The Vaccine Safety Datalink: a Model for Monitoring Immunization Safety
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SUPPLEMENT ARTICLES The Vaccine Safety Datalink: A Model for Monitoring Immunization Safety AUTHORS: James Baggs, PhD,a Julianne Gee, MPH,a Edwin Lewis, MPH,b Gabrielle Fowler, MPH,a Patti Benson, MPH,c abstract Tracy Lieu, MD, MPH,d Allison Naleway, PhD,e Nicola P. The Vaccine Safety Datalink (VSD) project is a collaborative project Klein, MD,b Roger Baxter, MD,b Edward Belongia, MD,f Jason Glanz, PhD,g Simon J. Hambidge, MD, PhD,g,h between the Centers for Disease Control and Prevention and 8 man- Steven J. Jacobsen, MD, PhD,i Lisa Jackson, MD, MPH,c aged care organizations (MCOs) in the United States. Established in Jim Nordin, MD, MPH,j and Eric Weintraub, MPHa 1990 to conduct postmarketing evaluations of vaccine safety, the aImmunization Safety Office, Centers for Disease Control and project has created an infrastructure that allows for high-quality re- Prevention, Atlanta, Georgia; bKaiser Permanente Vaccine Study search and surveillance. The 8 participating MCOs comprise a large Center, Oakland, California; cGroup Health Center for Health Studies, Seattle, Washington; dDepartment of Population population of 8.8 million members annually (3% of the US population), Medicine, Harvard Medical School and Harvard Pilgrim Health which enables researchers to conduct studies that assess adverse Care Institute, Boston, Massachusetts; eKaiser Permanente events after immunization. Each MCO prepares computerized data files f Northwest, Portland, Oregon; Marshfield Clinic Research by using a standardized data dictionary containing demographic and Foundation, Marshfield, Wisconsin; gKaiser Permanente Institute for Health Research, Denver, Colorado; hDenver Health medical information on its members, such as age and gender, health Community Health Services, Denver, Colorado; iKaiser plan enrollment, vaccinations, hospitalizations, outpatient clinic visits, Permanente Southern California, Pasadena, California; and emergency department visits, urgent care visits, and mortality data, as jHealthPartners Research Foundation, Minneapolis, Minnesota well as additional birth information (eg, birth weight) when available. KEY WORDS vaccine safety, immunization, Vaccine Safety Datalink, Other information sources, such as medical chart review, member postmarketing evaluation, surveillance surveys, and pharmacy, laboratory, and radiology data, are often used ABBREVIATIONS in VSD studies to validate outcomes and vaccination data. Since 2000, AEFI—adverse event(s) following immunization the VSD has undergone significant changes including an increase in CDC—Centers for Disease Control and Prevention the number of participating MCOs and enrolled population, changes in VSD—Vaccine Safety Datalink MCO—managed care organization data-collection procedures, the creation of near real-time data files, VAERS—Vaccine Adverse Event Reporting System and the development of near real-time postmarketing surveillance for DDM—distributed-data model newly licensed vaccines or changes in vaccine recommendations. Rec- DDF—dynamic data file RCA—rapid cycle analysis ognized as an important resource in vaccine safety, the VSD is working TIV—trivalent inactivated influenza vaccine toward increasing transparency through data-sharing and external OR—odds ratio input. With its recent enhancements, the VSD provides scientific exper- CI—confidence interval tise, continues to develop innovative approaches for vaccine-safety GBS—Guillain-Barré syndrome RR—rate ratio research, and may serve as a model for other patient safety collabor- The findings and conclusions in this article are those of the ative research projects. Pediatrics 2011;127:S45–S53 authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. www.pediatrics.org/cgi/doi/10.1542/peds.2010-1722H doi:10.1542/peds.2010-1722H Accepted for publication Nov 29, 2010 Address correspondence to James Baggs, PhD, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mail Stop D25, Atlanta, GA 30333. E-mail: [email protected] (Continued on last page) Downloaded from www.aappublications.org/news by guest on SeptemberPEDIATRICS 25, Volume2021 127, Supplement 1, May 2011 S45 High vaccination coverage has signifi- cine safety in the United States. The person within the VSD is assigned a cantly reduced vaccine-preventable VSD is part of the CDC Immunization unique, randomized VSD study identifi- disease morbidity and mortality world- Safety Office. The Immunization Safety cation number that is not linked to wide, especially among children.1,2 Office also includes the Vaccine Ad- their MCO member identification num- Vaccines are generally regarded as verse Event Reporting System (VAERS), ber. VSD study identification numbers safe and effective; however, serious