Audit of the up-to-date status of routine childhood immunisations of children presenting to A&E or admitted to paediatric wards in a London hospital.

Background and aims

Children in the UK are routinely vaccinated against a number of infectious diseases as a public health measure to prevent spread and reduce associated morbidity and mortality. High immunisation rates ensure the same protection to non-immunised individuals through herd immunity1,2. Although the majority of children have had their routine vaccinations, there are concerns that immunisation rates are not reaching WHO targets required to achieve herd immunity3. This audit was designed to determine the up-to-date status of routine immunisations of children presenting to A&E and those admitted to the paediatric wards at St George’s Hospital, London.

Parents were also asked about their views on opportunistic immunisation.

Method

Between 12th-23rd September and 5th-16th December 2011, parents of children attending the A&E department or admitted to the paediatric wards were approached. With their consent, the child’s immunisation record was extracted from the parents’ held Child Health Records. If this was not available, their consent was obtained to get this information from their GP. An audit proforma was then completed. Completeness was based on the routine schedule according to the DOH Green book (Table 1)4.

Results

The parents of 221 children were approached, 199 (90%) agreed to participate, and complete immunisation data were available for 140 (70%) children. The mean age (SD) was 4.3 years (4.4). 71 (51%) were male. The majority (54%) were Caucasian, 20% were African/Caribbean, 13% were Asian and 14% were mixed or other ethnic background. 100 children (71%) were up-to-date with immunisations scheduled for their age. A breakdown of the immunisation status is show in Table 1. Missing vaccines are detailed in Table 3. 83% of parents were willing for an appointment to be arranged  to complete  their child’s missing immunisations.

Discussion

This audit showed that that most children that present to our Hospital A&E or admitted to paediatric wards were up-to-date with their routine childhood immunisations. The proportion of children that is up-to-date is comparable to national coverage rate 95% for initial DTaP/IPV/Hib and 86% for MMR pre-school booster)5.

83% of the parents were willing for us to arrange for their child to complete their immunization if found not to be up-to-date. There is therefore an argument that after A&E/ ward care should include an opportunistic immunisation referral for such children in order to maintain our high vaccine coverage

Conclusion

Most children seen in our hospital during the audit period were up-to-date with scheduled immunisations. There remain a proportion of children not fully immunised. There might be a case for improving vaccine coverage through opportunistic immunisation

Limitations

The significant limitation of this study is the small sample size, which may not reflect the population as a whole, and would require further audits in other hospitals around the UK. Another limitation is that parents’ held Child Health Record is our source data and in some cases  immunisation details were obtained from the records held at the child’s GP and may not be complete.

References

1. Anderson. R. M. and May. R. M. Vaccination and Herd Immunity to Infectious Disease. Nature. 1985; 318 (28): 323-329.

2. Department of Health. NHS Immunisation Statistics, England 2004-05. London. Health and Social Care Information Centre. 2005 (2005/05 HSCIC).

3. Tickner. S., Leman. P. J. and Woodcock. A. Factors Underlying Suboptimal Childhood Immunisation. Vaccine. 2006; 24: 7030-7036.

4. The Green Book DOH

5. Health Protection Agency. http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/VaccineCoverageAndCOVER/

Acknowledgements: all parents and children who agreed to take part in this audit.

Vaccines and prevention