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Opportunistic immunisation in schools may be more effective than immunisation in hospital
  1. RICHARD J ROBERTS, Consultant in Communicable Disease Control
  1. Department of Public Health
  2. North Wales Health Authority
  3. Hendy Road, Mold, Flintshire CH7 1PZ, UK
  4. dr.richard.roberts{at}nwales-ha.wales.nhs.uk
  5. Conway and Denbighshire NHS Trust
  6. Royal Alexandra Hospital
  7. Marine Drive, Rhyl, Denbighshire LL18 3AS, UK
  8. North East Wales NHS Trust
  9. 16 Grosvenor Road, Wrexham LL11 1BU, UK
  10. Department of Public Health
  11. North Wales Health Authority
    1. SARAH HORROCKS, Consultant Community Paediatrician
    1. Department of Public Health
    2. North Wales Health Authority
    3. Hendy Road, Mold, Flintshire CH7 1PZ, UK
    4. dr.richard.roberts{at}nwales-ha.wales.nhs.uk
    5. Conway and Denbighshire NHS Trust
    6. Royal Alexandra Hospital
    7. Marine Drive, Rhyl, Denbighshire LL18 3AS, UK
    8. North East Wales NHS Trust
    9. 16 Grosvenor Road, Wrexham LL11 1BU, UK
    10. Department of Public Health
    11. North Wales Health Authority
      1. ADELE KELLY, Consultant Community Paediatrician
      1. Department of Public Health
      2. North Wales Health Authority
      3. Hendy Road, Mold, Flintshire CH7 1PZ, UK
      4. dr.richard.roberts{at}nwales-ha.wales.nhs.uk
      5. Conway and Denbighshire NHS Trust
      6. Royal Alexandra Hospital
      7. Marine Drive, Rhyl, Denbighshire LL18 3AS, UK
      8. North East Wales NHS Trust
      9. 16 Grosvenor Road, Wrexham LL11 1BU, UK
      10. Department of Public Health
      11. North Wales Health Authority
        1. SUE WILLIAMS, Epidemiology Assistant
        1. Department of Public Health
        2. North Wales Health Authority
        3. Hendy Road, Mold, Flintshire CH7 1PZ, UK
        4. dr.richard.roberts{at}nwales-ha.wales.nhs.uk
        5. Conway and Denbighshire NHS Trust
        6. Royal Alexandra Hospital
        7. Marine Drive, Rhyl, Denbighshire LL18 3AS, UK
        8. North East Wales NHS Trust
        9. 16 Grosvenor Road, Wrexham LL11 1BU, UK
        10. Department of Public Health
        11. North Wales Health Authority

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          Editor,—We support Conway's call for immunisation to be given greater emphasis during medical training, and for opportunistic immunisation in hospital to be more widely practiced.1 However, even in the context of that study, only 43 of 183 eligible children (23.4%) were offered immunisation before discharge. The reasons for this are not stated, but the pressures on the junior doctors asked to administer the vaccinations must have been a significant factor.

          Following a sustained decline in the uptake of MMR vaccine,2 we explored the feasibility of opportunistic immunisation with MMR vaccine during doctors' routine visits to schools to carry out medical inspections. We selected four primary schools from three counties in North Wales during May 1999. Out of a total of 2145 pupils in the schools, born between 1 September 1987 and 31 August 1994, 492 (22.9%) had not received two doses of MMR vaccine based on data held on the Child Health Computer database. The parents of these pupils were sent a letter describing the complications of measles, strongly recommending immunisation, and inviting them to return written consent to immunisation in school, also offering an opportunity to discuss MMR with the school doctor first if required. Of the 492 pupils given letters to take home, the parents of 242 (49.2%) consented and were vaccinated during a single visit to each the four schools.

          A large proportion of children in these primary schools had not received two doses of MMR. If the control of measles is to be maintained and the disease eventually eradicated, 95% of children must receive two doses of measles vaccine.3 Our findings suggest that opportunistic immunisation during routine visits to schools to carry out school medicals would be an efficient and effective method of targeting children who have not received two doses of MMR.

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