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Current Issue: Volume 16 Number 51 |
Published on: 21 December 2006 |
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Immunisation
Last updated: 21 December 2006, Volume 16, No. 51 (PDF file, KB) Next update: 26 January 2007
Immunisation Archives: | 2006 | 2005 | 2004 | 2003 | 2002 | 2001
CDR Home | Infection Reports | Immunisation
Invasive meningococcal infections, England and Wales: laboratory reports, weeks 43-47 2006
Invasive meningococcal infections, England and Wales : laboratory reports, weeks 43-47 2006
Method of diagnosis |
Total reports |
Cumulative* |
|||
CSF andblood Culture |
Non- culture |
Other sites |
43-47/06 |
Total to week 47/2006 |
|
| Group A | – |
– |
– |
– |
1 |
| B | 42 |
44 |
5 |
91 |
1099 |
| C | – |
– |
– |
– |
34 |
| W135 | 4 |
– |
– |
4 |
25 |
| X | – |
– |
– |
– |
– |
| Y | 4 |
1 |
– |
5 |
31 |
| Z/29E | – |
– |
– |
– |
2 |
| Ungroupable | – |
– |
– |
– |
45 |
| Ungrouped | – |
3 |
– |
3 |
13 |
| Total | 50 |
48 |
5 |
103 |
1250 |
*Latex antigen, microscopy, polymerase chain reaction combined Health Protection Agency Centre for Infections data and Meningococcal Reference Unit data.
COVER programme: July to September 2006
Quarterly vaccination coverage statistics for children aged up to five years in the United Kingdom
This report of the COVER programme presents quarterly coverage data for children in the United Kingdom (UK) who reached their first, second, or fifth birthday during the evaluation quarter, July to September 2006.
Children who reached their first birthday in the quarter would have been scheduled to receive their third-dose primary vaccinations (third-dose diphtheria, tetanus, pertussis [DTP vaccine], Haemophilus influenzae type b [Hib vaccine], polio vaccine, and MenC vaccine) between November 2005 and January 2006. Children who reached their second birthday would have been scheduled to receive their third-dose primary vaccinations between November 2004 and January 2005 and first measles, mumps, and rubella (MMR) vaccination between August 2005 and January 2006. Children who reached their fifth birthday would have been scheduled to receive their third-dose primary vaccinations between November 2001 and January 2002, their first MMR between July 2002 and January 2003, their pre-school diphtheria, tetanus, acellular pertussis (DTaP) booster, polio, and second-dose MMR from November 2004 onwards.
This is the fifth quarter to evaluate children at 12 months who have been routinely scheduled for the Pediacel® vaccine (commonly referred to as ‘5 in 1' vaccine containing DTaP/IPV/Hib) for their whole primary course .
Methods
Methods of data collection for COVER, sentinel MMR coverage and neonatal hepatitis B vaccination coverage are described on the HPA website <http://www.hpa.org.uk/infections/topics_az/vaccination/cover_methods.htm>).
Results
Data were received from all Health Boards (HBs) in Scotland and Northern Ireland, Administrative Regions (ARs) in Wales, and 290/303 Primary Care Trusts (PCTs) in England (tables 1 and 2). Five of the 31 PCTs in London were unable to publish data this quarter due to ongoing problems relating to the implementation of new child health systems as reported previously [1,2,3,4]. Six of the 28 PCTs in East Midlands were also unable to submit data. Coverage for London and East Midlands published this quarter should therefore be interpreted with caution.
England and UK coverage estimates were not calculated for the previous four COVER quarterly reports due to missing data from seven London PCTs, six of these PCTs are using a new child health system, the Child Health Interim Application (CHIA), in use in ten PCTs in London . This quarter, five of these PCTs have submitted data with caveats about the data quality. Estimates for England and the UK have been calculated, but caution is needed in using these data to evaluate the vaccination programme in London because of these ongoing data quality concerns. Coverage for all antigens at all ages is always significantly lower in London compared to all other regions in England and the devolved administrations. As no England or UK coverage estimates are available for the previous quarter four quarters [4] comparisons to the 2005-06 annual data, published by Information Centre for health and social care in September, have been made instead [5]. Estimates for English regions and devolved administrations can be compared to the previous quarter [4].
