Health professionals' attitudes to MMR vaccine

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7294.1120 (Published 05 May 2001) Cite this as: BMJ 2001;322:1120

“Green book” should be updated every six months

  1. Jonathan Howell (jonathan.howell@lycos.com), consultant in public health medicine,
  2. Harsh Duggal, consultant in communicable disease control,
  3. Karen Howell, director
  1. South Staffordshire Health Authority, Stafford ST16 3SR
  2. Travel Health, Stafford ST17 0TL
  3. Communicable Disease Surveillance Centre (CDSC) North West, Chester CH1 4EF
  4. Cheshire and Wirral Communicable Disease Unit, Public Health Laboratory, Chester CH2 1UL
  5. Public Health Department, South and West Devon Health Authority, Dartington, Devon TQ9 6JE
  6. Department of Primary Care and General Practice, Medical School, University of Birmingham, Birmingham B15 2TT
  7. Goodwood Court Medical Centre, Hove, Brighton BN3 3DX

    EDITOR—Petrovic et al describe some of the uncertainties of health professionals involved in giving vaccinations.1 A degree of vulnerability is evident in the decreased rates of vaccination against measles, mumps, and rubella (MMR) and the negative publicity in the media. We suggest a way of increasing confidence clinically by improving the supply of information.

    We have been concerned for some time about the lack of an up to date version of the Department of Health's “green book,” Immunisation against Infectious Disease. These concerns are reinforced by the controversy surrounding vaccine programmes such as against measles, mumps, and rubella. The green book is a convenient form of evidence and advice covering the main vaccinations delivered through the NHS and is regarded as the Bible by many health professionals. A wide range of NHS staff is given responsibility for implementing these major public health programmes and other protective immunisations. These staff become accountable for the standard of the service provided but are currently impeded by a lack of updated, timely, and accessible information.

    The green book was published in 1990, 1992, and 1996; the 1996 edition states on page 13 that its recommendations “reflect present national immunisation policy,” although clearly it is five years out of date.2 Updated information either has been sent out in loose-leaf form or is available on the internet, but these sources may not be readily available to community nurses as they carry out their immunisation clinics. Access to a copy of the book is more likely.

    If the British National Formulary were published only every four years or so and prescribers had to rely on companies sending out individual updates on their products they might feel vulnerable when prescribing. Would it not be possible to publish the green book every six months with the …

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