{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T22:00:15Z","timestamp":1788818415368,"version":"build-2803163510"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>This paper presents a proposal for the modelling and reference architecture of a digital twin for immunisation services in primary health care centres. The system leverages Industry 4.0 concepts and technologies, such as the Internet of Things (IoT), machine learning, and cloud computing, to improve vaccination management and monitoring.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The modelling was conducted using the Unified Modelling Language (UML) to define workflows and processes such as temperature monitoring of storage equipment and tracking of vaccination status. The proposed reference architecture follows the ISO 23247 standard and is structured into four domains: observable elements\/entities, data collection and device control, digital twin platform, and user domain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The system enables the storage, monitoring, and visualisation of data related to the immunisation room, specifically concerning the temperature control of ice-lined refrigerators (ILRs) and thermal boxes. An analytic module has been developed to monitor vaccination coverage, correlating individual vaccination statuses with the official vaccination calendar.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The proposed digital twin improves vaccine temperature management, reduces vaccine dose wastage, monitors the population\u2019s vaccination status, and supports the planning of more effective immunisation actions. The article also discusses the feasibility, potential benefits, and future impacts of deploying this technology within immunisation services.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1568123","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T05:37:13Z","timestamp":1747201033000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["TWINVAX: conceptual model of a digital twin for immunisation services in primary health care"],"prefix":"10.3389","volume":"13","author":[{"given":"L.","family":"De Oliveira El-Warrak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Miceli de Farias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.3390\/vaccines11071180","article-title":"Community-based approaches to increase COVID-19 vaccine uptake and demand: lessons learned from four UNICEF-supported interventions","volume":"11","author":"Hopkins","year":"2023","journal-title":"Vaccines (Basel)"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"220","DOI":"10.2105\/AJPH.2021.306585","article-title":"Targeting equity in COVID-19 vaccinations using the \"evaluating vulnerability and equity\" (EVE) model","volume":"112","author":"Weston","year":"2022","journal-title":"Am J Public Health"},{"key":"ref3","first-page":"347","article-title":"Proactive vaccine Management in Public Health: the role of digital technologies","volume":"26","author":"Davis","year":"2020","journal-title":"J Public Health Manag Pract"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2199656","DOI":"10.1080\/21645515.2023.2199656","article-title":"Impact of the COVID-19 pandemic on routine vaccine landscape: a global perspective","volume":"19","author":"Basu","year":"2023","journal-title":"Hum Vaccin Immunother"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1016\/j.amepre.2015.11.003","article-title":"Increasing coverage of appropriate vaccinations","volume":"50","author":"Jacob","year":"2023","journal-title":"Am J Prev Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"3118","DOI":"10.3390\/healthcare11243118","article-title":"Towards the future of public health: Roadmapping trends and scenarios in the post-COVID healthcare era","volume":"11","author":"El-Warrak","year":"2023","journal-title":"Healthcare"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.4161\/hv.25031","article-title":"Utilizing health information technology to improve vaccine communication and coverage","volume":"9","author":"Stockwell","year":"2013","journal-title":"Hum Vaccin Immunother"},{"key":"ref8","volume-title":"Intervention guidebook for implementing and monitoring activities to reduce missed opportunities for vaccination","year":"2019"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1093\/heapol\/czs020","article-title":"Global immunization vision and strategy (GIVS): a mid-term analysis of progress in 50 countries","volume":"28","author":"Kamara","year":"2013","journal-title":"Health Policy Plan"},{"key":"ref10","volume-title":"Global immunization vision and strategy 2006\u20132015","year":"2005"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"S62","DOI":"10.1093\/infdis\/jir130","article-title":"Is there enough vaccine to eradicate measles? 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