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NICE sets out plans for GPs to drive up ‘unacceptable’ child vaccination rates

GPs should chase young patients up with letters and phone calls to get them to come in for MMR jabs as part of plans by NICE chiefs to rectify 'unacceptable' variation in vaccination rates. 

The quality standards consultation published by NICE also proposed GPs should offer vaccinations straight away in any patient found not to be up to date.

It comes after falling rates of vaccinations in under-19s over the past two years, and recent reports of measles outbreaks linked to festivals.

NICE said around three million children have not received their MMR vaccine, with only a quarter of local authorities currently meeting the World Health Organisation target of 95% uptake.

In addition, it said only half of councils reach this target for vaccination against diphtheria, tetanus, pertussis and polio – and in some areas, only one in 10 children is vaccinated against these.

Groups most at risk of not being fully immunised include children who have missed vaccinations in the past, looked after children, those with physical or learning disabilities, children of teenage or lone parents and younger children in large families, and vulnerable children – such as those whose families are travellers, asylum seekers or are homeless.

Professor Gillian Leng, deputy chief executive at NICE, said the variation across the country was 'unacceptable'

She said: ‘Around three million children and young people may have missed a measles, mumps and rubella (MMR) vaccine.

‘With so many children open to exposure we are at risk of a serious outbreak. This variation in uptake across the country is unacceptable and we need to do more to ensure every child across the country gets the vaccinations they are supposed to.

‘We now need peoples’ views to make sure we have set the right priorities to tackle this variation. Vaccinations don’t just protect the people receiving them – vaccination also protects all of us by eliminating infections from the country.’

Dr Phil White, lead on immunisations at GPC Wales, told Pulse that ‘GPs already do a lot of chasing to maintain targets’ and that ‘for the younger children, the restoration of the integrated Primary Care Team, practice based, would be a big step forward – an integrated approach including Health Visitors, Midwives and practice staff works best’.

However, he said that the major drop-off in vaccination rates 'seems to be at pre-school and school levels as opposed to infant vaccinations’ and that ‘my school health colleagues cite apathy as the biggest cause of low rates’.

Dr White added: ‘I believe that informed dissent is the answer. Then our school health colleagues can jab everyone unless parents have said no.’

NICE's intervention comes despite a GP-led catch-up campaign to recall and vaccinate older children who had missed their infant MMR jabs, largely because of unsubstantiated claims the combination vaccine was linked to autism, which saw an extra 100,000 children vaccinated in early 2013.

NICE's proposed 'quality statements' for the NHS to boost vaccination uptake in under-19s

Statement 1. Children and young people who do not attend their immunisation are followed-up with a recall invitation and a phone call or text message.

Statement 2. Children and young people receiving a vaccination have it recorded in their GP record, their personal child health record and in the child health information system.

Statement 3. Young offenders have their immunisation status checked on entry into the secure setting and are offered any outstanding vaccinations.

Statement 4. Children and young people are offered vaccination as soon as it is known that they have missed a routine childhood vaccination.

Statement 5. (developmental) Children and young people have their vaccination status checked at key educational stages.

Source: NICE quality standard; Draft for consultation - Vaccine uptake in under 19s

Readers' comments (9)

  • Nothing to do with the Health Visiting service being in free fall!

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  • Maybe community pharmacies could do their bit...?

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  • One easy solution, as used in California. You can only register your child in a state school if they have been fully vaccinated as per the state schedule. Job done.

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  • produce properly resourced LCS for this. It will cost a lot to do it properly.

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  • |Anonymous | GP Partner|01 Sep 2016 7:46pm

    Fully agree, I would also stop parents from receiving Child Allowance unless they have had the child vaccinated or signed a disclaimer.
    If these figures have been obtained via CQRS they will not be correct. Many practices have not completed the manual uploads of these vaccination due to the continual disruption of not knowing what to report and what not to. We already contact patients to achieve a high % but its hard work and at times these are the greatest DNA's. The HV are professioanls, they see the children, as do School Nurses. Let them take some responsibility, they are ideally placed...

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  • The vast majority of people who don't get vaccinated don't do so because of structural problems - they didn't get the invitation/reminder; the clinic wasn't at a time and place they could easily get to... Only a small minority don't get vaccinated because they actively decided not to.

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  • This is a complete no brainer, it should have nothing to do with NICE other than get them to lobby government for sanctions like those advocated above which I have suggested for years.
    Unless there is a bona Fidel medical reason for non vaccination, then all Child Benefit should be withheld, additionally entry into any form of education should be withheld if the problem is perpetuated.
    The function is to create herd immunity letting people pick and choose is not an option.
    This would also facilitate a more sensible vaccine schedule than the current one which is used primarily to try to catch parents more easily but does not confer proper immunity as older schedules until the child is aged 5 years of age.

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  • Did we miss the mass outbreaks prior to repeat vaccination when we all believed one shot covered for 30-40 years, as no calamitous pandemics appear to have been recorded in the literature?

    Herd immunity came after infection which caused immunity.

    Vaccination fails to produce immunity which is why repeated vaccinations are advised although now found to have a low % sero-conversion rate, a short beneficial duration, don't prevent outbreaks among the vaccinated and can push the illness into later life when pathology is harsher and recovery slower.

    Would be good to have some placebo controlled research data on safety as no such trials were ever done.

    Keep jagging!

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  • Considering that there is no placebo controlled research data and that the Office of National Statistics cannot acertain whether confirmed measles cases affected vaccinated or unvaccinated children this is a bit of a sham. I am horrified by the attitude of some doctors that have commented on this post, you have clearly been ' bought'. The Paul Offits of this world need to alert themselves to the terminology of adversomics, immunogenetics, the genetically mediated individuals that have polymorphisms and genetic susceptibility to vaccine related adverse effects and events. One size does not fit all. In the long run you are potentially causing more harm than good.

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