Childhood Vaccination Searches

Childhood Vaccination Searches

The childhood vaccination searches have been revamped for 2021. They can be found within the Data Quality set of searches and also feature as part of COVID recovery.

The childhood vaccination schedule has been updated a number of times in the past decade, reflecting the introduction of new vaccines as well as evidence based alterations to the schedule. Whereas the first iteration of Primary Care IT's childhood vaccination searches required annual adjustments, the new searches have been designed to withstand most updates by basing each population on the academic year. Searches are therefore broken down into year group folders (eg: Children born Sep 2019 - Aug 2020).

Within each folder you will find a summary report, and a number of searches to show which patients have completed their courses - broken down to primary vaccinations (8, 12, 16 weeks), age 1 vaccinations, pre-school.

Vaccination Summary

The vaccination summary report displays the date of every vaccine each child has received. Gaps in a row indicate where the child did not receive a dose. The summary does not take into account whether a particular vaccine was coded as declined, meaning not every gap can be filled. Certain vaccinations are also age restricted, so for instance a child over the age of 2 cannot be given a MenB catch-up jab, nor can a baby aged 30 weeks receive a catch-up rotavirus dose.
Each vaccination summary only shows the vaccines recommended when the child was at target age. To accommodate where the schedule changed during the 'academic year' the children are sorted by date of birth, so there are some reports where a column is correctly blank until a specified date. Nurses who administer vaccinations will be familiar with these changeovers.
The dates shown in each cell are the earliest entry for a particular vaccination.
It is worth reviewing each summary report, looking for gaps caused by coding errors; a child might have dates for their 1st and 3rd doses but not 2nd, so where is it? Vaccinations might have been missed by a summariser, or a nurse mistakenly coded the wrong dose. Fixing these coding errors provide a more accurate vaccination report for the patient (if they later request a copy), and will improve the completed schedule percentage in the searches (see below).

Primary vaccinations - Complete

Over the years the primary vaccinations have changed, and these alterations are reflected in the searches depending on which age group is being reviewed. On the main folder page, the percentage uptake for each of the completed searches reflects how many children received a full schedule; in the case of primary vaccinations this means every vaccination at all three stages. The searches do not take into account whether the vaccinations were administered on time or delayed. If a single vaccine was missed or incorrectly coded, the child is excluded from the total.
The primary vaccination searches are the most complex in the set.

To understand why a patient is excluded from the final count, click on the Population Excluded tab, right click their name, and select Check Patient. You will see how the patient was tested against each criteria. The bottom rule will show how the patient ultimately passed or failed the rule.

Age 1 vaccinations - Complete

Age 1 searches look for the vaccinations which are administered after 12 months of age. There are no time parameters on these features, so if a dose was given before 12 months of age they are still included. There is an exception to this (see CV-003 Eligible for MMR).

Pre-school vaccinations - Complete

Pre-school vaccinations haven't changed in a decade; Td/IPV and 2nd MMR are scheduled to be given on or around 40 months (3y4m) of age.

Eligible for catch up vaccinations

To make your work easier, we have created some searches in a Catch up opportunities folder to show where patients can be given catch-up doses due to incomplete or never started courses.

CV-001) Eligible for rotavirus (1st or 2nd dose)
      Identifies children between 8 and 24 weeks old for immediate invitation who have received 1 or no doses of Rotavirus vaccine. This search ignores patients under 16 weeks old who have received their first dose, and those who received a dose in the previous 28 days.

CV-002) Eligible for meningococcal B vaccination
      Identifies children under the age of 2 years for immediate invitation who have received 1 or no doses of Men B vaccine. This search ignores patients under 16 weeks who have received their first dose, and those who received a dose in the previous 28 days.

CV-003) Eligible for MMR (1st or 2nd dose)
      Identifies children between 1 and 18 years for immediate invitation who have received 1 or no doses of MMR vaccine. This search ignores patients under 40 months who have received their first dose, and those who received a dose in the previous 28 days. Doses of measles-containing vaccine given prior to 12 months are disregarded in line with Public Health England guidance.

CV-004) Eligible for Men ACWY
      While Men ACWY is primarily administered in the schools vaccination programme, GP surgeries may give it as catch-up and opportunistic offering to young adults going to higher education.
CV-005) Eligible for HPV
      While HPV is primarily administered in the schools vaccination programme, GP surgeries may give it as catch-up. Females can have the HPV course from the age of 12 (in school year 8) until their 25th birthday. Eligibility to receive the vaccine in year 8 was extended to boys from September 2019. The catchup programme for males under the age of 25 is only for those born after 01/09/2006.

CV-006) HPV course incomplete
      A full course is defined by the age the patient received the first dose. Where the first dose was administered before the patient's 15th birthday, a full course is two doses. Patients starting the course after their 15th birthday should receive three doses.

What about declined/refused/contraindicated vaccinations?

This aspect presented a challenge in the building of searches due to wanting to make them as easy to understand as possible. We understand that a parent's refusal for the child to have a particular vaccine is their choice, and it would have an effect on overall cohort uptake, but when the child is older they have a right to make decisions for themselves. Therefore we do not want to obscure patients from being identified by a Practice's efforts to offer catch-up vaccinations. When reviewing the summary report this may unfortunately mean wasted checks of records (especially in the younger children) where vaccination declined has been coded.

The main catch-up vaccination searches exclude those patients where a declined code exists, regardless of their age at the time. We have created secondary searches for MMR, Men ACWY, and HPV to highlight patients between the age of 16 and 25 who have been previously declined. The lower age of 16 has been used in line with a young adult's capacity to consent to treatment (Green Book, chapter 2); the upper age of 25 reflects the typical catch-up programme cut-offs, although technically some older patients can receive these jabs. Check the patient record to review when a declined code had been added.
See CV-003a, CV-004a, CV-005a.

Coding variation

Fortunately for many childhood vaccines there is only one code to choose, but we have found historic variation in use of certain booster codes. To ensure the scope is as wide as possible the code list for each vaccination has been kept the same across all year groups; this means that the current 6-in-1 code also counts for children born 10 years prior to its introduction.

Users who inspect the Care History part of the Care Record may see some entries which were transferred via GP2GP showing the drug name rather than a description; these are mapped to the appropriate SNOMED codes and will be used for the searches.

When the vaccination schedule changes there are inevitably some cases where the old schedule is used; during our testing the adjustment of Men C, Men B, or pneumococcal schedules were all found to have been overlooked resulting in a patient not being included for a complete set by virtue of their date of birth. The vaccination summary report will show the patient with vaccinations appearing on the same schedule as some slightly older patients. Conversely a child who receives their vaccinations late may follow the newer schedule and therefore stand out on the summary report from similarly aged patients.

Information for building these resources was taken from Public Health England plus archived government sources for older schedules. The Green Book was used for reference where vaccinations have specified restrictions and time limits.

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