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Objectives The objective of this study was to assess if school characteristics were associated with the uptake of the meningococcal ACWY (MenACWY) vaccine in Greater Manchester in 2017/18. Study design This is an ecological cross-sectional study. Methods We analysed data on all 129 schools in seven local authorities in Greater Manchester from the Department for Education and from local child health information systems to determine whether school characteristics, including school type and Ofsted effectiveness score, were associated with vaccine uptake. Schools with no eligible pupils were excluded. We undertook single-variable and multivariable analysis and considered key interactions. Results The overall uptake rate was 80.7%, with a median uptake per school of 80.6% (interquartile range, 69.0%–87.4%). Lower vaccination rates were associated with lower overall effectiveness scores (odds ratio [OR]: 3.54, 95% confidence interval [CI]: 3.00–4.19) and lower numbers of pupils eligible for vaccination (OR: 1.39, 95% CI: 1.28–1.51). Schools with a lower percentage of pupils for whom English is a second language and high deprivation were associated with lower uptake (OR: 1.58, 95% CI: 1.41–1.78). In addition, community schools (the schools with the most local authority oversight) had lower vaccination rates than other categories of schools. Conclusions In this study, uptake rates of the MenACWY vaccine were associated with all five school characteristics considered. Effectiveness scores for schools had the largest association with vaccine uptake, with poorer schools having lower uptake. These characteristics should be used by vaccination providers to prioritise their interventions to increase immunisation rates.

Purpose The purpose of this paper is to explore perceptions of alcohol held by schoolchildren using the “Draw and Write” tool, to inform the planning of alcohol education in the classroom setting. Design/methodology/approach A specifically designed “Draw and Write” booklet was used with 169 children aged nine to ten years (Year 5) across seven primary schools in a small Local Authority in North West England. Written responses were thematically coded. Findings Results demonstrated that the children had a good basic understanding of alcohol, including who drinks, where it can be purchased and the range of products available. Participants were aware that alcohol could be harmful and held mainly negative views. Findings suggest that alcohol education at this age is both appropriate and necessary to help children explore, understand and clarify their perceptions and misconceptions in a safe classroom environment. Practical implications The range and depth of responses from the children demonstrated that Draw and Write can be used successfully to explore children’s perceptions of alcohol. The tool can be used as a baseline assessment to inform classroom-based alcohol education for primary school teachers and those supporting delivery at local level, in line with national policy recommendations. Originality/value This paper adds to the existing literature on the use of “Draw and Write” in personal, social and health education, demonstrating that it can be used specifically to investigate children’s knowledge and attitudes about alcohol.

Vaccination of immunocompromised patients is recommended in many national guidelines to protect against severe or complicated influenza infection. However, due to uncertainties over the evidence base, implementation is frequently patchy and dependent on individual clinical discretion. We conducted a systematic review and meta‐analysis to assess the evidence for influenza vaccination in this patient group. Healthcare databases and grey literature were searched and screened for eligibility. Data extraction and assessments of risk of bias were undertaken in duplicate, and results were synthesised narratively and using meta‐analysis where possible. Our data show that whilst the serological response following vaccination of immunocompromised patients is less vigorous than in healthy controls, clinical protection is still meaningful, with only mild variation in adverse events between aetiological groups. Although we encountered significant clinical and statistical heterogeneity in many of our meta‐analyses, we advocate that immunocompromised patients should be targeted for influenza vaccination.

The consumption of tobacco, alcohol and illegal drugs by young people is a public health concern. This study aimed to explore the associations between subjective wellbeing, living in a low-income household and substance use by schoolchildren.Data were analysed from a nationally representative cross-sectional survey of schoolchildren in England (Tellus4, 2009). Participants were 3903 children aged 10 and 15 years from two local authorities in the North West. Eligibility for free school meals provided a proxy for living in a low-income household. Multiple logistic regression was conducted with the main outcome measure, a composite indicator of self-reported regular substance use.More boys than girls had experimented with drugs or alcohol, but in the fourth year of secondary education, girls were significantly more likely than boys to have been drunk (P ≤ 0.001). In the multivariate analysis, older age was the most important factor associated with the consumption of substances. Living in a low-income household was associated with substance use, adjusting for age and subjective wellbeing (adj. OR = 1.78, 95% CI = 1.36-2.34). Respondents who reported being happy (adj. OR = 0.67, 95% CI = 0.52-0.86) or able to communicate with their family (adj. OR = 0.51, 95% CI = 0.39-0.65), were less likely to be regular users.Interventions to prevent regular substance use should be carefully targeted by age. Policies aimed at social determinants may be an important adjunct to individual-level interventions to reduce some inequalities in health associated with substance misuse.