Coverage at 12 and 24 months
Ninety-seven of the 324 participating PCTs/HBs/ARs (30%) achieved at least 95% coverage at 12 months for three doses of diphtheria, tetanus, pertussis, polio and Hib vaccine (DTaP/IPV/Hib3) and 104/324 (32%) for three doses of MenC vaccine (MenC) (see note on table 1 for Scotland). All countries and all English regions except London achieved at least 90% coverage at 12 months for DTaP/IPV/Hib. All countries and 7/9 English regions (all but London and East Midlands ) achieved at least 90% coverage at 12 months for MenC. One hundred and sixty-nine PCTs/HBs/ARs (52%) achieved at least 95% coverage at 24 months for DTPol3, 167 (52%) for P3, and 159 (49%) for Hib3 and MenC. Only two English PCTs and one Scottish HB achieved 95% coverage for MMR at 24 months.
Compared to the estimates reported in the 2005-06 annual data UK coverage at 12 months for DTaP/IPV/Hib3 remained the same at 92.1% and UK MenC coverage increased by 0.4% to 92.0% (table 1)[5], a trend reflected in all regions and devolved administrations except for London and East Midlands where not all PCTs were able to submit data.
UK coverage at 24 months was similar to the 2005-06 annual for all antigens except for MMR1 coverage which increased by 1% to 85.9%. MMR coverage was highest in Scotland and Northern Ireland, both achieving at least 90.0%; coverage for English regions (excluding London) and Wales ranged from 84.2% to 88.0% with most regions and devolved administrations reporting increased coverage. (table 2)
Table 1 Completed primary immunisations (all antigens) by 12 months: July to September 2006
| Region/Country |
PCT/HB/AR* (total) |
DTaP/IPV/ Hib3 % |
MenC % |
|
| Regions of England | ||||
| North East |
16 (16) |
93.3 |
93.3 |
|
| North West | 42 (42) |
93.1 |
93.0 |
|
| Yorkshire and the Humber |
34 (34) |
91.0 |
91.2 |
|
| East Midlands | 22 (28) |
91.0 |
87.7 |
|
| West Midlands | 30 (30) |
92.8 |
92.5 |
|
| East of England | 41 (41) |
93.4 |
93.4 |
|
| London | 26 (31) |
80.3 |
80.6 |
|
| South East | 49 (49) |
92.2 |
92.2 |
|
| South West | 30 (32) |
93.3 |
93.6 |
|
| England (Total) | 290 (303) |
91.4 |
91.2 |
|
| Wales | 3 (3) |
95.5 |
95.3 |
|
| Northern Ireland | 4 (4) |
95.9 |
96.0 |
|
| Scotland | 14 (14) |
96.5 |
98.0† |
|
| United Kingdom | 312 (324) |
92.1 |
92 |
|
Table 2 Completed primary immunisations (all antigens) by 24 months: July to September 2006
| Region/Country |
PCT/HB/AR* (total) |
DTPol3 % |
P3 % |
Hib3 % |
MenC % |
MMR1% |
|
| Regions of England | |||||||
| North East | 16 (16) |
95 |
95 |
94.8 |
94.7 |
87.9 |
|
| North West | 42 (42) |
95.3 |
95.3 |
95.1 |
95.2 |
87.6 |
|
| Yorkshire and the Humber |
34 (34) |
93.7 |
93.7 |
93.5 |
93.7 |
85.7 |
|
| East Midlands | 22 (28) |
94.5 |
94.4 |
94.4 |
92.8 |
87.6 |
|
| West Midlands | 30 (30) |
94.6 |
94.6 |
94.4 |
94.6 |
86.9 |
|
| East of England | 41 (41) |
95.1 |
95.0 |
94.9 |
94.8 |
84.2 |
|
| London | 26 (31) |
86.3 |
86.3 |
86 |
85.4 |
72.5 |
|
| South East | 49 (49) |
93.7 |
93.6 |
93.5 |
92.9 |
85.4 |
|
| South West | 30 (32) |
96.1 |
96 |
96.1 |
95.9 |
87.2 |
|
| England (Total) | 290 (303) |
93.9 |
93.9 |
93.8 |
93.4 |
85.0 |
|
| Wales | 3 (3) |
96.7 |
96.7 |
96.4 |
96.4 |
88.0 |
|
| Northern Ireland | 4 (4) |
97.1 |
97.1 |
97 |
97.3 |
90.8 |
|
| Scotland | 14 (14) |
97.7 |
97.7 |
97.4 |
97.1 |
92.0 |
|
| United Kingdom | 312 (324) |
94.5 |
94.5 |
94.3 |
94.0 |
85.9 |
|
Coverage at 5 years
Data were received from localities in England (290/303), Northern Ireland (4/4), and Wales (3/3). Data for Scotland were unavailable and therefore it was not possible to produce UK estimates for coverage at five years. Comparing this quarter to the 2005-06 annual figures, five year coverage in England for all antigens except MMR1 and MMR2 remained very similar (table 3) [5]. Coverage for MMR1 decreased 1.2% and MMR2 increased by 1.1%.
