Immunisation Update

1
Immunisation Update
Afua Nketia, Immunisation Coordinator Dr Agnes
Marossy, Consultant in Public Health
2
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.

3
Why are we not achieving the target?

• Not enough people being immunised
• We dont always have a record even if someone has
  been immunised

4
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

5
Why dont we know who has been immunised?

• Good question!

6
Why dont we know who has been immunised?

• Before 2010

• After 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
   childs record

• Immunisations on practice system not always
  entered on the correct template. Sometimes
  deleted by accident
• Wrong date of birth, name or other demographic
  details
• 2 and 3 from before 2010.

7
Bromley position 2008-9
8
Bromley position 2011-12
9
Trends in uptake
10
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)

11
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.

12
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 childrens
  Red books, to the coffee mornings where a gift
  was offered to completely immunised children.

13
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.

14
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.

15
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.

16
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.

17
Pathway for unregistered children with incomplete
immunisation history
18
Commissioning for Quality and Innovation (CQUIN)
payment
19
Bromley Immunisation uptake
20
Immunisation uptake at 5 years
21
Immunisation uptake at 2 years
22
Immunisations uptake at 1 year
23

• Thank you for your attention.
• Any questions?