Factors associated with uptake of measles, mumps, and rubella
vaccine (MMR) in the UK and use of single antigen vaccines in a
contemporary UK cohort: prospective cohort study
BMJ Editorial: Improving uptake of MMR vaccine
A
large study of children born 2000-2002 in the UK found that not enough
of them were being immunised against measles, mumps and rubella to
ensure adequate control of the diseases. Researchers at the UCL
Institute of Child Health and Great Ormond Street Hospital for Children
found that 88.6% of children had been immunised with MMR by the age of
three. 5.2% had received at least one of the single vaccines, and 6.1%
were unimmunised. Of the 634 children who had received at least one
single vaccine, just over half (52%) had received all three. The study
published on bmj.com today emphasised that this was well below the level
needed to prevent outbreaks of the diseases. Although uptake of MMR
vaccine has increased recently, there have been more cases of measles in
2007 than in any year for the past decade so further improvement is
essential.
The combined measles, mumps and rubella vaccine
(MMR) was introduced in 1988 in the UK. Following the publication of
unsubstantiated research in 1998, which was interpreted as suggesting a
link between the vaccine and autism and bowel disease, uptake in England
fell from 92% in 1995 to 79% in 2003.
The UCL researchers
explored social, economic and cultural factors associated with uptake as
well as parents’ reasons for not having MMR vaccine for the 14,578
children in the study. Children who had not received any MMR vaccine
were more likely to come from a large family, their mother was more
likely to smoke, and was either younger (under 20) or older (over 34)
than average when she gave birth. In contrast they found that parents
who chose single vaccines were significantly more likely to be white,
well educated, affluent, older, and have just one child compared with
parents who fully immunised their child. Of the parents who chose not
to have their child immunised with the MMR vaccine, the researchers
report that nearly three quarters (74.4%) said it was due to a
“conscious decision.” Common reasons given were being too scared,
thinking the vaccine was too dangerous, links with autism, and negative
media attention.
Although MMR uptake in this study is high, say
the authors, a substantial proportion of children remain susceptible to
avoidable infection, largely because parents consciously decide not to
immunise.
They conclude, as does the accompanying editorial,
that to achieve the best possible control of vaccine preventable
diseases, a variety of measures may be required to target the different
groups where uptake of the vaccine is low.
Notes to Editors
This
study only looked at uptake of the first dose of MMR vaccine. We know
from other data that uptake of the second dose is much lower. This
second dose is necessary to ensure all children are adequately
protected.
Single antigen vaccines are not licensed for use in
this country and are not a good substitute for the combined MMR vaccine.
They are only available on a private basis.
This study is based
on data from the Millennium Cohort Study, a longitudinal study of
children born in the UK from September 2000 to January 2002. At three
years, researchers determined MMR uptake and parents’ reasons for not
opting for MMR.
The Millennium Cohort Study is funded by grants
to Professor Heather Joshi, director of the study, from the ESRC and a
consortium of government funders. This work received funding from the
Department of Health and was undertaken at GOSH/UCL Institute of Child
Health which received a proportion of funding from the Department of
Health's NIHR Biomedical Research Centres funding scheme.
Contact:
Helen Bedford, Senior Lecturer, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
David Elliman Consultant in Community Child Health
Islington PCT and Great Ormond Street Hospital
Contact information:
GOSH-ICH Press Office: 020 7239 3125
Email: Coxs@gosh.nhs.uk
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