Increasing vaccination uptake JACQUI BOULTON 2015 Florence Nightingale School of Nursing & Midwifery Introduction of new vaccines The reduction in disease rates after the introduction of immunisation programmes Area DTaP/IPV/Hib (primary) MMR 1MMR 2Dtap/ipv/ (BOOSTER) Hib/Men C England London Lambeth Southwark Lewisham NHS immunisation statistics 2015 (APRIL-JUNE) for childhood vaccinations up to age 5 https://www.gov.uk/government/uploads/system/uploads/attachment_data/fi le/463537/hpr3415_COVER.pdf Lambeth Lewisham Merton Newham Redbridge Richmond upon Thames Southwark Sutton Tower Hamlets Waltham Forest Wandsworth Westminster Primary dtap/hib/ipvMEN C /HIBPCVMMR 1MMR 11 BOOSTER DTAP/IPV JULY SEPT 2014 ww.hscic.gov.uk 12m dtp/ipv/hib12m menc12 m pcv24 m mmr 1mmr 2Dtp/hib booster Barking and Dagenham Barnet Bexley Brent Bromley Camden Croydon Ealing EnfieldN.A. Greenwich Hackney Hammersmith and Fulham Haringey Harrow N.A Havering Hillingdon Hounslow Islington Kensington and Chelsea Kingston upon Thames WHAT FACTORS INFLUENCE UPTAKE? Common myths and misconceptions leading to the decision not to vaccinate Perception that the child is not at risk of this disease/it is not serious -Lack of visible evidence of the danger of the disease due to the success of immunisation programmes leads to poor appreciation of the benefits of the vaccine(Prislin et al 1988) -Herd immunity will protect my child(Pickering et al 2003) Perception that the vaccine is more dangerous than the disease Vaccination can cause:eg.Chronic fatigue, MS, asthma and autism(Zimmerman et al 2005) Vaccines are not natural. I prefer to have disease induced immunity(Pickering et al 2003) Frightening or memorable risks associated with vaccination(Kimmel et al 2007) Sensationalised media reports(Kimmel et al 2007) Erroneous perception of contraindications to immunisation(Prosad-Paul et al 2012) THE MEDIA - Long shadow cast by MMR scare Current rise in measles cases can be mostly attributed to the proportion of unprotected year olds, who missed out on vaccination in the late 1990s and early 2000s only 48.7% of 11-year- olds in Kensington and Chelsea have had two doses THE VACCINE SCHEDULE ITSELF Lack of awareness of schedule (Mills 2006) Too many immunisations weaken the immune system( Offit et al 2012) Number/timing of vaccines National HPV uptake Health professionals distrust of by those advocating vaccines (including belief in conspiracy), belief that vaccination should not occur when the child has a minor illness, unpleasant staff or poor communication (all identified by Mills et al 2005) Low uptake groups and poor access Those in deprived communities experience more barriers to uptake (Dixon et al 2003), Mills et al(2005), Brown (2007) Late imms associated with social disadvantage Friederichs(2006) - Studies show these families are at increased risk of developing vaccine- preventable diseases. Practices serving populations living in socially deprived areas and with poorer health were less likely to achieve the 90% target for childhood immunisations Non-completion of DTP and polio immunisation was significantly associated with local deprivation (Lynch 1995, Pearson et al 1993,DH (2005) Difficulties of access Single parent families Children in larger families Children not registered with the GP/travelling families/homeless/ asylum seekers Ethnic minority groups Young people who move between care environments Children in care Children with learning/physical disability Children who are hospitalised/chronic illness (NICE 2009, Henderson et al 2008, HPA 2003), Jarman et al (1988) Groups at risk of poor access Late immunisations associated with social disadvantage Non-completion of DTP and polio immunisation was significantly associated with local deprivation Practices serving populations living in socially deprived areas and with poorer health were less likely to achieve the 90% target for childhood immunisations Often associated with other factors relating to deprivation Studies show these families are at increased risk of developing vaccine- preventable diseases. ((Lynch 1995, Dixon et al (2003), Mills et al(2005), Brown (2007) Pearson et al (1993),DH (2005) Friederichs(2006) Barriers to immunisation? Factors associated with low coverage System -Poor quality immunisation services/resources -Lack of flexibility to offer user friendly appointment service -Poor coordination of services private/public IT systems -Inadequate IT systems-leading to inaccurate uptake data -computers incompatible -incomplete data/records not up to date /Time lag in data submission Staff -Poor coordination of staff and training of immunisers -Unclear or unwillingness to take responsibility/poor definition of roles and responsibilities -Lack of