Background Measles is a highly contagious vaccine-preventable infection that caused large outbreaks in England in 2012 and 2013 in areas which failed to achieve herd protection levels (95%) consistently. We sought to quantify the economic costs associated with the 2012–13 Merseyside measles outbreak, relative to the cost of extending preventative vaccination to secure herd protection. Methods A costing model based on a critical literature review was developed. A workshop and interviews were held with key stakeholders in the Merseyside outbreak to understand the pathway of a measles case and then quantify healthcare activity and costs for the main NHS providers and public health team incurred during the initial four month period to May 2012. These data were used to model the total costs of the full outbreak to August 2013, comprising those to healthcare providers for patient treatment, public health and societal productivity losses. The modelled total cost of the full outbreak was compared to the cost of extending the preventative vaccination programme to achieve herd protection. Findings The Merseyside outbreak included 2458 reported cases. The estimated cost of the outbreak was £4.4 m (sensitivity analysis £3.9 m to £5.2 m) comprising 15% (£0.7 m) NHS patient treatment costs, 40% (£1.8 m) public health costs and 44% (£2.0 m) for societal productivity losses. In comparison, over the previous five years in Cheshire and Merseyside a further 11,793 MMR vaccinations would have been needed to achieve herd protection at an estimated cost of £182,909 (4% of the total cost of the measles outbreak). Interpretation Failure to consistently reach MMR uptake levels of 95% across all localities and sectors (achieve herd protection) risks comparatively higher economic costs associated with the containment (including healthcare costs) and implementation of effective public health management of outbreaks. Funding Commissioned by the Cheshire and Merseyside Public Health England Centre.

Many national guidelines recommend annual influenza vaccination of immunocompromised patients, although the decision to vaccinate is usually at clinical discretion. We conducted a systematic review and meta-analyses to assess the evidence for influenza vaccination in this group, and we report our results by etiology. Meta-analyses showed significantly lower odds of influenza-like illness after vaccination in patients with human immunodeficiency virus (HIV) infection, patients with cancer, and transplant recipients and of laboratory-confirmed influenza in HIV-positive patients, compared with patients receiving placebo or no vaccination. Pooled odds of seroconversion and seroprotection were typically lower in HIV-positive patients, patients with cancer, and transplant recipients, compared with immunocompetent controls. Vaccination was generally well tolerated, with variation in mild adverse events between etiological groups. Limited evidence of a transient increase in viremia and a decrease in the percentage of CD4(+) cells in HIV-positive patients was found although not accompanied by worsening of clinical symptoms. Clinical judgment remains important when discussing the benefits and safety profile with immunocompromised patients.

As in other specialties, doctors working in public health must provide cover during out of hours periods. Siobhan Farmer looks at how out of hours work fits within public health roles

Objectives Substance use among young people is associated with poor health outcomes. Interventions to reduce consumption of tobacco, alcohol and illicit substances have been targeted on disadvantaged areas, and many address self-esteem or other aspects of subjective wellbeing. The evidence for this approach is conflicting. The aim of this paper is to explore the relationship between measures of subjective wellbeing, substance use and living in a low income household, for school children in England. Design Analysis of a cross sectional survey of pupils from schools in two English local authorities in 2009 (Tellus4), using multivariate logistic regression. Eligibility for free school meals was used as a proxy measure for residence in a low income household. Setting Schools in two local authorities in north west England Participants 3903 schoolchildren in school years 6, 8 and 10 (aged between 10 and 15 years). Main outcome measure Composite indicator of self-reported regular substance use, including smoking more than once per week, and being drunk and/or using drugs in the preceding 4 weeks. Results Data were available from 3093 respondents, accounting for one third of registered pupils in these age groups. Respondents were distributed evenly across year groups, (1354 (34.7%) in year 6, 1266 (32.4%) in year 8, 1283 (32.9%) in Year 10). Each year group contained similar numbers of males and females (χ 2 =1.332, df=2, p=0.51) with 18.2% of the sample entitled to free school meals. Increasing age (year group) was strongly associated with regular substance use in multivariate analysis. Free school meal eligibility was associated with a greater likelihood of being a regular substance user, adjusting for age and subjective measures of wellbeing (adjusted OR=1.78, 95% CI=1.36 to 2.34). Two subjective measures of wellbeing, (happiness and the ability to talk to parents if worried), were inversely associated with substance use (adjusted OR=0.67, 95% CI = 0.52 to 0.86 and OR=0.51, 95% CI =0.39 to 0.65). A positive association was found between substance use and the ability to talk to friends if worried (OR=1.37, 95% CI=1.04 to 1.82). Conclusion Living in a low-income household increases the risk of substance misuse for young people, though older age is the most important predictive factor. Subjective happiness and open communication with family rather than friends appear to help young people to avoid being regular users. Policies aimed at maintaining household income and stability in disadvantaged areas may be more effective than those targeting individual self efficacy at reducing inequalities in health.