) Primary Access Regional Information System (PARIS), Vancouver Coastal Health Authority BC Ministry of Education (MoE), school enrollment data 1 Numerators: Number of children with active records in Panorama/iPHIS/PARIS who are up-to-date for the specified agent(s) by their seventh birthday. 2 Denominators: For VCHA - All children in the specified birth cohort with active records in PARIS. For IHA - All children in the specified birth cohort with active records in iphis/panorama. For all other Health Authorities - All children in the specified birth cohort in the Ministry of Education (MoE) enrollment data. 3 Up to Date Definitions Only doses given prior to the seventh birthday are included in this assessment. o Up to date for age - Children who met the up-to-date requirements for D/T/aP/IPV, measles, mumps, rubella, varicella, meningococcal C and hepatitis B, as defined below. o D/T/aP/IPV - 4th or 5th dose of diphtheria/acellular pertussis/tetanus and 3rd or 4th dose of polio after the fourth birthday o Hepatitis B - 3 doses hepatitis B vaccine o Measles - 2 doses measles-containing vaccine o Mumps - 2 doses mumps-containing vaccine o Rubella - At least 1 dose rubella-containing vaccine o Varicella - 1 (2012-2014) or 2 (2015 onward) dose(s) of varicella (chickenpox) vaccine or recorded exemption for varicella due to previous disease or protective antibody levels. These children are only considered protected if disease or immunization occurred on or after the first birthday. o Meningococcal C conjugate - At least 1 dose of Meningococcal C conjugate vaccine on or after 12 months of age All analyses were conducted using business rules which calculated ages and time intervals at receipt of immunization. Each dose was counted as a valid dose only if given at or after the earliest eligible age, or at a time interval equal to or greater than the shortest recommended interval. See Appendix 1: Minimum Intervals Between Eligible Doses. 2

Table 1. Percent of Seven-year-olds with Up-to-date Immunizations British Columbia and Health Authorities Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional informatio Province / Percent Vaccination Details Health Authority 2012 2013 2014 2015 2016 2017 British Columbia Up-to-date for age 70% 71% 72% 63% 66% 68% BC D/T/aP/IPV 79% 79% 78% 77% 76% 76% Hepatitis B 90% 91% 91% 89% 89% 89% Measles 89% 91% 90% 90% 90% 88% Mumps 89% 91% 90% 90% 90% 88% Rubella 95% 96% 96% 96% 96% 95% Varicella 89% 91% 92% 69% 72% 74% Meningococcal C conjugate 89% 91% 92% 93% 94% 93% Interior Health Up-to-date for age 70% 73% 74% 64% 64% 62% IHA D/T/aP/IPV 79% 81% 82% 76% 73% 68% Hepatitis B 86% 88% 88% 84% 84% 81% Measles 89% 89% 89% 86% 87% 80% Mumps 89% 89% 89% 86% 87% 80% Rubella 92% 93% 93% 90% 91% 86% Varicella 88% 89% 89% 69% 69% 66% Meningococcal C conjugate 87% 88% 89% 88% 90% 85% Fraser Health Up-to-date for age 66% 68% 69% 59% 64% 67% FHA D/T/aP/IPV 75% 77% 76% 76% 75% 75% Hepatitis B 90% 93% 93% 89% 91% 91% Measles 89% 91% 90% 91% 91% 90% Mumps 89% 91% 90% 91% 91% 90% Rubella 96% 98% 97% 99% 98% 98% Varicella 89% 92% 93% 66% 71% 73% Meningococcal C conjugate 90% 92% 93% 95% 95% 95% Vancouver Coastal Health Up-to-date for age 75% 76% 75% 69% 73% 76% VCHA D/T/aP/IPV 82% 81% 80% 80% 82% 84% Hepatitis B 90% 89% 89% 90% 87% 90% Measles 88% 90% 88% 89% 89% 90% Mumps 87% 89% 87% 88% 89% 89% Rubella 94% 93% 93% 93% 93% 94% Varicella 88% 90% 90% 73% 79% 82% Meningococcal C conjugate 86% 90% 91% 91% 92% 92% 3

