Improving the coverage of neonatal BCG vaccination

It is recommended that neonates at higher risk of contracting tuberculosis (such as in certain ethnic groups) should be vaccinated with BCG as soon as possible after birth. In Milton Keynes, during the late 1980s, there was anecdotal evidence to suggest that many higher-risk cases were not receiving BCG vaccination. The objectives of the study were to audit the neonatal BCG vaccination programme and to develop a system for improving and monitoring coverage.

Two main sources of data were used: the obstetric computer, which gave the denominator of women considered to be in a higher-risk group, and the community child health computer, which gave the numerator of BCG vaccinations given. A case note audit was used to check the quality of these data. A computer-generated reminder was used to make sure that the antenatal assessment of risk was known about immediately after delivery.

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 unnecessarily. In addition, about 2 per cent were picked up postnatally and 1 per cent were missed completely.

Improved coverage and adequate monitoring can be achieved using the two computerized systems. This methods has applications to other conditions where antenatal assessment can predict risk for a neonate, such as Hepatitis B or sickle cell disease.