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Children And Young People

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Julie Pal

Immunization rates in Barnet, particularly for MMR, are substantially below the levels required to prevent disease outbreaks like measles epidemics. Measles cases in Barnet have increased alarmingly in recent years due to declining herd immunity as fewer children receive the MMR vaccine. In order to increase immunization rates and achieve local targets, efforts must focus on ensuring accurate immunization records, strengthening reminder systems, providing access through various community sites, and promoting immunization through social marketing and engagement with community leaders.

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Children and Young People Immunisation Immunisation is second only to a clean drinking water supply as a way of improving and maintaining the health of the population. Whilst smallpox has been eradicated from the world, by immunisation, all other infectious diseases remain. The only way to protect children and adults from avoidable death and serious, often long-term, complications from such diseases is to maintain high levels of immunisation in the population.1 The risk we face Barnet, in common with all other London boroughs, now faces the likelihood of a measles epidemic. In the last year or so the number of children and adults catching measles the most contagious disease that there is has been much higher than in past years and there have been several outbreaks, as shown in . Figure 1 Figure 2: The number of reported cases of measles in Barnet in recent years 90 80 70 The 60 50 40 30 20 10 0 2005/06 2006/07 2007/08 reasons for the alarming increase in people catching measles in Barnet are outlined below demonstrating that MMR immunisation rates in Barnet are substantially below the level required for safety. The reason that so many people have caught measles and the fact that we now face the very real risk of a measles epidemic is because there are now so many children whose parents have refused consent for them to be 1mmunizat with measles, mumps and rubella vaccine. The herd immunity of the population is now sufficiently low to enable each person with measles to infect more than one other person. The problem of measles is more widespread in other parts of London, as shown below. 1 The main exception to this is TB. Whilst BCG vaccine is an important way to protect people most at risk the way this disease affects the population has changed.
Source: Health Protection Agency. Measles and MMR uptake in London, 2008 Cover data and trends in vaccine uptake 2005-2008 MMR uptake at age 2 years for London and UK January 1996 March 2008* signify that immunisation rates are beginning to decline significantly .
95.0 90.0 85.0 80.0 75.0 % 70.0 65.0 60.0 55.0 Hib primary MenC DTP/Polio primary 50.0 MMR 2nd dose DTaP/IPV booster MMR 1st dose 45.0 Q3 05/06 Q4 05/06 Q1 06/07 Q2 06/07 Q3 06/07 Q4 06/07 Q1 07/08 Q2 07/08 Q3 07/08 Q4 07/08 Q1 08/09 Quarter in each year Immunisation rates in children in Barnet for: first course of diphtheria, tetanus, pertussis and polio; first dose of Haemophilus influenzae B; meningococcus C; first dose of measles, mumps and rubella (MMR); second dose of MMR; and diphtheria, tetanus and pertussis and inactivated polio booster. This shows clearly that MMR 3mmunization rates in Barnet are very substantially below the level required for safety, i.e. to avoid measles outbreaks and to avoid a measles epidemic, although they are beginning to increase Local targets In common with other London PCTs, Barnet has agreed to increase all of its childhood immunisations to 90% by 2010/2011. The trajectory for immunisation rates for MMR by the age of two years shows the trajectory for MMR, which is the most challenging as all other childhood immunisation rates are currently in the high eighties and thus closer to the target. The trajectory for immunisation rates for MMR by the age of two years Proportion (%) of 2-year olds with first MMR immunisation actual estimate trajectory 100 90 90 80 77 75.6 76.4 80 74.5 73.9 70 60 50 40 30 20 10 0 2004_05 2005_06 2006_07 2007_08 2008_09 2009_10 2010_2011
