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Meet the Queen Mary team preventing measles outbreaks in east London

As the UK Health Security Agency (UKHSA) declares a national incident following a measles outbreak in the West Midlands, we look at the work of the Clinical Effectiveness Group at Queen Mary, who are helping GPs to protect our local communities in east London.

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In some east London neighbourhoods almost half of children are completely unprotected from measles by 18 months of age, which is beyond the recommended timeframe for a first dose of the measles, mumps and rubella (MMR) vaccine. The Clinical Effectiveness Group (CEG) in Queen Mary’s Wolfson Institute of Population Health, has been working with local NHS teams to understand the issues and address the problem with a practical intervention.  

CEG’s Child Health team, led by Professor Carol Dezateux, have built a software tool for use by GP practices. It displays data from patient health records to simplify the ‘call and recall’ of children for routine vaccinations. The tool is known as ‘APL-Imms’ (Active Patient Link tool for immunisations) and works in a similar way to other tools built by CEG to manage patients with chronic kidney disease or atrial fibrillation. But APL-Imms is CEG’s most complex tool yet. The algorithms account for 17 pre-school vaccine doses administered on 9 occasions, for every child registered at a practice. Using APL-Imms, GPs can quickly list children who are due or overdue for specific immunisations. The tool also flags anomalies – for example where a child’s vaccine schedule may have been disrupted or started abroad, which is common in London’s mobile populations. Without a resource like this, the childhood immunisation schedule can be very difficult for practices and parents to manage, and this can lead to inequalities in protection.  

Children living in deprived areas are at highest risk 

London had declining MMR vaccine coverage before Covid-19, but the pandemic has made the situation (and inequalities) worse. Research published by CEG in December 2022 found that the proportion of children given the first dose of MMR on time in north-east London dropped from 79% to 75% during the Covid-19 pandemic (the World Health organization recommendation is 95% coverage to prevent an outbreak). The poorest neighbourhoods saw the biggest drop in timely vaccinations – almost 5% in the most deprived areas, compared to 1% in the least deprived areas. The research also revealed an increase in ‘hotspots’ – neighbourhoods where measles outbreaks are most likely because fewer than 60% of children receive the first MMR vaccine on time. Again, these were clustered in the region’s most deprived neighbourhoods. Such inequalities mean that the risk and consequences of a measles outbreak in north-east London are disproportionately borne by children and families who already face multiple social and economic inequalities.  

Empowering GPs with data insight 

About two thirds of GP practices in the north-east London NHS region have now adopted the APL-Imms tool into their childhood immunisation processes, and the CEG primary care support team are on the ground supporting staff to use it effectively. A detailed evaluation of the intervention is underway, but early practice feedback indicates that the tool gives a vital insight into immunisation data, helping practices to tailor their strategies for improving local immunisation coverage, and prioritise the most vulnerable children for appointments. 

Carol Dezateux, Professor of Clinical Epidemiology and Health Data Science at Queen Mary University of London, said: “There is an urgent need to ensure all families have equitable, timely access to routine immunisations, regardless of their circumstances. The risk of an unprotected child catching measles is much higher if they are surrounded by other unprotected children, so we are particularly concerned about ‘hotspots’ where timely vaccination is below 60%.  

“At CEG, we’re working closely with the NHS and local authorities in north -east London, so we understand the immense pressure on primary care teams. We have developed free software tools to support practices to manage and deliver the complex childhood immunisation programme as part of a region-wide quality improvement programme. Our data shows where more targeted services are needed and can support local initiatives to remove barriers to access and ensure all children in the region have an equal chance of protection. We are working with the NHS in north -east London to tackle this problem together.” 

About APL-Imms 

Professor Carol Dezateaux explains how the APL-Imms tool helps GP practice teams call and recall children for their routine immunisations on time. 

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