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Establishing an opportunistic catch up immunisation service for children attending an acute trust in London
  1. M Gandhi1,
  2. S McKenna1,
  3. A Geraets1,
  4. R Bhatt1,
  5. M Greenberg1,
  6. A Bartley2,
  7. A J Rodger2,3
  1. 1Department of Child Health, Royal Free NHS Trust, London, UK
  2. 2Department of Infectious Diseases, Royal Free NHS Trust, London, UK
  3. 3Research Department of Infection & Population Health, University College London, London, UK
  1. Correspondence to Minal Gandhi, Consultant Paediatrician, Royal Free Hospital, 10 Pond Street, London NW3 2QG, UK; minal.gandhi{at}

Statistics from

Vaccination rates in London are significantly lower than in the rest of the UK, especially for MMR vaccine. MMR uptake in London ranges from 50 to 75% compared with 80–90% nationally.1 Our aim was to assess the feasibility and acceptability of an opportunistic immunisation service for children attending the paediatric outpatient department (OPD) at the Royal Free Acute NHS Trust (RFH). We are not aware of any UK acute paediatric department currently routinely offering such a service.2 3


Funding was obtained from Barnet and Camden Primary Care Trusts and senior RFH staff supported development of the service. Trust policies, guidelines and checklists were developed. The service was aimed at children >1 month behind immunisation schedule. A combined information leaflet/questionnaire screened for eligibility and collected information on demographics and reasons for failure to immunise. Process mapping of patients attending the OPD was used (figure 1). Immunisation history was obtained from the Personal Child Health Record (PCHR) or if not available by parental recall.

Figure 1

Immunisation service process mapping of patients attending the paediatric outpatient department.


In total, 733 (18%) out of 4070 paediatric OPD attendances from January to July 2009 were screened for immunisation history from parental recall in 62% (456/733), the PCHR in 33% (245/733) or unknown in 32 (4%). Of the 733 screened, 98 children (13%) in the community were identified as not vaccinated due to concerns about illness (26%), allergy (8%) or vaccine safety (17%). Of those eligible, 41 children were immunised and a total of 76 vaccinations were given; 54% (23/41) given MMR vaccine and 14/41 (34%) DTaP/IPV/Hib vaccine (Pediacel). Over half (58%, 24/41) were preschool children and 24% (10/41) were teenagers (figure 2). Of the 57 eligible children not vaccinated, reasons were available only for 21 children, but in 13 cases it was due to parental refusal to consent.

Figure 2

Number of vaccinations per age range

All parents whose children were vaccinated reported that they found the service satisfactory and acceptable. There was initial reluctance by OPD staff to accept the service as a core clinical duty. On review a small number of vaccines (n=5) was noted to have been given out of protocol and this issue was addressed. Strategies and training to improve staff competencies and motivation were developed.


We found that 13% of screened children attending the RFH paediatric OPD over a 6-month period were incompletely immunised. Of these, just under half accepted the offer of opportunistic vaccination including 23 parents of children who accepted MMR. Although the numbers were small, we achieved significant uptake of immunisations in a population who had previously not been immunised in the community. The opinion of an experienced paediatric nurse was crucial in persuading parents to accept immunisations. Changing staff culture to incorporate this service into core clinical practice was our greatest challenge. Providing incentives and timely feedback to staff proved important strategies as was adding the programme to the paediatric targets review. Availability of the online immunisation database (RIO) would improve accuracy of screening for eligible patients.

Parental attitudes towards immunisations and reasons for refusal have been well documented.4 We have demonstrated the value of offering immunisations to children attending OPD in an acute trust to promote immunisation uptake.

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  • Funding Funding for the programme obtained from Barnet and Camden Primary Care Trusts.

  • Competing interests None.

  • Patient consent Parental/guardian consent obtained prior to vaccination.

  • Ethics approval Deemed exempt by the UCLH/UCL Joint Biomedical Research and Development Unit and the Department of Clinical Effectiveness at Royal Free Hospital as the project was part of a service evaluation initiative.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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