Adult Immunisations

Headlines:

  • Vaccination coverage in Wakefield is above the national average for Flu and Pneumonia, however it is below the national ambition of 75% in over 65s and 55% in the at risk populations under 65
  • Only half of individuals under 65 in an at risk group received the Flu vaccination for the last few years
  • Coverage varies by age in the at risk groups, with people aged between 15 and 44 the least likely to get vaccinated
  • Around 56% of people aged 70-76 have received the Shingles vaccination, although there is large variation between Practices (Lowest = 28%, Highest = 80%)

Vaccination is the most important thing we can do to protect ourselves against ill health. Since vaccines were introduced in the UK, diseases like smallpox, polio and tetanus that used to kill or disable millions of people are either gone or seen very rarely.
Vaccines work by making the body produce antibodies to fight disease, without actually infecting a person with the disease. This means that if the body comes into contact with the disease in the future, their immune system will recognize it and quickly produce the relevant antibodies to fight the infection.

The following vaccinations are routinely offered to adults:

Flu

Flu vaccination is available every year on the NHS to help protect adults and children at risk of flu and its complications. Flu can be more severe in certain people, such as:

  • anyone aged 65 and over
  • pregnant women
  • children and adults with an underlying health condition (such as long-term heart or respiratory disease)
  • children and adults with weakened immune systems

Anyone in these risk groups is more likely to develop potentially serious complications of flu, such as pneumonia (a lung infection), so it’s recommended that they have a flu vaccine every year to help protect them.

The national expectation is that over 75% of over 65s and over 55% of those in high risk groups should receive the flu vaccination on an annual basis.

Pneumococcal (Pneumonia vaccine)

The pneumococcal vaccine protects against serious and potentially fatal pneumococcal infections. It’s also known as the pneumonia vaccine. Pneumococcal infections are caused by the bacterium Streptococcus pneumoniae and can lead to pneumonia, septicaemia (a kind of blood poisoning) and meningitis. At their worst, they can cause permanent brain damage, or even kill.

A pneumococcal infection can affect anyone, but there are certain people who are at a higher risk of serious illness. These groups are similar to those listed above for flu (except pregnant women). To read more about the Pneumococcal coverage in young children and other immunisations delivered under 5 years old, visit our Under 5 immunisations page.

Shingles

A vaccine to prevent shingles, a common, painful skin disease is available on the NHS to people in their 70s. The shingles vaccine is expected to reduce your risk of getting shingles. If you do go on to have the disease, your symptoms may be milder and the illness shorter.

Pertussis

Young babies with whooping cough are often very unwell and most will be admitted to hospital because of their illness. When whooping cough is particularly severe, they can die. Pregnant women can help protect their babies by getting vaccinated – ideally from 16 weeks up to 32 weeks pregnant. The vaccine can be delivered right up until the mother goes in to labour. The immunity the mother gains from receiving the vaccine is passed on to the baby through the placenta and provides passive protection for the baby until they are old enough to be routinely vaccinated at 2 months old. Due to some limitations around the data available to us, we are unable to provide local analysis of pertussis uptake and coverage at this time.

The Population

The eligible populations for flu and pneumococcal vaccines are very similar, covering people aged 65+ and those with certain conditions that put them at a higher risk of serious illness. The main difference is that pregnant women are advised to get the flu vaccine, whereas they are advised to wait until after birth for the pneumococcal vaccine unless it would be detrimental to do so. Due to data quality issues, we’re unable to report on the age breakdown of pregnant mothers at this time.

The charts below show the age breakdown of the different risk groups.


Data Source: Primary Care Systems, 2019. *Data from SystmOne Practices only, which covers 33 out of the 37 GP Practices in Wakefield.

The Challenges

The table below shows how Wakefield is performing compared to the other local authorities within Yorkshire and Humber, and also against the national expectations. Flu coverage in 2017/18 was 73.1%, which is below the national expectation of 75%. For people aged 6 months to 64 years who are in the at risk groups, only 51% received a flu vaccination in 2017/18.
Coverage for both PPV (Pneumococcal) and Shingles were also below the national targets.

Source: Public Health England, Fingertips

The Inequality

Whilst immunisation is the best way of protecting ourselves against ill health, the uptake and coverage of the various vaccines can vary between different age groups and different sections of society across Wakefield. The chart below can be used to explore the different coverage by age group within the various risk groups.

The general pattern across all risk groups is that coverage is lowest amongst the working age population. There is also a consistent trend of coverage being slightly lower in males than in females.


Data Source: Primary Care Systems, 2019. *Data from SystmOne Practices only, which covers 33 out of the 37 GP Practices in Wakefield.

The dashboard below allows you to look at the difference in coverage for each vaccination and for a variety of breakdowns, both geographical and GP Practice based. As vaccinations are primarily delivered through the GP Practice, there is a clear link between vaccination coverage at a Practice and the coverage of the geographical area it serves. If we look at the data by Deprivation Decile there is a noticable trend of coverage being higher in the less deprived areas (Deciles 7 – 10) and lower in the more deprived communities (Deciles 1-4), however these differences are more marked for the flu and shingles vaccination than they are for pneumococcal.

The GP Practice breakdown shows great inequality in terms of the different levels of coverage provided by different Practices, with some Practices being consistently amongst the lowest coverage levels for the different vaccinations and risk groups.


Data Source: GP Practice and Primary Care Home breakdowns include all Practices from Public Health England’s Immform data collection System, 2019. All other breakdowns data from Primary Care systesm, including SystmOne Practices only, which covers 33 out of the 37 GP Practices in Wakefield, 2019.

Individuals in these high risk groups who do not receive the recommended vaccination are at an increased risk of ill health, with the result often being the requirement to be admitted to hospital for treatment. The below dashboard shows the rate of emergency hospital admission of people aged 65 or over for either flu or pneumonia, by the various breakdowns. Those Practices with the highest rates of admission don’t appear to be the same Practices with the poorest coverage levels. The admission rates seem to be far more strongly related to deprivation, suggesting that there are other influences on a person being admitted for flu and pneumonia aside from the lack of vaccination.


Data source: Hospital Episode Statistics, Data Access Environment, NHS Digital, 2019

Service Provision

Adult immunisations are delivered through GP Practices and Pharmacies as part of their NHS contract.

To read more about the different types of vaccinations and who is eligble to receive them, please visit the NHS website: https://www.nhs.uk/conditions/vaccinations/