Compared to last quarter, five year coverage for Northern Ireland increased between 0.1% and 0.4% for DTPol3, P3, and MMR1 and decreased by 0.2% for MenC, 0.3% for Hib, 0.8% for MMR2, and 0.9% for DTaP/Pol4. In Wales coverage decreased between 0.3% and 0.4% for P3, Hib and MenC, and increased by 0.7% for MMR1, 1.1% for MMR2 and 0.3% for DTaP/Pol4.
Table 3 Completed primary immunisations (all antigens) by 5 years: July to September 2006
| Region/Country |
PCT/HB/AR* (total) |
DTPol3 % |
P3 % |
Hib3 % |
MenC % |
MMR1 % |
MMR2 % |
DTPol4 % |
|
| Regions of England | |||||||||
| North East | 16 (16) |
95.7 |
95.2 |
95.5 |
95.2 |
89.5 |
78.8 |
85.6 |
|
| North West | 42 (42) |
95.4 |
94.9 |
94.6 |
95 |
88.4 |
76.4 |
82.8 |
|
| Yorkshire and the Humber |
34 (34) |
94.8 |
94.5 |
94.1 |
93.9 |
89.3 |
76.5 |
80.6 |
|
| East Midlands | 22 (28) |
95.5 |
95.1 |
95.3 |
94.1 |
89.3 |
75.1 |
82.0 |
|
| West Midlands | 30 (30) |
95.6 |
95.2 |
94.5 |
94.9 |
88.5 |
76.4 |
83.5 |
|
| East of England | 41(41) |
93.9 |
93.4 |
93.5 |
92.1 |
82.2 |
73.1 |
82.4 |
|
| London | 26 (31) |
83.1 |
82.8 |
82.6 |
80.2 |
75.2 |
51.7 |
56.7 |
|
| South East | 49(49) |
93.6 |
93.1 |
93.3 |
91.9 |
85.1 |
72.3 |
81.7 |
|
| South West | 30 (32) |
96.2 |
95.4 |
95.7 |
94.9 |
88.0 |
77.0 |
85.4 |
|
| England (Total) | 290(303) |
93.9 |
93.4 |
93.3 |
92.5 |
85.8 |
72.9 |
80.3 |
|
| Wales | 3 (3) |
95.4 |
94.1 |
94.9 |
94.4 |
87.2 |
75.6 |
84.8 |
|
| Northern Ireland | 4 (4) |
97.5 |
97.0 |
96.2 |
96.1 |
95.3 |
86.2 |
88.0 |
|
| Scotland | 14 (14) |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
|
| United Kingdom | 312 (324) |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
n/a |
|
MMR sentinel surveillance scheme coverage
For methods of data collection see <http://www.hpa.org.uk/infections/topics_az/vaccination/cover_methods.htm>.
Data collected from September to November 2006 for children in the four age cohorts is summarised in table 4. The range for the three months was from 74.2% to 76.8%, at 16 months, 82.5% to 82.6% at 20 months, 84.2% to 85.1% at 24 months, and 87.7% to 88.6% at 36 months).
