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Introduction The health need identified within my placement area is the poor uptake of the Measles, Mumps and Rubella (MMR) vaccine. Despite the availability of a safe and effective vaccine, Measles, Mumps and Rubella remain a threat of death and serious neurological complications among young children (WHO 2005a). The MMR vaccine is safe, effective and inexpensive, making vaccination against these three potentially devastating infections one of the most cost effective public health interventions available (WHO 2005b). According to Twelvetrees (2002) a health profile is a tool which can be compiled and utilised by community workers. By gathering information about the needs of a locality this information can then be used to provide the basis for an analysis of possible courses of action. During recent years there has been huge adverse media coverage concerning the safety of the triple vaccine, with claims that it may cause Crohn's Disease and Autism. Adverse publicity can have detrimental effects resulting in the loss of public confidence and therefore a reduction in the coverage rates of such vaccinations. In 2003-04, immunisation records for the cohort of children reaching their second birthday showed that 80% had been immunised against MMR with the combined MMR vaccine compared with 82% in 2002-2003, 84% in 2001-2002 and 87% in 2000-01. This is well below that achieved in 1995-96, which was 92% (DoH 2004). The practice, which is part of Castle Ward is located within the Worthing local authority in South East region, see appendix 1, and provides a primary heath care service to the community of Goring. The Primary Care Trust (PCT) responsible for this area is Adur, Arun and Worthing (AAW). For statistical purposes Castle Ward can be split into smaller areas called Super Output Areas. Electoral wards often vary greatly in size and are subject to boundary changes, Super Output Areas aim to make comparisons with other areas 'like for like' and enable pockets of deprivation within electoral wards to be identified (ONS 2001), however for simplicity this report will focus on Castle Ward as a whole.
Although the number of notifications may be considered relatively small compared to national figures it is a concern that preventable diseases are still occurring in a developed country where preventative vaccines are readily available. Table 1 summarises notifications from 1999 to 2003 for Adur, Arun and Worthing and compares these to notifications for the same period in England and Wales. Measles Adur, Arun, Worthing Mumps Adur, Arun, Worthing Rubella Adur, Arun, Worthing Measles England and Wales Mumps England and Wales Rubella England and Wales 1999 4 9 7 92 372 162 2000 4 3 8 100 703 60 2001 5 2 7 70 777 43 2002 7 1 0 308 502 65 2003 10 6 0 442 1,549 17 Table 1 Source: Health protection Agency A report published in The Lancet by Wakefield et al in 1998 claimed there was a link between the MMR vaccine and autism and inflammatory bowel disease (Fitzpatrick 2004). This soon lead to a loss of public confidence in the vaccination programme, as a result of this a steady decline in uptake of the vaccine has been seen nationally, regionally and locally (AAW 2005a) please see appendix 7. Although the uptake in AAW continues to be above the regional average, a decline in recent years has been observed. The Health Care Commissions 2004 ratings shows that AAW PCT fell into Band 3 for MMR uptake with just 81% coverage. (Healthcare Commission 2004). Although the most recent performance ratings (2004/2005), have shown a slight increase of coverage of MMR to 85% compared to the national figure of 81%, this still places the trust in Band 4 for performance level (Healthcare Commission 2005), which suggests that there is still room for improvement. The PCT annual report statistics show a variation in uptake rates across GP practices, these range from 64% with the highest practice achieving 95% (AAW 2005b). Table 2 below shows the number of eligible children aged 2 by April 2004 and their immunisation status.
This would enable parents and carers to take information away to discuss with partners or other significant others. To improve the uptake rates of immunisations I think it would be advantageous to encourage parents to start to consider having their baby vaccinated during pregnancy. Future parents are bombarded with literature throughout pregnancy with regards to the 'Breast is Best' campaign, although there is no mention of the current vaccination programme recommended by the Department of Health and World Health Organisation in any of the pregnancy books I have read. Highlighting the benefits of vaccinations early in pregnancy will enable parents and guardians time to seek support and advice from friends and health care professionals before making an informed decision regarding the welfare of their child. Information leaflets could also be placed within the local chemists, where parents would be able to pick up a copy while waiting for prescriptions and would also be able to seek the professional advice from the pharmacist. Conclusion Although I have highlighted some of the issues which may influence the uptake of the MMR vaccination within the text, some of these need to be explored more thoroughly as there may be wider implications involved. All practices need to strive to reach the 95% target required to achieve an adequate coverage to prevent the return of these potentially devastating childhood diseases. Unfortunately rebuilding public confidence in the MMR vaccine will take time. There will continue to be an ongoing need for clear, accessible and accurate information for each cohort of new parents to enable them to make informed choices about MMR. It is vital that healthcare professionals have a sound knowledge of the facts of MMR so these can be conveyed to parents/carers. Equally important is the need to continue a positive image through the use of effective campaigns and a more relaxed approach so a higher percentage of children can be opportunistically vaccinated. Healthcare professionals will need to work together in providing parents with accurate information and support parents in making these decisions if these targets are to be met.
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