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—Clarification of the ideas presented in our article on IIS by Dr Orenstein and colleagues is most welcome. The CDC's National Immunization Program supported our study and contributed richly to its intellectual development. Orenstein and colleagues raise 2 central issues in the conceptualization of IIS—implementation of IIS at the state, as opposed to the national level, and the adequacy of privacy protection for children and their families.Orenstein and colleagues make a strong case for state data systems to accommodate local solutions and preferences. While state-based data systems achieve many benefits, variability in state rules can render them less effective from a public health perspective. The flow of immunization information is rarely restricted to the state in which it is generated. Families move from state to state, and the ability to track children and meet their medical needs wherever they live remains an important feature of IIS. Managed
Gostin LO, Lazzarini Z. Childhood Immunization Registries-Reply. JAMA. 1996;275(17):1313. doi:10.1001/jama.1996.03530410026023