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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.

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.