Abstract
The Joint Committee for Vaccination and Immunisation recommended to implement an earlier second dose for the Measles-Mumps-Rubella (MMR) vaccine starting in 2026 in the United Kingdom. We investigated the impact of these changes on measles transmission in England. Using an age- and region-stratified mathematical model, we simulated outbreaks with different vaccination schedules and coverage, using electronic health records and outbreak data from 2010 to 2019. Delivering the second MMR dose at 24 months reduced cases by 11.86% (IQR: -3.3; 23.81%) compared to the current schedule (3 years and 4 months) and showed a 22.39% (IQR: 10.05; 32.79%) reduction of cases if achieving the same coverage as the first MMR dose. The effect of delivering an earlier second MMR was lower when waning of vaccine-induced immunity was included (5.28% (-10.92; 19.63%)). Increasing first-dose coverage by 0.5% annually yielded slightly better outcomes than an earlier second dose (14.68% reduction, IQR:1.19; 27.49.9%). While improving first-dose uptake had the greatest impact, it may be difficult to achieve. Thus, an earlier second MMR dose can be a feasible alternative to reduce the measles burden in England where measles transmission follows typical near-elimination dynamics.
| Original language | English |
|---|---|
| Article number | 8601 |
| Journal | Nature Communications |
| Volume | 16 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 29 Sept 2025 |
Data Availability Statement
The individual-level case data were collected by the UK Health Security Agency (UKHSA) and cannot be shared publicly due to privacy concerns. However, this data is not required to run the model and the simulations and was only used for the original model fitting presented in our previous publication, Robert et al.31. The individual-level vaccination data was obtained from the Clinical Practice Research Datalink (CPRD). CPRD does not allow the sharing of patient-level data to protect the patient’s anonymity and privacy. The data specification for the CPRD dataset is available at: https://cprd.com/cprd-aurum-may-2022-dataset. For data access, a protocol needs to be submitted to the Electronic Research Applications Portal (eRAP) at www.erap.cprd.com and be approved for data access, which takes around 3 months. The COVER vaccination data is publicly available: https://www.england.nhs.uk/statistics/statistical-work-areas/child-immunisation/. The data to implement the alternative vaccination scenarios can be found in the GitHub repository: https://github.com/Eyedeet/measles_vaccination_scenarios/tree/main/Output.Acknowledgements
This work uses data provided by patients and collected by the NHS as part of their care and support (usemydata.org).Funding
A.S. and H.M. are funded by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation (NIHR200929), a partnership between the UK Health Security Agency and the London School of Hygiene and Tropical Medicine. The views expressed are those of the author(s) and not necessarily those of the NIHR, UK Health Security Agency or the Department of Health and Social Care. C.W.G. is supported by a Wellcome Career Development Award (225868/Z/22/Z). A.R. was supported by the National Institute for Health Research (NIHR200908), A.J.K. was supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust, the Royal Society (206250/Z/17/Z) and by the National Institute for Health and Care Research (NIHR200908).
Keywords
- Humans
- Measles/prevention & control
- Measles-Mumps-Rubella Vaccine/administration & dosage
- Infant
- Immunization Schedule
- Models, Theoretical
- England/epidemiology
- Child, Preschool
- Child
- Vaccination Coverage/statistics & numerical data
- Adolescent
- Disease Outbreaks/prevention & control
- Vaccination
- Adult
- Disease Eradication
- Young Adult
- United Kingdom/epidemiology
