Child Health Information Systems Research Articles

A new neonatal BCG vaccination pathway in England: a mixed methods evaluation of its implementation

IntroductionThe introduction of a national evaluation of newborn screening for Severe Combined Immunodeficiency (SCID) in England triggered a change to the selective Bacillus Calmette-Guerin (BCG) vaccination programme delivery pathway, as this live attenuated vaccine is contraindicated in infants with SCID. The neonatal BCG vaccination programme is a targeted programme for infants at increased risk of tuberculosis and used to be offered shortly after birth. Since September 2021 the BCG vaccine is given to eligible infants within 28 days of birth, when the SCID screening outcome is available. We explore the experiences of those implementing the new pathway, and how they made sense of, engaged with, and appraised the change.MethodsA mixed-methods evaluation was conducted between October 2022 and February 2023. This involved national online surveys with BCG commissioners and providers and qualitative semi-structured interviews with commissioners, providers, and Child Health Information System stakeholders in two urban areas. Survey data was analysed using descriptive statistics and interview data was analysed thematically. The data was triangulated using Normalization Process Theory as a guiding framework.ResultsSurvey respondents (n = 65) and qualitative interviewees (n = 16) revealed that making sense of the new pathway was an iterative process. Some expressed a desire for more direction on how to implement the new pathway. The perceived value of the change varied from positive, ambivalent, to concerned. Some felt well-prepared and that improvements to data capture, eligibility screening, and accountably brought by the change were valuable. Others were concerned about the feasibility of the 28-day target, reductions in vaccination coverage, increased resource burden, and the outcome of the SCID evaluation. New collaborations and communities of practice were required to facilitate the change. Three main challenges in implementing the pathway and meeting the 28-day vaccination target were identified: appointment non-attendance; appointment and data systems; and staffing and resourcing. Feedback mechanisms were informal and took place in tandem with implementation.ConclusionThe new NHS neonatal BCG service specification has created an effective structure for monitoring and managing the BCG vaccination programme, but further work is required to support delivery of the 28-day vaccination target and improve uptake rates.

Analysis of Breast Cancer Screening Results and Influencing Factors of Breast Cancer in Guangdong Province from 2017 to 2021.

Breast cancer screening plays an important role in the early detection, diagnosis and treatment of breast cancer. The aim of this study was to evaluate the screening results and explore the influencing factors of breast cancer detection rate in Guangdong. This cross-sectional study was conducted among 2,024,960 women aged 35-64 in Guangdong Province during 2017-2021. The data about breast cancer screening information were collected from the Guangdong maternal and child health information system. Descriptive statistical analysis was used to explain demographic characteristics and results of breast cancer screening. The generalized linear regression model was applied to analyze the related influencing factors of breast cancer detection rate. The estimated detection rate of breast cancer in Guangdong Province is 70.32/105, with an early diagnosis rate of 82.06%. After adjusting covariates, those women with older age (45-55 [OR (95% CI) 2.174 (1.872, 2.526)], 55-65 [OR (95% CI) 2.162 (1.760, 2.657)]), education for high school ([OR (95% CI) 1.491 (1.254, 1.773)]) and older age at first birth ([OR (95% CI) 1.632 (1.445, 1.844)]) were more likely to have higher detection rate of breast cancer. No history of surgery or biopsy ([OR (95% CI) 0.527 (0.387, 0.718)]), no history of breast cancer check ([OR (95% CI) 0.873 (0.774, 0.985)]) and no family history of breast cancer ([OR (95% CI) 0.255 (0.151, 0.432)]) women were more likely to screen negative for breast cancer (P < 0.05). The detection rate of breast cancer in screening showed an increasing trend year by year in Guangdong Province. Older age, education for high school and older age at first birth were risk factors for breast cancer detection rate, while no surgery or biopsy history, no family history of breast cancer and no history of breast cancer check were protective factors.

Development and Testing Requirements for an Integrated Maternal and Child Health Information System in Iran: A Design Thinking Case Study.