Table 2. Percent of Seven-year-olds with Up-to-date Immunizations by Health Service Delivery Area Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. Health Authority IHA Health Service Delivery Area East Kootenay Kootenay Boundary Okanagan Thompson Cariboo Shuswap Vaccination Details Percent 2012 2013 2014 2015 2016 2017 Up-to-date for age 66% 74% 73% 63% 69% 68% D/T/aP/IPV 79% 85% 83% 81% 79% 76% Hepatitis B 86% 89% 87% 84% 85% 82% Measles 91% 92% 91% 89% 90% 82% Mumps 91% 91% 91% 89% 90% 82% Rubella 95% 94% 94% 93% 93% 87% Varicella 90% 90% 90% 73% 75% 72% Meningococcal C conjugate 86% 87% 87% 89% 91% 86% Up-to-date for age 60% 61% 61% 48% 52% 52% D/T/aP/IPV 73% 71% 70% 66% 67% 63% Hepatitis B 77% 77% 76% 70% 72% 69% Measles 80% 79% 80% 76% 77% 71% Mumps 80% 79% 80% 76% 77% 71% Rubella 84% 83% 83% 82% 84% 76% Varicella 75% 77% 78% 56% 57% 58% Meningococcal C conjugate 79% 78% 79% 79% 80% 74% Up-to-date for age 69% 72% 74% 63% 64% 60% D/T/aP/IPV 78% 81% 81% 74% 73% 67% Hepatitis B 86% 87% 88% 84% 85% 81% Measles 89% 89% 88% 85% 87% 79% Mumps 89% 89% 88% 85% 87% 79% Rubella 92% 93% 93% 90% 91% 85% Varicella 88% 89% 90% 68% 70% 64% Meningococcal C conjugate 87% 88% 89% 88% 90% 84% Up-to-date for age 76% 80% 81% 70% 67% 65% D/T/aP/IPV 82% 85% 86% 79% 74% 70% Hepatitis B 90% 92% 92% 89% 88% 85% Measles 91% 93% 93% 89% 89% 83% Mumps 91% 93% 93% 89% 89% 83% Rubella 94% 95% 95% 92% 92% 89% Varicella 91% 93% 92% 73% 70% 68% Meningococcal C conjugate 91% 93% 93% 91% 92% 88% 5

Table 2. Percent of Seven-year-olds with Up-to-date Immunizations by Health Service Delivery Area Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. Health Authority FHA Health Service Delivery Area Fraser East Fraser North Fraser South Vaccination Details Percent 2012 2013 2014 2015 2016 2017 Up-to-date for age 72% 75% 75% 71% 72% 76% D/T/aP/IPV 79% 81% 80% 82% 80% 82% Hepatitis B 93% 98% 96% 97% 95% 96% Measles 91% 96% 94% 96% 94% 93% Mumps 91% 96% 94% 96% 94% 93% Rubella 96% 101% 98% 101% 99% 99% Varicella 92% 96% 95% 75% 76% 79% Meningococcal C conjugate 93% 98% 96% 100% 98% 98% Up-to-date for age 67% 69% 69% 60% 66% 66% D/T/aP/IPV 77% 78% 76% 77% 77% 75% Hepatitis B 95% 95% 96% 90% 96% 93% Measles 93% 94% 94% 94% 97% 92% Mumps 93% 94% 94% 94% 96% 92% Rubella 101% 102% 102% 102% 105% 100% Varicella 94% 95% 98% 69% 73% 73% Meningococcal C conjugate 94% 95% 96% 98% 100% 96% Up-to-date for age 63% 65% 66% 53% 60% 64% D/T/aP/IPV 73% 75% 74% 73% 72% 73% Hepatitis B 86% 89% 89% 86% 86% 88% Measles 85% 87% 87% 87% 87% 88% Mumps 85% 87% 86% 87% 86% 88% Rubella 92% 95% 94% 96% 94% 95% Varicella 85% 88% 89% 61% 67% 70% Meningococcal C conjugate 87% 88% 89% 91% 90% 92% 6

