Polio vaccination coverage search (EMIS)

Polio vaccination coverage search (EMIS)

The latest version of Polio vaccination coverage is v2
Primary Care IT has produced some searches (freely available to download here) to support Practices who receive enquiries from patients wanting to check their vaccination status for polio as a result of the Public Health incident declared after vaccine derived poliovirus was detected in sewage in parts of London.

The UK Health Security Agency issued a briefing in June of actions to be taken in response to the findings. Primary care organisations were initially told to opportunistically check vaccine coverage of their patients, with the greatest attention being advised for Practices whose 6-in-1 vaccination uptake is below 85% of the eligible population. Where there is an absence of vaccination history or an incomplete vaccination history, Practices should offer vaccination to identified patients.
UPDATE A further briefing was issued on 10th August 2022 announcing a city-wide booster programme for children between 1 and 9 years of age. Alongside the announcement an IPV Booster algorithm was published presenting a guide for how each patient's current vaccination status determines what vaccine they should receive. We adapted our search cohorts to reflect the change, making it easier for Practices to identify patients between the age of 1 year and 9 years.

Searches

We have produced several sets of searches to help break down the patients. The main folder contains a set of searches for all under 18s, while the folder 'Age cohorts for polio vaccine coverage' breaks down the POL-00 search into smaller age groups.



There are 6 cohorts for children, each of which shows figures for full vaccination coverage, partial coverage, and no vaccinations.
The cohorts are based around the routine vaccination schedule, and for v2 have been subdivided to reflect the Health Security Agency's recommendations:
  1. Babies under 8 weeks : this relatively small cohort is too young for routine vaccination.
  2. Babies aged 8 weeks - 12 months : this covers the age at which the primary vaccinations are routinely offered.
  3. Infants aged 1 year - 3 years : this cohort's upper age is just before the pre-school vaccination. This cohort and child searches can be used to support the booster campaign.
  4. Children aged 3 years - 9 years : this cohort starts just before children are recommended to receive their pre-school 4-in-1 vaccination (at 3 years 4 months) up until a child's 10th birthday. This cohort and child searches can be used to support the booster campaign.
  5. Children aged 10 years - 14 years : this cohort is based on UKHSA recommendations for patients not currently eligible for a polio booster, up until a child's 14th birthday.
  6. Young people aged 14 years - 17 years : this cohort starts when patients are offered a 3-in-1 teenage booster vaccination up until their 18th birthday.
  1. A seventh cohort is offered of Adults aged 18 years - 30 years. This could be copied (remember to Include descendants) and modified to create older cohorts.


Each cohort has a set of sub-searches which can be used for reference.
The searches and reports have been built using every available polio related code in EMIS, meaning these cohorts can be copied if Practices want to review older age groups. The rules have been built to look at distinct vaccinations (at least 21 days apart) to avoid overstating how many vaccinations have been administered if codes have been doubled up on a particular day.
  1. Unvaccinated : there are no vaccination codes on the system. Some patients may have contraindications or declined codes on their record. Practices should be mindful that data may be degraded, particularly where a record has been transferred electronically via GP2GP. This presents an opportunity to improve coded data. There may also be rare instances where a vaccination has been added as a medication issue without associated coding.
  2. Fully vaccinated : patients who have a full complement of polio containing vaccinations for their age.
  3. Partially vaccinated : any patient who has received at least 1 vaccination, but not the full complement for their age. Each partially vaccinated search has an associated report which will help Practices to identify gaps in the record. Consider the advice described in 'unvaccinated' above relating to degraded coding.


Practices should be aware that the youngest patients in the cohort may not yet have received the additional vaccination following the schedule. This will be typical for babies under 16 weeks of age and children who have just had their 3rd or 14th birthdays.
Practices may consider it reasonable to maintain a master list of patients who are unvaccinated or appear partially vaccinated; absence from the list could be interpreted as the enquirer having received a full set of doses.

Recall & Booster Campaign

Given UKHSA's recommendation to offer catch up to patients identified as having incomplete coverage, Practices may wish to be proactive and invite patients via SMS or letter. We advise caution about taking the unvaccinated and partially vaccinated groups as they show, and running a campaign. As stated previously, some young patients may be a couple of months away from the scheduled date of receiving the vaccination anyway. In the babies group, there will be babies on schedule around the ages of 8 to 20 weeks who are in the required 4 week interval between doses.
Some patients may have a coded allergy or contraindication to the vaccination, while others may have (recently) declined. All of this data can be verified by reviewing the reports and individual patient records.
Practices may identify patients on the report who appear as unvaccinated or partially vaccinated, but their record shows a vaccination. We expect there will be a number of patients with [DEGRADE] entries; this is where a record has come via GP2GP (from a SystmOne Practice) and the vaccination codes are not recognised. It is a good opportunity to rectify this data as it may be useful for future recall, QOF VI, and even future CQRS Enhanced Service vaccination claims. A support article about degraded codes can be viewed here.

Complete data validation exercise first, then re-run the search folder. The reports include NHS numbers to allow the creation of patient lists. One approach is to export the results of a report into Excel and annotate or remove any patients where it is deemed they should not be contacted. The remaining column of NHS numbers can be saved to a Notepad (txt) file and imported to a Patient List. An address or phone number report can be generated off this list to be used by your mail merge or bulk mailing or texting systems.

For identifying patients in the main 1 year to 9 years group for a booster dose, Practices should look at POL-03 and POL-04, and their associated child searches and reports. 



The searches are not specifically designed to keep a track of which patients have been vaccinated but it should be possible to identify recent vaccinations using the report, exported into Excel.

Remember that the POL-02 searches could still be useful to target babies who have not yet responded to invitations for routine primary vaccination, and are still a worthwhile group for Practices to focus on, even if their PCN is running the booster programme.

What about a Protocol?

A protocol to be run off F12 was considered to support staff who might be asked for confirmation of coverage, but this has not been pursued. Such a protocol would need to be deployed widely and require Practices to ensure that all staff members knew how to access it.
A protocol might create a sense of certainty about the result; this may be fine where a patient is coded as fully vaccinated, but data quality errors in coding may reveal an incorrect outcome. If staff were to resort to EMIS Web's Care History to identify which vaccinations contain polio, this would be a potentially time-consuming exercise.



Development Log

v2 - Adjusted age cohorts to account for HSA announcement 10/08/2022. 8w-3y became 8w-12m; new 1y-3y; 3y-14y became 3y-9y; new 10y-14y.

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