Management of child health care can be negatively affected by incomplete recording, low data quality, and lack of data integration of health management information systems to support decision making and public health program needs. Given the importance of identifying key determinants of child health via capturing and integrating accurate and high-quality information, we aim to address this gap through the development and testing requirements for an integrated child health information system. A five-phase design thinking approach including empathizing, defining, ideation, prototyping, and testing was applied. We employed observations and interviews with the health workers at the primary health care network to identify end-users' challenges and needs using tools in human-centered design and focus group discussion. Then, a potential solution to the identified problems was developed as an integrated maternal and child health information system (IMCHIS) prototype and tested using Software Quality Requirements and Evaluation Model (SQuaRE) ISO/IEC 25000. IMCHIS was developed as a web-based system with 74 data elements and seven maternal and child health care requirements. The requirements of "child disease" with weight (0.26), "child nutrition" with weight (0.20), and "prenatal care" with weight (0.16) acquired the maximum weight coefficient. In the testing phase, the highest score with the weight coefficient of 0.48 and 0.73 was attributed to efficiency and functionality characteristics, focusing on software capability to fulfill the tasks that meet users' needs. Implementing a successful child health care system integrates both maternal and child health care information systems to track the effect of maternal conditions on child health and support managing performance and optimizing service delivery. The highest quality score of IMCHIS in efficiency and functionality characteristics confirms that it owns the capability to identify key determinants of child health.

Recording and reporting information system model integrated from midwife practices to public health center

Introduction: Maternal and child health problems (MCH) are still a health problem in Indonesia. The high rate of maternal and child mortality requires intensive intervention and monitoring by the health department through health facilities available in the community. The recording and reporting of the MCH program at the Jagir and Wonokromo Health Centers has not been well documented because most of the MCH program recording and reporting is done manually. The purpose of this research is to produce a model of recording and reporting information system that is useful in handling the recording and reporting process of the integrated MCH program from the Independent Midwife Practice to the Puskesmas. Method: The method used in the development of this software is the Scrum Management Framework. The result of this research is the SISKIA (Maternal and Child Health Information and Surveillance System) software application which is integrated from the Independent Midwife Practice to the Puskesmas which can be used to manage maternal and child health data. Results: The SISKIA software application makes it easier to map Maternal and Child Health data, including in high-risk cases, in order to get health services according to the schedule determined by the midwife. SISKIA can directly assess the condition of mothers and children reported by the midwife and can be accurately displayed on the map included in SISKIA installed at the Jagir and Wonokromo Health Centers. Mobilization of the entire community in reducing MMR and IMR in the Jagir and Wonokromo Health Centers can be carried out by monitoring maternal health conditions in the surrounding environment by using this software application. Conclusion: The Maternal and Child Health Information and Surveillance System (SISKIA) has proven useful for obtaining regular and up-to-date maternal and child health data.

Hepatitis B Virus Infection and Increased Risk of Gestational Diabetes Regardless of Liver Function Status: A Xiamen Area Population-Based Study.

