MMR Uptake Research Articles

Primary care utilization in Bulgaria: some effects of the COVID-19 pandemic

Abstract Background Disruptions to primary care provision during the pandemic set back prior advancements in screening and chronic disease management. Delays in routine vaccination added to preexisting hesitancy and sustained the downward trend in vaccination rates. The study examines the magnitude and duration of primary care disruptions in Bulgaria between 2020 and 2022. Methods The impact of the pandemic on primary care is assessed using administrative data from the National Health Insurance Fund covering the annual number of primary care services. To evaluate the effect on healthcare utilization, the average number of check-ups per person during the pandemic is compared to a pre-pandemic period (2017-2019). Results After the onset of the pandemic, all visits declined significantly on an annual basis. In 2020, overall prophylactic check-ups dropped by 6-13% and remained lower than the baseline until 2022. Initial figures for 2023 suggest some recovery, while specific services are likely to experience an ongoing decrease. During the pandemic, the average number of prophylactic examinations for children fell between 6.9 and 9.3%. In 2022, there was a modest resumption, although these services did not reach the preceding levels. Adult prophylactic visits declined by approximately 10-12% between 2020 and 2021, but following a U-shaped pattern, they rebounded in 2022. Visits associated with chronic diseases experienced a drop of 7.8% in 2020 and continued to decrease in the next two years. Child vaccination was affected for a shorter period. In 2022, the coverage for most vaccine-preventable diseases was close to the pre-pandemic levels. However, the uptake of MMR and pneumococcal vaccines failed to demonstrate a clear path to recovery. Conclusions During the pandemic, a considerable drop in primary care utilization has been recorded. Effective recovery requires sustained service delivery and a rapid post-lockdown rebound to mitigate the negative impact on health outcomes. Key messages • Primary care needs additional recovery measures to prevent long-term harmful impacts on health outcomes. • Investing in service delivery innovations can boost resilience during disruptive events.

Interventions’ transferability assessment to strengthen Vaccination Uptake Among Migrants in Greece

Abstract Background Migrant children in Greece face significantly lower vaccination coverage rates for MMR and HPV compared to their counterparts. To address this disparity, our research focuses on selecting and adapting evidence-based interventions tailored to the specific needs of different migrant communities staying in Greece, guided by the PIET-T framework. Methods Using a stakeholder-engaged approach, we involved 26 key stakeholders to select evidence-based interventions relevant to the Greek context. These interventions underwent detailed analysis, considering their effectiveness, cultural appropriateness, and potential for transferability within the PIET-T framework. Key stakeholders provided input on intervention feasibility and country- and context-specific adaptation. Results Three interventions were identified as promising for MMR and HPV vaccination uptake: two health promoter interventions and a school-based vaccination one. The health promoter intervention was adapted so to involve health professionals and trusted community members delivering culturally sensitive education and navigation support, addressing barriers such as language and lack of information. The original school-based program implements education sessions and on-site vaccinations, leveraging the trusted environment of schools to reach parents and children. On-site vaccinations were omitted since they were not relevant to the Greek context due to legal barriers. Conclusions Our stakeholder-engaged approach, guided by the PIET-T framework, ensures interventions are tailored to the specific needs and contexts of different migrant communities in Greece. By prioritizing cultural sensitivity and community involvement, we aim to enhance MMR and HPV vaccination uptake and improve health outcomes among migrant populations.

Mitigating Vaccine Hesitancy and Building Trust to Prevent Future Measles Outbreaks in England.

Measles, a highly infectious respiratory viral infection associated with severe morbidity and mortality, is preventable when coverage with the highly effective measles, mumps and rubella vaccine (MMR) is ≥95%. Vaccine hesitancy is responsible for measles outbreaks in countries where measles had previously been eliminated, including in England, and is one of the ten threats to global public health identified by the World Health Organization (WHO). Official administrative 2012-2021 data on measles incidence and MMR coverage in England were reviewed alongside a scoping literature review on factors associated with MMR uptake in England. Whilst measles incidence has reduced significantly since 2012, sporadic measles outbreaks in England have occurred with geographic disparities and variations in MMR coverage. Over the last decade, MMR uptake has fallen across all regions with no area currently reaching the WHO target of 95% coverage of both doses of MMR necessary for herd immunity. Factors associated with MMR coverage overlap with the 3C (convenience, complacency and confidence) model of vaccine hesitancy. The COVID-19 pandemic has reinforced pre-existing vaccine hesitancy. Increasing MMR uptake by reducing vaccine hesitancy requires allocated funding for area-based and targeted domiciliary and community-specific immunisation services and interventions, public health catch-up campaigns and web-based decision aid tools.

