Immunisation and vaccination

Vaccinations protect people and communities from infectious diseases. Immunisation programmes not only help the individual being vaccinated but also the wider community, including individuals who cannot be vaccinated, by reducing the number of individuals able to spread an infection. Therefore, immunisations are a highly effective way of maintaining the health of the population by reducing the occurrence of infectious diseases.

While the majority of routine vaccinations are given in early childhood, there are immunisation programmes run for older children and teens. Three main vaccination programmes running for teens include the three-in-one teenage booster, the recently added Meningitis ACWY vaccine and the HPV vaccine which is delivered to females aged 12-13 (year 8).

As of September 2014, the HPV vaccine course is given as a series of two injections within a six month – two year period. The vaccine is usually delivered through schools, organised by the school nurse. Parents will usually receive a letter explaining the programme and a consent form before the vaccine is due. More information on the HPV vaccine can be found at NHS choices.

What do we know?

The Human Papilloma Virus (HPV) is a virus that affects skin and mucous membranes that line parts of the body. There are more than 100 types of HPV, some cause warts and verrucas (low risk HPVs) others can cause changes in the cells of the cervix that increase the risk of cancer (high risk HPVs). High risk HPVs are usually sexually transmitted.

Cervical cancer is a common cancer in young women and causes over 900 deaths each year in the UK. Cervical cancer has been found to be highly associated with HPV infection, in fact almost all cases of cervical cancer are found to be related to HPV. Two strains alone (types 16 and 18) cause about 70% of all cases of cervical cancer.

The HPV vaccine protects against cervical cancer through preventing infection with HPV types 16 and 18. It is estimated that about 400 lives could be saved every year in the UK as a result of this programme.

The three-in-one booster aims to boost protection against diphtheria, tetanus and polio and is usually given at the same time as the Meningitis vaccine (previously the Meningitis C booster).

The new Men ACWY vaccine was introduced due to increases in cases of other strains of meningitis, particularly Meningitis W. Meningococcal disease can be life-threatening and may result in permanent disability. This vaccine is offered to pupils in year 13 of school or the first year in University, this group of young people are particularly at risk of meningitis as well as very young children.

Facts, figures and trends

The latest data, for the 2013-14 school year shows that 85.1% of Slough residents eligible for the HPV vaccine (females aged 12-13) received the full course of vaccinations. This is slightly less than the 85.9% coverage that was achieved the previous year but is still below the national target. The target set each year is to exceed the previous year’s national average uptake.

Figure 1. HPV vaccination coverage in Slough

Figure1

Data for uptake of the Men ACWY vaccine are not yet available, neither are booster uptake rates. There is, however, anecdotal evidence of good engagement across Slough schools with the school immunisation team.

National and local strategies (current best practices)

Immunisation Against Infectious Diseases, which is often referred to as the Green Book, is a document which explains how the immunisation program has developed. It also 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 Public Health England website.

Additional information about the Human Papilloma Virus (HPV) and the vaccination programme can be found at on Cancer Research UK’s website.

Similarly, information about the new Men ACWY vaccine and three-in-one booster for teens is available via NHS Choices Vaccinations pages.

What is this telling us?

While coverage has improved over the last four years, the HPV vaccine programme in Slough is still not reaching the uptake target. Greater intelligence on uptake of the other adolescent immunisation programmes is needed.

What are the gaps/unmet needs?

There remains a need to improve HPV vaccine uptake in girls. More data on local uptake rates is required to map needs in terms of the other immunisations available.

What are the key inequalities?

Encouragingly, research shows that uptake of the HPV vaccine is not lower in those from socioeconomically deprived backgrounds. This is important because women from deprived areas are both more likely to develop cervical cancer and less likely to attend screening.

Black and minority ethnic (BME) groups Research shows that uptake of the HPV is lower among young women from BME groups. One study has demonstrated that the odds of completing HPV vaccination in young women belonging to minority ethnic groups is approximately half that of White British young women.

A recent study of the barriers and facilitators to uptake of the school-based HPV vaccination programme in an ethnically diverse group of young women showed that barriers included stigma of vaccination against a sexually transmitted infection, low levels of information about the vaccine, and issues of consent. Issues around consent included varying commitment and capacity of schools to ensure that parental consent forms were returned, but also a reluctance of staff to accept consent of young person without parental consent, despite a legal right to do so.

Recommendations

  • To work with the school immunisation team towards enhanced data reporting in order to assess gaps in the service and address needs
  • For schools to continue engaging with the school immunisation team to facilitate their work

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