Source: Barnet PCT Operating Plan The key activities required are: ensuring the accuracy of immunisation records it is apparent that a lot of children have been immunised but the fact has not been recorded on the PCTs child health surveillance system; bolstering the immunisation call system to ensure that all children who need immunisation (because it is due or have, apparently, been missed) are invited for immunisation; providing immunisations in various sites, e.g. GP surgeries, community pharmacies, A&E departments, walk-in centres, childrens centres, childrens outpatient departments; promoting immunisation widely, using social marketing techniques, to better ensure that the right message is received; and working with local community and religious leaders, and in schools, pre-school facilities, childrens centres, NHS facilities and other places to promote immunisation. Data on ethnicity and religious belief are not currently routinely recorded in the context of childhood immunisation. However, it is apparent that in the North East and North central London area, the majority of people affected by measles have been Jewish. The reasons for this need to be explored further.
Jewish White: British White: Eastern European Black: African White: Irish Any Other ethnic group White: Other Asian: Bangladeshi Black: Caribbean Mixed: Other Mixed Asian: Indian Asian: Other Chinese Not known Mixed: White & Black African Mixed: White & Asian Black: Other Asian: Pakistani 0 50 100 150 200 250 300 Number of reported measles cases Teenage pregnancy Barnet has one of the lowest rates of teenage pregnancy (TP) in London, and this is also lower than similar boroughs (including those matched for deprivation) such as Merton, Hounslow and Enfield. Not only is it lower than the London average, but it is also lower than the national average. The graph below summarises the his trend and the comparison between Barnet, London and England. Approximately 68% of teenagers who conceived in Barnet in 2006 had a termination of pregnancy (TOP), the remainder having had either a live or still birth. Data on the residential postcodes of all TOPs performed by Marie Stopes, the PCTs main provider of abortion services, on women in Barnet aged under 18 years show that 15.2% of teenage abortions were performed on young women who had had at least one previous TOP. Teenagers who have had one TOP are a high risk group for further unplanned pregnancy.
Under 18 conception rate per 1000 10 20 30 40 50 60 0 March June 1998 Sept Dec March June 1999 Sept Dec London England March June 2000 Sept Dec Barnet rolling average March June 2001 Sept Dec March June 2002 Sept Dec March June 2003 Sept Dec March June 2004 Sept Dec March June 2005 Sept Dec March June 2006 Sept Dec March 2007 June
Quarterly rate 45 Rolling average 40 Under 18 conception rate per 1000 35 30 25 20 15 10 5 0 March March March March March March March March March March Sept Sept Sept Sept Sept June June June June June Sept Sept Sept Sept Dec Dec June June Dec June Dec June Dec June Dec Dec Dec Dec 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Teenage pregnancy rates have been decreasing since 2004. actual estimate trajectory Conception rate per 1,000 females aged 15-17 35 30 25 20 168 149 167 15 10 131 107 84 5 0 2005 2006 2007 2008 2009 2010 The graph above illustrates the target trajectory for Barnet.

