1. Protecting Children’s Health
© Leah Millinship
Protecting Children’s Health
Practice nurses and MMR immunisation
Nicola Joyce

2. Wales 3 Million People 492 General Practices 7 new Health Boards
22 Local Health Boards (LHBs)
7 NHS Trusts
1 National Public Health Service (NPHS)
Background and 1 Welsh Assembly Government

3. Within Wales in 2008/9 there were 46,080 school aged children age 5-18 years who had inadequate protection against measles, mumps and rubella (only one dose of MMR) and 39,807 with no protection.
Around 1 in 10
© Leah Millinship

4. MMR Protects from measles, mumps and rubella A course of 2 vaccines
Included in the childhood schedule at ages 13 months and 3 years 4 months

5. MMR uptake is improving but remains suboptimum
MMR1 at 2 years of age
Improvement noted as distance between the media height of poor information sharing now builds we are currently seeing an outbreak of measles in Wales with media coverage more focused on the potential; severity of the disease
COVER Apr-Jun 2008
COVER Apr-Jun 2009

6. MMR uptake is improving but remains suboptimum
MMR at 5 years of age
COVER Apr-Jun2009
Still not great!
After starting school at 5 no more scheduled appointments for imms for a few years- so which HCP are they likely to see and be offered imms opportunistically??
MMR1
MMR2

7. MMR uptake is improving but remains suboptimum
MMR at 15 years of age
COVER Apr-Jun 2009
MMR2 remains poor (less than 90% in most areas
MMR1
MMR 2

8. Parents attitudes to MMR
MMR easily remains the most recognised immunisation.
In November 2008, MMR was still considered to be amongst the least safe immunisations
Only MMR was seen as an immunisation where the risk of the immunisation may outweigh the risk of the disease.
MMR was the vaccine parents were by far most likely to deliberate over.
BMRB
© Leah Millinship

9. People trust HCPs (GP data only for 05 06)
Chart 6.3.4: Trust of advice given by different sources about immunisation
People trust HCPs (GP data only for 05 06)
Childhood Immunisation Wave 20 (Wales) report - February 2008, BMRB., available at

10. The practice nurse role
A postal questionnaire was sent to all practices in Wales.
Response rate was 70% (345)
All LHBs were represented
Practices were of varying sizes
Urban, rural and suburban practices
68% (235) advised on immunisation
74% (257) administered immunisations
Is the PN role in child immunisation key?
© Leah Millinship

11. How much do you agree with the following phrases?
I feel confident in explaining to parents about the safety of the MMR vaccine
I agree  I disagree  I am unsure 
I feel confident explaining to parents the reasons for giving the second dose of MMR vaccine
I agree  I disagree  I am unsure 
The policy of giving a second dose of MMR vaccine is entirely appropriate

12. MMR safety – a practice nurse perspective
82% (275) were confident they could explain the safety of MMR vaccination to parents
2% (6) disagree
7% (25) were unsure
© Leah Millinship

13. Confidence rows with experience- does this reflect knowledge base?

14. MMR schedule - a practice nurse perspective
83% (280) agree with the 2 dose schedule
1% (2) disagree
6% (21) remain unsure
Does experience or training influence insight and confidence in the r dose schedule

15. AT 1year- everyone agrees!!

16. In the least experienced nurses although all agreed with the policy they were most likely to lack confidence in explaining this to parents Confidence grows with experience

17. Training influence on knowledge and confidence in MMR
Various training providers were identified
51% (167) of the practice nurses who had attended immunisation training had done so in the last year.
9% (32) identified training either never (2) or more than 2 years ago.
Length of training ranged from 1 hour to more than 2 days.
What was our resoponse ont his?
© Leah Millinship

18. 2003 and 2004 only 1 in each group
From 2005 on the more recent the training ???take this one out??

19. Significant, so recent training has an impact on this
If training was less recent there is the possibility it was during MMR controversy - has information been updated? NB recent shift in media attention and Measles is increasing
More recent the training- more likely to agree-increased knowledge

20. Significant
More recent the training- more confidence likely

21. Do practice nurses know what they don’t know?
They are aware of their own training need in immunisation. So can they address it?
Those who identified a need for training were less confident.

22. So the group who have identified a training need are more likely to lack confidence in this area- implies a self awarenes of lack of knowledge

23. So the group who have identified a training need lack confidence in explaining this to parents too

24. In conclusion Parents trust health care professionals
Practice nurses have input into child immunisation - advising and administering
More experienced practice nurses are more likely to have greater confidence in explaining issues around MMR
Nurses who have attended immunisation training recently are proportionately more likely to agree with the 2 dose schedule and be confident in explaining MMR related issues to parents
Practice nurses in Wales are broadly aware of their own immunisation training needs

25. Thanks are extended to Simon Cottrell, Epidemiologist, NPHS