Researchers identified the immunisation status of all children in nine health districts in the United Kingdom. Because universal childhood meningococcal C vaccination was introduced in 1999, they were able to measure immunisation uptake in public care, unbiased by historical health neglect.
Overall, 33% of children in public care did not receive meningococcal C vaccine compared with 15% of children at home. Uptake decreased with age in both groups.
The team did not examine the reasons for failure to immunise. However, during 2001, 16% of children in public care moved placement more than three times. "This instability creates potent risk factors, including missed school based immunisation and discontinuity of primary care," they say.
The authors suggest two ways forward. Firstly, health services should be made accountable for immunisation uptake as well as social services. Secondly, effective shared information systems between health and social services need to be introduced.
Together these measures would better protect our most vulnerable children from disease, they conclude.