Pneumococcal (PPV) immunisation uptake in Wales 2006 Surveillance Report, October 2006

Transcription

1 Pneumococcal (PPV) immunisation uptake in Wales 2006 Surveillance Report, October 2006 Key Findings In July 2006, uptake of pneumococcal vaccination amongst those aged 65 years and over in Wales, immunised at any time in the previous 10 years was 44.2% Uptake by LHB ranged from 25.0% to 64.2% (figure 1). Uptake amongst patients aged under 65 years in specific risk groups recommended for pneumococcal immunisation was highest in patients with diabetes (35.5%) and lowest in patients with chronic respiratory disease (10.4%). Response rate to this survey amongst Welsh practices was 90.0%. Response rate by LHB ranged from 42.9% to 100.0%. This is the first time data on the uptake of pneumococcal immunisation has been available for Wales, quality of this data is expected to improve with use. 1. Background Invasive pneumococcal disease (mostly septicaemia, bacteraemia or meningitis) is caused by the bacterium Streptococcus pneumoniae (also called Pneumococcus). Invasive pneumococcal disease is a cause of severe morbidity and mortality, particularly affecting the elderly, the very young, and those with an absent or nonfunctioning spleen (and those with other causes of impaired immunity). Currently in Wales, protection from invasive pneumococcal disease is available using two different types of pneumococcal vaccine: The pneumococcal conjugate vaccine (PCV, Prevenar ) is part of the routine childhood immunisation schedule (additional doses are also recommended for children aged up to 4 years of age in the appropriate clinical risk groups see latest version of The Green Book for details 1 ). The pneumococcal polysaccharide vaccine (PPV, Pneumovax ) is currently recommended for those aged 65 years and over and for those aged 2 to 64 years in one of the clinical risk groups. The clinical risk groups who should receive pneumococcal immunisation are those with: Asplenia or dysfunction of the spleen, chronic respiratory disease, chronic heart disease, chronic renal disease, chronic liver disease, diabetes, immunosuppression, cochlear implants, and cerebrospinal fluid leaks. This report details uptake of pneumococcal polysaccharide vaccine (PPV) in patients aged 65 years and over or in clinical risk groups, it does not contain information regarding uptake of pneumococcal conjugate vaccine (PCV) which will in due course appear in the childhood immunisation (COVER) report

2 2. Data collection 2.3 The NPHS Communicable Disease Surveillance Centre and Vaccine Preventable Disease Programme worked with the Welsh Assembly Government s Programme Commissioning Unit (PMU) to capture data on pneumococcal immunisation directly from General Practice systems, minimising practice workload and maximizing data quality. This was achieved using Clinical Audit. Ninety-eight percent of practices in Wales possess 'Clinical Audit', a software product designed by MSD Informatics 2 to provide practices and Local Health Boards (LHBs) the facility to analyse data held on General Practice Clinical Information systems. Clinical Audit together with Contract Manager have been provided to practices in Wales to support delivery of the General Medical Service Contract 'Quality and Outcomes Framework'. 2.4 The Clinical Audit tool interrogates practice clinical information systems using specific read-codes, then forwards appropriate data to the practice LHB and PMU, who collate the data on behalf of NPHS. Therefore data must be recorded and coded correctly on the practice system to be collected in this way. This report is expected to highlight issues with data quality that need to be addressed. 2.5 Using this method data were collected on pneumococcal immunisations given to those aged 65 years and over and those in the appropriate clinical risk groups during the 10 year period July 1996 July 2006 and were still registered with the practice in July However, data from practices using EMIS based practice software were only available for the 3 year period (July 2003 July 2006) these practices comprised 29% of the total practices in Wales (as at July 2006). 3. Analysis 3.1 Uptake was calculated by dividing the number of patients immunised during the designated period by the number of patients registered in participating practices (by age or risk group). Numerator and denominator data from individual practices were summed to give overall uptake by LHB, Welsh Assembly Government Region and for Wales. 4. Results 4.1 As at 7 July 2006, 451 of the 501 (90.0%) general practices in Wales had provided data on the number of patients registered with the practice and the number immunised (Table 1). 4.2 A 100% response rate from practices was obtained from four of the 22 (18%) LHBs in Wales. Response was lowest in Monmouthshire (43%). 4.3 Uptake in those aged 65 years and over (DOB on or before 31/03/1940) was 44.2% (Table 1). Within this age-group uptake in those aged 65 to 74 years was 42.8% and uptake in those aged 75 years and over was 45.7%. 4.4 LHB uptake (Figure 1) in those aged 65 years and over ranged from 25.0% (Gwynedd) to 64.2% (Newport). 4.5 Uptake in specific clinical risk groups in Wales (Table 2) was highest amongst patients with diabetes (35.3%) and lowest amongst patients with chronic respiratory disease (10.4%). The specific clinical risk group with the largest denominator was the chronic respiratory disease group (272,556) and the lowest denominator figure was found in the chronic liver disease group (2,857). 4.6 Combined data for uptake in those aged under 65 years and considered to be at risk were not available. 4.7 Uptake in patients with Asplenia or spleen dysfunction was 26.3% (LHB range 12.6% (Conwy) 41.9% (Carmarthenshire)). 4.8 Uptake in patients with chronic heart disease was 14.2% (LHB range 7.7% (Bridgend) 22.4% (Torfaen))

