Abstract
In the context of recent measles outbreaks, substantial factors associated with measles-mumps-rubella (MMR) unvaccination need to be clarified. This study aimed to identify differential demographic and clinical characteristics between MMR vaccinated and unvaccinated groups. We used a large-linked database to identify children born between 2008 and 2016 by combining data from the Korea Immunization Registry Information System and National Health Information database. The MMR vaccination status was ascertained up to the age of 2 to define MMR vaccinated and unvaccinated groups. We conducted a multivariate logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs) to identify factors associated with MMR unvaccination. Of 3,973,253 children, 75,674 (1.9%) did not receive the MMR vaccine. Compared with the MMR vaccinated group, the underutilization of healthcare resources was more notable in the MMR unvaccinated group (number of outpatient visits (5.73 ± 12.1 vs. 25.8 ± 17.06); days hospitalized (1.69 ± 14.5 vs. 2.32 ± 6.90)). Children were less likely to receive the MMR vaccine if they were born with congenital anomaly (OR 2.12; 95% CI 1.90–2.36), were never admitted to an intensive care unit (1.88; 1.78–1.98), or never visited an emergency room (3.57; 3.53–3.72). There were substantial factors associated with MMR unvaccination, underscoring a need to optimize targeted interventions tailored to the subset of children in South Korea.
Highlights
Measles accounted for the leading cause of death in children with its elimination being one of the top global priorities [1]
Data on the type of vaccine, date of immunization, age at immunization, dosing schedule information and immunization site were retrieved from the Korea Immunization Registry Information System (KIRIS), and data on diagnosis information, prescription, treatment or procedure information, medical insurance type, income level and location of residence were retrieved from the National Health Information Database (NHID)
In the MMR vaccinated group, employer-sponsored health insurance accounted for the majority of the group (68.1%), and self-employed health insurance only accounted insurance was 57.8%, and employer-sponsored health insurance only accounted for 27.9%
Summary
Measles accounted for the leading cause of death in children with its elimination being one of the top global priorities [1]. Following the introduction of the measles-containing vaccine, a tremendous effort made by the health authorities as well as healthcare practitioners in promoting its uptake led to the declaration of measles elimination in several countries. Despite such an effort, a recent resurgence of measles outbreaks has taken its toll on the global health burden [2]. There were 48 out of 194 cases involving children aged less than nine years old, of which 38 did not receive and 10 only received one dose of the measles-mumps-rubella (MMR) vaccine [3]. Given that all identified cases were either partially or not vaccinated, maintaining a high vaccination coverage is strongly recommended to prevent a measles outbreak
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