Enablers and barriers associated with high MMR uptake among the Finnish Somali population

Abstract Introduction In Finland, the Somali-speaking community is the fourth largest migrant group after Russian, Estonian, and Arabic-speaking communities. Finland is home to 21,000 Somali-speaking individuals, with around 70 % of them living in the capital region. Even though vaccine uptake in most ethnic minority communities is usually lower, MMR coverage in Finnish Somali children is partly higher than that of ethnic Finns. Methods We interviewed 30 Somali-origin mothers living in the capital region of Finland in terms of childhood vaccination acceptance, and in specific, issues affecting their children's MMR vaccine uptake. All interviews were conducted by a Somali researcher either in Somali or Finnish language. The interviews were recorded, transcribed, translated, and analysed using thematic analysis of the transcripts. To understand the enablers presented by the health care system in Finland, 10-15 public health nurses working in maternal and child health clinics in the capital region will be interviewed. Results and discussion Preliminary results show that trust in the health care system is the main enabler of high MMR vaccine coverage in the Somali population - even when mother's knowledge of the vaccine was very limited. In terms of information sources, mothers indicated that they ask, and trust maternal and child health clinics in all vaccine-related information- often more than any other source, including the internet. Conclusions This study enhances our understanding of system level enablers in the Finnish Somali community regarding MMR vaccination. The results of this study are applicable to improve vaccine uptake in other underserved minority communities throughout Europe.

MMR Vaccine Attitude and Uptake Research in the United Kingdom: A Critical Review.

This review critically assesses the body of research about Measles-Mumps-and-Rubella (MMR) vaccine attitudes and uptake in the United Kingdom (UK) over the past 10 years. We searched PubMed and Scopus, with terms aimed at capturing relevant literature on attitudes about, and uptake of, the MMR vaccine. Two researchers screened for abstract eligibility and after de-duplication 934 studies were selected. After screening, 40 references were included for full-text review and thematic synthesis by three researchers. We were interested in the methodologies employed and grouped findings by whether studies concerned: (1) Uptake and Demographics; (2) Beliefs and Attitudes; (3) Healthcare Worker Focus; (4) Experimental and Psychometric Intervention; and (5) Mixed Methods. We identified group and individual level determinants for attitudes, operating directly and indirectly, which influence vaccine uptake. We found that access issues, often ignored within the public “anti-vax” debate, remain highly pertinent. Finally, a consistent theme was the effect of misinformation or lack of knowledge and trust in healthcare, often stemming from the Wakefield controversy. Future immunisation campaigns for children, including for COVID-19, should consider both access and attitudinal aspects of vaccination, and incorporate a range of methodologies to assess progress, taking into account socio-economic variables and the needs of disadvantaged groups.

"I think meningitis is a virus, while septicaemia might be caused by bacteria." A study of vaccination views, disease awareness and MenACWY and MMR uptake among freshers at a London university.

University students are at particular risk of invasive meningococcal disease (IMD). Group W, an aggressive strain, is increasing in prevalence and the high case-fatality rate is concerning. Adolescents have been offered the MenACWY vaccine since 2015. National uptake has been low, leaving students vulnerable to infection. To investigate MenACWY uptake, knowledge of IMD and attitudes towards vaccination among UCL first-year students. A mixed methods approach was used, involving a questionnaire (n=144) and follow-up interviews (n=13). Students were asked for demographic details and questions including vaccination status, awareness of the vaccine, other vaccination history and knowledge of IMD, which was assessed through true/false/unsure statements. Interviews explored these issues in more detail as well as their suggestions for making vaccination more accessible for students. MenACWY uptake was 84%, with more socioeconomically disadvantaged students being less likely to be vaccinated (aOR=0.117, p=0.006). Most students thought vaccines were safe and important. Students with above average knowledge were more likely to be vaccinated (OR=3.057, p=0.019). Vaccination views were positive and knowledge level was moderate to high. Reasons for non-vaccination included illness, laziness, forgetfulness and difficulty with GP access. Of concern, many students believed that the vaccine prevents any cause of meningitis. High vaccine uptake is essential to protect students. Uptake at University College London is higher than at other universities in previous studies. This research highlights several areas requiring further study and has implications for university vaccination policy.

Resurgence of Measles in Europe: A Systematic Review on Parental Attitudes and Beliefs of Measles Vaccine

