Vaccines are a great global health success. However, in the UK, populations remain vulnerable to vaccine-preventable diseases due to variable coverage. Recent data for Lancashire and Greater Manchester showed 93.5% of children had completed a primary course of tetanus vaccination and 90.2% had received a first dose of MMR (MMR1) by their second birthday. Every year in England, millions of children and young people (CYP) attend Paediatric Emergency Departments (PED), with under-twos relatively over-represented. Many may have additional unmet health need (e.g. be under-immunised). The PED attendance therefore offers an opportunity to improve health beyond the reason for presentation and a pilot suggests that parents/carers are amenable to this. This work is part of a larger project assessing sources of vaccination data and levels of unmet vaccination-related need in PED attendees. The aim of the component presented here was to explore the vaccination status of children under the age of two, with a focus on tetanus-containing vaccines and MMR1. Vaccination is important in the PED management of a tetanus-prone wound and MMR1 protects against measles and mumps, both of which cause outbreaks where vaccination is part of the control strategy.

Methods

This cross-sectional observational study had a single data point for each participant attending the PED of a large district general in Greater Manchester in October 2021. Ethics approval was obtained to use an ‘opt-out’ approach. A power calculation showed 577 participants were needed to detect a five percent difference between PED attendees and their peers. Vaccination data were extracted from individual electronic summary care records (SCR) (part of the primary care record visible to those in secondary care).

Results

In the study period, 724 children under the age of two attended the PED. As first routine immunisations are offered at the age of two months, all those under this age were excluded (n = 116). SCRs were not available for a further 58 children, meaning 550 sets of data were included in the analysis. At the time of attendance, 86.5% of children were up-to-date with tetanus-containing and MMR vaccination (where age-appropriate), when compared to the national schedule (tetanus at 2, 3,and 4 months; MMR around 12-13 months). However, amongst those eligible to receive an MMR (over the age of 13 months; n = 284), this dropped to 81.7%. In this older age group, there were 17 children who had incomplete tetanus and no MMR1.

Conclusion

Children under the age of two attending the PED appear to be no better vaccinated than their local peers and may have even lower coverage rates for MMR1. Ongoing work will look at coverage in older age groups. An earlier part of this work demonstrated that parent/care recall of vaccination status should not be the only source of vaccination data during a consultation (due to its low specificity), suggesting vaccination status should be formally checked where possible e.g. via SCRs. This population might benefit from an intervention to improve vaccination uptake, delivered in the PED and future work will seek to co-design one or more interventions.

Attendance

10.1136/ard.2009.111971

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Citations (51)

Achilles tendon biomechanics in psoriatic arthritis patients with ultrasound proven enthesitis

Scandinavian Journal of Rheumatology (2013)

James Woodburn E. Hyslop Ruth Barn Iain B. McInnes Deborah E. Turner

To investigate Achilles tendon (AT) biomechanics in psoriatic arthritis (PsA) patients with ultrasound confirmed features of enthesitis.PsA patients and healthy control subjects underwent three-dimensional (3D) gait analysis to measure walking speed, rotational joint motion and the moments, power, and AT force at the ankle-subtalar joint complex. The Glasgow Ultrasound Enthesitis Scoring System (GUESS) was used to score the presence of enthesophytes, erosions, retrocalcaneal bursitis, and tendon thickening. Power Doppler ultrasound signal (PDUS) was used to detect active disease. Peripheral joint arthritis, acute-phase reactants, global health, disability, and foot impairments were recorded. A core set of biomechanical variables that influence the insertion of the AT and indirect estimates of tendon loading were compared between PsA patients and control subjects with and without enthesitis.Forty-two PsA patients with a mean disease duration of 10.6 (SD 9.4) years and 29 control subjects were studied. Seventeen (40%) PsA patients had clinically detectable AT entheseal pain. Twenty-eight (67%) PsA patients and nine (31%) control subjects had one or more GUESS enthesitis features, predominantly enthesophytes. PsA patients with enthesitis walked significantly more slowly than control subjects (p = 0.019) and generated lower peak ankle joint moments (p = 0.006), power (p = 0.001), and AT force (p = 0.003). Ankle-subtalar joint complex motion was comparable and no between-group differences were found for peak dorsiflexion (p = 0.59), eversion (p = 0.05), and internal rotation (p = 0.19).In this group of PsA patients, the AT insertional angle was not influenced by ankle-subtalar joint motion in those with and without enthesitis. Moreover, the PsA patients with enthesitis had significantly lower AT loading.

Biomechanics

Subtalar joint

Metatarsophalangeal joints

10.3109/03009742.2012.747626

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Citations (35)

A reliability study of biomechanical foot function in psoriatic arthritis based on a novel multi-segmented foot model

Gait & Posture (2010)

E. Hyslop James Woodburn Iain B. McInnes Ruth Semple Lisa Newcombe

Foot (prosody)

10.1016/j.gaitpost.2010.09.004

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