Nurses working with children who are unwilling to undergo invasive procedures experience negative emotions but these are short lived due to a combination of protective factors and coping strategies. Further research is needed to understand the experiences of medical staff and of nurses working outside paediatric environments who may not experience the same support and protection as those in paediatric settings.

Use of the Louisiana Immunization Network for Kids Statewide (LINKS) during the aftermath of Hurricane Katrina saved parents and immunization providers' time, money, and the inconvenience of having to unnecessarily revaccinate children displaced both inside and outside Louisiana. This immunization information system remained online via a backup system following the hurricane, thereby making immunization history data available to queries from healthcare providers caring for displaced persons both within Louisiana and throughout the United States. LINKS contained immunization records for approximately 1.5 million people of all ages at the time of the hurricane. Assessment of more than 21 000 successful electronic immunization queries of children and adolescents displaced outside Louisiana state boundaries from virtually all states estimates that more than $4.6 million was saved in revaccination expenses. The impact of recovered records for these children within Louisiana is certainly as critical. Our review illustrates the value of an immunization information system as a tool to support not only individuals, healthcare providers, and public health authorities but also the presidential vision to develop Electronic Health Records in the United States over the next 10 years.

This article summarizes principal findings and recommendations of the National Vaccine Advisory Committee 2007 Progress report on Immunization Information Systems (IIS). Considerable progress has been made in each of the four primary objectives of the IIS: ensure appropriate protections of privacy and confidentiality for individuals and security for information included in the registry; ensure participation of all immunization providers and recipients; ensure appropriate functioning of registries; and ensure sustainable funding for registries. In addition, IIS use has been extended to deal with adolescent/adult immunization, preparedness, vaccine shortages, health information exchanges, and electronic medical records. Notwithstanding the progress, several factors impede smooth achievement of the 2010 goal. The three most critical are difficulties in exchanging information among different information systems, difficulties in exchanging information across state lines, and ensuring sustainable funding for registries. The committee has made a number of recommendations to address these issues.

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