Measles, Mumps and Rubella

The health need identified within my placement area is the poor uptake of the Measles, Mumps and Rubella (MMR) vaccine.

Despite the availability of a safe and effective vaccine, Measles, Mumps and Rubella remain a threat of death and serious neurological complications among young children (WHO 2005a). The MMR vaccine is safe, effective and inexpensive, making vaccination against these three potentially devastating infections one of the most cost effective public health interventions available (WHO 2005b).According to Twelvetrees (2002) a health profile is a tool which can be compiled and utilised by community workers. By gathering information about the needs of a locality this information can then be used to provide the basis for an analysis of possible courses of action.During recent years there has been huge adverse media coverage concerning the safety of the triple vaccine, with claims that it may cause Crohn's Disease and Autism. Adverse publicity can have detrimental effects resulting in the loss of public confidence and therefore a reduction in the coverage rates of such vaccinations.

In 2003-04, immunisation records for the cohort of children reaching their second birthday showed that 80% had been immunised against MMR with the combined MMR vaccine compared with 82% in 2002-2003, 84% in 2001-2002 and 87% in 2000-01. This is well below that achieved in 1995-96, which was 92% (DoH 2004).The practice, which is part of Castle Ward is located within the Worthing local authority in South East region, see appendix 1, and provides a primary heath care service to the community of Goring. The Primary Care Trust (PCT) responsible for this area is Adur, Arun and Worthing (AAW). For statistical purposes Castle Ward can be split into smaller areas called Super Output Areas. Electoral wards often vary greatly in size and are subject to boundary changes, Super Output Areas aim to make comparisons with other areas 'like for like' and enable pockets of deprivation within electoral wards to be identified (ONS 2001), however for simplicity this report will focus on Castle Ward as a whole.

The General Practitioners (GP) surgery has a practice population of approx. 14,969, who are cared for by 6 GP's and often a GP trainee. The practice covers a large area of Goring through to Durrington. Although most patients live locally (see map appendix 2), the large area covered is due to patients moving away from the area and choosing to remain with their doctor, instead of re-registering with a new doctors' practice.

The beginning of this profile will give the reader an overview of the local community. This will consist of objective data identifying the immediate environment, with identification of locality, population status and amenities available to the community. Using this data, I will then address the health need and consider ways of promoting and maintaining recommended vaccination levels by looking at existing services within the placement area, identifying gaps within the service and by making recommendations according to these findings.The health profile will conclude by summarising the main points made within this report.

Overview Of Goring.The area the report will focus on is Castle ward, which is part of Goring by Sea. Castle Ward is situated on the south coast area of West Sussex, (appendix 3). The area is a popular holiday destination for both the elderly and young families. The Sussex Downs lie to the North of the ward and provides the area with a certain amount of protection from northerly weather conditions, with the coast keeping hot conditions bearable with sea breezes and the sea salt in the air providing a basic deterrent from icy conditions during the cold winter months.The resident population of Castle Ward, as measured in the 2001 Census, was 7,895, of which 46% were male and 54% were female (appendix 4).

This compared with a resident population in Worthing of 97,568 people, of whom 47 per cent were male and 53 per cent were female. The average age of the population within this area was 42.4 years. This compared with an average age for England and Wales of 38.

6 years (ONS 2001). Population age groups for Castle, Worthing and England are provided in appendix 5.According to national statistics, 97.5% of the population of Castle are white, 0.8% are of mixed race, 0.8 are Asian or Asian British, 0.

2% are Black or Black British with the remaining 0.67% being Chinese or other ethnic group. Comparisons for Worthing and England can be found in appendix 6.Castle Ward is primarily a residential area with 3,419 households in 2001. The average size of households within Castle Ward was 2.2 people compared withan average of 2.

4 people for England and Wales. Of these 3,419 households a high percentage of these are privately owned (76.6%), just 7.8% are rented from the local authority (ONS 2001).

Goring has two main shopping parades and several small shops which serve the local community well. Goring also has a small trading estate, allowing the basic commercial needs of residents to be met whilst also providing job opportunities. Employment statistics for the area are quite good - of the economically active just 1.84% of Castles population are unemployed.

Approximately half of the workforce of Castle travel a distance of less than 3 miles to their place of work.The area is well served with local busses and trains, community transport is also available to those who require, providing links to neighbouring towns where more specific needs can be met. Statistics show that nearly a quater of households within Castle (23.2%) have no access to a private vehicle (ONS 2001), these residents therefore may be reliant on public transport.Five schools can be found within the Goring region, serving primary, secondary and adult education, Goring also hosts several pre-school nurseries.

There are also 2 day centres, a residential home and a respite home for people with learning disabilities. The number of dependent children within Castle Ward is 1,443, this equates to 18.28% of the population.Leisure facilities for children and adults are well catered for with designated play areas for the younger children and a local leisure centre with many activities offered to appeal to all ages and fitness levels.

The A27 runs along the North of Goring, connecting it to the adjacent towns of Littlehampton and Worthing, access is also available to Worthing via the A259.The nearest town, Worthing, which is the largest town in West Sussex, lies to the East of Goring, here there is a hospital specialising in many aspects of health care and which has a busy Accident and Emergency department. A smaller hospital is situated 9 miles away in Shoreham-by-Sea.Health care is easily accessible in this area due to the vast amount of G.P surgeries and it appeared that the majority of the populations needs were being met. The majority of the residents of Castle Ward report their general health as 'good' with just 9.

03% complaining of poor health, however 19.03% are reported to be living with a limiting long term illness (ONS 2001). Within Goring there are several chemists, chiropodists and dentists, all of which aim to support the general health of residents.Health NeedThe health need that has been identified in my placement area is the poor uptake of the MMR (Measles, Mumps and Rubella) vaccine, and the implications this can have on health. The recent outbreaks of Measles and Mumps and the general decline of uptake we have seen nationally is cause for concern that these childhood diseases will be re-emerging. The rationale for this Health Profile is the high rate of non-attendance for the MMR vaccine observed whilst on placement with the practice nurse.

Measles is one of the most contagious diseases known, it is an acute viral illness which can cause serious complications including blindness, encephalitis, severe diarrhoea (possibly leading to dehydration), ear infections and severe respiratory infections such as pneumonia, which is the most common cause of death associated with measles.Mumps, is a viral infection primarily affecting the salivary glands. Although mostly a mild childhood disease, mumps virus may also affect adults, among whom complications such as meningitis and orchitis are relatively common. Encephalitis is a rare complications of mumps.Rubella is normally a mild childhood disease. however, infection during early pregnancy may cause fetal death or congenital rubella syndrome (CRS); characterised by multiple defects, particularly to the brain, heart, eyes and ears.

Suffering, complications and death caused by measles, mumps and rubella can be easily prevented through immunisation, however for an immunisation programme to be effective there should be an uptake of 95% in each practice population in order to maintain an adequate herd immunity (WHO 2005b).Following the introduction of the MMR vaccine in 1988, there was a considerable decrease in the notifications of measles, mumps and rubella. However for the children receiving just one dose of MMR only a 90% protection against measles and mumps was obtained and 95% for rubella (NHS 2004). A second dose of MMR was introduced to the immunisation shekel in 1996, adding a second dose increases the protection for all three diseases to over 99% (NHS 2004).Although the number of notifications may be considered relatively small compared to national figures it is a concern that preventable diseases are still occurring in a developed country where preventative vaccines are readily available.

Table 1 summarises notifications from 1999 to 2003 for Adur, Arun and Worthing and compares these to notifications for the same period in England and Wales.