Immunisation state of young children admitted to hospital and effectiveness of a ward based opportunistic immunisation policy

Abstract

Objective - To study the need for and effectiveness of a ward based opportunistic immunisation policy. Design - A six month prospective study. Setting - An acute medical paediatric ward of an inner city teaching hospital. Subjects - 296 children admitted to the ward who lived within Central Manchester Health Authority boundaries and were aged from 5 months to 6 years. Main outcome measures - Completion of immunisation schedule appropriate for age. Results - 56 children were three or more months behind with immunisations. The parent's history was not reliable for 18 children. Accessing health authority immunisation records was not difficult. The main reasons for falling behind were the mobility of the families (15 children), lack of motivation (14) and frequent minor illnesses (9). 40 children were immunised before discharge, but three could not be because of valid contraindications. Of the 16 children requiring more immunisations after discharge, only four obtained them at the correct time and five children not at all. Conclusion - An opportunistic immunisation policy is an important means of immunising a vulnerable group of children who would often default on routine immunisations, and such policies should operate wherever possible. Our ward based policy can achieve immunisation of three quarters of possible children without change or inconvenience to the daily ward work, but efficacy relies on adequate levels of enthusiastic staff. The system can be improved by having accurate and updated immunisation records available in the hospital, and by encouraging nursing staff to participate.