Reducing differences in
the uptake of
immunisations
Implementing NICE guidance
2009
NICE public health guidance 21
What this presentation covers
Scope
Background
Recommendations
Costs and savings
Discussion
Find out more
Scope
The guidance focuses on:
• increasing immunisation uptake among children
and young people aged under 19 years in
groups and settings where immunisation
coverage is low
• improving uptake of the hepatitis B vaccination
programme for babies born to mothers infected
with hepatitis B
Background
Children and young people most at risk of not
being immunised include those:
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who are ‘looked after’
with physical or learning disabilities
with teenage or lone parents
who are vulnerable (for example, travellers)
from non-English speaking families and some
minority ethnic groups
who are the youngest in large families
Background: local context
Insert a summary of local childhood immunisation
coverage
Recommendations
The areas covered are:
• immunisation programmes (provision, access and
support)
• information systems
• training
• the contribution of nurseries, schools, colleges
of further education
• targeting groups at risk of not being fully immunised
• hepatitis B immunisation for infants
Immunisation programmes:
provision
• Ensure DH guidance and updates are implemented
• Adopt a multifaceted, coordinated programme to
increase timely uptake
• Monitor vaccination status as part of a wider
assessment of children and young people’s health
• Ensure an identified healthcare professional in the
PCT and all GP practices is responsible for
childhood immunisation
Immunisation programmes:
improving access
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Ensure clinics are child and family ‘friendly’
Ensure children and young people are seen promptly
Consider extending clinic times
Ensure there are enough appointments available
Send out tailored invitations and reminders
Consider home visits to families who have not
responded
Immunisation programmes:
providing support
• Provide tailored information, advice and support
• Offer the opportunity to discuss any concerns
• Whenever possible, check children and young
people’s immunisation status and offer them any
outstanding vaccinations
• Ensure young people understand what immunisation
involves so they can give their consent
Information systems: 1
• Ensure patient records, personal child health
records and the child health information system
are regularly updated, reconciled and consistent
• Use this data when reporting vaccinations for
child health systems, GP and practice payments
• Encourage and enable private providers to give
details of vaccinations administered
Information systems: 2
• Record any factors that make it less likely that a
child or young person’s vaccinations will be
up-to-date
• Use immunisation and infection data to inform
needs assessments and equity audits
• Monitor practice populations to ensure there is
capacity for timely immunisations – waiting lists
are unacceptable
Training
Ensure all staff involved in immunisation services are
appropriately trained. Training should:
• comply with the Health Protection Agency ‘National
minimum standard for immunisation training’
• ensure staff who give advice on the benefits and
risks of immunisation have the necessary
knowledge and skills
• be regularly updated
Contribution of nurseries,
schools, colleges of further education
• The Healthy Child team should check each child’s
immunisation record and status when they join a
playgroup or nursery or start school
• School nursing teams should check vaccination
status when children and young people transfer
to a new school or college
• Health visitors and school nursing teams should
provide information, offer vaccinations or refer
children who are not up-to-date
Groups at risk of
not being fully immunised
• Improve access to immunisation services
• Provide accurate information on the benefits of
immunisation in a variety of formats
• Consider using local venues to promote childhood
immunisation
• Whenever possible, check the immunisation history
of ‘at-risk’ groups and offer to vaccinate them
Hepatitis B immunisation
for infants
• Give babies born to hepatitis B-positive mothers:
- the first dose of the vaccine promptly after birth, a
blood test and hepatitis B immunoglobulin, if needed
- all other recommended doses on time, according to
the schedule
• PCTs should identify a person to take charge of the
local programme
• Record the mother’s hepatitis B status in the
PCHR as soon as possible after birth
Costs and savings
The guidance is unlikely to result in a significant change
in resource use. However, recommendations in the
following areas may result in additional costs/savings:
• Ensuring staff are fully trained and that data is
consistent across systems may incur a cost
• Ensuring reminders are tailored for those who do not
respond to initial appointments
• Increasing the number of children and young people
who are immunised should reduce infection rates,
leading to savings
Discussion
• How can we improve access to local services for
children and young people who are not immunised?
• How can we improve uptake using our current
record systems?
• How can we work with other provider organisations
to improve immunisation uptake?
• Do we need to develop or change the process for
the vaccination of babies born to mothers who
are hepatitis B-positive and if so, how?
Find out more
Visit www.nice.org.uk/PH21 for the:
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guidance
quick reference guide
costing statement
costing template
audit support
guide to resources