National MMR catch-up campaign

A national campaign to increase the uptake of the MMR vaccine is running in England. The most recent guidance (PRN00914) promotes a 2 stage campaign to cover all children and young people.

1. From November 2023 to March 2024– practices will be required to undertake local call and recall for eligible individuals aged 12 months up to and including 5 years
   
2. From January 2024 to March 2024– practices are asked to support requests for vaccination from eligible individuals aged 6 years up to and including 25 years
   

The first stage is directs Practices to proactively follow up on unvaccinated children under the age of 6, while the second stage is underpinned by a national call and recall campaign (Practices do not have to send invitations) where young people will need to contact the Practice to ask for a vaccination. Practices may take a view that pursuing both of these groups is worthwhile, if only to confirm that a young adult still does not want an MMR jab.

Primary Care IT already offered a search identifying unvaccinated individuals between the age of 12 months and 18 years (CV-003), and this has been the foundation of a new set of searches to reflect these national criteria. The searches now include a report which will not only display any related MMR coding, but a patient's contact details to facilitate an efficient communications campaign.

Before sending out invitations it is important to read through this article to understand how the searches and reports work, and what data cleansing exercises must be undertaken.

Searches for MMR

All the following searches & reports can be found here, in the PrimaryCare IT search folder within your surgery: 

Following some early requests we included some additional searches which Practices might find useful. The main searches for the Catch-up campaign are listed first.

CV-012 MMR Catch-up Campaign (Age 2-5)

As the name implies, this search and report combination looks at patients between the ages of 2 and 5 inclusive. This age range is intentional to avoid showing patients who have just had their 1st birthday which gives the parents/guardian some leeway to arrange an appointment following the centrally generated invitation letter.

The search will exclude any patient in the age range who:

1. has received a full course of MMR vaccination (1st and 2nd dose both given after 1st birthday) if they are aged 40 months or above
2. is aged under 4 years and has received 1st dose (8 month leeway for arranging 2nd dose - see CV-011)
   
3. has received a (first) MMR dose in the last 28 days 

CV-013 MMR Catch-up Campaign (Age 6-25)

This search is simpler than the version for younger children.

Patients are excluded if they:

1. have received a full course of MMR vaccination (1st and 2nd dose both given after 1st birthday)
2. have received a (first) MMR dose in the last 28 days 

CV-011 MMR Routine Follow up (12m and 40m)

This search looks at children aged 12-23 months who have not yet received their first MMR vaccination, plus children aged 40-47 months who have received their first dose but not their 2nd dose since becoming eligible at 40 months of age (3y4m). This search is technically part of the first wave of the national catch-up campaign, except most of the patients appearing will have received their initial invitation letter in the previous few months. 

Practices may wish to ignore this group, or take a softer approach on those parents who have had just a handful of weeks or months to arrange a convenient appointment. We recommend taking a selective approach to this group, targeting the older patients in each cohort - the nearly 2s with no MMR are listed halfway down, while the nearly 4s with 1 dose are at the bottom of the list.

Patients are included if they:

1. are aged 12 months - 23 months and have not received any MMR dose
   
2. are aged 40 months - 47 months and have not received their 2nd dose (they would have received their routine 1st dose around the age of 12 months)
   

Patients are excluded if they received a (first) MMR dose in the last 28 days

CV-014 MMR Catch-up opportunity (Age 26-39)

Following a number of requests for older ages, we extended the searches beyond a patient's 26th birthday. This cohort up to and including the age of 39 represents those patients who (as of November 2023) would have been offered MMR as children. The MMR vaccination was introduced to the UK in 1988, and at the time there were some catch-up opportunities for slightly older children starting school - we estimate this to be those born 1984/1985.

Like the searches above, this excludes patients who received a (first) MMR dose in the last 28 days.

CV-015 MMR Catch-up opportunity (Age 40-49)

There were requests for searches for even older patients, for which the projected numbers would be enormous. In patients born before 1984, it is less likely that patients have been vaccinated with MMR unless they received it as adults due to being a healthcare professional or possibly a mandatory requirement of travel to certain countries.

Like the searches above, this excludes patients who received a (first) MMR dose in the last 28 days.

Reports for MMR

Interpreting the reports

The reports for CV-012 and CV-013 are identical. They will pull out any data pertinent to the MMR vaccination programme, so any existing coded vaccinations will be shown, as well as separate measles or mumps or rubella vaccinations, and the most recent MMR declined or contraindicated code.

The reports are sorted in age order, with youngest at the top and oldest at the bottom.

Patient appears to have received 2 doses on different days - the search intentionally places a 21 day gap between coded doses (the Green Book advises a 28 day interval in the catch-up programme for), so a likely reason is that the first dose was given before the patient's 1st birthday. Technically even the day before the 1st birthday is considered an invalid dose, and the patient would still be subject to 2 doses after their 1st birthday.

Separate Measles, Mumps, and Rubella jabs as well as combined Measles/Rubella will be shown in the single doses column. The Green Book states patients with this history should still be offered combined MMR.

There may be cases where the patient was vaccinated as a child using single doses - perhaps due to the claims about MMR in the late 1990s - who can still be given combined MMR.
Beware of situations where somebody has accidentally coded separate vaccines instead of combined - a likely scenario is where notes from a previous SystmOne or Vision site have been interpreted as single doses.

We know some entries originally added by a different clinical system will have 3 separate codes for Measles, Mumps, and Rubella. The report also contains an Associated text column as these clinical systems tended to include a pre-configured comment to show that it was a component of a combined vaccination.

Patients who received vaccinations in their previous Practice may appear where the entry has come via GP2GP. This is particularly evident where the previous Practice used SystmOne and the vaccination entry is generic. There are several examples of code terms which will point to a dose coded in SystmOne. Look for MMRvaxPRO, Priorix1. This is highly indicative of a coded entry, where another may have been missed; these would appear in the Care History prefixed by [DEGRADE].

Patients who were vaccinated abroad under a different schedule are likely to appear. There is no provision for this in the search or indeed QOF. Clinical judgement will be needed to determine whether it is possible or appropriate to engage in a catch-up schedule.

Invitations

Any coded MMR invitation from the last 12 months will be listed on the right hand end of the report. This may be useful if Practices wish to conduct a second call, or a cleanup of patients being added to the cohort (either by newly registering or coming of age).

Appointments

The searches and reports have not been configured to take into account upcoming booked appointments. 

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