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Childhood Immunisations (5 years and over)

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Introduction

After clean water, vaccination is the most effective public health intervention in the world for saving lives and promoting good health. Immunisation is the most essential way of protecting people and communities from serious infectious diseases. As well as the individual being protected themselves, vaccinated people are also less likely to be a source of infection to others.

Many vaccine preventable childhood diseases are now so rare that it is easy to underestimate the importance of children's vaccinations. However, whooping cough and diphtheria are still a threat. The diseases are rare now, but if children are not vaccinated, they can return with a vengeance.

Currently the European Region of the World Health Organization (WHO) recommends that on a national basis at least 95% of children are immunised against diseases preventable by immunisation and targeted for elimination or control (specifically, diphtheria, tetanus, pertussis, polio, Hib, measles, mumps and rubella)1. The routine childhood immunisation programme for the UK includes these immunisations recommended by WHO as well as a number of others as defined by Public Health England (PHE) in Figure 1.

Figure 1: Routine childhood immunisation schedule

Starting well - immunisation schedule
Source: PHE, Routine Childhood Immunisation Schedule, Summer 2016

Childhood immunisations (0-4 years) and adult vaccinations provides data on younger children and adults. Further information on infectious diseases and other noncommunicable health threats is available in the Health Protection section.

Facts, figures and trends

Blackpool has achieved vaccination coverage of over 90% for all the routine childhood vaccinations recommended in the first two years of life. For children aged 5 years and over, 2014/15 data published by Public Health England shows that in Blackpool:

    • The number of children who had received the Haemophilus influenza type b and meningitis C (Hib/MenC) booster by age 5 years was 1,632 (94.0%).
    • The number of children who had received the measles, mumps and rubella (MMR) vaccine, 1 dose, by age 5 years was 1,666 (95.9%).
    • The number of children who had received the measles, mumps and rubella (MMR) vaccine, 2 doses at age 5 years was 1,524 (87.7%).
    • The number of girls aged 12 to 13 years who had received the HPV vaccine was 560 (93.3%).

Figure 2: Percent of children immunised by their 5th birthday: 2014/15

Developing Well-ChildImm-Fig2-vacc-5yr-1415
Source: PHE, Children and Young People's Health Benchmarking Tool   

Figure 3: Trend in proportion of children immunised by their 5th birthday

Developing Well-ChildImm-Fig3-vacctrend-5yr-1415
Source: PHE, Children and Young People's Health Benchmarking Tool

Across Blackpool, immunisation uptake by the age of 5 years is slightly higher than the national averages for the Hib/Men C booster and for one dose of the MMR vaccine and is above the 90% goal. However, two doses of MMR vaccine are required to provide satisfactory protection against measles, mumps and rubella4 and although coverage in Blackpool is increasing, it is still lower than the national average (Figure 2) and the 90% goal. In 2014/15 88% of Blackpool's children had two doses of the MMR vaccine by the time they began school. Although the proportion of children receiving two doses of the MMR vaccine has been rising in recent years (Figure 3), approximately 5%-10% of children are not fully immune after only one dose of the vaccine, therefore the second dose provides a further opportunity to protect children, with less than 1% of children remaining susceptible after receiving the two recommended doses2.

Figure 4: Trend in the proportion of children who have 2 doses of MMR vaccine by their 5th birthday

Developing Well-ChildImm-Fig4-mmrtrend2dose-5yr-1415
Source: HSCIC, NHS Immunisation Statistics

Figure 5: Proportion of children who have 2 doses of MMR vaccine by their 5th birthday, comparison showing Blackpool with upper tier local authorities in England, 2014/15

Developing Well-ChildImm-Fig5-mmr2dose-5yr-LA-1415
Source: PHE, Children and Young People's Health Benchmarking Tool

Figure 4 shows the longer term trend in the proportion of children who have received 2 doses of the MMR vaccine by their 5th birthday. In Blackpool coverage has gone from higher than the national average in 2005/06 to lower than the national average in recent years though if the current trend continues the proportion of vaccinated children could overtake the national average. The increase in coverage in 2008/09 and 2009/10 was due to a 'catch-up' campaign at the time. Figure 5 compares Blackpool with other local authorities in England, Blackpool ranks 48/149 and is in the second lowest quintile for coverage.

In the four year period 2011-14 there were 19 cases of measles in children aged under 15 in Blackpool, a rate of 20 per 100,000 population. While this was lower than the national average of 29.9 per 100,000, outbreaks can happen and therefore it's important to make sure children are up-to-date with the MMR vaccination.

