Starting Well - Health

High vaccination rates are the key factor in preventing the spread of infectious disease, and to help protect the population at both individual and collective levels.

Vaccinations work by stimulating the immune system to develop a memory of a specific disease, protecting it from further exposure to the same disease. The aim of a vaccination programme is to offer mass immunisation for a particular disease in order to protect either the entire population from it, those at high risk, or to eliminate it completely.

Immunisation programmes not only provide protection to vaccinated individuals – they can also provide protection to the wider population. This is known as ‘herd immunity’. Herd immunity can be defined as: 'immunity that occurs when the vaccination of a significant portion of a population (or herd) provides a measure of protection for individuals who have not developed immunity’ (Vaccines Today, 2015).

The World Health Organization (WHO) recommends that at least 95% of children are immunised against polio, diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), measles, mumps and rubella as these are all diseases preventable by immunisation.

Screening is the process of identifying apparently healthy people who may be at increased risk of a given disease or condition. They can then be offered information, further tests and treatment to reduce their risk from the condition or any potential complications associated with the condition.

Childhood Vaccinations

Dtap / IPV / Hib (Diphtheria, Pertussis, Tetanus, Haemophilus influenzae type b and Polio)

Hartlepool have failed to reach the 95% cover rate for the Dtap / IPV / Hib vaccination for one year olds for the last four years.

Hartlepool’s coverage rate of 93.2% in 2017/18 is the lowest since 2011/12, and is the 4th consecutive year the rate has not increased. However, even accounting for the four year downward trend, Hartlepool’s coverage rate has remained in line with the England average, staying within 0.1% of the England average in the last four years.

The Dtap / IPV / Hib vaccine for two year olds however, has consistently hit the 95% coverage rate in Hartlepool for the last six years.

Hartlepool’s coverage rate in 2017/18 of 96.7% is the highest of the eight year reporting period. The coverage increase in 2017/18 ended a run of two years where the coverage rate declined. Hartlepool’s coverage rate has been above the England average since 2014/15, with the gap in 2017/18 of 1.6%pp being the largest across the reporting period.

Hib / MenC Booster (Haemophilus influenzae type b and meningitis C)

The booster for Hib / MenC has seen an increase in its coverage rates in Hartlepool for both two year olds and five year olds.

The booster for two year olds has increased its coverage rate from 87.5% in 2010/11 to 92.1% in 2017/18. After a three year period of year on year improvement up to 2013/14, Hartlepool’s coverage rate has alternated increases and decreases. Hartlepool’s 2017/18 rate is marginally above the England average of 91.2%.

For five year olds the coverage rate again starts below 90%, 88.4%, and again rises year on year, though this time for four years, reaching a high of 94.8%. However, unlike the booster at two years old, the five year olds have had a much more stable period after the year on year increases, stabilising at around 94.5%. Hartlepool’s coverage rate has been superior to the England average for the past four years, though the gap between the two rates has closed in the last two years.

MMR (Measles, Mumps and Rubella)

Hartlepool’s MMR for one dose at two years old has improved greatly over the eight year reporting period, beginning at 85.4% in 2010/11 and reaching a high of 92.4% in 2017/18.

However Hartlepool has failed to reach a 95% coverage rate every year across the eight year reporting period. After a rapid increase from 84.8% in 2011/12 to 91.7% in 2013/14 Hartlepool has had four years of inconsistent trend in its coverage rate, increasing twice and declining twice. During the same four year period the England average has seen a gradual year on year decline, culminating in Hartlepool’s coverage rate overtaking the England average for the first time in 2017/18.

MMR for one dose at five years old has achieved 95% coverage rate in Hartlepool for each of the last three years, and for five of the last six years.

Hartlepool’s coverage rate has, with the exception of 2014/15, been higher than the England average across the reporting period. Hartlepool’s 2017/18 coverage rate is a slight decrease on the preceding rate, but still remains above 95%, and above the England average.

However, when looking at coverage rates for MMR for two doses at five years old, the picture is very different.

