Campaign reaches mid point.

The Meningococcal B immunisation programme--New Zealand's largest mass immunisation campaign--has peaked nationwide, with more than 20,000 doses being given each day.

The programme began just over a year ago in Counties Manukau District Health Board (DHB) and is now available in all DHBs. The target population is 1.18 million children aged six weeks to 19 years.

As of last month, nearly two million doses of MeNZB[TM] vaccine had been given, including nearly one million first doses, 727,000 second doses and 400,000 third doses. An estimated 40 percent of under-fives have received all three doses.

According to Ministry of Health updates, all DHBs have achieved return rates of over 90 percent and most over 95 percent; and 90 percent of parents returning forms have consented to vaccination at school.

Director of the Ministry of Hearth's immunisation programme, Jane O'Hallahan, is pleased with the response and the fact the programme is running within the $200 million budget. She is also delighted that for school-aged Maori children, the coverage is as high as any other group. "This is an historical first," she said. "It is clear that Maori see vaccination against this deadly disease as a priority. However, there is a slower uptake for Maori parents in the under-five group. Practice nurses are doing a great job among all population groups, but getting parents to bring their children back for their second and third doses is not so easy. We are finding a 20 percent fall off at the third close stage. It is very important that children complete all three doses, if they are to receive the protection they need."

O'Hallahan believes the problem for Maori parents is probably one of access. To counter this, a number of outreach community clinics are being set up in remote areas. Previous adverse publicity about the programme probably affected about one percent of the target population, she said. However, many people were now opting back into the programme, since receiving more accurate information. Adverse reactions had also been relatively low, considering the newness of the vaccine. The vaccine is expected to be effective for at least two years. During this time, it is hoped the epidemic strain will disappear, although there is the possibility that certain age groups may require a booster. "Based on overseas experience, if we did not immunise, it is likely to be another six to 10 years before we get back to pre-epidemic rates," said O'Hallahan. "Last year, we had 342 cases with eight deaths. So far this year, we've had ten deaths from 168 cases. Maori and Pacific children are still over-represented in the case numbers."

The worst year during the epidemic was in 2001 when the total number of cases was 650, including 26 deaths, she said. Prior to the start of the epidemic in 1991, around 60 cases were reported each year. Provisional figures from Counties Manukau DHB have shown that rates of the disease have halved for the 2004/2005 year compared to 2003/2004, before the immunisation programme began.

Key to the success of the programme were nurses, said O'Hallahan, up to 5000 of whom had been involved in its delivery. "Many nurses have come out of retirement to work on the programme. It is proving very taxing and very intensive for them, though many are enjoying the great team work in the school-based programme. In general practices, nurses are showing real leadership and commitment. They are determined that all the recalls will be done."

Communities across New Zealand have adopted some novel methods of advertising and delivering the programme. Kaikoura Medical Centre hired the local movie theatre to vaccinate their out-of-school youth, offering a free movie and giving them a talk on Chlamydia during the 20 minutes after vaccination. Southland's Community Trust provided free drink bottles to school children, reminding them of the need for three doses of the vaccine. In June, Invercargill City Council lit up its water tower in yellow as a reminder to parents to get their children vaccinated. Northland DHB runs catch-up clinics every Saturday morning at its offices in Whangarei. Shots are also being offered at homes across the region for those who are overdue for their second and third doses. On Chatham Islands, the consent rate is 98 percent, with 85 children bussed to the health centre for their vaccinations. Hawke's Bay DHB school-based coordinator Joan Plowman flew over to assist with dose one. On Pitt Island, all 14 school-aged children have been immunised, with the local nurse assisted by a Chatham Islands' nurse, who arrived by plane with a chilly-bin of vaccine.

The programme is due to finish at the end of next June.