2 Public health need and practice

2 Public health need and practice

The government is committed to an effective childhood immunisation programme to reduce the incidence of childhood infections such as meningitis C and measles. This commitment is emphasised in the government strategy for children and young people's health (DH 2009a) and the 'National service framework for children, young people and maternity services' (DH 2004). A priority is to increase the proportion of children who have received all their immunisations (DH 2008a; 2009b).

The national childhood immunisation programme is offered routinely through primary care and other health services. However, differences in uptake persist and are associated with a range of social, demographic, maternal- and infant-related factors (Peckham et al. 1989; Samad et al. 2006).

Immunisation coverage varies within and between regions. In most regions except London, overall uptake of diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B, meningitis C and pneumococcal vaccines is above 90%. (These are due to be completed by the time a child is aged 13 months.) However, first doses of measles mumps and rubella (MMR) vaccination levels are below 86% in England. Even lower levels are reported for second doses. Even where coverage appears to be high, there may still be groups of children who are at risk of acquiring vaccine-preventable infections.

Groups at risk

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

  • those who have missed previous vaccinations (whether 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 travellers, asylum seekers or are homeless.

    (DH 2005; Hill et al. 2003; Peckham et al. 1989; Samad et al. 2006.)

In addition, some groups are less likely to have received certain vaccines. There is some evidence that uptake of MMR has declined at a greater rate among children of more highly educated parents and among those living in more affluent areas (Wright and Polack 2005). Pearce et al. (2008) found that maternal education to degree level was a risk factor for not receiving the MMR triple vaccine. A study of over a million children born in Scotland between 1987 and 2004 found that children of more affluent parents were generally either vaccinated with MMR on time or not at all. In contrast, late MMR vaccination was associated with socioeconomic disadvantage (Friederichs et al. 2006).

An estimated 3 million children aged 18 months to 18 years may have missed either their first or their second MMR vaccination (DH 2008b). The potential exposure of so many children and young people to the measles virus means that there is a risk of a large outbreak. As measles can lead to serious complications – and can even be fatal – local healthcare commissioning organisations have been supported and funded to help these children have the MMR vaccination during 2008/09 (DH 2008b).

Infant hepatitis B vaccination

Hepatitis B infection can be transmitted at birth to babies whose mothers are infected with the hepatitis B virus, so all pregnant women should be offered screening for hepatitis B during pregnancy (DH 2006).

If a pregnant woman has chronic hepatitis B infection, the baby should receive an initial dose of the vaccine within 24 hours of birth, with further doses at 1, 2 and 12 months. Some babies, who are particularly at risk, may also need hepatitis B immunoglobulin at birth (DH 2006).

Hepatitis B infection is relatively uncommon in the UK. The rates of chronic infection are higher among groups that have their origins in endemic countries. The incidence of infection is also higher among South Asian and African residents in England and Wales, particularly children (Giraudon et al. 2009; Hahné et al. 2004). Infection in children rarely leads to acute hepatitis; chronic infection is more common and, if untreated, it may result in cirrhosis or liver cancer, leading to liver failure and death.

  • National Institute for Health and Care Excellence (NICE)