Hartlepool has failed to reach 90% coverage for six of the eight years, with the 2017/18 rate of 87.9% the second consecutive year of decline, and the second consecutive year of below 90% coverage. However this is still slightly above the England average of 87.2%.

PCV (Pneumococcal infections)

Hartlepool’s PCV coverage rate initially increased at a faster rate than the England average.

However since meeting the England average in 2013/14 Hartlepool’s coverage rate has broadly followed the same pattern as the wider England average. Hartlepool’s coverage rate has remained above 90%, but below 95% across the entire reporting period.

The PCV booster also initially increased at a faster rate than the England average.

Hartlepool’s coverage rate of 85.1% in 2010/11 was increased up to 91.7% in 2013/14, to sit significantly closer to the England average of 92.4%. However since this point the Hartlepool coverage rate has been quite inconsistent, alternating between increases and decreases in alternating years. Hartlepool’s coverage rate in 2017/18 was an increase on the previous year of 3%pp, the largest single increase in the reporting period. This has taken Hartlepool above the England average by 2.5%pp.

Flu

Hartlepool’s flu vaccination coverage rates for 2-3 year olds has not exceeded 40% in the four year reporting period.

Hartlepool’s coverage rate has remained substantially below the England average throughout the reporting period. Hartlepool’s 2017/18 rate of 31.1% is a decrease on the previous year, the only decrease in the reporting period, and creates the largest gap, 12.4%pp between the Hartlepool rate and the England average of the four year reporting period. Hartlepool’s coverage rate is below 1 in 3 throughout this period.

HPV (Human Papillomavirus)

Hartlepool’s coverage rate for HPV for one dose for females 12-13 years old has declined from 93.6% in 2014/15 to 82.2% in 2017/18.

Hartlepool has seen a year on year decrease for the last three years, moving Hartlepool from a position above 90% coverage in 2014/15 to 82.2% in 2017/18. During the same period the England average has stabilised at around 87% coverage, meaning that Hartlepool has moved from a position of superiority to the England average in 2014/15, to one of inferiority in 2017/18.

Hartlepool’s HPV vaccinations for two doses for females aged 13-14 has seen wildly inconsistent coverage.

Hartlepool’s coverage rate in 2015/16 was 90.1%, above the England average of 85.1%, however this almost halved the following year, when coverage fell 44% to 50.4%, well below the England average of 83.1%. This was followed in 2017/18 by an increase of 74%, up to 87.6%. While this is only three years’ worth of data, there has so far been a lack of consistency in Hartlepool’s coverage rate for HPV for 13-14 year olds.

Current Services

Vaccinations

Children’s vaccination is commissioned by NHS England and the childhood vaccination programme which includes is delivered by GP’s in Primary Care.  The school based vaccination which includes HPV (boys and girls), Tetanus, diphtheria and polio and Meningococcal Groups A, C, W and Y disease is provided by Harrogate and District Foundation Trust.  This programme is delivered in school based settings.  Click on the following to access the routine immunisation schedule from autumn 2019 Immunisation Schedule

Screening

Children’s screening is commissioned by Hartlepool and Stockton CCG and is provided by North Tees and Hartlepool Foundation Trust.  The following screening activities take place: screening for infectious diseases, inherited conditions, Downs, Edwards and Patau’s Syndromes and screening for abnormalities at 18 -21 weeks.

Screening tests will also be offered to babies’ antenatal period, this screening is commissioned by NHS England and provided by North Tees and Hartlepool Foundation Trust.  These screening tests includes: new-born physical examination, new-born hearing screening and new-born blood spot screening.  Click on the following link to access more information about children’s screening programmes https://www.nhs.uk/conditions/pregnancy-and-baby/screening-tests-abnormality-pregnant/

Future Intentions

Vaccinations

The variation between some of the vaccination coverage is of a concern particularly the second dose MMR at 5 years.

Work to understand the cover data and the quality of the data submitted has commenced.  This will ensure that we have robust understanding of the coverage of all childhood vaccinations.

We will work with the provider of school based immunistions to ensure that they have access to school rolls in order to identify children to be immunised.

RETURN TO JSNA HOMEPAGE