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Exploring how the uptake of childhood immunisations can be improved in England: A systematic review

02 February 2024
Volume 5 | British Journal of Child health · Issue 1

Abstract

Background:

Childhood immunisations protect communities against preventable and infectious diseases. Coverage for childhood immunisations in the UK is declining and coverage for the MMR vaccine stands at 85.5%, significantly below the target set by the Department of Health and Social Care to achieve herd immunity and prevent sustained disease transmission.

Methods:

Three medical databases were searched using PICO, supported by the application of inclusion and exclusion criteria and critical appraisal.

Results:

Reminder and recall activities are identified as a cost-effective method for improving childhood immunisation uptake but targeted, individualised and family-centred interventions should be utilised to promote access to childhood immunisations for underserved populations. Vaccination data should remain up to date and a child's vaccination status should be reviewed and meaningfully discussed at every healthcare contact and staff involved in immunisation should have access to appropriate education, training and support.

Recommendations:

Understanding how to provide services and improve vaccine coverage for patients who frequently are not brought is identified as an opportunity for further research, as well as analysing the role of public health teams in identifying local inequalities and supporting GP practices to design and deliver bespoke interventions for their community. It is recommended that communication emphasises the safety and effectiveness of vaccines, while highlighting a child's susceptibility or risk to developing complications. Further research is needed to evaluate how best to communicate this to ensure that the information provided is clear and factual and comprehensible to all parents and carers.

Childhood immunisations protect infants, children and the wider community from infectious diseases that would otherwise be common in childhood (Parliamentary Office of Science and Technology, 2013). Every child in the UK is offered free immunisations as part of the National Immunisation Programme, which offers protection against 14 preventable and infectious diseases (Birmingham Community Healthcare, 2021). The Department of Health regularly amends the childhood immunisation schedule based on recommendations from The Joint Committee on Vaccination and Immunisation (JCVI), an independent scientific advisory body (Parliamentary Office of Science and Technology, 2013; UK Health Security Agency [UKSHA], 2020).

Sepsis is the leading cause of child morbidity and mortality, and immunisation remains the principal method of primary sepsis prevention (Plunkett and Tong, 2015). After immunisation, children are far less likely to contract the infection they have been vaccinated against and once enough people in the community are immunised, the infection can no longer spread so dies out (NHS England, 2018). Herd immunity occurs when a significant proportion of the population becomes immune (either through infection and recovery, or by vaccination) to a disease, making transmission from person-to-person unlikely and offering protection to the rest of the population. The proportion of a community which must be protected to achieve herd immunity differs between diseases, for example, measles ‘requires more than 95% of the population to be immune to stop sustained disease transmission and achieve herd immunity’ (Desai and Majumder:2113). Evidence has shown that some vaccinations, such as the Bacillus Calmette-Guérin (BCG) vaccine against tuberculosis (TB), can reduce (neonatal) mortality from infections other than TB ‘in a non-specific or pathogen agonistic manner’ (Aaby et al, 2011; Biering-Sørensen et al, 2017; Williamson et al, 2021:1887), providing additional benefits.

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