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Childhood immunisations and public health nursing

Marilyn Eveleigh
Consultant Editor

By the time you are reading this, the national childhood immunisation schedule will have incorporated some significant changes, and GPs, practice nurses and health visitors will be at the forefront of making those changes. If readers need more information, turn to page 6 for a summary or, better still, go to the DH website
(www.dh.gov.uk/AboutUs/HeadsOfProfession/ChiefMedicalOfficer/CMOLetters/f...) for the full announcement.
The leaked news of the changes on the front page of the Daily Telegraph in August added to the intensity of the debate, particularly regarding the reassurance that parents ask of the person who gives their child the vaccination - usually a practice nurse. Can readers say they were prepared for the responsibility that carried? Were you all aware of what the changes were and why they were happening? I have been fascinated with how the announcement has impacted on the key players - the DH, primary care staff in surgeries and parents have all viewed the news from a different angle.
There has been the bigger picture proclaiming the public health benefits of this change  - and no one should underestimate the phenomenal success of the national and international immunisation programme. It has provided an opportunity to remind everyone how important mass vaccination is to public wellbeing when there has been a succession of bad press around a particular vaccine that has created doubt and reduced uptake of the whole immunisation programme. The good news is that improvements in disease control and eradication worldwide have reduced the risk of polio being brought into the country. Therefore, an inactivated intramuscular polio vaccine can now replace the oral dose previously administered - given at one time on a sugar lump! The new measure is safer, and there is less room for error in administration.  
Parents have needed additional explanation and reassurance - fitted into overstretched appointments. There have been tangible elements of unease and suspicion in parents over the existing immunisation schedule, which often came to a head at the immunisation appointment. Nurses and GPs have now had to rapidly assimilate the new evidence for change, translate that for patients and explain the implications for parents in agreeing to consent. Such was the level of suspicion that the withdrawal of the mercury-based preservative used for the last 60 years was frequently discussed as being an added bonus of the vaccine change and not the reason for it. All in a day's work …
At practice level there has been some very frenzied activity: getting the supplies from the manufacturer, ensuring all staff understand the new changes and preparing patient information and consent accordingly. In addition, there has been the practical reality of practices rapidly having to order new or more supplies of needles and syringes. The new primary vaccine at 2, 3 and 4 months is supplied in a single-dose vial that needs drawing up, and not in the prefilled syringes that staff have used in the past. Add to that heady challenge the need for adapting to new Patient Group Directions(*) (PGDs), in support of prescription-only medication supplied and administered by a nurse, and we should be congratulating ourselves in primary care.
*PGDs are available on the above-mentioned website.
Yet again, caught up in the slipstream of media and government announcements, primary care nurses have responded with professionalism and pragmatism. The supply of DH centrally designed PGDs to support the changes was appreciated, but more robust warning would have avoided some of the tensions that the recent weeks have brought.