Human Papillomavirus (HPV)

In the UK, all 12-13 year old girls (school year 8) are offered the human papilloma virus (HPV) vaccination through the national HPV immunisation programme, the aim of which is to reduce the incidence of cervical cancer in women. HPV is one of the most common sexually transmitted infections. The HPV vaccine protects against two types of HPV virus (HPV-16 and HPV-18) which together are responsible for about 70% of cervical cancers. In addition, the vaccine can also protect against HPV-6 and HPV-11, the two strains of HPV that cause most cases of genital warts.

The national human papillomavirus (HPV) immunisation programme was introduced in 2008. While it was initially a three dose vaccination programme, following expert advice it was run as a two-dose schedule from September 2014.  This means that during the first year of the two-dose programme data will only be available for the first dose. National coverage for the completed course of HPV vaccination for the first cohort offered the two-dose schedule will not be available for publication until after September 2016 and therefore trend data is not yet available.

    • In Blackpool in 2014/15, 597 (78.9%) girls aged 12-13 were vaccinated against HPV.
    • Coverage is higher than national and regional averages (Figure 6).

Figure 6: Proportion of girls aged 12 to 13 years who received one dose of the HPV vaccine: 2014/15

Developing Well-ChildImm-Fig6-HPV-12-13yr-1415
Source: PHE, Children and Young People's Health Benchmarking Tool

It is important that coverage is maintained as reductions in the prevalence of HPV 16/18 infections are consistent with very high vaccine effectiveness among those vaccinated and suggest that herd-protection is also lowering prevalence among those who are not vaccinated. Early findings from PHE support the expectation that vaccination will impact on cervical cancer and other HPV-related diseases in due course3 and it is anticipated that, with the new two-dose schedule, higher coverage of the completed course should be achievable, thus increasing the potential impact of the programme.

Variation within Blackpool

At a local level, there is variation in the proportion of children immunised in each of Blackpool's GP practices though none are significantly different from the Blackpool average. Figure 7 shows immunisations by the age of 5 years and the proportion of children immunised by each practice in 2015/16. Figure 8 shows proportions immunised by the age of 5 years for selected diseases

Figure 7: Child Immunisations by the age of 5 years by GP Practice in Blackpool, 2015/16

GP level imms table age 5yrs-1516
Source: NHS England, Child Immunisation at Practice level

Figure 8: Proportion immunised for Hib/Men C booster and MMR Doses 1 and 2 by the age of 5 years in Blackpool by GP practice, 2015/16

GP level imms age 5yrs-1516
Source: NHS England, Child Immunisation at Practice level

 

Looked After Children

In recent years there has been a renewed focus on improving outcomes for looked-after children and young people and one of the first standards to be published was to promote the health and wellbeing of looked-after children and young people4. Compared to the national average, looked after children in Blackpool are significantly more likely to be up to date with their immunisations, in 2015, 96.8% of children in care for at least 12 months had all their immunisations compared to 87.8% nationally.

Risks

There are many reasons why people choose not to immunise themselves or their children. Studies have looked into how parents make decisions on whether to vaccinate their children or not and found that this is related to gaps in their knowledge of vaccine preventable diseases, concerns over vaccine safety and their attitudes towards immunisations, health professionals and health organisations.

Blackpool recognises there is a need to target both overall improvement of immunisation coverage and specifically to improve the low levels of coverage amongst certain groups and in certain places.

Evidence has shown that the following groups of children and young people are at risk of not being fully immunised5:

• those who have missed previous vaccinations (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 Gypsy Travellers, asylum seekers or are homeless.

National and local strategies

Department of Health (2013) immunisation information for health professionals and immunisation practitioners

The 'Green Book' has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.

The Complete Immunisation Schedule in the UK includes the ages of when the vaccines should be given.

In September 2009 the National Institute for Health and Clinical Excellence (NICE) published public health guidance 'Reducing the difference in the uptake of immunisations' which focuses on increasing immunisation uptake among children and young people aged under 19 years in groups and settings where immunisation coverage is low.

Department of Health (2009) Healthy Child Programme sets out the universal programme to be commissioned and provided for all families.

Public Health England's vaccination and immunisation snapshot provides a summary of demand, risk factors, provision and outcomes for services in a particular area.


[1] Source: WHO, Health 21 The health for all policy framework for the WHO European Region, 1999

[2] DH, 2014, NHS public health functions agreement 2015-16, Service specification No.10, Measles, mumps and rubella (MMR) immunisation programme

[3] PHE, Human Papillomavirus (HPV) Vaccine Coverage in England, 2008/09 to 2013/14. A review of the full six years of the three-dose schedule, March 2015

[4] NICE Quality Standard 31(6) Looked-after children and young people: Tailored resource for corporate parents and providers on health and wellbeing of looked-after children and young people

[5] NICE. Reducing differences in the uptake of immunisations (including targeted vaccines) among children and young people aged under 19 years. London: National Institute for Health and Clinical Excellence; 2009