SCHOOL-HEALTH NURSE INTERVENTIONS TO INCREASE IMMUNIZATION UPTAKE IN SCHOOL ENTRANTS

In New South Wales, health screening of school entrants provides the o nly mechanism for routine monitoring of immunisation uptake in childre n. School health nurses are in the best position to improve the compli ance with immunisation at this age. We compared two interventions to b e used by the nurses to increase immunisation uptake in school entrant s who reported missing either the measles-mumps vaccine and/or the pre -school diptheria-tetanus toxoid and oral polio vaccine boosters. Pare nts in the passive intervention group were sent a letter and leaflet e ncouraging immunisation; the active intervention group received a tele phone reminder from the nurse in addition to the written materials. Bo th groups were followed up at a later date to assess final immunisatio n outcome. Of 817 children screened, 88.2% had been immunised against measles and 73.6% had received the booster; 239 children were randomis ed to the two interventions. Excluding children lost to follow up and those fully immunised at the start of the study, 20 (37%) of 54 were i mmunised following the passive intervention, and 35 (71%) out of 49 fo llowing the active intervention (P = 0.001). Receipt of the letter and leaflet was associated with an increased uptake of booster vaccinatio n (P = 0.036). The active intervention required 14.7 telephone calls a nd 1.6 uses of the interpreter service per completed immunisation. The passive intervention resulted in worthwhile increases in immunisation rate with minimum cost. A greater improvement in immunisation outcome was achieved by the active intervention, but its use was labour inten sive and may only be warranted if high immunisation rates in this age- group are given priority.