Table 2. Percent of Seven-year-olds with Up-to-date Immunizations by Health Service Delivery Area Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. Health Authority VCHA Health Service Delivery Area Richmond Vancouver North Shore / Coast Garibaldi Vaccination Details Percent 2012 2013 2014 2015 2016 2017 Up-to-date for age 81% 85% 87% 82% 83% 86% D/T/aP/IPV 87% 89% 91% 89% 88% 91% Hepatitis B 95% 94% 95% 96% 93% 95% Measles 91% 95% 94% 95% 95% 94% Mumps 90% 93% 93% 94% 94% 94% Rubella 96% 97% 97% 97% 97% 97% Varicella 93% 95% 95% 84% 87% 89% Meningococcal C conjugate 88% 93% 95% 95% 95% 96% Up-to-date for age 78% 78% 76% 69% 73% 75% D/T/aP/IPV 83% 82% 81% 80% 82% 82% Hepatitis B 90% 90% 90% 90% 87% 90% Measles 90% 91% 90% 89% 89% 90% Mumps 89% 90% 89% 88% 88% 89% Rubella 94% 94% 94% 94% 93% 94% Varicella 89% 91% 91% 72% 80% 81% Meningococcal C conjugate 88% 91% 92% 92% 91% 91% Up-to-date for age 63% 63% 63% 61% 66% 73% D/T/aP/IPV 76% 71% 71% 75% 78% 82% Hepatitis B 85% 82% 83% 84% 83% 86% Measles 81% 84% 81% 84% 86% 87% Mumps 81% 84% 81% 83% 86% 87% Rubella 92% 90% 88% 89% 91% 92% Varicella 83% 85% 84% 66% 74% 79% Meningococcal C conjugate 81% 86% 87% 89% 90% 91% 7

Table 2. Percent of Seven-year-olds with Up-to-date Immunizations by Health Service Delivery Area Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. Health Authority VIHA Health Service Delivery Area South Vancouver Island Central Vancouver Island North Vancouver Island Vaccination Details Percent 2012 2013 2014 2015 2016 2017 Up-to-date for age 72% 71% 73% 63% 67% 70% D/T/aP/IPV 80% 77% 78% 75% 76% 77% Hepatitis B 92% 91% 94% 88% 89% 91% Measles 93% 92% 94% 91% 91% 90% Mumps 93% 91% 94% 91% 91% 90% Rubella 97% 95% 97% 96% 97% 96% Varicella 93% 91% 94% 69% 72% 74% Meningococcal C conjugate 93% 92% 95% 94% 95% 94% Up-to-date for age 70% 69% 69% 60% 62% 67% D/T/aP/IPV 76% 75% 74% 75% 73% 74% Hepatitis B 91% 92% 92% 92% 90% 93% Measles 90% 91% 92% 93% 89% 90% Mumps 90% 91% 92% 93% 89% 90% Rubella 95% 95% 97% 99% 96% 98% Varicella 90% 92% 93% 65% 68% 71% Meningococcal C conjugate 92% 92% 94% 97% 95% 97% Up-to-date for age 72% 65% 71% 63% 66% 64% D/T/aP/IPV 81% 75% 79% 77% 76% 71% Hepatitis B 90% 91% 95% 92% 93% 88% Measles 93% 93% 96% 94% 94% 88% Mumps 93% 93% 96% 94% 94% 88% Rubella 96% 99% 101% 100% 100% 95% Varicella 90% 93% 96% 69% 71% 68% Meningococcal C conjugate 93% 93% 97% 98% 99% 94% 8

