Family Practice Vol. 18, No. 4, 464
© Oxford University Press 2001
The role of opportunistic vaccination should not be forgotten
Academic Assistant in General Practice, 57 Kimble Road, Colliers Wood, London SW19 2AU, UK
Dabelstein and Cromer1 state that despite recommendations for pneumococcal immunization, >70% of those eligible had not received the vaccine. Problems of attaining immunization targets are likely to be worse in the developing world, where systems of child health surveillance may be less advanced. In 1998, I was working as a medical officer in a government hospital on Lamu, a small Kenyan island, when I undertook an audit project on childhood immunizations.
We were concerned that we were not making the most of opportunities for routine health surveillance, when children came to the hospital out-patients department. Reports from the private clinics in town stated that they were picking up high levels of malnutrition, yet few children that we saw were being weighed, measured or vaccinated unless they came specifically for that purpose.
In Kenya, there is no system of health visiting, and many children will never see any sort of health worker. Vaccination promotion depends mainly on word of mouth and government campaigns. Health workers were encouraged to give talks in schools and mosques, and traditional birth attendants were encouraged to bring babies for their first vaccinations. The hospital out-patient department operated much like a general practice surgery, as there were no doctors working in the community, so this was an important access point for medical services.
In Lamu, the clinical officers seeing the patients were encouraged to direct children to the Maternal Child Health Clinic (MCHC), where children could be weighed and measured and brought up to date with their vaccinations. However, we did not think that this was happening. We decided to check whether children's immunization status was being checked when they attended out-patients.
We performed a short questionnaire on 100 consecutive families who passed through the department, over several days. We found that 94% of children were up to date with their vaccinations (a very pleasant surprise, especially as the government set targets of >70% coverage). However, only five parents were asked if their child was up to date with vaccinations, and nobody was advised to attend the MCHC.
As a result of this audit, the out-patients department was re-arranged so that all children passed through the MCHC, and were weighed, measured, and brought up to date with vaccinations, as well as seeing the Clinical Officer for their presenting problem.
Dabelstein and Cromer mention that successful immunization campaigns have all but eradicated many infectious diseases. Eradication depends on adequate coverage, and this can present problems. The role of opportunistic immunization should not be forgotten.
Reference
1
Dabelstein D, Cromer B. Recent advances in conjugated pneumococcal vaccination. Fam Pract 2000; 17: 435–441.
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