Immunisation is one of the most important
public health initiatives of the last 60 years.
According to the World Health Organisation
“the two public health interventions that
have had the greatest impact on the world’s
health are clean water and vaccines.”(1)
Ensuring and encouraging high rates of uptake
of vaccines from across the community is
essential, as immunisation protects the individual,
the family and the community.
Population immunity (also called herd immunity) is
achieved when immunisation programmes reach
sufficiently high coverage in the target population
to interrupt transmission within the community. A
successful immunisation programme therefore
protects the most vulnerable groups, including
babies too young to be vaccinated.
Sustaining population immunity through high
uptake of vaccination remains a priority in NHS
Lothian. This is especially so as there have been
changes to the immunisation schedule throughout
2006 and 2007 and there remain significant
challenges in ensuring parental confidence in
uptake of the Measles, Mumps, and Rubella
Uptake rates across Lothian are excellent. Uptake
of primary immunisation at 24 months of age
is generally >98%, exceeding both the Scottish
average and the 95% target. Uptake of pre school
boosters for the cohort reaching five years of age
by end September 2007 was 89.4% (on a par with
the Scottish average). These figures demonstrate
the confidence shown by parents in vaccination.
However, continuing effort is required by health
professionals, largely through the provision of
accurate, tailored and timely information to parents
to maintain such good uptake.
As Box 1 shows, MMR uptake rates are
generally good, but further work is required to
reach the Government’s 95% target.
The new childhood vaccination schedule
From 4 September 2006 significant changes were
made to the national immunisation schedule.
The introduction of pneumococcal conjugate
vaccine (PCV) at two, four and 13 months of age;
A booster dose of Hib and men C combination
vaccine at 12 months; and
A PCV catch up campaign for all children under
two years of age.
The practical implications of these changes were
that infants are now offered different combinations
of vaccines at two, three and four month visits.
There are now three injections at the four month
visit and a new 12 month vaccination visit has
been included in the programme. The new
programme was successfully rolled out across
NHS Lothian. The catch-up campaign resulted
in a total of 19,000 children being called for
pneumococcal vaccinations between September
2006 and end of March 2007.
The first data on uptake of PCV were
released in December 2007. Uptake for Lothian
children who reached 12 months of age by end
September 2007 was excellent at 96%. Uptake of
PCV doses appropriate to age for the catch-up
campaign was 84.9%.
The Haemophilus Influenza (Type b) catch -up campaign
A national Haemophilus Influenza (Type b) (Hib)
catch-up campaign was introduced in November
2007. This affects children born between 4 April
2003 and 3 September 2005 who were either too
young to be part of the Hib booster campaign
in 2003 or too old to have the new booster at 12
months. This booster will give these children the
extra protection they need against diseases such
as meningitis, blood poisoning and pneumonia
caused by Hib infection.
For most children the booster will be given
at the same time as their routine pre-school
immunisation so a separate appointment is not
required. In addition, as the vaccine used for
the pre-school immunisation has been changed
temporarily to a Hib containing preparation,
most children do not need an extra injection.
Until now the routine call up for pre-school
immunisation in Lothian was at four-and-a-half
years of age. In line with the catch-up, the age at
which this is offered will be progressively reduced
so that by March 2009 all children will be called up
from three years, four months of age.
Keeping vaccines effective
Maintenance of the cold chain throughout the
entire life of a vaccine is essential to maintaining
its effectiveness. A NHS Lothian policy ‘Handling
and storage of vaccines’ was developed in 2006
and distributed widely both in 2006 and 2007.
Regular training sessions are held on vaccines
handling and storage. During 2007 an audit was
completed of adherence to cold chain in all GP
fridges throughout Lothian. This showed a high
level of adherence.
Immunisation remains one of the most
important public health initiatives.
High rates of vaccine uptake are
necessary to achieve sustainable
immunity across the population.
High levels of uptake don’t just happen,
they require a sustained co-ordinated
programme and continuing effort.
Whilst immunisation rates across Lothian
are generally high, further work is
required to reach the Government’s 95%
target in relation to MMR vaccination.
During 2006 and 2007 significant changes
to the childhood immunisation programme
were successfully implemented within
Between September 2006 and April 2007
a catch-up programme of pneumococcal
vaccination was offered to all children under
two years of age. From November 2007 a
Hib catch-up programme was also run.