National Institute for Health and Clinical Excellence (NICE)
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New NICE guidance on reducing differences in the uptake of immunisations

The National Institute for Health and Clinical Excellence (NICE) has today (23 September 2009) published guidance on the uptake of immunisations (including targeted vaccines) in people younger than 19 years. The guidance aims to tackle inequalities across England by offering practical recommendations to increase the number of children and young people who are up-to-date with their vaccinations.

Evidence shows that groups of children and young people who are at particular risk of not being fully immunised include, those who have missed previous vaccinations (whether as a result of parental choice or otherwise), looked after children, those with physical or learning disabilities, those from non-English speaking families  and younger children from large families.

Professor Mike Kelly, Public Health Excellence Centre Director, NICE said: “Childhood immunisation has already had a positive impact on the health of the population in the UK. However, there is still widespread variation in uptake rates in all kinds of vaccines among different social groups, and this guidance seeks to remedy that state of affairs.

“The guidance makes recommendations applying to all vaccinations and recommendations about the vaccination programme for babies born to mothers who are hepatitis B-positive specifically. These babies are at risk of infection and serious illness, and implementing a follow-up vaccination programme to help prevent hepatitis B infection will not only have positive health benefits for the child, but save the NHS money in the future.

“This is the first guidance NICE has produced on immunisation. It will support existing national policy and guidance such as the Department of Health’s ‘Green book’ and the information available on the NHS immunisation website (, by offering evidenced-based recommendations to increase the timely uptake of immunisations.”

The recommendations are aimed at all those who have a direct or indirect responsibility for the immunisation of children and young people, in the NHS and also those working in children’s services, local authorities and education.

Recommendations applying to all vaccinations for children from birth to 19 years covering immunisation programmes, information systems, training, the role of nurseries and schools and groups at particular risk, include:

  • Adopt a multifaceted, coordinated programme across different settings to increase timely immunisation among groups with low or partial uptake. The programme should form part of the local child health strategy and should include actions such as monitoring vaccination status as part of a wider assessment of children and young people’s health.
  • Ensure PCTs and GP practices have a structured, systematic method for recording, maintaining and transferring accurate information on the vaccination status of all children and young people.
  • Record any factors which may make it less likely that a child or young person will be up-to-date with vaccinations in their patient records and the personal child health record. For example, note if children and young people are looked after, have special needs or have any contraindications to vaccination. Also note if the parents or young person have expressed concerns about vaccination.
  • The Healthy Child team, led by a health visitor working with other practitioners, should check the immunisation record (including the personal child health record) of each child aged up to 5 years. They should carry out this check when the child joins a day nursery, nursery school, playgroup, Sure Start children’s centre or when they start primary school. The check should be carried out in conjunction with childcare or education staff and the parents.
  • Improve access to immunisation services for those with transport, language or communication difficulties, and those with physical or learning disabilities. For example, provide longer appointment times, walk-in vaccination clinics, services offering extended hours and mobile or outreach services.

The guidance makes some specific recommendations about the vaccination programme for babies born to mothers who have been screened during pregnancy and found to be hepatitis B-positive. Their babies are at risk of infection and serious illness. Recommendations include:

  • A clear process for the local infant hepatitis B vaccination programme should be developed and implemented.
  • Health professionals should record the mother's hepatitis B status in the personal child health record as soon as possible after birth, before the midwife hands over care of the baby to the health visitor.
  • Babies born to hepatitis B-positive mothers should be given the first dose of the vaccine promptly, whether they are delivered in hospital or at home. They should then receive all other recommended doses, a blood test to check for infection and, where appropriate, hepatitis B immunoglobulin

Professor Catherine Law, Chair of the Public Health Interventions Advisory Committee (PHIAC) at NICE and Professor of Public Health and Epidemiology, University College London Institute of Child Health said: “Immunisation plays a vital role in children’s health by providing protection against common infections . These infections can have devastating effects and even cause death. This new guidance, for those who have a role in immunisation, makes recommendations which aim to increase the uptake in groups and settings where immunisation levels are currently low.”

Dr David Elliman Consultant Community Paediatrician, Great Ormond Street Hospital NHS Trust and Haringey Teaching PCT said: “Although immunisation rates are rising, there is still a way to go before all PCTs have achieved the desired public health targets. Uptake varies significantly within PCTs – mobile populations, some ethnic minority groups and the more disadvantaged all have lower rates of immunisation. The new guidance emphasises the importance of providing these groups with tailored interventions, including accurate, up-to-date information available in a variety of formats that are relevant to different communities and groups.”

Dr Mary Ramsay Consultant Epidemiologist, Health Protection Agency Centre for Infections said: “Immunisation saves lives and the aim of this guidance is to ensure that children are given the best possible opportunity to receive the protection they need. This could be achieved by ensuring that children are offered immunisation at every possible opportunity by improving access by offering walk-in vaccination clinics, mobile or outreach services which may include home visits or vaccinations at children's centres and keeping track of their immunisation history.”

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