3 4.9 Uptake in patients with chronic respiratory disease was 10.4% (LHB range 5.3% (Gwynedd) 15.6% (Torfaen)). 4.9 Uptake in patients with chronic renal disease was 26.0% (LHB range 10.7% (Conwy) 45.6% (Blaenau Gwent)) Uptake in patients with diabetes was 35.3% (LHB range 17.8% (Bridgend) 49.2% (Torfaen)) Uptake in immunosuppressed patients was 13.6% (LHB range 7.3% (Bridgend) 26.8% (Torfaen)) Uptake in patients with chronic liver disease was 19.6% (LHB range 6.7% (Bridgend) 27.2% (Newport)) The number of individuals aged 65 years and over recorded as being immunised against pneumococcal disease in responding practices during the period July 1996 July 2006 was 211,492. The true figure for the number of individuals receiving pneumococcal is likely to be higher than this since data was received for only 90.0% of practices in Wales, there may also have been under-reporting, particularly in those immunised many years ago. Assuming that non-responding practices are similar in size and nature to responding practices the total number of individuals aged 65 years and over immunised against pneumococcal disease during the last 10 years can be estimated as 232, Discussion This is the first survey of the uptake of pneumococcal polysaccharide vaccine amongst adults in Wales. It reflects vaccination given at any time during the previous 10 years in most practices, or the previous 3 year in 29% of practices in Wales. Although the extent of under recording of vaccinations given some time ago is unknown, it is clear that the uptake in those aged under 65 years and in clinical risk groups is poorer than in those aged 65 years and over. In particular, in those with an absent or dysfunctional spleen, the group most at risk of severe invasive pneumococcal infection, uptake is only 26.3%. This is the first time that these data have been collected, analysed and reported in Wales. This report is expected to highlight any issues with data quality that need to be addressed and the quality of the data used to generate this report is expected to improve with use. This survey provides a baseline from which to measure progress in uptake of pneumococcal polysaccharide vaccine in Wales. Report prepared by NPHS Communicable Disease Surveillance Centre (CDSC) and Vaccine Preventable Disease Programme (VPDP) in collaboration with the Welsh Assembly Government Programme Commissioning Unit (PMU) October Immunisation Against Infectious Disease - "The Green Book", Department of Health, MSD Informatics:

4 Figure 1. Pneumococcal immunisation coverage (based on 10 years of uptake data) by LHB

5 Table 1. Uptake of pneumococcal immunisation in patients aged 65 years and over by LHB (based on those vaccinated at any time in the previous 10 years*) Patients aged 65 and over immunised against pneumoccal disease (in the last 10 years) LHB Number of practices Practices providing returns % providing returns Patients aged 65 years and over (n) Patients aged 65 years and over immunised (%) Patients aged 65 to 74 years (n) Patients aged 65 to 74 years immunised (%) Patients aged 75 years and over (n) Patients aged 75 years and over immunised (%) Anglesey Conwy Denbighshire Flintshire Gwynedd Wrexham North Wales Bridgend Carmarthen Ceredigion Neath Port Talbot Pembrokeshire Powys Swansea Mid and West Wales Blaenau Gwent Caerphilly Cardiff Merthy Tydfil Monmouthshire Newport Rhondda Cynon taff Torfaen Vale of Glamorgan South East Wales All Wales * data from practices using EMIS based practice software were only available for the 3 year period (July 2003 July 2006) these practices comprised 29% of the total practices in Wales (as at July 2006)

6 Table 2. Uptake of pneumococcal immunisation in patients aged under 65 years in specific risk groups, by LHB (based on those vaccinated at any time in the previous 10 years*) LHB Patients aged under 65 years in specific risk groups immunised against pneumococcal disease (in the last 10 years) Asplenic patients heart disease respiratory disease renal disease Patients with diabetes Immunosuppressed patients liver disease (n) % immunised (n) % immunised (n) % immunised (n) % immunised (n) % immunised (n) % immunised (n) % immunised Anglesey Conwy Denbighshire Flintshire Gwynedd Wrexham North Wales Bridgend Carmarthen Ceredigion Neath Port Talbot Pembrokeshire Powys Swansea Mid Wales Blaenau Gwent Caerphilly Cardiff Merthy Tydfil Monmouthshire Newport Rhondda Cynon taff Torfaen Vale of Glamorgan South East Wales All Wales * data from practices using EMIS based practice software were only available for the 3 year period (July 2003 July 2006) these practices comprised 29%l of the total practices in Wales (as at July 2006)