Immunisation - Keeping up the focus by Helen Donovan

Helen DonovanI often say I have been involved with vaccination and immunisation for more years than I really care to think about. As a midwife, practice nurse, health visitor and specialist nurse. As such I am unashamedly passionate about it, wanting to instil that passion and confidence in its value to other health professionals.

It is important I think to remember the success of vaccination which has enabled the eradication of smallpox and almost the eradicated polio. It has meant that many other infectious diseases such as diphtheria, tetanus and measles are now thankfully relatively rare. The UK immunisation programme is highly successful, with high overall uptake rates and good disease control. It is a core component of the healthy child programme and all children are offered vaccines for a range of diseases. The programme starts from birth and goes through to the teenage years. The benefits are not just for the individual child but also for the wider community by halting the transmission of disease. If enough people are protected occasional cases of disease will not spread to others.

Immunisation is primarily a nursing role and most vaccines are given by nurses. This is mainly practice nurses but also school nurses and occasionally health visitors. It is however essential for all Nurses, Midwifes and Health Visitors who work with children and young people to understand about the programme and the important role they have in delivering this part of the healthy child programme. It is not just the giving of the vaccines, which I would suggest is a very small part of the process, it is about being able to provide accurate information and support and being able to respond appropriately to parents and children and young peoples’ questions and concerns. It is also about understanding the local population and being able to following up on children who have missed out for whatever reason.

When I was working as a Health Visitor in the early 2000’s I ran a weekly immunisation clinic which I found it very rewarding and an excellent way to get to know my case load and the families. It was certainly very useful in supporting those families who had concerns. For me this was particularly the local traveller community. Travelling families are often anxious about vaccination and the community have deep set fears and health beliefs about the risks of vaccination which go back through many years. As the regular health visitor I was able to gain their trust and in the main they eventually felt able to bring their children for vaccination. This is however, often controversial and concerns about capacity within health visiting teams rightly voiced so I certainly would not advocate that all Health Visitors immunise. It needs to be a local decision and based on what works. What is essential is that there is a system wide approach and the team; practice nurses, health visitors, school nurses and others work together to make sure as many children as possible are vaccinated and that they provide consistent evidence based information.

Despite the obvious benefits from vaccines there is a small but vocal anti-vaccination lobby in this country and around the world and frequent reports and stories voicing concerns about the safety and necessity for vaccines. These reports put understandable doubts into parents’ minds and add to the pressure in deciding what to do for the best for their child.

It is important not to underestimate the power of negative messages. It can be very difficult for health professionals and parents to discriminate between authoritative, evidenced based sources of information and those based on anecdote and misinformation.

Immunisation is by and large a success in this country, in terms of the overall uptake of vaccines and in disease control. We know there are however, pockets across the country where immunisation rates are not as high as we would like and outbreaks of vaccine preventable disease. It is therefore imperative that all of us maintain the focus and minimise any outbreaks of vaccine preventable disease.

Helen Donovan is the Public Health Adviser at the Royal College of Nursing

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