Table 2. Percent of Seven-year-olds with Up-to-date Immunizations by Health Service Delivery Area Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. Health Authority NHA Health Service Delivery Area Northwest Northern Interior Northeast Vaccination Details Percent 2012 2013 2014 2015 2016 2017 Up-to-date for age 68% 73% 70% 59% 61% 62% D/T/aP/IPV 78% 83% 78% 77% 76% 74% Hepatitis B 87% 89% 85% 84% 82% 83% Measles 87% 90% 85% 86% 86% 82% Mumps 87% 89% 85% 86% 86% 82% Rubella 92% 94% 88% 91% 92% 89% Varicella 85% 89% 83% 66% 69% 68% Meningococcal C conjugate 86% 90% 85% 90% 91% 88% Up-to-date for age 79% 82% 80% 81% 72% 78% D/T/aP/IPV 88% 90% 88% 90% 81% 86% Hepatitis B 93% 98% 94% 95% 95% 96% Measles 94% 97% 94% 97% 96% 95% Mumps 94% 97% 94% 96% 96% 95% Rubella 97% 101% 97% 99% 100% 99% Varicella 91% 95% 94% 85% 75% 81% Meningococcal C conjugate 93% 98% 94% 98% 98% 98% Up-to-date for age 73% 70% 74% 67% 47% 70% D/T/aP/IPV 86% 78% 84% 81% 54% 80% Hepatitis B 95% 92% 95% 94% 96% 96% Measles 98% 93% 97% 95% 95% 95% Mumps 98% 93% 97% 95% 95% 95% Rubella 103% 99% 102% 102% 101% 102% Varicella 96% 93% 98% 74% 51% 75% Meningococcal C conjugate 97% 93% 98% 99% 100% 100% 9

Percent Up-to-date for Age Immunization Uptake in Children by the 100% Figure 1. Percent of Seven-year Olds with Up-to-date Immunizations: Up to Date for Age, Health Authorities and British Columbia, 2012-2017 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA FHA VCHA VIHA NHA BC 2012 70% 70% 66% 75% 71% 75% 2013 73% 68% 76% 69% 77% 71% 2014 74% 69% 75% 71% 76% 72% 2015 64% 59% 69% 62% 72% 63% 2016 66% 64% 64% 73% 65% 62% 2017 68% 62% 67% 76% 68% 72% Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. 10

Percent Up-to-date for Age Immunization Uptake in Children by the 100% Figure 2. Percent of Seven-year Olds with Up-to-date Immunizations: D/T/aP/IPV Health Authorities and British Columbia, 2012-2017 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA FHA VCHA VIHA NHA BC 2012 79% 75% 82% 79% 85% 79% 2013 81% 77% 81% 76% 85% 79% 2014 82% 76% 80% 77% 84% 78% 2015 76% 76% 80% 75% 84% 77% 2017 68% 75% 84% 75% 82% 76% Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. 11

Percent Up-to-date for Age Immunization Uptake in Children by the 100% Figure 3. Percent of Seven-year Olds with Up-to-date Immunizations: Hepatitis B Health Authorities and British Columbia, 2012-2017 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA FHA VCHA VIHA NHA BC 2012 86% 90% 90% 91% 92% 90% 2013 88% 93% 89% 91% 94% 91% 2014 88% 93% 89% 93% 92% 91% 2015 84% 89% 90% 91% 92% 89% 2017 81% 91% 90% 91% 93% 89% Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. 12

Percent Up-to-date for Age Immunization Uptake in Children by the 100% Figure 4. Percent of Seven-year Olds with Up-to-date Immunizations: Measles Health Authorities and British Columbia, 2012-2017 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA FHA VCHA VIHA NHA BC 2012 89% 89% 88% 92% 93% 89% 2013 89% 91% 90% 92% 94% 91% 2014 89% 90% 88% 93% 92% 90% 2015 86% 91% 89% 92% 94% 90% 2017 80% 90% 90% 90% 92% 88% Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. 13