the Clinical Immunization Safety As- can be used to link data on demo- adverse events following immuniza- sessment Network, and the Brighton graphics and medical services. A stan- tion (AEFI) can occur.3,4 Although vac- Collaboration. dardized data dictionary, which en- cine safety is rigorously assessed dur- In this article we provide a review of sures data consistency across sites, is ing prelicensing clinical trials, sample the VSD and focus on the important updated each year by the CDC and the sizes are not adequate to detect rare modifications and enhancements the VSD MCOs. Frequently, medical record adverse events, long-term adverse project has undertaken since 2001. data and, occasionally, participant events are not examined, and popula- survey or interview data are used to tions are not heterogenous.3 In recent THE VSD PROJECT SINCE 2001 validate clinical diagnosis and vaccina- years, public concerns about the Population tion data. safety of vaccines have grown signifi- The VSD population has increased sub- cantly.5 Immunization-safety programs Distributed Data Model stantially since 2001, when 4 new MCOs are an important component of main- From 1991 through 2000, the VSD used joined the project to provide data on taining the public trust in our national a centralized-data model, which re- members younger than 18 years: Kai- immunization program.5 Close monitor- quired each MCO to send its cycle files ser Permanente of Colorado (Denver, ing of vaccine safety also protects the to the CDC annually for merging and CO); Marshfield Clinic Research Foun- public’s health and contributes to safer analyses. When data were needed for a dation (Marshfield, WI); Health Part- vaccines and vaccination practices. specific VSD study, the CDC would send ners Research Foundation (Minneapo- In 1990, the Centers for Disease Con- lis, MN); and Harvard Pilgrim/Harvard a subset of cycle data to the MCO re- trol and Prevention (CDC) National Im- Vanguard (Boston, MA). In 2007, the sponsible for performing the study munization Program created the Vac- VSD population expanded again as all analysis. Because of heightened confi- cine Safety Datalink (VSD) project to participating sites except 2 began pro- dentiality concerns, the centralized- conduct postmarketing evaluations of viding data on members of all ages. data model was replaced by a more vaccine safety.6,7 Initially, the project Currently, data for Ͼ18 million per- secure distributed-data model (DDM) used medical event and demographic sons spanning 16 years are available in 2001 (see Fig 1). information from ϳ6 million children for VSD research. The DDM allows each MCO to assemble younger than 6 years for VSD research and maintain its computerized data from 4 participating managed care or- Data Sources, Collection, and files on a secure server at the site ganizations (MCOs): Group Health Co- Confidentiality rather than transferring data to the operative of Puget Sound (GHC) (Seat- Since inception of the VSD, each MCO CDC,10 and ownership of the data is re- tle, WA); Kaiser Permanente Northwest has prepared annual data files, called tained by the MCOs. Data required for (NWK) (Portland, OR); Kaiser Perma- cycle files, that contain member infor- specific VSD studies are transferred nente of Northern California (KPNC) mation obtained from administrative between the CDC and the VSD sites by (Oakland, CA); and Kaiser Permanente files maintained by the individual using 2 secure methods known as the of Southern California (Los Angeles, MCOs. The cycle files include demo- “indirect” and “direct” methods. With CA).6–9 Later, vaccine-safety studies graphic and medical services informa- the indirect method, CDC and MCO were conducted to include children tion on their members, such as age computers share information through younger than 18 years at all 4 sites and and gender, health plan enrollment, a secure server known as the “hub.” adults 18 years of age and older at vaccinations, hospitalizations, outpa- CDC researchers send computer pro- GHC, KPNC, and NWK. In 2001, 4 addi- tient clinic visits, emergency depart- grams to the hub, which are retrieved tional MCOs joined the VSD, and during ment visits, urgent care visits, mortal- at specified intervals by an MCO com- the last 7 years the VSD has made ity data, and additional birth puter. All computer programs are writ- other changes to enhance its ability to information (eg, birth weight) when ten for a statistical computer program serve as the primary mechanism for available. To ensure confidentiality and (SAS [SAS Institute, Inc, Cary, NC]); data population-based evaluations of vac- comply with federal regulations, each files are also stored by using this plat- S46 BAGGS et al Downloaded from www.aappublications.org/news by guest on September 25, 2021 SUPPLEMENT ARTICLES TABLE