Background & Aims: Hepatitis B virus (HBV) infection is a significant cause of liver function damage. However, previous studies on HBV mainly aimed at ordinary people, and there is a lack of consensus on the relationship between HBV infection and gestational diabetes mellitus (GDM) and whether HBV-infected pregnant women should undergo antiviral treatment. In addition, systematic studies on the impact of HBV infection on GDM have rarely been studied directly. Therefore, the overall goal of this study was to pursue the association between HBV infection, liver function, and GDM using Xiamen area gestational big data. Methods: Using the Xiamen Primary Health Information System-maternal and child health information system, the data on participants (138,867 in total) expected confinement between 2008 and 2018 were included. Using univariate and multivariate logistic regressions, we constructed models to determine the role of HBV infection and liver function status in GDM. In addition, an analysis of variance tests was performed to study whether the relationship between HBsAg and GDM differed in the normal liver function and the abnormal liver function subgroups. Results: HBsAg's positive status showed a substantial correlation with GDM onset in univariate and multivariate logistic regressions (p < 0.001). Subgroup analysis among HBsAg, liver function, and GDM suggests that both HBsAg and liver function affect the onset of GDM and have the highest prevalence of both abnormalities. Furthermore, ANOVA was used to investigate the association of HBsAg positive (p < 0.001), abnormal liver function (p < 0.001), and their interaction (p = 0.302) on the onset of GDM. This result showed that HBsAg is an independent factor of GDM pathogenesis, regardless of liver function status. Conclusion: HBsAg and liver function are independent factors in GDM. Therefore, regarding these results, while clinicians consider the traditional risk factors of GDM, it is necessary to consider the HBV infection status. Conducting a dietary intervention for HBsAg-positive pregnant women at the early stage of pregnancy is conducive to reducing the adverse effects.

Interoperability of Health Digitalization

: Introduction : Maternal and child health (MCH) is a global priority as health care innovation continues to evolve, including the use of information and communication technology. Studies showed that interoperable information systems can improve the quality of health services and at the same time facilitate the integration of data for the purpose of monitoring and evaluating the performance of health services, especially MCH. Aims : This study aims to identify various maternal and child health information systems used in Indonesia and opportunity of interoperability between systems to support continuum of care services. Methodology: Qualitative descriptive research was conducted in Yogyakarta Province from November to December 2020. This study assessed MCH applications that have been used in public and private primary health care, hospitals, health offices and in the community by identifying their functions and mapped data elements used by each application to assess potential interoperability between systems. The online focus group discussions with various application providers was conducted to explore the challenges of interoperability between digital systems. Results and Discussion : There were 18 maternal and child health information systems have been developed by the government (central and local), health facilities and private sector. The initiation of interoperability between systems has not yet occurred, except to support regular reporting at the health office and Ministry of Health level. Interoperability between information systems required efforts to improve information technology facilities and infrastructure, development of health data standards, strengthening governance and regulation and utilization of data as an effort to monitor, evaluation and continuity of interoperability between systems to support the digitalization of services and routine reporting. Conclusions and Recommendations : Digitalization of MCH services in Indonesia has the opportunity to support the continuum of care through an interoperable system. However, several enabler factors need to be prepared to support interoperability between information systems.

Acceptance Model of a Mandatory Health Information System in Indonesia.

ObjectivesThe purpose of this study was to develop a model of acceptance of the Mother and Child Health Information System in the Ngawi Regency Health Office, Indonesia based on the technology acceptance model, by integrating organizational support and personal characteristics as external variables and enjoyment as an intervening variable.MethodsThe design of this study was cross-sectional. The subjects of this study were 217 village midwives who had operated the Maternal and Child Health Information System in the Ngawi Regency Health Office, Indonesia. The variables studied were perceived organizational support, personal characteristics, perceived ease of use, perceived usefulness, perceived enjoyment, behavioral intention, and actual system use. Data were collected through questionnaires, and then analyzed using structural equation modeling.ResultsIn terms of the total effect, the most meaningful factor affecting actual system use was perceived organizational support (0.766), followed in descending order by behavioral intention to use (0.344), perceived enjoyment (0.238), personal characteristics (0.118), perceived usefulness (0.054), and perceived ease of use (0.048).ConclusionsIn the acceptance model of the Mother and Child Health Information System in Ngawi Regency, perceived organizational support was the main determinant of actual system use, while enjoyment was the main intermediate determinant of the indirect effects of perceived organizational support and personal characteristics on actual system use.