Percent Up-to-date for Age Immunization Uptake in Children by the 100% Figure 5. Percent of Seven-year Olds with Up-to-date Immunizations: Mumps Health Authorities and British Columbia, 2012-2017 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA FHA VCHA VIHA NHA BC 2012 89% 89% 87% 92% 93% 89% 2013 89% 91% 89% 91% 94% 91% 2014 89% 90% 87% 93% 92% 90% 2015 86% 91% 88% 92% 94% 90% 2017 80% 90% 89% 90% 92% 88% Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. 14

Percent Up-to-date for Age Immunization Uptake in Children by the 100% Figure 6. Percent of Seven-year Olds with Up-to-date Immunizations: Rubella Health Authorities and British Columbia, 2012-2017 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA FHA VCHA VIHA NHA BC 2012 92% 96% 94% 96% 97% 95% 2013 93% 98% 93% 96% 98% 96% 2014 93% 97% 93% 98% 96% 96% 2015 90% 99% 93% 98% 98% 96% 2017 86% 98% 94% 96% 98% 95% Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. 15

Percent Up-to-date for Age Immunization Uptake in Children by the 100% Figure 7. Percent of Seven-year Olds with Up-to-date Immunizations: Varicella (Chickenpox), Health Authorities and British Columbia, 2012-2017 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA FHA VCHA VIHA NHA BC 2012 88% 89% 88% 91% 91% 89% 2013 89% 92% 90% 92% 93% 91% 2014 89% 93% 90% 94% 92% 92% 2015 69% 66% 73% 68% 77% 69% 2017 66% 73% 82% 72% 77% 74% Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. 16

Percent Up-to-date for Age Immunization Uptake in Children by the 100% Figure 8. Percent of Seven-year Olds with Up-to-date Immunizations: Meningococcal C, Health Authorities and British Columbia, 2012-2017 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IHA FHA VCHA VIHA NHA BC 2012 87% 90% 86% 93% 92% 89% 2013 88% 92% 90% 92% 95% 91% 2014 89% 93% 91% 95% 93% 92% 2015 88% 95% 91% 96% 96% 93% 2017 85% 95% 92% 95% 97% 93% Data should be interpreted with caution. Please refer to the Measure Specifications and Explanatory Notes for additional information. 17

Appendix 1: Minimum Intervals Between Eligible Doses Seven-year Olds with Up-to-date Immunizations Vaccine Diphtheria, Tetanus, acellular Pertussis (DTaP or Tdap) Polio B Minimum Age or Minimum Time Interval Between Eligible Doses Dose 1 A Dose 2 Dose 3 Dose 4 42 days 28 days 28 days 24 weeks 42 days 28 days 24 weeks Hepatitis B received 3rd dose before June 2007 received 3rd dose between June 2007 and May 2014 received 3rd dose in June 2014 or later Measles Mumps Rubella E Varicella F Meningococcal C Conjugate G 0 days 28 days 28 days 0 days 28 days 56 days C 0 days 28 days 56 days C,D 12 months 28 days 12 months 28 days 12 months 12 months 28 days 12 months A. Dose 1 refers to the earliest age a child can receive the initial dose. B. Schedule for DTaP should be followed when poliomyelitis provided in combination vaccine. C. Dose 3 must be given at least 16 weeks (112 days) after dose 1. D. Dose 3 must be given on or after 24 weeks of age. E. Schedule for measles/mumps should be followed when rubella provided in combination vaccine with measles/mumps. F. To be counted as valid, varicella vaccine must be administered on or after 12 months of age. Guidelines also state that children with a history of varicella disease should only be considered protected if the illness occurred on or after 12 months of age. The date of varicella disease onset is not systematically entered into iphis/panorama. For the purposes of this assessment, any child with a past history if varicella disease recorded in iphis/panorama is considered protected, regardless of their age at the time of illness. G. Dose must be given at least 56 days after any previous meningococcal C conjugate dose (if previous dose given). 18

