Childhood vaccination provides vital protection to children and young people, and results in indirect protection to those around them, including infants, older people, and those in clinical risk groups. By delivering a quality vaccination service to children, public health nurses support a healthy society which is only possible through the collaboration and partnership of all members of the health service.
School nurses, Health Visitors and other nurses working with children and young people are at the forefront of protecting the health of children and young people. Their role is invaluable in achieving successful uptake and compliance. For pre-school children the Health Visiting service, through their knowledge and relationships with families and partners, will ensure provision of targeted services regarding immunisations. They and other health professionals utilise each and every contact (ref MECC), offering awareness raising, health education and immunisation opportunities re disease prevention and protection.
For school nurses this will take many forms including school assemblies, parent, school and community events, social media, websites, texts, emails and other routes of creative engagement, particularly with our most vulnerable groups e.g those not in school, young offenders, travellers etc, which may include outreach clinics and/or home visits. Providing evidence based accessible expert advice, support and information which is clear, concise and understandable, not only reduces fear and anxiety but also enables families to make informed consent and, for young people, helps in empowering them to make healthy choices and decisions regarding their lifestyles. As part of their holistic planning for immunisations, School nurses invest time in assessing and responding to any issues such as contraindications, phobia, side-effects, consent and work towards a positive resolution which for some children and young people may mean offering alternative provision/vaccines, ‘trouble-shooting’ re consent issues e.g. looked after children, negotiation and advocacy. Strong partnerships with schools, GP’s and other partners enable school nurses to offer accessible services so that all children and young people have the necessary support they require to access their immunisations and administer vaccines such Diphtheria, Tetanus and Polio, and HPV for girls and will be providing the new nasal childhood flu vaccine, of which more later. Health visitors, with their access to families, have a key role in promoting the messages around the importance of immunisation and helping to ensure parents know the timetable for the key vaccinations during childhood.
In 2013-14, 94.3% of children reaching their first birthday were reported to have completed primary immunisation courses , however, this is below the World Health Organisation (WHO) target of ‘at least 95%’. Most local authorities do achieve coverage of over 95% but it is variations at a local level which bring the national figure down. It is therefore important that we continue to promote and push for as wide coverage as possible
The MMR vaccine has received plenty of negative media coverage in recent years and we have seen serious outbreaks of measles as a consequence of a fall in coverage This provides a valuable lesson for the need of robust evidence based information, delivered to children, young people, families and wider partners. Coverage of MMR vaccine in England for children reaching their second birthday has risen to 92.7%. This is the sixth consecutive year that a rise in MMR coverage has been reported and is at its highest level since the vaccine was first introduced in 1988. However, despite these increases MMR coverage in England is still below the WHO target o
With the introduction of any new vaccine, the communication process by healthcare professionals to provide strong evidence-based information and to reassure and encourage parents to have their child vaccinated and for young people to be empowered to make healthy choices is perhaps their most vital role. We have recently seen the introduction of the following:
Nasal Flu Vaccine for Children
This vaccination will provide important protection to children, and offer indirect protection to people at high risk of complications from flu, including infants, older people, and those in clinical risk groups.
The Fluenza Tetra® nasal vaccine was introduced for the 2013-2014 flu season, and is provided to children of the age of 2, 3 and, from this year, 4 year olds as well.
By entering the body through the nose, Fluenz Tetra ® mimics the flu virus and results in a better immune response than an injected vaccine. This means that, compared with injected and less active vaccines, Fluenz:
- is more effective,
- provides protection for longer
- may offer protection against slightly different types of flu virus
- is easier to give and more comfortable to have.
Because Fluenz reduces the amount of flu amongst all children, not just the ones who have the vaccine, there should be less demands on doctor and nurses during the busy winter season and fewer days missed from childcare, nursery and school. In turn, this means less worry for parents and less time away from work and other activities, caring for children who are unwell.
Rotavirus
Rotavirus infection is the commonest cause of gastroenteritis in children under five years of age. Infection in the UK is seasonal, occurring mostly in winter and early spring. Prior to the introduction of immunisation, an estimated 130,000 episodes of rotavirus-induced gastroenteritis occurred each year in England and Wales and approximately 12,700 of these children were hospitalised.
Immunisation against rotavirus was introduced into the routine childhood schedule in July 2013 and is offered to all babies at two and three months of age. Vaccine uptake as at September 2014 was 93% for the first dose, and 88% for both doses.
Laboratory reports of confirmed instances of rotavirus for the period July 2013 to June 2014 were about 70% lower than the ten-season average for the same period in the seasons 2003/2004 to 2012/2013. This is an early indication, which needs to be confirmed by further investigation, that rotavirus immunisation is having an effect on the level of disease.
Jill Beswick and Sharon White are Executive Board members of SAPHNA (School and Public Health Nurses Association
