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Are Your New Patients Missing Their Immunization Records?

August 2011

Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
Are Your New Patients Missing Their Immunization Records?
Published August 2011
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit
Vaccination providers often see patients who think their or their children’s vaccinations are up to date but who do not have documentation of these vaccinations. According to the CDC, healthcare providers should only accept written records as evidence of vaccination — with two exceptions: Self-reports of receipt of influenza vaccine (given to any age person) and pneumococcal polysaccharide vaccine (PPSV; given to adults) can be accepted. Self-reports for any other vaccines without written and dated documentation should not be accepted. You should attempt to locate missing records whenever possible by:
Contacting previous healthcare providers
Reviewing state or local immunization registries
Contacting the child’s school
Asking the patient to search (again) for a personally held record
If records cannot be located or will never be available because of the patient’s situation (e.g., immigrant with no access to immunization records), revaccinate the patient using the age-appropriate vaccination schedule. Receiving extra doses of a vaccine does not pose a significant medical risk; instead it provides a boost to immunity if the patient was previously vaccinated.
Serologic testing for immunity is an alternative to vaccination for certain antigens (e.g., measles, rubella, hepatitis A, and tetanus). However, commercially available testing may not always be sufficiently sensitive or standardized to detect vaccine-induced immunity. Further, if the test does not indicate seroconversion, you will need to administer the needed vaccines anyway, likely requiring an additional appointment and, for the patient, possible increased out-of-pocket expenses.
ACIP’s General Recommendations on Immunization (pages 27-29) includes detailed guidance on the use of questionable vaccination records for people vaccinated outside of the U.S. When you need to catch up an inadequately vaccinated person quickly, you can administer doses of all routine vaccines simultaneously (at the same visit, not in the same syringe). For children, use CDC’s catch-up schedule to determine the necessary minimal intervals for additional doses.
Finally, remember to always give patients a record of any vaccines you administer to avoid confusion and receipt of unnecessary doses in the future. Print-outs from registries will serve this purpose. Also, some state health departments and medical practices make record cards available free of charge. If such cards are not available to you, and you would like to consider purchasing them, you can order them from the Immunization Action Coalition’s shopping page. You can choose from three styles of cards—for children, for adults, and for people of any age. If you would like to receive samples, send a request to IAC at


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