1. Children and Young People
Immunisation
Immunisation is second only to a clean drinking water supply as a way of improving and
maintaining the health of the population. Whilst smallpox has been eradicated from the world,
by immunisation, all other infectious diseases remain. The only way to protect children and
adults from avoidable death and serious, often long-term, complications from such diseases is
to maintain high levels of immunisation in the population.1
The risk we face
Barnet, in common with all other London boroughs, now faces the likelihood of a measles
epidemic. In the last year or so the number of children and adults catching measles – the most
contagious disease that there is – has been much higher than in past years and there have
been several outbreaks, as shown in . Figure 1
Figure 2: The number of reported cases of measles in Barnet in recent years
90
80
70
The 60
50
40
30
20
10
0
2005/06 2006/07 2007/08
reasons for the alarming increase in people catching measles in Barnet are outlined below
demonstrating that MMR immunisation rates in Barnet are substantially below the level required
for safety.
The reason that so many people have caught measles and the fact that we now face the very
real risk of a measles epidemic is because there are now so many children whose parents have
refused consent for them to be 1mmunizat with measles, mumps and rubella vaccine. The
‘herd immunity’ of the population is now sufficiently low to enable each person with measles to
infect more than one other person. The problem of measles is more widespread in other parts
of London, as shown below.
1
The main exception to this is TB. Whilst BCG vaccine is an important way to protect people most at risk the way this disease
affects the population has changed.

2. Source: Health Protection Agency. Measles and MMR uptake in London, 2008 Cover data and trends in vaccine
uptake 2005-2008
MMR uptake at age 2 years for London and UK – January 1996 – March 2008* signify that
immunisation rates are beginning to decline significantly
.

3. 95.0
90.0
85.0
80.0
75.0
% 70.0
65.0
60.0
55.0
Hib primary MenC
DTP/Polio primary
50.0
MMR 2nd dose DTaP/IPV booster
MMR 1st dose
45.0
Q3 05/06 Q4 05/06 Q1 06/07 Q2 06/07 Q3 06/07 Q4 06/07 Q1 07/08 Q2 07/08 Q3 07/08 Q4 07/08 Q1 08/09
Quarter in each year
Immunisation rates in children in Barnet for:
first course of diphtheria, tetanus, pertussis and polio;

first dose of Haemophilus influenzae B;

meningococcus C;

first dose of measles, mumps and rubella (MMR);

second dose of MMR; and

diphtheria, tetanus and pertussis and inactivated polio booster.

This shows clearly that MMR 3mmunization rates in Barnet are very substantially below the level
required for safety, i.e. to avoid measles outbreaks and to avoid a measles epidemic, although they are
beginning to increase
Local targets
In common with other London PCTs, Barnet has agreed to increase all of its childhood
immunisations to 90% by 2010/2011. The trajectory for immunisation rates for MMR by the age
of two years shows the trajectory for MMR, which is the most challenging as all other childhood
immunisation rates are currently in the high eighties and thus closer to the target.
The trajectory for immunisation rates for MMR by the age of two years
Proportion (%) of 2-year olds with first MMR immunisation
actual estimate trajectory
100
90
90
80
77
75.6 76.4
80 74.5
73.9
70
60
50
40
30
20
10
0
2004_05 2005_06 2006_07 2007_08 2008_09 2009_10 2010_2011

4. Source: Barnet PCT Operating Plan
The key activities required are:
• ensuring the accuracy of immunisation records – it is apparent that a lot of children have
been immunised but the fact has not been recorded on the PCT’s child health surveillance
system;
• bolstering the immunisation call system to ensure that all children who need immunisation
(because it is due or have, apparently, been missed) are invited for immunisation;
• providing immunisations in various sites, e.g. GP surgeries, community pharmacies, A&E
departments, walk-in centres, children’s centres, children’s outpatient departments;
• promoting immunisation widely, using social marketing techniques, to better ensure that the
right message is received; and
• working with local community and religious leaders, and in schools, pre-school facilities,
children’s centres, NHS facilities and other places to promote immunisation.
Data on ethnicity and religious belief are not currently routinely recorded in the context of
childhood immunisation. However, it is apparent that in the North East and North central
London area, the majority of people affected by measles have been Jewish. The reasons for
this need to be explored further.

5. Jewish
White: British
White: Eastern European
Black: African
White: Irish
Any Other ethnic group
White: Other
Asian: Bangladeshi
Black: Caribbean
Mixed: Other Mixed
Asian: Indian
Asian: Other
Chinese
Not known
Mixed: White & Black African
Mixed: White & Asian
Black: Other
Asian: Pakistani
0 50 100 150 200 250 300
Number of reported measles cases
Teenage pregnancy
Barnet has one of the lowest rates of teenage pregnancy (TP) in London, and this is also lower
than similar boroughs (including those matched for deprivation) such as Merton, Hounslow and
Enfield. Not only is it lower than the London average, but it is also lower than the national
average. The graph below summarises the his trend and the comparison between Barnet,
London and England.
Approximately 68% of teenagers who conceived in Barnet in 2006 had a termination of
pregnancy (TOP), the remainder having had either a live or still birth. Data on the residential
postcodes of all TOPs performed by Marie Stopes, the PCT’s main provider of abortion
services, on women in Barnet aged under 18 years show that 15.2% of teenage abortions were
performed on young women who had had at least one previous TOP. Teenagers who have had
one TOP are a high risk group for further unplanned pregnancy.

6. Under 18 conception rate per 1000
10
20
30
40
50
60
0
March
June
1998
Sept
Dec
March
June
1999
Sept
Dec
London
England
March
June
2000
Sept
Dec
Barnet rolling average
March
June
2001
Sept
Dec
March
June
2002
Sept
Dec
March
June
2003
Sept
Dec
March
June
2004
Sept
Dec
March
June
2005
Sept
Dec
March
June
2006
Sept
Dec
March
2007
June

7. Quarterly rate
45
Rolling average
40
Under 18 conception rate per 1000
35
30
25
20
15
10
5
0
March
March
March
March
March
March
March
March
March
March
Sept
Sept
Sept
Sept
Sept
June
June
June
June
June
Sept
Sept
Sept
Sept
Dec
Dec
June
June
Dec
June
Dec
June
Dec
June
Dec
Dec
Dec
Dec
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Teenage pregnancy rates have been decreasing since 2004.
actual estimate trajectory
Conception rate per 1,000 females aged 15-17
35
30
25
20
168 149
167
15
10
131 107 84
5
0
2005 2006 2007 2008 2009 2010
The graph above illustrates the target trajectory for Barnet.