Pregnant women with COVID-19 and risk of adverse birth outcomes and maternal-fetal vertical transmission: a population-based cohort study in Wuhan, China

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. However, little is known about the association between pregnant women with COVID-19 and the risk of adverse birth outcomes.MethodWe conducted a retrospective cohort study based on the Maternal and Child Health Information System (MCHIMS) of Wuhan, China. All pregnant women with singleton live birth recorded by the system between January 13 and March 18, 2020, were included. The adverse birth outcomes were preterm birth, low birth weight, neonatal asphyxia, premature rupture of membrane (PROM), and cesarean section delivery. Multivariate logistic regression was used to evaluate the associations between maternal COVID-19 diagnosis and adverse birth outcomes.ResultsOut of 11,078 pregnant women, 65 were confirmed with coronavirus disease 2019 (COVID-19). No deaths occurred from these confirmed cases or their newborns. Compared to pregnant women without COVID-19, pregnant women with a confirmed COVID-19 diagnosis had an increased risk of preterm birth (OR 3.34, 95% CI 1.60–7.00) and cesarean section (OR 3.63, 95% CI 1.95–6.76). There was no statistical difference in low birth weight, neonatal asphyxia, and PROM between the mothers with and without COVID-19. Among these newborns that were born to mothers with confirmed COVID-19, none was tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive or had abnormal CT results. Only one had diarrhea and three had a fever.ConclusionsThis population-based cohort study suggests that COVID-19 during the later pregnancy is associated with an increased risk of adverse birth outcomes, including iatrogenic preterm birth and cesarean section delivery. Our data provide little evidence for maternal-fetal vertical transmission of SARS-CoV-2. It is important to monitor the long-term health effects of SARS-CoV-2 infection on pregnant women and their children.

Did school characteristics affect the uptake of meningococcal quadrivalent vaccine in Greater Manchester, United Kingdom?

ObjectivesThe objective of this study was to assess if school characteristics were associated with the uptake of the meningococcal ACWY (MenACWY) vaccine in Greater Manchester in 2017/18. Study designThis is an ecological cross-sectional study. MethodsWe analysed data on all 129 schools in seven local authorities in Greater Manchester from the Department for Education and from local child health information systems to determine whether school characteristics, including school type and Ofsted effectiveness score, were associated with vaccine uptake. Schools with no eligible pupils were excluded. We undertook single-variable and multivariable analysis and considered key interactions. ResultsThe overall uptake rate was 80.7%, with a median uptake per school of 80.6% (interquartile range, 69.0%–87.4%). Lower vaccination rates were associated with lower overall effectiveness scores (odds ratio [OR]: 3.54, 95% confidence interval [CI]: 3.00–4.19) and lower numbers of pupils eligible for vaccination (OR: 1.39, 95% CI: 1.28–1.51). Schools with a lower percentage of pupils for whom English is a second language and high deprivation were associated with lower uptake (OR: 1.58, 95% CI: 1.41–1.78). In addition, community schools (the schools with the most local authority oversight) had lower vaccination rates than other categories of schools. ConclusionsIn this study, uptake rates of the MenACWY vaccine were associated with all five school characteristics considered. Effectiveness scores for schools had the largest association with vaccine uptake, with poorer schools having lower uptake. These characteristics should be used by vaccination providers to prioritise their interventions to increase immunisation rates.

Inequalities in childhood vaccination timing and completion in London

The UK primary vaccination course includes vaccination against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP/IPV/Hib) and is scheduled at ages four, 8 and 12 weeks, followed by a ‘preschool booster’ at age three years four months. Vaccine coverage is generally measured at age one, two and five years. In addition to high coverage, vaccination should be timely to maximise population protection.Vaccination histories for 315,381 children born March 2001 to April 2010 were extracted from Child Health Information Systems in nine London health service areas and grouped into first and fifth birthday cohorts. We assessed timeliness of receipt of DTaP/IPV/Hib and drop-out rates by ethnicity, deprivation and area.Most children received their first, second and third doses on time at two, three, and four months. Among children completing by one year and after adjusting for deprivation and health area, compared with White-British children, Somali and Bangladeshi children were less likely to have received three doses of DTaP/IPV/Hib by six months of age (−11% and −5% respectively). Differences in timeliness by deprivation and health area existed, but were smaller. Compared with White-British children, children of Polish, Somali and Caribbean ethnicities were less likely to return for preschool booster, with a drop-out rate at least 7% higher in these groups. Within the fifth birthday cohort, only 2.3% of children who were completely unvaccinated (575/25,095) at age one year were fully vaccinated by age five. Higher proportions of partially vaccinated (one or two doses) children at age one year went on to be fully vaccinated by age five ((836/3213) 26.0% and (3565/6076) 58.7% respectively).These inequalities suggest that tailored approaches may be required to target specific groups with regards to improving vaccine uptake.

