Timeliness of childhood vaccination in England: A population-based cohort study

Anne M Suffel, Jemma L Walker, Elizabeth Williamson, Helen I McDonald, Charlotte Warren-Gash

Research output: Contribution to journalArticlepeer-review

1 Citation (SciVal)

Abstract

INTRODUCTION: Vaccine surveillance for children in England focuses on coverage at ages 1, 2, and 5 years. Previous studies exploring vaccine timeliness have used different arbitrary categories to define whether vaccines were received 'late' or 'on time'. This paper aims to provide more detailed and holistic information on timing and patterns of vaccine uptake across the childhood immunisation schedule in England.

METHODS: We included all children born in England between 2006 and 2014 and registered in the Clinical Practice Research Datalink (CPRD) Aurum, a primary care electronic health record. We described vaccine uptake for representative antigens (pertussis, pneumococcus, measles) by age in days and stratified by ethnicity, region and birth cohort. Alluvial diagrams were used to illustrate common journeys through the vaccination schedule, and we applied survival analysis using accelerated failure time models (AFT) to predict age of vaccine receipt based on timing of previous doses.

RESULTS: 573,015 children were followed up until their fifth birthday, when they had 90.16 % coverage for two doses of measles, mumps, rubella (MMR) vaccine and 88.78% coverage for four doses of diphtheria, tetanus, pertussis (DTP) vaccine. Overall, the later the age at which a vaccine was due, the more delay in vaccination. Children of Black Ethnicity or from London showed deviating uptake patterns. If a child received their third DTP dose more than a year later than recommended, they would receive the next dose 2.7 times later than a child who was vaccinated on time. A smaller delay was found for children who did not receive first MMR dose on time.

DISCUSSION: We showed that the risk of vaccination delay increased with the age of the child and significant delay of previous doses. Primary care data can help to promptly identify children at higher risk of delayed vaccination.

Original languageEnglish
Pages (from-to)5775-5781
Number of pages7
JournalVaccine
Volume41
Issue number39
Early online date11 Aug 2023
DOIs
Publication statusPublished - 7 Sept 2023

Bibliographical note

Funding Statement:
This study is funded by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation (NIHR200929), a partnership between 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. CWG is supported by a Wellcome Career Development Award (225868/Z/22/Z).

Data availability:
The authors do not have permission to share data.

Keywords

  • Childhood immunisations
  • Patterns
  • Vaccine coverage
  • Vaccine delay
  • Vaccine uptake

ASJC Scopus subject areas

  • General Veterinary
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Molecular Medicine
  • General Immunology and Microbiology

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