1. Strategies for improving immunisation rates

2. Factors associated with low vaccine uptake –parents Socio-demographic variables – Certain groups of people, such as those: –in deprived, inner city areas –in mobile families –in large families –with chronic illness –in lone parent families –under local authority care – have been identified as being at risk of being undervaccinated Parental attitudes –to disease –to vaccine – also have a strong influence on decisions whether to vaccinate their child or not

3. Influenza uptake in adults (June 2014, Devon) Change the way you think about Hull. October 2014 Age = uptake increases with age until mobility issues occur Gender = uptake greater in ? What do you think? Ethnicity Association with other lifestyle choices Scepticism, fear about vaccine Level of trust in person recommending vaccine

4. Influenza & pertussis uptake in pregnant women (review of the literature globally, 2015) Change the way you think about Hull. October 2014 Vaccine safety Risk perception Not recommended Poor knowledge Lack of access Conflicting advice

5. HPV uptake in teenage girls: a systematic review (mostly US studies, 2012) Change the way you think about Hull. October 2014 Older age Receipt of childhood vaccines Higher level of vaccine related knowledge Higher usage of health services Having a healthcare provider as a source of information Having a healthcare provider with a positive vaccine attitude

6. Change the way you think about Hull. October 2014 Factors associated with low coverage – Health service Poor co-ordination of immunisation service Unclear or unwillingness to take responsibility Lack of access to current guidelines and policies Misconceptions of contra-indications Computerisation – inaccurate or records not up to date Professional knowledge and attitudes – to disease – to vaccine

7. Change the way you think about Hull. October 2014 Strategies to improve uptake All Healthcare Professionals who immunise need to: Keep up to date with changes to policy and parental concerns Ensure they have access to current vaccine policy Ensure they know who to contact when they need further advice or information Attend regular training updates Make time to discuss parental concerns about immunisation BE KNOWLEDGABLE AND CONFIDENT PROMOTE VACCINATION

8. Change the way you think about Hull. October 2014 Consider immunisation service offered Need to offer a flexible and accessible service to maximise uptake: Are your clinics held at convenient times for patients? Can you hold evening or weekend immunisation clinics? Are you flexible - do you only offer immunisations at ‘baby’ or ‘child health’ clinics? Are clinics adequately staffed with sufficient administrative support? Are clinic appointments of sufficient length to allow discussion with parents/patients

9. Change the way you think about Hull. October 2014 Opportunistic Vaccination Every effort should be made to vaccinate individuals – even if they are older than the recommended age No opportunity to vaccinate should be missed If seeing the individual for a different reason, take the opportunity to check their vaccination status and bring them up to date Remember – there is no limit to the number of vaccines that can be given at any one time

10. Change the way you think about Hull. October 2014 Multi-disciplinary working Work together as a multi-disciplinary team e.g. ensure consistent message e.g. discuss who will and how to follow-up unimmunised patients – be flexible in professional role Involve every member of the team or practice in improving immunisation uptake e.g. ensure Receptionist/ Admin staff aware of the importance of immunisation, that they are positive about it and flexible in booking appointments Encourage different professional groups across the organisation to take interest in and responsibility for improving uptake Share effective practice and discuss successful initiatives with other professionals and practices within the organisation

11. Change the way you think about Hull. October 2014 Community Initiatives Ensure up to date immunisation education material available in places where parents can access them e.g. playgroups, community centres, schools, etc. Identify any groups within the community who are not accessing immunisation Work with community leaders to develop strategies to promote immunisation within these groups

12. Change the way you think about Hull. October 2014 Other initiatives to improve vaccine uptake If in doubt, seek further advice or refer patient to specialist – don’t leave patient unnecessarily un- vaccinated Actively follow-up unimmunised individuals e.g. review records of all 18m children to ensure they have completed primary immunisation course and had 1 st MMR Offer domiciliary vaccination service - take vaccines out to the homes of non-attenders

13. References/further reading Change the way you think about Hull. October 2014 Wilson, R.J. et al. (2015) Understanding factors influencing vaccination acceptance during pregnancy globally: A literature review. Vaccine, 33(47), 6420-6429. Public Health Devon (2014) Factors Influencing Vaccination Uptake. Available online: https://www.england.nhs.uk/south/wp- content/uploads/sites/6/2014/08/influe-vacc-lit-rev.pdf https://www.england.nhs.uk/south/wp- content/uploads/sites/6/2014/08/influe-vacc-lit-rev.pdf Kessels, S. et al. (2012) Factors associated with HPV vaccine uptake in teenage girls: a systematic review. Vaccine, 30(24), 3546-3556