access to current guidelines and policies Attitudes Professional knowledge and attitudes => user knowledge and fears -to disease (low incidence means that diseases not seen) -to vaccine (eg. Misconceptions of contraindications) (Gardner et al 2008, Kimmel et al 2007) Factors associated with low vaccine uptake - Parents Socio-demographic variables Certain groups of children, such as those: in deprived, inner city areas in mobile families in large families with chronic illness in lone parent families under local authority care Parental attitudes to disease to vaccine ( Mills et al. 2005; NICE 2009 ;Pearce et al ) Are your clinics held at convenient times for patients? Can you hold evening or weekend immunisation clinics? Are you flexible - do you only offer immunisations at baby or child health clinics? Are clinics adequately staffed with sufficient administrative support? Are clinic appointments of sufficient length to allow discussion with parents/patients Are your clinics held at convenient times for patients? Can you hold evening or weekend immunisation clinics? Are you flexible - do you only offer immunisations at baby or child health clinics? Are clinics adequately staffed with sufficient administrative support? Are clinic appointments of sufficient length to allow discussion with parents/patients System change-improve access User Friendly service MMR Hackney months 800 children Swindon 2002 Immunisation rate 54-84% 2 years Nottingham city PCT Joint strategic needs assessment 2008 Deployed specialist immuniser for the travelling community - Only 54% of those who had been in care for more than 12 months were up to date with their immunisations -Introduced health assessments for all looked after children. -Identified unimmunised children ered a flexible service in the home -A health liaison worker who ensured information sharing between agencies and a flexible service and increased the uptake rate to 84% within 2 years Ethnic minorities Working with mosques-Meningitis/Hib clinics Using advocates Using interpreters Systematic review of qualitative studies Mills et al. (2005) Barriers identified included concern about the risk of adverse effects, concern that vaccinations are painful, distrust of by those advocating vaccines (including belief in conspiracy), belief that vaccination should not occur when the child has a minor illness, unpleasant staff or poor communication, and lack of awareness of the vaccination schedule. NHS Immunisation Statistics England https://catalogue.ic.nhs.uk/publications/pu blic-health/immunisation/nhs-immu-stat- eng /nhs-immu-stat-eng rep.pdfhttps://catalogue.ic.nhs.uk/publications/pu blic-health/immunisation/nhs-immu-stat- eng /nhs-immu-stat-eng rep.pdf Health and Social Care Information Centre (hscic) Published September 2013 References Brown KF, Shanley R, Cowley NAL et al(2011)Attitudinal and demographic predictors of measles Mumps and Rubella(MMR). Vaccine acceptance: Vaccine 29, Falagas E, Zarkadoulia E(2008) Factors associated with suboptimal compliance to vaccinations 18 th European congress of clinical biology and infectious diseases Gardiner B, Davies A, McAlteer J et al(2008) How can MMR uptake be increased? A feasibility study and literature review published online atcontent/uploads/2011/03/UCHL-How can MMR uptake be increased report-pdf Health and Social Care Information Centre (hscic) (2013) NHS Immunisation Statistics, England https://catalogue.ic.nhs.uk/publications/public-health/immunisation/nhs- immu-stat-eng /nhs-immu-stat-eng rep.pdfhttps://catalogue.ic.nhs.uk/publications/public-health/immunisation/nhs- immu-stat-eng /nhs-immu-stat-eng rep.pdf Kimmel S, Burns IT, Wolfe RM(2007)Addressing immunisation barriers, benefits and risks J Fam Prac 56(2) s217-s135 NHS information centre (2012)NHS immunisation statistics for England /Immunisations_Bulletin_2010_11_v1_2.pdf /Immunisations_Bulletin_2010_11_v1_2.pdf NICE (2009) Reducing differences in the uptake of immunisations. National Institute of Health and Clinical Excellence Mills E, Jadad AR, Ross C, Wilson K. (2005) Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. J Clin Epidemiol. ;58:10811088 McIntyre P, Leask J (2008) Improving uptake of MMR vaccine. BMJ 336(7647): 729730. References MMR catch-up programme 2013 https://www.gov.uk/government/organisations/public-health- england/series/MMR-catch-up-programme-2013 https://www.gov.uk/government/organisations/public-health- england/series/MMR-catch-up-programme-2013 Offit(2002)Do multiple vaccines exhaust the immune system-Ped Pearce A, Law C, Elliman D et al. (2008) Factors associated with uptake of measles, mumps and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study. 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