Childhood immunisations

Immunisation protects people and communities from serious infectious diseases. In the UK there are a number of routine vaccinations that are offered.

Vaccination is particularly important for infants and young children, as their immune system is less well developed than in older children and adults. Vaccinations are quick, safe and extremely effective. Once a child has been vaccinated against a disease, their body can fight it more effectively.

What do we know?

As well as the individual being protected themselves, vaccinated people are also less likely to be a source of infection to others. This reduces the risk of unvaccinated people being exposed to infection, this means that an individual who cannot be vaccinated will still benefit from the routine vaccination programme. Therefore immunisations are a highly effective way of maintaining the health of the population by reducing the occurrence of infectious diseases.

This concept is called population or “herd” immunity. For example, babies below the age of two months, who are too young to be immunised, are at greater risk of dying if they catch whooping cough. These babies are protected because other people , including their siblings have been routinely immunised as part of the childhood immunisation programme.

When vaccine coverage is high enough to provide high levels of population immunity, infections may even be eliminated from the country, for example: diphtheria. However, if high vaccination coverage is not maintained, it may be possible for the disease to return.

Immunisations are commissioned by the NHS England Area Team, from General Practices and other providers. The role of local Public Health is to monitor and scrutinise the delivery of the vaccination programmes. Local Public Health also gives assurance to the Health and Wellbeing board on how these programmes are being delivered to the local communities.

Facts, Figures and Trends

Uptake of childhood vaccinations in Slough is lower than the national target of 95%. While the rate of vaccinations in those under one is improving and approaching the target, vaccination rate for those aged two to five remains poor.

Table 1. Routine Childhood Vaccination Uptake 2014/15

 Vaccination  Measured  Target   Slough value  England average  DOT
 Three doses of Diptheria Tetanus Pertussis Polio Hib  By age 1   >95% 94.4% 94.2%   ↑
 Three doses of Pneumococcal (PCV)  By age 2   >95% 88.6%
  ↔
 Hib/Men C booster  By age 2   >95% 88.2% 92.1%   ↓
 MMR first dose  By age 2   >95% 88.3% 92.3%   ↓
 MMR second dose  By age 5   >95% 82.2% 88.6%   ↔
 Diptheria Tetanus Pertussis Polio Hib booster  By age 5   >95%  81.7%  88.5%   ↔

Optional vaccines

Hepatitis B and BCG vaccines are offered to children at high risk of exposure, while chickenpox vaccine is offered to the siblings of children with suppressed immune system. Data from 2013/14 shows that 100% of at risk children in Slough correctly received their Hepatitis B vaccination.

National & Local Strategies (Current best practices)

National

The online Green Book has the latest information on vaccines and vaccination procedures for all the vaccine preventable infectious diseases that may occur in the UK.

The complete immunisation schedule in the UK including the ages of when the vaccines should be given can be found on the government website as well as via NHS choices.

The immunisationschedule comprises the recommended universal or routine immunisations which are offered to all children and young people, as well as selective immunisations which are targeted to children who are at higher risk from certain diseases.

Local

NHS England South Central is developing a plan which involves working together with local stakeholders to improve immunisation coverage across Berkshire for the under 5’s age group, this includes MMR. Part of the plan will be to ensure that data is robust toto give an accurate picture of the actual coverage, along with supporting GP practices to improve their immunisation uptakes.

Work is continuing in all areas across Berkshire to increase the uptake of the second MMR injections. The NHS England South Central screening and immunisation team are regularly identifying those GP practices with low uptake and work with the local Child Health Information System (CHIS) team and relevant practices to increase uptake and improve data robustness.

The Berkshire School Health Nursing service is commissioned to catch up children with missing MMR dose 1, 2 or both during school based immunisation sessions.Enhanced outreach work is being undertaken in partnership with the Oxford AHSN in targeted practices and early years setting. A faith group led promotion of flu vaccine uptake, especially targeted at children is still underway.

What is this telling us?

In Berkshire, we are not achieving the national uptake target of 95% for any of the childhood vaccines. Slough has the lowest uptake among the six Berkshire Unitary Authorities, particularly for MMR. Though the number of measles cases has not increased in recent years, there is a potential for an outbreak.

What are the key inequalities?

Evidence has shown that the following groups of children and young people are at risk of not being fully immunised:

  • those who have missed previous vaccinations (whether as a result of parental choice or otherwise
  • looked after children
  • those with physical or learning disabilities
  • children of teenage or lone parents
  • those not registered with a GP
  • younger children from large families
  • children who are hospitalised or have a chronic illness
  • those from some minority ethnic groups
  • those from non-English speaking families
  • vulnerable children, such as those whose families are travellers, asylum seekers or are homeless.

(Souce: NICE Guideline PH21: Immunisations: reducing differences in uptake in under 19s).

What are the unmet needs/ service gaps?

As illustrated above, there remains a significant proportion of two and five year olds in Slough who are not receiving the recommended vaccinations and so are less protected against infectious diseases than other children in the borough.

From what we know about children who are not fully immunised, they are more likely to have other vulnerabilities and so reaching and protecting this cohort is important.

Recommendations for other key organisations:

  • Continue partnership working with the NHS England Thames Valley screening and immunisation team and Oxford AHSN to promote uptake of childhood immunisation programmes.
  • Continue outreach work to those at high risk of not being immunised.

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