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Children And Young People

  • 1. Children and Young People Immunisation Immunisation is second only to a clean drinking water supply as a way of improving and maintaining the health of the population. Whilst smallpox has been eradicated from the world, by immunisation, all other infectious diseases remain. The only way to protect children and adults from avoidable death and serious, often long-term, complications from such diseases is to maintain high levels of immunisation in the population.1 The risk we face Barnet, in common with all other London boroughs, now faces the likelihood of a measles epidemic. In the last year or so the number of children and adults catching measles the most contagious disease that there is has been much higher than in past years and there have been several outbreaks, as shown in . Figure 1 Figure 2: The number of reported cases of measles in Barnet in recent years 90 80 70 The 60 50 40 30 20 10 0 2005/06 2006/07 2007/08 reasons for the alarming increase in people catching measles in Barnet are outlined below demonstrating that MMR immunisation rates in Barnet are substantially below the level required for safety. The reason that so many people have caught measles and the fact that we now face the very real risk of a measles epidemic is because there are now so many children whose parents have refused consent for them to be 1mmunizat with measles, mumps and rubella vaccine. The herd immunity of the population is now sufficiently low to enable each person with measles to infect more than one other person. The problem of measles is more widespread in other parts of London, as shown below. 1 The main exception to this is TB. Whilst BCG vaccine is an important way to protect people most at risk the way this disease affects the population has changed.
  • 2. Source: Health Protection Agency. Measles and MMR uptake in London, 2008 Cover data and trends in vaccine uptake 2005-2008 MMR uptake at age 2 years for London and UK January 1996 March 2008* signify that immunisation rates are beginning to decline significantly .
  • 3. 95.0 90.0 85.0 80.0 75.0 % 70.0 65.0 60.0 55.0 Hib primary MenC DTP/Polio primary 50.0 MMR 2nd dose DTaP/IPV booster MMR 1st dose 45.0 Q3 05/06 Q4 05/06 Q1 06/07 Q2 06/07 Q3 06/07 Q4 06/07 Q1 07/08 Q2 07/08 Q3 07/08 Q4 07/08 Q1 08/09 Quarter in each year Immunisation rates in children in Barnet for: first course of diphtheria, tetanus, pertussis and polio; first dose of Haemophilus influenzae B; meningococcus C; first dose of measles, mumps and rubella (MMR); second dose of MMR; and diphtheria, tetanus and pertussis and inactivated polio booster. This shows clearly that MMR 3mmunization rates in Barnet are very substantially below the level required for safety, i.e. to avoid measles outbreaks and to avoid a measles epidemic, although they are beginning to increase Local targets In common with other London PCTs, Barnet has agreed to increase all of its childhood immunisations to 90% by 2010/2011. The trajectory for immunisation rates for MMR by the age of two years shows the trajectory for MMR, which is the most challenging as all other childhood immunisation rates are currently in the high eighties and thus closer to the target. The trajectory for immunisation rates for MMR by the age of two years Proportion (%) of 2-year olds with first MMR immunisation actual estimate trajectory 100 90 90 80 77 75.6 76.4 80 74.5 73.9 70 60 50 40 30 20 10 0 2004_05 2005_06 2006_07 2007_08 2008_09 2009_10 2010_2011
  • 4. Source: Barnet PCT Operating Plan The key activities required are: ensuring the accuracy of immunisation records it is apparent that a lot of children have been immunised but the fact has not been recorded on the PCTs child health surveillance system; bolstering the immunisation call system to ensure that all children who need immunisation (because it is due or have, apparently, been missed) are invited for immunisation; providing immunisations in various sites, e.g. GP surgeries, community pharmacies, A&E departments, walk-in centres, childrens centres, childrens outpatient departments; promoting immunisation widely, using social marketing techniques, to better ensure that the right message is received; and working with local community and religious leaders, and in schools, pre-school facilities, childrens centres, NHS facilities and other places to promote immunisation. Data on ethnicity and religious belief are not currently routinely recorded in the context of childhood immunisation. However, it is apparent that in the North East and North central London area, the majority of people affected by measles have been Jewish. The reasons for this need to be explored further.
  • 5. Jewish White: British White: Eastern European Black: African White: Irish Any Other ethnic group White: Other Asian: Bangladeshi Black: Caribbean Mixed: Other Mixed Asian: Indian Asian: Other Chinese Not known Mixed: White & Black African Mixed: White & Asian Black: Other Asian: Pakistani 0 50 100 150 200 250 300 Number of reported measles cases Teenage pregnancy Barnet has one of the lowest rates of teenage pregnancy (TP) in London, and this is also lower than similar boroughs (including those matched for deprivation) such as Merton, Hounslow and Enfield. Not only is it lower than the London average, but it is also lower than the national average. The graph below summarises the his trend and the comparison between Barnet, London and England. Approximately 68% of teenagers who conceived in Barnet in 2006 had a termination of pregnancy (TOP), the remainder having had either a live or still birth. Data on the residential postcodes of all TOPs performed by Marie Stopes, the PCTs main provider of abortion services, on women in Barnet aged under 18 years show that 15.2% of teenage abortions were performed on young women who had had at least one previous TOP. Teenagers who have had one TOP are a high risk group for further unplanned pregnancy.
  • 6. Under 18 conception rate per 1000 10 20 30 40 50 60 0 March June 1998 Sept Dec March June 1999 Sept Dec London England March June 2000 Sept Dec Barnet rolling average March June 2001 Sept Dec March June 2002 Sept Dec March June 2003 Sept Dec March June 2004 Sept Dec March June 2005 Sept Dec March June 2006 Sept Dec March 2007 June
  • 7. Quarterly rate 45 Rolling average 40 Under 18 conception rate per 1000 35 30 25 20 15 10 5 0 March March March March March March March March March March Sept Sept Sept Sept Sept June June June June June Sept Sept Sept Sept Dec Dec June June Dec June Dec June Dec June Dec Dec Dec Dec 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Teenage pregnancy rates have been decreasing since 2004. actual estimate trajectory Conception rate per 1,000 females aged 15-17 35 30 25 20 168 149 167 15 10 131 107 84 5 0 2005 2006 2007 2008 2009 2010 The graph above illustrates the target trajectory for Barnet.