By Carol Dezateux, Professor of Clinical Epidemiology and Health Data Science at the Clinical Effectiveness Group (CEG), Queen Mary University of London
Measles is entirely preventable, and it is thanks to five decades of routine preschool immunisation that many people alive in the UK today have never seen the effects of measles first-hand. It is a serious, highly contagious infection and vaccination prevents illness and disability, and saves lives.
Worryingly, childhood immunisation rates in London are among the worst in Europe and consistently below the levels required to protect our children and their communities from these serious infections: this has worsened during the Covid-19 pandemic. Not a single London region is currently meeting the World Health Organization target of 95% coverage for MMR - the immunisation that protects children from measles, mumps and rubella. When rates fall below 95% there is a real danger of a measles outbreak. We also know from our research that some groups are disproportionately at risk of measles: in some areas, fewer than 60% of children are protected from measles by 18 months of age, the recommended time for protection. This has consequences for children living in very deprived areas or who come from families from certain ethnic backgrounds. These inequalities mean that the risk and consequences of a measles outbreak will be disproportionately borne by children and families who already face multiple social and economic inequalities and are living in disadvantaged neighbourhoods where international travel to areas where measles is endemic is common.
Health data scientists, clinicians and facilitators in the Clinical Effectiveness Group (CEG) at Queen Mary are meeting this challenge by developing a quality improvement programme in general practice which includes a software tool built in-house by CEG data scientists. This Active Patient Link immunisation (APL-Imms) tool uses data from the patient records within a GP practice to help staff identify at a glance which children are due or are late in getting their immunisations. This may sound simple, but GP practice IT systems are not set up to do this in a straightforward way. Without the tools to help practice teams systematically review, prioritise and call families, the requirement to administer 17 different preschool vaccines on 9 occasions can become difficult to manage. It becomes even more complex when a child’s vaccine schedule was disrupted or started abroad, which is common in London’s mobile populations.
CEG’s software tool ‘APL-Imms’ was launched across the NHS North East London region in February. It has now been downloaded by 150 practices – that’s more than half in the region – and our primary care support team are on the ground supporting practice staff to use it effectively. The tool forms part of a wider quality improvement programme led by CEG which was selected and funded as a 'pathfinder' for the London Health Data Strategy. The programme will extend to the South East and North West London regions later in 2022 in close collaboration with our project partners in those regions.
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