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  1. 1. Immunisation Barnet, in common with all other London boroughs, now faces the likelihood of a measles epidemic. In the last year of 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. Figure90 The number of reported cases of measles in Barnet in recent years 1: The 80 70 60 50 40 30 20 10 0 2005/06 2006/07 2007/08 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 immunised 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 in Figure 2. Figure 2: Notified cases of measles in London by sector and district between 1 January and 5 July 2008 Source: Health Protection Agency. Measles and MMR uptake in London, 2008
  2. 2. Figure 3 shows how MMR immunisation rates have dropped, more so in London than in the rest of the country. Figure 3: MMR uptake at age 2 years for London and UK – January 1996 – March 2008* Source: Health Protection Agency. Measles and MMR uptake in London, 2008 Cover data and trends in vaccine uptake 2005-2008 Figure 4: Immunisation rates in Barnet by children’s fifth birthdays 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 Figure 4 shows the current achievement in immunising 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. 
  3. 3. This shows clearly that MMR immunisation 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. The relationship between diversity and deprivation and infectious disease 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 (see Figure 5). It is not clear why this should be and it is not apparent that this is the case in Barnet. Figure 5: The number of reported cases of measles in North East and North Central London in 2007/2008 by religious/ethnic group (Source: Health Protection Agency) 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 Local targets In common with other London PCTs, Barnet has agreed to increase all of its childhood immunisations to 90% by 2010/2011. Figure 6 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.
  4. 4. Figure 6: 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 Key things that need to be done 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 PCT’s 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, children’s centres, children’s 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,  children’s centres, NHS facilities and other places to promote immunisation.