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SAN ANTONIO
MEDICINE

Decreasing Barriers to Vaccine-

Preventable Diseases in Bexar County

By Marina Moreno and Adelita G. Cantu, PhD, RN, FAAN

Background: Vaccination disparities continue in Texas’ five most
populous counties, including Bexar County. According to the City of
San Antonio, Sean Cummings has estimated that 296,019 out of
417,222 non-Hispanic white people were vaccinated at least once
against COVID in 2021. The percentage of those people who were
vaccinated is roughly 71%. On the other hand, 437,807 out of 906,742
Hispanics in San Antonio were vaccinated at least once. The percentage
1
of Hispanics vaccinated was roughly 48% in 2021.
The Centers for Disease Control and Prevention (CDC) states that,
“Immunization information systems (IIS) are confidential, population-
based, computerized databases that record all immunization doses ad-
ministered by participating providers to persons residing within a given Figure 1 Comparison of ethnicities in Bexar County vaccinated in 2021
https://cosacovid-cosagis.hub.arcgis.com/datasets/CoSAGIS::vaccinations-weekly-totals-
2
geopolitical area.” In clinical practice, these information systems assist public-share-1/about
healthcare providers and public health agencies by authorizing access to
an individual’s vaccination record to determine appropriate vaccination
interventions. In the United States, many states use an IIS to collect “ag-
gregate data on vaccinations for use in surveillance and program opera-
tions,” but the overall goal is to guide public health action by “improving
2
vaccination rates and reducing vaccine-preventable disease.”
ImmTrac (Immunization Registry of Texas) is an online IIS database
that tracks immunization records in the state of Texas. It was enacted
by Texas HB 1921, which was first passed in 2003 by the 78th state leg-
islature. ImmTrac2 replaced the original ImmTrac in April 2017.
The bill was initially passed to increase the use of authorized consent
and transition from paper forms to online forms. The registry was de-
Figure 2 Comparison of ethnicities in Bexar County vaccinated in 2023
signed to keep patient information secure and private while allowing https://cosacovid-cosagis.hub.arcgis.com/datasets/CoSAGIS::vaccinations-weekly-to-
tals-public-share-1/about
access to authorized healthcare providers, schools and public health
departments. “The registry is secure and confidential, and safely con-
solidates and stores immunization records from multiple sources in one
3
centralized system.”
Certain vaccinations are mandatory for childcare, school, military
enlistment, travel, employment, and may be necessary in other fields.
Records of those vaccinations last a lifetime. However, tracking records
from various sources can be time-consuming, and may lead to over or
under use of vaccinations. “Reducing the hassle of record-keeping pre-
4
vents children from being either under- or overimmunized.” In addi-
tion, ImmTrac2 stores individual information on antiviral
immunizations and medications that are associated with disaster
4
events. Thus, keeping a centralized database of immunization records Figure 3 Comparison of boosters by ethnicity in Bexar County 2021-2023
https://cosacovid-cosagis.hub.arcgis.com/datasets/CoSAGIS::vaccinations-weekly-totals-
prevents user error and confusion. public-share-1/about

36 SAN ANTONIO MEDICINE • August 2023