Passive smoking and postpartum depression among Chinese women: A prospective cohort study in Tianjin, China

ABSTRACTSmoking has been associated with depression in the general population. Whether passive smoking is also associated with postpartum depression (PPD) is uncertain. From 2010 to 2012, we recruited 8,842 pregnant women in Tianjin, China. The mainland Chinese version of the Edinburgh Postnatal Depression Scale was used to evaluate postpartum depressive symptoms after birth, with a score of >9 defining PPD. Data were collected using specially designed questionnaires or data from the electronic database of Tianjin Maternal and Child Health Information System. Odds ratios (OR) and 95 percent confidence intervals (CI) were obtained for the association of smoking status with PPD using binary logistic regression. Passive smoke exposure rates before and during pregnancy were 40.9 percent and 52.1 percent, respectively. A total of 8.5% (n = 747) of participants had PPD. Compared with those not exposed, women passively exposed to smoke before and during pregnancy had higher odds of PPD (before pregnancy: OR: 1.24, 95 percent CI: 1.03–1.50; during pregnancy: OR: 1.43, 95 percent CI: 1.16–1.77) after adjustment for confounding factors. Passive smoking before and during pregnancy were associated with PPD in Chinese women. Reducing passive smoke exposure may reduce PPD in Chinese women; further longitudinal studies are warranted to replicate these findings.

Identifying risk factors associated with acquiring measles in an outbreak among age-appropriately vaccinated school children: a cohort analysis.

A measles outbreak occurred in age-appropriately vaccinated children in a school in a town in the South East of Ireland in September-November 2013. The purpose of this study was to investigate the risk factors associated with catching measles during the outbreak. Ninety-five children (4-5years) in three classes, in the first year of primary school, were included in the study. Immunisation records on the South East Child Health Information System for first Measles Mumps and Rubella (MMR) vaccine for the 95 children were reviewed. Data collected included age at MMR, date of administration of MMR, MMR brand and batch number, and the General Practice at which MMR was administered. The risk factors analysed included age at vaccination, time of vaccination, class and the GP practice where MMR was administered. Statistical analysis was performed using Epi info 7 and SPSS v24. Thirteen children in the cohort developed measles during the outbreak. All children in the cohort were age-appropriately vaccinated, with one dose of MMR vaccine. Analysis demonstrated statistically significant differences in the relative risk of developing measles according to the class a child was in, and the General Practice at which they were vaccinated. The reason for intense measles activity in one class was not established. Although a concurrent investigation into cold chain and vaccine stock management did not identify a cause for the high relative risk of measles in children vaccinated, recommendations were made for improving cold chain and vaccine stock management in General Practices.

Impact and acceptability of self-consent procedures for the school-based human papillomavirus vaccine: a mixed-methods study protocol

IntroductionThe human papillomavirus (HPV) vaccine, administered in early adolescence, can substantially reduce cervical cancer incidence and mortality. However, lack of written parental consent is a key reason why some young...

