IMPROVING THE COVERAGE OF NEONATAL BCG VACCINATION

Background It is recommended that neonates at higher risk of contracti ng tuberculosis (such as in certain ethnic groups) should be vaccinate d with BCG as soon as possible after birth. In Milton Keynes, during t he late 1980s, there was anecdotal evidence to suggest that many highe r-risk cases were not receiving BCG vaccination. The objectives of the study were to audit the neonatal BCG vaccination programme and to dev elop a system for improving and monitoring coverage. Method Two main s ources of data were used: the obstetric computer, which gave the denom inator of women considered to be in a higher-risk group, and the commu nity child health computer, which gave the numerator of BCG vaccinatio ns given. A case note audit was used to check the quality of these dat a. A computer-generated reminder was used to make sure that the antena tal assessment of risk was known about immediately after delivery. Res ults Estimated vaccine coverage rose from about 20 per cent (1988-1990 ) to 78 per cent by 1993. The audit suggested that about 8 per cent of vaccinations were not being recorded and 9 per cent were given unnece ssarily. In addition, about 2 per cent were picked up postnatally and 1 per cent were missed completely. Conclusion Improved coverage and ad equate monitoring can be achieved using the two computerized systems. This method has applications to other conditions where antenatal asses sment can predict risk for a neonate, such as Hepatitis B or sickle ce ll disease.