News & Views: Interpreting Foreign Immunization Records and Immunizing Newly Immigrated Populations

Editor’s note: The idea for this month’s article was the result of a question submitted by a doctor in the suburbs of Philadelphia. As we communicated with our colleagues in the Philadelphia Department of Public Health and the Pennsylvania Immunization Coalition, we determined that it was likely that other healthcare providers throughout the country were also dealing with this issue. Therefore, we were pleased when Joanne Sullivan, executive director, Pennsylvania Immunization Coalition, offered to write an article for our newsletter readers. We thank Joanne and hope you will find this article to be of help if this issue arises in your practice.
 

Have you had the challenge of deciphering a foreign immunization record lately? The process can be confusing and time consuming especially if you don’t have the resources to interpret the records. If you have had this type of issue or think you might in the future, read more.

Immigration trends in Pennsylvania

Like many states in America, Pennsylvania is a “melting pot” of immigrants from countries all over the world. Early in the 20th century, Pennsylvania welcomed thousands of immigrants — mostly German, Irish, Italian, Polish and Russian — who established homes and businesses in communities throughout our Commonwealth. 

In the last 10 years, approximately 15,000 refugees settled in Pennsylvania. The majority of these came from Bhutan, the Democratic Republic of Congo, Burma, Somalia, Iraq, Cuba, Afghanistan, Syria, Ukraine and Sudan.

Additionally, more than 136,000 unauthorized individuals live in Pennsylvania communities, the majority originating from Mexico, Dominican Republic, Guatemala, India and China. 

So, if you are in Pennsylvania and you haven’t had the challenge of examining a foreign immunization record yet, it is likely that you will in the future. The same is likely to be true in states across the country. So, where should you start? 

Resources

First, refer to the “Pink Book” — CDC’s “Epidemiology and Prevention of Vaccine-Preventable Diseases Course Textbook” (13^th Edition – 2015). Appendix B – “Foreign Language Terms – Aids to Translating Foreign Immunization Records” contains two useful resources:

• Disease, Vaccines and Related Terms (Table 1) — Lists terms for vaccine-preventable diseases, vaccines and other terms that might be found on an immunization record. It is organized by language. (Appendix B – p. 16-21 in the printed version)
• Trade Names (Table 2) — Lists the names of specific vaccines that are or have been used internationally along with the manufacturer and country or region where the vaccine is produced or used, when known. (Appendix B – p. 22-32 in the printed version)

Another helpful resource is the “Quick Chart of Vaccine-Preventable Disease Terms in Multiple Languages,” produced by the Immunization Action Coalition (IAC). This resource displays each vaccine in English as well as in multiple eastern and western European languages.   

Process

Once you have any immunization record offered, ask the client, parent or interpreter whether they:

• Have any additional records or documents that may contain immunization history. 
• Received any immunizations that may not have been recorded on the documents provided. However, remember that according to CDC recommendations, only written or electronic documentation from an official source should be accepted as valid.
• Checked your state’s or county’s registry for any immunization history for the client.

With the above resources, you should be able to go line by line to identify each vaccine. It may be helpful to have the assistance of an interpreter, but always rely on your review of the immunization record as your most reliable information source. Be sure to pay special attention to the following:

• Date of administration for each vaccine listed — Be aware that some countries typically record dates with the day and month listed before the year (e.g., 30/1/2016 would be January 30, 2016).
• Age of the person at the time each vaccine was administered — Vaccine schedules in other countries may vary from schedules in the United States. For example, MMR vaccine might have been administered before 12 months of age in their country of origin. Likewise, DTaP doses may have been administered according to a schedule different from that of the CDC recommendations. Discrepancies like this in children often require administration of additional doses of vaccine to ensure that the child will be compliant when entering school. If you are unsure, check with your local health department.
  
  Parents or guardians may be concerned about the extra doses of vaccine; however, you should assure them that additional doses of vaccine do not typically present a safety issue. The VEC at CHOP has information for concerned parents to get additional information (See “Are extra doses of vaccines harmful?”).

Once you have determined which vaccines the person has received, use the recommended immunization schedules as your guide for determining which vaccines are needed:

• Infants and Children Vaccine Schedule (birth through 6 years old)
• Preteens and Teens (7 through 18 years old)
• Birth to 18 years of age and "Catch-up" Schedule
• Adults (19 years and older)

After a comprehensive review of the client’s immunization record, inform the client, parent or legal guardian of your vaccine recommendations. If you are unsure about how to proceed or have specific questions about one or more vaccines, contact the immunization team at your local health department or the CDC. The CDC can be contacted by:

• Email: nipinfo@cdc.gov
• Phone: 1-800-CDC-INFO [1-800-232-4636] or TTY: 888-232-6348, Monday – Friday 8 a.m. - 8 p.m. EST, English or Spanish)
• Online form

Once you are ready to proceed with immunizations, remember the following:

• Vaccine Information Statements (VIS) — As required by law, a VIS must be provided for each vaccine prior to administration. If the family you are working with is more comfortable using a language other than English, you might want to visit the IAC website which contains VISs in about 40 languages. The IAC also has a “Language Locator” webpage to help you figure out which language you need. 
• Pre-vaccination assessment questions — It is important that the client, parent or legal guardian fully understand your pre-vaccination assessment questions. A family member with a better grasp of English or an interpreter may be valuable. Interpreters may be available in your community for languages common to your population, or you may need to contact an interpretation and translation service organization. Your public health department colleagues may be familiar with resources available in your area.
• Many immigrants and refugees arrive in communities throughout the country after a great deal of travel and duress. They may be reserved about or suspicious of vaccinations as well as other medical care or treatments. It is important for clinicians to work with these clients, their families and interpreters patiently and respectfully and to remember that there may be reasons for that reaction based on their previous experiences or beliefs or practices in their country of origin.
• Finally, show appreciation for their cooperation in receiving their vaccinations and any vaccinations scheduled in the future. Our ability to educate and guide these new residents will help to maintain “community immunity” in our cities and towns throughout Pennsylvania and the country.