Appendix 3: Explanatory Notes 1. Ideally, numerators and denominators should be taken from the same data source. 2. In order to maintain accurate denominators in an immunization registry, the Health Authorities need to be aware of every child who moves into and out of the health region. As not all health regions have been able to fully establish these processes, FHA, VIHA and NHA felt that the Ministry of Education (MoE) enrollment data were more accurate estimates of the number of children in each health region than iphis/panorama. School district boundaries do not directly line up with health region boundaries. As such, the MoE enrollment data are based on a process of identifying the schools that lie within each Health Service Delivery Area (with Health Authority input). The MoE enrollment data exclude youth custody and continuing education schools. Using different data sources for numerators and denominators can result in inaccurate results, including coverage results that appear to be greater than 100%. In 2016 (2008 birth cohort), the in-panorama coverage report was used to assess immunization coverage, because the routine method (analysis using an external analysis program) could not be applied. The in-panorama reports allow for doses to be counted as adequate even if these do not meet the minimum age/interval criteria through a manual validation process at the user and record level. However, an assessment of the differences between estimates produced by the two reporting methods indicated that these produce very similar results. For the 2007 birth cohort, the differences in coverage results between the two reporting methods were less than 0.7% for all measure at the provincial level. 3. 4. In July 2013, Northern Health Authority began using the Community Medical Office Information System (MOIS) to record immunizations at point of care, with secondary data entry into Panorama. As of 2016, Northern Health Authority has also been undergoing changes to the delivery of publicly funded immunization programs. It is unclear whether the fluctuations seen in coverage in NHA are data artifacts or true changes in uptake; if true changes, the root cause is unknown. Northern Health Authority continues to monitor the situation. In 2015 (2007 birth cohort), the varicella requirement changed from requiring one to two doses of varicella for a child to be considered up-to-date. As a result of this change, the percent of children born in 2007 who were considered up-to-date for varicella decreased considerably when compared to previous years. If only one dose of varicella vaccine had been required for the 2007 birth cohort, the percent of children up-to-date for varicella would have been approximately 24% higher (93%) and the percent of up-to-date for age would have been 6% higher (69%). 5. Historically, health regions using the iphis immunization registry inactivated the records of clients receiving the majority of their immunizations from First Nations Health Services Organizations (FNHSOs) that did not use the iphis immunization registry. The reason for inactivation was because the iphis records were likely incomplete as their immunizations were recorded in other systems. Inactivated records were excluded from coverage analyses. There were three FNHSOs that used the iphis immunization registry, and these records remained active. Starting in 2015, these records were activated to facilitate the use of Panorama by the FNHSOs that have adopted Panorama. The overall effect of including these children on the provincial immunization coverage estimate for children up-to-date for age in 2017 was an increase of 0.02%. 6. Starting in 2015, only exemptions for previous disease that were effective at the time of the 7th birthday were considered as proof of immunity, while in previous years all recorded exemptions for previous disease in Panorama were considered as proof of immunity. This change only applied to a small number of children and did not have an appreciable effect on overall coverage rates. 7. Starting in 2015, doses marked invalid in Panorama due to vaccine interactions and manual invalidation were excluded from counts, while in previous years these invalid doses in Panorama had been counted. At the provincial level, this change resulted in a decrease in coverage rates that ranged between 0.0% to 0.5% for all measures. 19

Appendix 3: Explanatory Notes 8. Data need to be interpreted with caution for the following reasons: a. b. There can be a delay in obtaining immunization records, which can result in delay of data entry. c. To be considered up-to-date for age, documentation of every dose in an immunization registry (Panorama/PARIS) is required. Some children may have received doses that have not been documented. All regions make their best efforts to obtain vaccination records pertaining to immunizations given by providers other than BC public health. First Nations children may not be completely captured in the registries. On-reserve birth records and immunizations may not be reported to the regional health authorities. 9. Health Authorities IHA - Interior Health FHA - Fraser Health VCHA - Vancouver Coastal Health VIHA - Island Health NHA - Northern Health BC - Province of British Columbia For an explanation of BC Health Authorities, please visit: http://www.health.gov.bc.ca/socsec/index.html 20