Indicators of Husband's Role in Pregnancy and Maternity Care

The maternal mortality rate (MMR) in developing countries is still a major health problem, including in Indonesia. Antenatal Care (ANC), delivery with skilled birth attendance (SBA) at the time of delivery and delivery in institutional are universally considered important for reducing maternal mortality. Husbands can play a crucial role in pregnancy and childbirth. Therefore, the aim of this study was analyze the indicators of husband's role in pregnancy and maternity care which were suspected as one of the determinants of ANC and SBA use in Polewali Mandar Regency. The population of this prospective cohort study was all married and pregnant woman, before using contraceptives and contraceptive failure or not using contraception and pregnancy is planned, unplanned pregnancy or mistimed pregnancy in Polewali Mandar 2015 (Size of sample = 100). Samples were randomly selected from participants of screening in 12 sub-districts in Polewali Mandar. Data about husband's role in pregnancy and maternity care was obtained through interviews using a structured questionnaire data processing by using SMART-PLS. The result of data analysis suggested that the coefficient value that has been standardized from each indicator were as follows: accessibility = 0.944 and engagement = 0.954, dan responsibility = 0.968. Indicators of organizational support in implementing Maternal and Child Health Information System at Polewali Mandar Regency, respectively from the most important are: responsibility, engagement, and accessibility.

Measles outbreaks in the UK, is it when and where, rather than if? A database cohort study of childhood population susceptibility in Liverpool, UK

ObjectivesThere was a large outbreak of measles in Liverpool, UK, in 2012–2013, despite measles, mumps and rubella (MMR) immunisation uptake rates that were higher than the national average. We estimated...

A Granular Ontology Model for Maternal and Child Health Information System.

In several developing countries, maternal and child health indicators trail behind the international targets set by the UN as Millennium or Sustainable Development Goals. One of the reasons is poor and nonstandardized maternal health record keeping that affects data quality. Effective decision making to improve public healthcare depends essentially on the availability of reliable data. Therefore, the aim of this research is the design and development of the standard compliant data access model for maintaining maternal and child health data to enable the effective exchange of healthcare data. The proposed model is very granular and comprehensive in contrast with existing systems. To evaluate the effectiveness of the model, a web application was implemented and was reviewed by healthcare providers and expectant mothers. User feedback highlights the usefulness of the proposed approach as compared to traditional record-keeping techniques. It is anticipated that the proposed model will lay a foundation for a comprehensive maternal and child healthcare information system. This shall enable trend analysis for policy making to help accelerate the efforts for meeting global maternal and child health targets.

Indicators of Organizational Support in Implementing Maternal and Child Health Information System

&lt;p style="color: #000000; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-style: initial; text-decoration-color: initial;"&gt;Nowadays, the implementation of health informtion system in Indonesia still encounters a number of obstacles e.g. redundant data, activities duplication, data quality, data not in harmony with the necessities, report not submitted on time, unoptimized feedback, low information utilization, and inefficient resources. This research aimed to analyze the indicators of organizational support which were suspected as one of the obstacles of the implementation of Maternal and Child Health Information System in Health Office of Ngawi Regency. The population of this cross sectional research was all village midwives administratively in duty in the areas of Ngawi Regency in 2015. Data was taken from all member of populaton through questionnaire filling, which was then analyzed by using confirmatory factor analysis (CFA). The result of data analysis suggested that the coefficient value that has been standardized from each indicators were as follows: supervisor support = 0.82, work condition = 0.80, and reard = 0.90. Indicators of organizational support&lt;br /&gt;in implementing Maternal and Child Health Information System at Ngawi Regency Health Office, respectively from the most important are: reward, supervisor support, and work condition.&lt;/p&gt;

Indicators of Organizational Support in Implementing Maternal and Child Health Information System

&lt;p style="color: #000000; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-style: initial; text-decoration-color: initial;"&gt;Nowadays, the implementation of health informtion system in Indonesia still encounters a number of obstacles e.g. redundant data, activities duplication, data quality, data not in harmony with the necessities, report not submitted on time, unoptimized feedback, low information utilization, and inefficient resources. This research aimed to analyze the indicators of organizational support which were suspected as one of the obstacles of the implementation of Maternal and Child Health Information System in Health Office of Ngawi Regency. The population of this cross sectional research was all village midwives administratively in duty in the areas of Ngawi Regency in 2015. Data was taken from all member of populaton through questionnaire filling, which was then analyzed by using confirmatory factor analysis (CFA). The result of data analysis suggested that the coefficient value that has been standardized from each indicators were as follows: supervisor support = 0.82, work condition = 0.80, and reard = 0.90. Indicators of organizational supportin implementing Maternal and Child Health Information System at Ngawi Regency Health Office, respectively from the most important are: reward, supervisor support, and work condition.&lt;/p&gt;

