Awdurdod Iechyd Gogledd Cymru
North Wales Health Authority

Trish Groves
Assistant Editor
BMJ
BMA House
Tavistock Square
London, WC1H 9JR

Dear Dr. Groves,

Title: Health professionals and the second MMR vaccine

Thank you for your letter dated 20 July 2000 regarding the above paper. We are pleased that you are able to offer publication of this paper subject to the revisions that were suggested by the BMJ’s editorial committee.

We have dealt with the points raised in the report of the committee as follows.
 

1The total word count for the main body of text is now 1498 words.
 The length of the discussion has been reduced from 1229 words to 523 words.
 The abstract has also been slightly revised to reduce the word count to 249 words.
 The ‘This Week in the BMJ’ section has also been slightly revised to reduce the word count to 100 words.
 Additional tables have been used, as has a textbox for the selection of open comments, which have been further revised.
2Tables 1 and 2 have been combined and revised as suggested.
3A box summarising the current UK vaccine schedule is now included (see tables and textboxes file).
4aThe method of selection used for the GP sample is now included in the first paragraph of the methods section (page 4).
4bWe agree that it may be difficult to attribute the uptake of vaccine by children registered with a particular practitioner to the knowledge, attitudes and practice of only that practitioner. Data on MMR uptake has, therefore, been deleted from the paper.
4cWhilst, for brevity, we have removed most of the results that are expressed as odds ratios, in the following sections they have been retained because this enables more detailed interpretation of the data:
 
  • Confidence in explaining the rationale behind a two-dose schedule to a "well informed parent" (results section, page 6)
 
  • How health professionals advise those parents who remain unsure about the second dose of MMR vaccine (results section, page 6)
 
  • Do health professionals agree with the policy of giving a second dose of MMR? (results section, page 7)
5Comments of the independent reviewer. (The paragraph numbers refer to those of the reviewer’s report.)
 - Paragraph 3:
 
  • The North Wales Health Authority’s Director of Public Health and local general practitioner, health visitor and practice nurse professional representatives were informed of the intention to carry out this survey. Feedback was sought, both at this stage and during piloting of the questionnaire.
 
  • The sampling frame was all GPs in the North Wales Health Authority area.
 - Paragraph 4:
 
  • The question regarding the giving of advice to parents about immunisation was, in part, a filter. It was not thought appropriate to include the views of health professionals that had no input into the childhood immunisation programme. The four practice nurses that did not respond to this question could not be accurately categorised and were excluded from further analysis.
 - Paragraph 5:
 
  • Text in the results section has been replaced with tabulation wherever possible. Please note that, in line with the presentation of results in the text, tables do not include blank or invalid responses.
 
  • In accordance with the request of the BMJ’s editorial board, all reference to uptake has now been deleted.
 - Paragraph 6:
 
  • The original question refers to a colleague. Although implying any professional colleague, given the original wording of the question, it is not possible to be more specific.
 - Paragraph 7:
 
  • Given the current practice for submission of scientific work to peer-reviewed biomedical journals it was not thought appropriate to consider dissemination of the results in such a forum at this stage.
6The title of the paper has been amended as suggested and a copy of the paper is enclosed on a 3.5inch floppy disk in WordPerfect 5.x for Windows format.

Many thanks for your interest in this paper.

Yours sincerely

Dr. Marko Petrovic
On behalf of the authors
 

Copy: Dr. Mary Ramsay
Dr. Richard Roberts