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Ben RHM II - LZG.NRW

Ben RHM II - LZG.NRW

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ 7.2.1 Individual reminder During the outbreak, together with the local health authorities and the Robert Koch Institute, the Institute for Public Health, NRW (lögd) carried out a detailed examination at a school where more than 50 cases of measles had erupted. As part of the examination, the parents of those children who had not been immunised against measles were interviewed for possible reasons and causes for not having their children immunised. According to this admittedly small-scale survey, an individual reminder would have had a possible benefit in at least 38% of the cases. If the reminder is combined with information material on the risks of measles disease and the benefit of the immunisation, the benefit to be expected might even be higher. After all, 75% of the parents who quite consciously refrained from having their children immunised justified their behaviour with the fear of side effects or with the opinion that measles are a harmless disease. 7.2.2 Establishment of vaccination campaigns The Standing Immunisation Committee (STIKO) presently recommends a combined measles, mumps and rubella immunisation of two doses which should be administered up to the end of a child’s 24 th month of life. A catch-up campaign which could be aimed at having older chil- dren and adolescents without immunisation protection immunised does not exist at the mo- ment. As already shown, the immunisation rate for school beginners has been continuously rising for some years now. An analysis of the age distribution of the outbreak in NRW reveals that the age groups mainly hit by the disease were those between 5 and 20 years. More than 60% of all cases fell into this age group. This shows that there seem to be considerable gaps in the immunisation coverage rate for this age group. It has therefore to be feared that despite rising immunisation rates in small children the expected decline in the number of diseases will only be very slow if adolescents and young grown-ups are not included in the immunisation programmes. 7.2.3 Education of possible multiplicators It is not only the family doctor who has an influence on the immunisation behaviour of parents and children. From what we know, midwives have a very pronounced influence on young - 302 -

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ parents. But often particularly midwives feel reserved about immunisations, an attitude which could be changed through further training and information measures. Teachers and educators also play an important role in the children’s health education and often serve as an example. Unfortunately, teachers themselves are often not immunised and are therefore no good exam- ple to their pupils. During the above-described measles outbreak, two schools were for exam- ple closed for some days because a great number of teachers had not been immunised against measles and because it also could not be clarified if the teachers had been ill with measles during their childhood. 7.2.4 Bonus system for parents A financial incentive is certainly suited to motivate many parents who are undecided about immunisation to think about this issue critically and perhaps have their children immunised. Such a bonus system could for example consist of cost reductions for medical examinations when the child enters kindergarten, provided the child has been immunised. An alternative would be to include parents into the bonus system of their health insurance company if they have their child immunised. With 1,715 cases last year, NRW has seen the biggest measles outbreak since introduction of the Infectious Disease Control Act (IfSG) in 2001. Seven children fell ill with encephalitis or meningitis and two children have died up to now. Against the background of this outbreak, the measures established in NRW did not seem to be sufficient in order to reach the objective of WHO Europe and to eradicate measles up to the year 2010. The work carried out under the Ben RHMII project has led to defining important further measures for NRW which could help to still achieve this objective. 7.2.5 Conclusions Based on these results a comprehensive concept has already been drawn up and has become the subject of a political agreement process. The Ben RHM II has thus already contributed to the effective improvement of health management within a region. This can be a paradigm how the reference frameworks and the results of Ben RHM II in general can be utilised to improve the public’s health in Europe. - 303 -

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