Report of the system of vaccination uptake 1998-2003, in the Health Service Executive Mid-Western Area / prepared by Kevin Kelleher ... [et al.] Item Type Report Authors Kelleher, Kevin Rights HSE Download date 05/10/2021 12:45:03 Link to Item http://hdl.handle.net/10147/43817 Find this and similar works at - http://www.lenus.ie/hse Report of the system of Vaccination Uptake 1998 – 2003, in the Health Service Executive Mid-Western Area September 2004 Prepared by Dr Kevin Kelleher Mr Dominic Whyte, Dr Rose Fitzgerald Director of Public Health Surveillance Scientist Specialist in Public Health Medicine Dept of Public Health, Health Service Executive Mid-Western Area, Catherine Street, Limerick Dr Frank Houghton Ms Esther Connellan Dr Ann Hogan Health Geographer Immunisation Co-ordinator, Regional Child Health Co-ordinator, HSE-MW HSE-MW HSE-MW Page 1 of 34 Introduction: Vaccination is offered to all children born in Ireland and other groups. Administration of the vaccines is performed according to the Immunisation Advisory Committee of the RCPI publication – “Immunisation Guidelines for Ireland” (2002). The primary childhood immunisation programme (PCIP) covers vaccination against diphtheria (D), tetanus (T) and pertussis (P). These have been available as 2-in-1 and 3-in-1 vaccines. Vaccines against polio and Haemophilus influenzae b (Hib) have been added to give 4-in-1 and 5-in-1. These are normally completed within 12 months from birth. The Mumps, Measles, Rubella (MMR) vaccine is given at 12 months now but may have been administered at 15 months. BCG vaccination is given near birth. Vaccination against N. meningitidis group C was introduced in October 2000. Uptake statistics regionally and nationally depend on all general practitioners returning, in a timely fashion, notification of vaccination in all children. The target uptake desired is 95% of all eligible children. At this level in a homogenous population, there is a good community protective effect which will benefit the remaining unvaccinated population. However, exposure to the disease may still cause infection in those not vaccinated. Vaccination is a child’s best defence against a range of potentially fatal childhood diseases. Uptake of the PCIP, especially MMR has suffered greatly from adverse and ill-founded scientific and media reports. Primary childhood immunisation in Ireland is free of charge – for both vaccine and visit to the doctor. Acknowledgements: The Department of Public Health appreciates the efforts of the public health nurses, area medical officers, senior area medical officers and general practitioners for their role in facilitating the timely collection and collation of vaccination uptake data. The Department is grateful to systems analysts Anne Keane and Margaret Mansell in Management Services for their role in implementing and maintaining the IT infrastructure for recording and reporting of vaccination uptake in the region. Page 2 of 34 Method: The CareWorks Immunisation database in the Health Service Executive-Mid Western Area (HSE-MW), formerly Mid-Western Health Board, was utilised to export data concerning three cohorts of children born between July 1st 1998 and June 30th 2003. These data were stratified by Electoral Division (ED) and by county. Cohort 1: Children born between July 1st 1998 and June 30th 2000 were examined. Uptake for DTP/Polio/Hib and MMR were computed. This is a two-year cohort and DTP/polio/Hib and MMR vaccinations would be completed. Cohort 2: Children born between July 1st 2000 and June 30th 2002 were examined. Uptake for DTP/Polio/Hib and MMR were computed. This is a two-year cohort and DTP/polio/Hib and MMR vaccinations would be completed. Cohort 3: Children born between July 1st 2000 and June 30th 2003 were examined. Uptake for DTP/Polio/Hib, MMR and MenC were computed. This is a three-year cohort and DTP/polio/Hib and MenC vaccinations only would be completed. On a quarterly basis the vaccination uptake at 24 months and 12 months is assessed and reported to the Health Protection Surveillance Centre (HPSC). The data used in this report is “live” data and represents the current vaccination status of the cohorts at the end of August 2004 and not when the reports for the HPSC were produced. Considerable cleaning of systems and data has been carried out by the medical, nursing and management services personnel, to improve the quality of vaccination data in the HSE-MW. Anomalies still occur and data must be regarded as provisional. The data includes only children eligible for vaccination (those born minus those who died minus those who moved out of the area plus those moved into the area) Birth rates vary hugely