Immunisation Update

Afua Nketia, Immunisation Coordinator

Dr Agnes Marossy, Consultant in Public Health

Immunisation

Immunisation is one of the most effective public health interventions.

The World Health Organisation recommend that uptake for childhood immunisations should be at least 95%.

We are not achieving this target.

Why are we not achieving the target? Not enough people being immunised We don’t always have a record even if

someone has been immunised

Why are people not immunised?

Lack of knowledge- Schedule changes- second dose MMR,

12 mth baby immunisations Misinformation - Wakefield Misunderstanding of when immunisations are due -

pre-school booster Lack of access-hard to reach, language problems,

migration, chaotic lifestyles Cultural reasons

Why don’t we know who has been immunised?

Good question!

Why don’t we know who has been immunised? Before 2010

1. Paper records not sent / never arrived in post

2. Child moved out of area and records sent away

3. Immunisations missed elsewhere not entered on child’s record

After 2010

1. Immunisations on practice system not always entered on the correct template. Sometimes deleted by accident

2. Wrong date of birth, name or other demographic details

2 and 3 from “before 2010”.

Bromley position 2008-9

Immunisation Actual 2008-2009

Trajectories 2010- 2011

DPT at age 1 year 75.5% 90%

PCV booster at age 2 yrs

75.4% 90%

Hib/MenC booster at age 2yrs years

82.2% 95%

MMR 1st dose at age 2 years

82.2% 90%

DTaP/IPV booster at age 5 yrs

74.3% 95%

MMR booster at age 5 yrs

71.1% 90%

Bromley position 2011-12

Immunisation

Actual 2011-2012

Trajectories 2010-11

DPT at age 1 year 95.1% 90%

PCV booster at age 2 yrs

90.0% 90%

Hib/MenC booster at age 2yrs years

91.9% 95%

MMR 1st dose at age 2 years

91.5% 90%

DTaP/IPV booster at age 5 yrs

87.6% 95%

MMR booster at age 5 yrs

88.5% 90%

Trends in uptake

Immunisation Trends

50.00%

55.00%60.00%

65.00%70.00%

75.00%

80.00%85.00%

90.00%95.00%

100.00%

1yr

DT

aP

/IPV

/Hib

2 yr P

CV

Bo

oste

r

2yr H

ib/M

en

CB

oo

ster

2yrs M

MR

1

5yr D

Ta

P/IP

V

5yr M

MR

2

Actual 2008-09 Actual 2009-10 Actual 2010-11

Actual 2011-12 Trajectories 2010-11

What have we done to improve……

Knowledge Awareness of the schedule, posters, leaflets Nursery visits Glades adverts

Access Defaulter project Misinformation- national approach Cultural- gypsy traveller work Data quality work. (collection and training)

Defaulter project

Better data- better analysis of individual practice data Training all practices to run timely searches Defaulter project introduced. Health visitors and

practice working together in targeting defaulters. This exercise highlighted the health visitor role in childhood immunisations.

Evaluation of defaulter project indicated a need to change the process-

Improving immunisation uptake was piloted following the defaulter project evaluation.

Nursery Projects

All Bromley nurseries asked to take part in survey about childhood immunisations

5 nurseries agreed to hold coffee mornings to raise awareness of childhood immunisations.

Parents were invited to bring their children’s Red books, to the coffee mornings where a gift was offered to completely immunised children.

Nursery project findings

Some parents were unsure what immunisations their children had. The extra MMR in 2008/9 was especially confusing to most parents.

Most thought the pre-school booster meant just that.

Improving immunisation project

30 practices in Bromley were included in the improving immunisation project. A snapshot of defaulting children in these practices were targeted by the Public health team.

Steps- team member contacts practice to check if child has been

immunised or has an appointment. Where required team member contacted the guardian by phone.

When appointment booked, option of a text reminder was given. Where no response to phone calls (9) a home visit was made Active refusers had the immunisation record changed to reflect

this.

Improving immunisation project evaluation The use of prewritten script and text

message reminder successful. Home visits took up more time than

expected and there was a lower response rate.

Improving immunisation project what next 37.84% of the defaulter children had previous

immunisations but no record on the GP data base. ? Encourage practices to implement the processes used.

Non medical staff could make the telephone call with the aid of the prewritten script.

Encourage practices to use text reminders- many already do.

Good practice findings to be circulated to practices.

Pathway for unregistered children with incomplete immunisation history

Unregistered children

Data analyst to run report on immunisations for appropriate quarter. Search to be for all children in the cohort aged 6 months, 16months and

4 years who are unregistered and have missing immunisations. Information to include NHS number, RiO number, team and HCP if

known

Child health to check RiO system to ascertain if missing result due to unsynchronised record and run

registration checks

If GP still unknown, child health to notify appropriate team/HV of missing immunisation on child with unknown GP

HV to try and contact family to find out GP registration and remind re immunisation. If no GP to advise parent to register child

HV to record in RiO progress notes outcome of contact.

If HV was unable to contact, to record this in the progress note and action to be taken

as per HV Service Visiting New Clients Procedure. If no longer living at address to

inform child health address unknown

If child has had the outstanding immunisation HV to inform child health manager date and immunisation given

Child health manager to input immunisation on RiO

If no GP at time of contact with parent, HV to check RiO 4 weeks after contact to check child has been registered. If still not registered to follow up as per HV Service New Clients Procedure.

Unregistered children Data analyst to run report on

immunisations for appropriate quarter and also for all children in the above cohort

aged 6 months, 16months and 4 years who are unregistered and have

missing immunisations This means two different searches are

being done

Commissioning for Quality and Innovation (CQUIN) payment

Immunisation uptake at 5 years

Immunisation uptake at 2 years

Immunisations uptake at 1 year

Thank you for your attention.

Any questions?