Table 4 Monthly sentinel estimates of measles, mumps, and rubella (MMR) coverage at 16, 20, 24, and 36 months: June to August 2006
| Evaluation month | Number of PCTs/trust |
Age at vaccination |
|||
|
16 months |
20 months |
24 months |
36 months |
||
| Sep 06 | 39 |
76.8 |
82.5 |
84.8 |
88.2 |
| Oct 06 | 39 |
75.2 |
82.6 |
85.1 |
88.6 |
| Nov 06 | 38 |
74.2 |
82.6 |
84.2 |
87.7 |
Hepatitis B vaccine coverage data in England
The data presented below represents coverage for three doses of hepatitis B vaccine in those infants born to HBsAg positive mothers who reached the age of one year in this quarter (ie those born between July to September 2005), and coverage of four doses of vaccine in infants who reached two years of age (ie those born between July to September 2004).
Table 5 Neonatal hepatitis B coverage in England : July to September 2006
| Region | Returns with data | 12 month denominator | Coverage at 12 months | 24 month denominator | Coverage at 24 months |
| North East | 11 |
– |
– |
– |
– |
| North West | 27 |
27 |
70% |
32 |
63% |
| Yorkshire & the Humber | 30 |
36 |
83% |
36 |
58% |
| East Midlands | 11 |
16 |
81% |
10 |
40% |
| West Midlands | 26 |
65 |
74% |
32 |
31% |
| East of England | 35 |
28 |
71% |
28 |
14% |
| London | 17 |
152 |
74% |
144 |
64% |
| South East | 43 |
28 |
82% |
33 |
58% |
| South West | 23 |
6 |
50% |
4 |
25% |
| Total | 223 |
358 |
75% |
319 |
54% |
Data were received for 222/303 (73%) PCTs in England, the highest reporting level since mandatory reporting was introduced in April 2005, and 32 more than reported in the last quarter [4]. Coverage in England for three doses in those aged one year reached 75% overall, 1% up on last quarter [4] (table 5). Although this is lower than the coverage obtained for routine antigens at this age (table 1), the population at risk are highly mobile and high uptake is difficult to achieve [5-9]. The largest number of infants at risk is in London where coverage was 74% at 12 months (table 5). Coverage in England for four doses in those aged 24 months was lower at 54%; a decrease of 1% on last quarter. As data systems are still being established in some areas, it is likely that 24 month data is less complete and therefore that this represents an under-estimate of coverage at this age.
Comments
The HPA has been cautious and not published national quarterly data since September 2005 due to missing data from London PCTs using a new child health system, CHIA, supplied to ten PCTs in London as this may have led to a spurious increase in coverage which would be misleading . This is the first COVER report in over a year where UK and England coverage estimates have been produced as five of these PCTs have submitted data this quarter. However, there are still issues of data quality with the output from this system. CHIA is unable to schedule appointments and identify defaulters for re-invitation and follow-up and this may have led to falls in vaccination coverage as well as poorer data quality. Unlike the previous system, CHIA has not been generating automated COVER reports, the method used to produce vaccination coverage data, and this may have led to inflated denominators and apparently decreased coverage, particularly at 12 and 24 months. Two of the CHIA PCTs have submitted COVER data based on the GP EMIS system rather than the CHIA system, although this is incomplete as not all practices are represented. Consequently, London coverage data should still be interpreted with caution. Data for the five other CHIA PCTs is still not available for publication. HPA has previously stated that the missing quarters' data would be published as soon as it becomes available. If the next annual data are supplied before the missing quarters become available, then these data will supplant the missing quarter.
As no England or UK coverage estimates are available for the previous quarter four quarters [4] comparisons have been made instead to the 2005-06 annual data, published by Information Centre for health and social care in September this year [5]. Estimates for English regions and devolved administrations can be compared to the previous quarter [4].
UK coverage data for all antigens evaluated at 24 months this quarter was similar to that observed in the 2005-06 annual statistics, with the exception of MMR. MMR coverage continues to improve, increased by 1% to 85.9% compared to 2005-06 annual, and is now at the highest level recorded since January to March 2001, when coverage was 86.4% [11]. The monthly MMR sentinel surveillance data suggests that this trend should continue into the early part of 2007 as estimated coverage at 20 months has risen consecutively for each of the last nine monthly evaluations. The introduction of the new pneumococcal booster in September 2006 may have temporarily affected MMR uptake at 16 months as the October and November evaluations are lower than figures reported consecutively in the previous six months [1,4]. This is consistent with some PCTs having reported that they have delayed MMR1, normally scheduled at around 13 to 15 months of age, by a month or two to accommodate the pnuemococcal catch-up programme. If the delay in immunisation is only a month or two then routine 24 month MMR1 coverage should not be affected.