within small areas like EDs from no births to almost 200 births per year. For the 2 year cohort there was an average of 21.6 births per ED (Median=10) and for the 3-year cohort there was an average of 33.6 births per ED (Median=17). The tables in this report include EDs in comparisons, only when over 20 births occurred in the cohort for the ED. There are 417 EDs in the HSE-MW region. Limerick City – 37 (about 1500 persons/ED) Limerick County – 136 (about 890 persons/ED) Clare County – 163 (about 650 persons/ED) Tipperary North – 81 (about 750 persons/ED) Over the period July 1998 to June 2003, two EDs reported no births – Lackagh in Tipperary North and Clareabbey (part in UD) in Clare. With 417 EDs it is not always feasible to label areas. Variance in codes, sectors and regions make it difficult to establish contiguous geographical boundaries recognisable to all. Key Questions: What is the current DTP/polio/Hib vaccination uptake for Cohort 1 and Cohort 2 / Cohort 3? What is the current MMR vaccination uptake for Cohort 1 and Cohort 2? What is uptake like in the HSE-MW and the counties therein? Which EDs perform best and which perform worst with respect to uptake? Page 3 of 34 Review: Data on vaccination uptake in the HSE-MW has been reported from the Department of Public Health since 1998. The data illustrate a constant improvement in uptake of DTP/polio/Hib, but uptake still falls short of 95%. Data shown in this section is based on uptake at 24 months. Data has not always been available for uptake by county. However, recent data suggests that uptake of DTP/polio/Hib is best in Tipperary (often over 90%) compared to Limerick and Clare. Clare has shown improvements in recent months, rising from 82% to 87%. For MMR the uptake is lower than DTP/polio/Hib and it varies greatly but has improved over the last two years. In 2004, it recovered to levels seen in 2000/2001 (83%). D3/T3 P3 Hib3 MMR1 Polio3 95 90 85 80 75 Uptake % (24months) Uptake % 70 2 01 01 02 000 000 1999 2 2 20 20 20 200 2003 2003 2004 1 3 1 3 1 3 1 3 1 Q Q3 1999 Q1 Q Q Q Q Q Q Q Q Period Figure 1: Vaccination uptake at 24 months for diphtheria, tetanus, pertussis, Hib, polio (DTP/Hib/polio-3 doses) and measles, mumps and rubella (MMR-1 dose) in the HSE-MW, 1999-2004. In early 2000, the uptake rates for all vaccinations were very low. Data for BCG vaccination uptake is available through the Parent Child Health Record and is reported to be between 85 and 88%. Page 4 of 34 Results: There are about 4500 births annually in the HSE-MW each year. A number of children move in and move out of the area. Caveat: EDs in rural areas can be large and may have small numbers of births. Uptake in areas with small numbers of births must be interpreted cautiously as variation in uptake from year can be large. Uptake of diphtheria, tetanus and polio is generally 1-2% better than uptake of pertussis and Hib vaccination. The number of eligible children in the three cohorts examined are shown in the tables below and uptake rates (county rate rounded to 0.5%, HSE-MW to 0.1): Table 1: Number of eligible children, percentage vaccination uptake, by area (HSE- MW). Eligible children Area 1998 - 2000 2000 - 2002 2000- 2003* Limerick City 1398 1323 2041 Limerick County 3108 3137 4906 Limerick (all) 4506 4460 6947 Clare 2831 2959 4551 Tipperary North 1690 1639 2521 HSE-MW 9027 9058 14019 *Three year cohort %Uptake Diphtheria, Tetanus Area 1998 - 2000 2000 - 2002 2000- 2003* Limerick City 86 87.5 87 Limerick County 84.5 88 88 Limerick (all) 85 88 88 Clare 84.5 88.5 88.5 Tipperary North 86.5 88 88 HSE-MW 85.1 88.2 88.2 %Uptake Pertussis Area 1998 - 2000 2000 - 2002 2000- 2003* Limerick City 84 85.5 85.5 Limerick County 82 86.5 87 Limerick (all) 82.5 86.5 86.5 Clare 81.5 87 87.5 Tipperary North 85 87.5 87 HSE-MW 82.6 86.6 86.9 %Uptake Polio Area 1998 - 2000 2000 - 2002 2000- 2003* Limerick City 86 88 87 Limerick County 84.5 88 88 Limerick (all) 85 88 88 Clare 84.5 88.5 88.5 Tipperary North 86.5 88 88.5 HSE-MW 85.1 88 88.2 Page 5 of 34 %Uptake Hib Area 1998 - 2000 2000 - 2002 2000- 2003* Limerick City 84.5 87 86.5 Limerick County 84 87.5 88 Limerick (all) 84 87.5 87.5 Clare 84 88 88 Tipperary North 85.5 87.5 87.5 HSE-MW 84.4 87.6 87.7 %Uptake Men C* Area 1998 - 2000 2000 - 2002 2000- 2003 Limerick City - 83 83.5 Limerick County - 85 86 Limerick (all) - 84.5 85.5 Clare - 84 85.5 Tipperary North - 84.5 85.5 HSE-MW - 84.8 85.4 *introduced October 2000 %Uptake MMR Area 1998 - 2000 2000 - 2002 Limerick City 85 85 Limerick County 84.5 86 Limerick (all) 84.5 85.5 Clare 83.5 83.5 Tipperary North 87.5 88 HSE-MW 84.8 85.4 These data show that uptake levels can be slightly higher than reported to HPSC.