Giving MMR alongside teenage vaccines in schools Barbara Morgan Senior Nurse Quality Assurance School Nursing Firstly I would like to thank Simon and the team in Public Health Wales and VPDP for allowing me to use their tables in my presentation, sorry if I repeat some of what Simon has just said but I am repeating it with regards to figures for uptake in Hywel Dda University Health Board. .

Back ground Hywel Dda includes 3 local authority areas which is a mix of rural with some urban areas. Hywel Dda University Health Board area, covering a quarter of the landmass of Wales (5,781 square km), is the second most sparsely populated HB area after Powys. Within Hywel Dda University HB, Carmarthenshire accounts for 41 per cent of the land area There are approximately 44,000 school aged children 5-16 years old In 211 primary schools and 26 secondary schools, 3 special schools and 3 private schools. A teams of 55 staff , skill mix of Band 6, Band 5 and Band 3 all working part time term time only

Why do we bother! Page Title Source: Public Health Wales Tables show all Wales levels of uptake of MMR 1 & 2 and then the levels by individual HB, Hywel Dda is second lowest for MMR 1 despite the work that went into the catch-up programme in 2012-13 local outbreak of measles. Source: Public Health Wales

Why do we bother! Source: Public Health Wales These tables speak for themselves, any increase identified is worth the slight increases in effort. Source: Public Health Wales

Why do we bother! Public health role prevention of further outbreaks Prudent health care We’re already in schools immunising

Risks and challenges Professional concerns increase in vaccine errors pupils will not be compliant parents will not consent for 3 vaccines for fear of overload Pilot carried out in a small secondary school Pilot carried out in one secondary school which was successful so rolled out to the remaining schools., Initially only targeted pupils that had originally had MMR1, now routinely offered to all pupils with none or incomplete MMR status

School Sessions Named nurse for school checks consent forms, separates pupils needing 3 One nurse does either 2 or 3 injections at a time MenACWY & MMR same arm 2.5cm apart dT/IPV in the other arm

Immunisation incidents recorded 2016-17, only 1 incident is recorded as vaccine error should actually be recorded as a consent issue and was regarding fluenz.

Source: Public Health Wales

Source: Public Health Wales

Session in school 2018 Video clip of an immunisation session carried out in Coedcae School, Llanelli Teenage booster, MenACWY and MMR

A Whole Team Approach All nurses now deliver vaccines in this manner No new concerns have ever emerged School nurses now looking proactively at immunisation history for any opportunity to complete immunisations. This is a snap shot of a session in school, this is being shown to evidence how simple and easy it is to administer 3 vaccines to one pupil and to show how well it is received by pupils.

Thank you for listening