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Arch Dis Child. 2007 August; 92(8): 732.
Published online 2007 May 23. doi:  10.1136/adc.2007.121822
PMCID: PMC2083885

Pneumococcal and influenza vaccines: a survey of knowledge and practice among UK paediatricians

Since January 2002 the Chief Medical Officer (CMO) in the UK has issued newsletters recommending limited use of the heptavalent pneumococcal conjugate vaccine (PCV) in children under 2 years old considered to be at high risk of pneumococcal infection.1 In September 2006, the PCV was incorporated into the universal national immunisation schedule in the UK.2

A survey of paediatricians in the North East of England was conducted to determine their knowledge and practice in respect of the CMO's recommendations. Fifty paediatricians working in 10 district general hospitals (n = 41), five community centres (n = 7) or both (n = 2) completed self‐administered questionnaires. The overall response rate was 67%. Forty seven paediatricians (94%) claimed to be aware of the CMO's recommendations for high‐risk children requiring pneumococcal and yearly influenza vaccines.

The highest rates of appropriate vaccine recommendations were for children with chronic lung disease (76%), cystic fibrosis (74%), neuromuscular diseases (66%), congenital heart disease (64%), asplenia or severe splenic dysfunction (63%), chronic heart failure (54%), nephrotic syndrome (58%) and chronic renal failure (50%).

The lowest rates of appropriate vaccine recommendations were for children with chronic liver diseases such as cirrhosis (34%), biliary atresia and chronic hepatitis (33%), and for influenza vaccines for children previously admitted for asthma (17%) or with a lower respiratory tract disease (15%).

There were no significant differences between the average rates of recommendation of the pneumococcal (50%) or influenza vaccines (47%), or between the paediatricians working in the community or in district general hospitals (χ2 = 0.73, p = 0.693).

Influenza vaccine was incorrectly recommended for children with cochlear implants (18%) or CSF shunts (16%), and for children with a previous invasive pneumococcal disease under the age of 5 (28%). Pneumococcal vaccine was incorrectly recommended for children previously admitted for asthma (12%) or with a lower respiratory tract disease (14%).

Forty three respondents (86%) recommended the vaccines by clinical letters to the GPs and 40 (80%) by verbal advice to the parents/carers, while 28 respondents (56%) recommended the vaccines via letters to the parents/carers.

The generally poor rate of correct responses that were in accordance with the CMO's recommendations reflects a lack of familiarity with the recommended guidelines on the vaccinations of high‐risk children. However, this could be partly explained by the fact that some of the paediatricians do not regularly see some categories of the patients in the community or in the district general hospitals, because the patients are being exclusively followed up by the tertiary hospital paediatricians. It is also possible that some paediatricians are not convinced that either or both vaccines are useful in some categories of high‐risk children as recommended by the CMO.


Funding: None.

Competing interests: None.


1. Department of Health Extending meningitis C vaccine to 20–24 year olds: pneumococcal vaccine for at‐risk 2 year olds, 2002. PL/CMO/2002/1: 1–4, (accessed 25 May 2007)
2. Department of Health Important changes to the childhood immunisation programme, 2006. PL/CMO/2006/1: 1–16,‐CNO‐CPHOletterchangestoscheduleJuly2006.pdf (accessed 25 May 2007)

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