As of 1 October 2006, the new PCT configurations in England (except London) came into effect [12]. In relation to COVER report data, any changes to PCT responsible populations should not made until after the October to December 2006 quarter data have been submitted.
Neonatal hepatitis B vaccination
Reporting of neonatal hepatitis B vaccination has improved and almost 75% of all English PCTs provided data this quarter, the highest reporting level since mandatory reporting was introduced in April 2005. However, many PCTs that sent in returns had zero cases in this period. It is unclear whether these latter returns represent valid data for areas with a low prevalence of infection or missing data. It is hoped that PCTs will increasingly give these returns the priority level to match their status; the quality of neonatal hepatitis B reporting should also improve as more areas establish new data systems which can capture these data.
Relevant links for country specific coverage data
Wales
<http://www.wales.nhs.uk/sites/page.cfm?OrgID=368&PID=2278>
Scotland
<http://www.show.scot.nhs.uk/scieh/>
Northern Ireland
<http://www.cdscni.org.uk/surveillance/Coveragestats/default.asp>
England
<http://www.ic.nhs.uk/pubs/immstats2005to2006>
Other relevant links
<http://www.hpa.org.uk/infections/topics_az/vaccination/vac_coverage.htm>
<http://www.mmrthefacts.nhs.uk/>
References
1. HPA. COVER programme: January to March 2006. Commun Dis Rep CDR Wkly [serial online] 2006 [cited 19 September 2006]; 16 (25): Immunisation. Available at <http://www.hpa.org.uk/cdr/archives/2006/cdr2506.pdf>.
2. HPA. COVER programme: October to December 2005. Commun Dis Rep CDR Wkly [serial online] 2006 [cited 19 June 2006]; 16 (12): Immunisation. Available at <http://www.hpa.org.uk/cdr/archives/2006/cdr1206.pdf> .
3. HPA. COVER programme: July to September 2005. Commun Dis Rep CDR Wkly [serial online] 2005 [cited 20 March 2006]; 15 (51): Immunisation. Available at <http://www.hpa.org.uk/cdr/archives/2005/cdr5105.pdf>.
4. HPA. COVER programme: April to June 2006. Commun Dis Rep CDR Wkly [serial online] 2006 [cited 18 December 2006]; 16 (39): Immunisation. Available at <http://www.hpa.org.uk/cdr/archives/2006/cdr3906.pdf>.
5. The Information Centre for health and social care. Statistical Bulletin. NHS Immunisation Statistics , England: 2005-06 . Available at <http://www.ic.nhs.uk/pubs/immstats2005to2006>.
6. Smith CP, Parle M, Morris DJ. Implementation of government recommendations for immunising infants at risk of hepatitis B. BMJ 1994;309:1339.
7. Wallis DE and Boxall EH. Immunisation of infants at risk of perinatal transmission of hepatitis B: retrospective audit of vaccine uptake. BMJ 1994; 318(7191): 1112-3.
8. Dunn J, Shukla R, Neal K. Survey of neonatal hepatitis B vaccination in Leicestershire. Comm Dis Public Health 1999; 2(3): 218-9. Available at <http://www.hpa.org.uk/cdph/issues/CDPHVol2/no3/shorts.pdf>
9. Larcher VF, Bourne J, Aitken C, Jeffries D, Hodes D. Overcoming barriers to hepatitis B immunisation by a dedicated hepatitis B immunisation service. Arch Dis Child. 2001 ;84(2):114-9
10. Nesbitt A, Heathcock R, Dunn J, Shukla R, Neal K. Integration of hepatitis B vaccination into national immunisation programmes. BMJ 1997; 315: 121.
11. PHLS. COVER programme : January to March 2001. Commun Dis Rep CDR Wkly [serial online] 2001 [cited 19 December 2006]; 11 (25): Immunisation. Available at <http://www.hpa.org.uk/cdr/PDFfiles/2001/cdr2501.pdf>.
12. Department of Health. Policy and Guidance. Health reform article. Reorganisation of ambulance trusts, SHAs and PCTs . Available online at <http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/HealthReform/HealthReformArticle/fs/en
?CONTENT_ID=4135663&chk=4bDZqY>.
