Monday, 31 May 2010

Vaccination uptake increases in Brighton and Hove despite safety worries of some

· One in five Brightonians think MMR is not safe
· MMR2 vaccine uptake increases to 68% in 2009
· “Opportunistic” vaccination at A & E wards under consideration in Brighton and Hove

More than one in five (22% of people) do not believe MMR vaccination is safe, according to a Brighton and Hove 2009 Citizen’s Panel survey. Despite the safety worries, uptake rates are increasing in a city that has historically resisted vaccination. The information was published in a report compiled by City Council Public Health Specialist Barbara Hardcastle in April 2010. The report said “opportunistic” vaccination at A&E wards was under consideration in Brighton and Hove.

821 people responded to the survey. Of those, 201 had children aged under 18. Of these, 73% said their children had received all the immunisations offered. 6.5% said they had received none of the immunisations offered. 14% said they had received some of the vaccinations offered.

When asked why some or all of the vaccinations had been missed, 22.2% (22 people out of 201) said they “didn’t believe MMR was safe.”

65% felt they had been given enough information about the risks of immunisation, while 81% felt they had been given enough information about the risks of not immunising their child.

The report said MMR uptake had been badly affected by the negative press associated with the now discredited Wakefield paper published in the Lancet in the 1998.

In addition, the report said: “There is also a strong “natural health” movement in Brighton and Hove which is anti-vaccination in general and anti-MMR in particular. “
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However, the report continued, since April 2003 there has been a substantial increase in first dose MMR uptake, from 67.3% to 84.30% in September 2009.

In 2008/09, out of 3053 eligible children, 2491 were vaccinated for MMR, representing an 81.6% uptake. This was 3% lower than the uptake rate for the region and England as a whole.

MMR is said to be most effective when two doses are given. The uptake for the second dose (MMR2) is lower than for the first dose, but has also improved since April 2003, from 59% to 77% in September 2009. The report said: “MMR catch-up campaign introduced in October 2008 has contributed towards an 8% increase in uptake in one year for the MMR2, as people who had received one or no MMRs were followed up.“

2,816 children were eligible for MMR2 vaccination in 2008/09. 2,600 were immunised, representing a 68.8% uptake. Brighton & Hove City PCT had a lower uptake rate for the second MMR dose than both the regional and England average of around 78%.

Despite the overall increases in uptake for MMR2, some GP practices reported MMR uptake rates of less than 50%. This was said to be due to demographic reasons in practices with very small numbers of children. Brighton and Hove’s PCT MMR2 uptake target for 2009/10 is 69%.

By contrast, the relatively new HPV vaccination has relatively high uptake in Brighton and Hove, at around 78-80% over the past three years, when the national average has fallen to from above 85% to 70%. The report says: “Brighton & Hove City PCT had a higher uptake rate for all 3 HPV doses than both the region and England in 2008/09. The Annual PCT Target for 2009/10 is 85%.

This is the second year of the HPV vaccination programme for Year 8 girls. Catch-up campaigns are also running for Years 10, 11, 12 and 13 in 2009/10. Years 8, 10 and 11 are school-based programmes, the rest are delivered by GP Practices.

The report recommended action. Firstly, in response to the Citizens Panel survey, communications should be developed to ensure parents are better informed of the risks and benefits of immunisation both to their children and to the community. “This will have training implications for Health Visitors and Practice Nurses.,” the report said.

In addition, the multiagency “Immunisation and Vaccination Group” is also “looking into appointment systems and waiting lists for vaccination at practice level. The possibility of opportunistic vaccination in A&E, and Walk-in centres, and of at-risk hospital patients are also being considered.” The Group meets on a quarterly basis to review uptake figures and co-ordinate immunisation programmes across the city to increase uptake.

A specialist immunisation team is being developed in CYPT (Brighton and Hove’s Children’s’ Department.) This will include a specialist nurse who will work with GPs to follow-up people who have missed their immunisations and if necessary provide an outreach vaccination service. They will also follow up hard to reach groups. The team will also review the possibility of transferring the school-leaving booster from a GP to a school-based programme to help improve uptake.

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