Evaluation of the measles, mumps and rubella vaccination catch-up campaign in England in 2013

In January–March 2013 in England, confirmed measles cases increased in children aged 10–16 years. In April–September 2013, the National Health System and Public Health England launched a national measles-mumps-rubella (MMR) campaign based on data from Child Health Information Systems (CHIS) estimating that approximately 8% in this age group were unvaccinated. We estimated coverage at baseline, and, of those unvaccinated (target), the proportion vaccinated up to 20/08/2013 (mid-point) to inform further public health action.We selected a sample of 6644 children aged 10–16 years using multistage sampling from those reported unvaccinated in CHIS at baseline and validated their records against GP records. We adjusted the CHIS MMR vaccine coverage estimates correcting by the proportion of vaccinated children obtained through sample validation.We validated 5179/6644 (78%) of the sample records. Coverage at baseline was estimated as 94.7% (95% confidence intervals, CI: 93.5–96.0%), lower in London (86.9%, 95%CI: 83.0–90.9%) than outside (96.1%, 95%CI 95.5–96.8%). The campaign reached 10.8% (95%CI: 7.0–14.6%) of the target population, lower in London (7.1%, 95%CI: 4.9–9.3) than in the rest of England (11.4%, 95%CI: 7.0–15.9%). Coverage increased by 0.5% up to 95.3% (95% CI: 94.1–96.4%) but an estimated 210,000 10–16 year old children remained unvaccinated nationally.Baseline MMR coverage was higher than previously reported and was estimated to have reached the 95% campaign objective at midpoint. Eleven per cent of the target population were vaccinated during the campaign, and may be underestimated, especially in London. No further national campaigns are needed but targeted local vaccination activities should be considered.

Increased measles–mumps–rubella (MMR) vaccine uptake in the context of a targeted immunisation campaign during a measles outbreak in a vaccine-reluctant community in England

BackgroundFollowing a measles outbreak in a vaccine-rejecting community between April and September 2011 in South-East England, local health agencies implemented a two-pronged measles–mumps–rubella (MMR) immunisation campaign from August to October offered at the local general practice where most cases were registered. The campaign included (a) accelerated vaccination of children earlier than scheduled (1st dose at 6–11 months, or 2nd dose at 18–39 months), (b) catch-up of those aged over 18 months who had had no MMR immunisations or were late for second MMR. We investigated the impact of the outbreak and campaign on the number of MMR doses given. Materials and methodsIn January 2012, we collected information on MMR vaccination for children registered at the practice aged 6 months–16 years on 1 August 2011, through the child health information system. We counted the number of MMR doses administered in 2011 and compared it to 2008–2010 data. We estimated the proportion vaccinated among the children eligible for the accelerated and catch-up campaign. ResultsThe local practice administered 257 MMR doses in 2011, a 114% increase on the average for 2008–2010. Among children eligible for earlier MMR vaccination 5/26 (19%) received a first dose, and 34/57 (60%) a second dose. Among children eligible for catch-up, 20/329 (6%) received their first MMR and 39/121 (32%) their second. Of 1538 children, the proportion completely unimmunised for MMR declined by 3 percentage-points after the outbreak. DiscussionUptake of MMR vaccination significantly increased during the outbreak following the immunisation campaign. Those amenable to MMR vaccination seem to have benefited from the campaign more than those with no previous vaccinations. Future evaluations should address what made a few parents change their mind and have their children vaccinated for the first time during the outbreak.