Background and ObjectivesEurope has experienced a major resurgence of measles in recent years, despite the availability and free access to a safe, effective, and affordable vaccination measles, mumps and rubella vaccine (MMR). The main driver for this is suboptimal vaccine coverage. Parental attitudes and beliefs toward measles vaccination are of paramount importance in influencing vaccine coverage. The three objectives of this study are to synthesize and critically assess parental attitudes and beliefs toward MMR uptake, to develop strategies and policy recommendations to effectively improve MMR vaccine uptake accordingly, and ultimately to identify areas for further research.MethodsA systematic review was conducted using primary studies from PubMed, Medline, Embase, and Scopus published between 2011 and April 2019. Inclusion criteria comprised primary studies in English conducted in Europe and studying parental attitudes and behavior regarding MMR uptake. Data were extracted using an inductive grounded theory approach.ResultsIn all, 20 high-quality studies were identified. Vaccine hesitancy or refusal were mainly due to concerns about vaccine safety, effectiveness, perception of measles risk and burden, mistrust in experts, and accessibility. Factors for MMR uptake included a sense of responsibility toward child and community health, peer judgement, trust in experts and vaccine, and measles severity. Anthroposophical and Gypsy, Roma, and Traveler populations presented unique barriers such as accessibility.ConclusionA multi-interventional, evidence-based approach is vital to improve confidence, competence, and convenience of measles vaccination uptake. Healthcare professionals need an understanding of individual contextual attitudes and barriers to MMR uptake to tailor effective communication. Effective surveillance is needed to identify under-vaccinated populations for vaccination outreach programs to improve accessibility and uptake.

A novel measles outbreak control strategy in the Netherlands in 2013-2014 using a national electronic immunization register: A study of early MMR uptake and its determinants.

During a large measles outbreak in the Netherlands in 2013-2014, infants aged 6-14months living in municipalities with low (<90%) measles-mumps-rubella (MMR) coverage were individually invited for an early MMR using the national electronic immunization register, Præventis. We estimated uptake of early MMR prior to and during the 2013-2014 outbreak and assessed determinants for early MMR vaccination. We obtained vaccination records from Præventis, and defined early MMR as vaccination before 415days (13months) of age. A multi-level multivariable logistic regression model, restricted to infants with three diphtheria-pertussis-tetanus-polio (DPTP) vaccinations was used to examine the association between early MMR uptake and sex, parents' country of birth, socioeconomic status (SES; at postcode level) and voting proportions for the Reformed Political Party (SGP; at municipal level), used as a proxy for religious objections towards vaccination. In the 29 municipalities with low MMR coverage, uptake of early MMR was 0.5-2.2% prior to the outbreak. Between July 2013 and March 2014, 5,800 (57%) invited infants received an early MMR. Among infants with three DPTP, 70% received an early MMR. Only 1% of infants without prior DPTP received an early MMR. Lower early MMR uptake was associated with a higher SGP voter-ship (OR 0.89 per 5% increase, 95%CI 0.83-0.96), parents' with unknown country of birth (OR 0.66 95%CI 0.47-0.93) and compared with very high SES, high SES had significantly lower early MMR uptake (OR 0.66 95%CI 0.50-0.87). This is the first study describing use of Præventis during an outbreak and to assess determinants of early MMR uptake. More than half of invited infants obtained an early MMR. SES, parents' with unknown country of birth and religious objections towards vaccination were found to be associated with lower early MMR uptake. In future outbreaks, these determinants could be used to tailor intervention strategies.

The economic cost of measles: Healthcare, public health and societal costs of the 2012–13 outbreak in Merseyside, UK

BackgroundMeasles is a highly contagious vaccine-preventable infection that caused large outbreaks in England in 2012 and 2013 in areas which failed to achieve herd protection levels (95%) consistently. We sought to quantify the economic costs associated with the 2012–13 Merseyside measles outbreak, relative to the cost of extending preventative vaccination to secure herd protection. MethodsA costing model based on a critical literature review was developed. A workshop and interviews were held with key stakeholders in the Merseyside outbreak to understand the pathway of a measles case and then quantify healthcare activity and costs for the main NHS providers and public health team incurred during the initial four month period to May 2012. These data were used to model the total costs of the full outbreak to August 2013, comprising those to healthcare providers for patient treatment, public health and societal productivity losses. The modelled total cost of the full outbreak was compared to the cost of extending the preventative vaccination programme to achieve herd protection. FindingsThe Merseyside outbreak included 2458 reported cases. The estimated cost of the outbreak was £4.4m (sensitivity analysis £3.9m to £5.2m) comprising 15% (£0.7m) NHS patient treatment costs, 40% (£1.8m) public health costs and 44% (£2.0m) for societal productivity losses. In comparison, over the previous five years in Cheshire and Merseyside a further 11,793 MMR vaccinations would have been needed to achieve herd protection at an estimated cost of £182,909 (4% of the total cost of the measles outbreak). InterpretationFailure to consistently reach MMR uptake levels of 95% across all localities and sectors (achieve herd protection) risks comparatively higher economic costs associated with the containment (including healthcare costs) and implementation of effective public health management of outbreaks. FundingCommissioned by the Cheshire and Merseyside Public Health England Centre.

Low vaccination coverage among italian healthcare workers in 2013

Vaccination of healthcare workers (HCWs) reduces the risk of occupational infections, prevents nosocomial transmission and maintains healthcare delivery during outbreaks. Despite the European directive and national legislation on workers’ protection, immunization coverage among HCWs has often been very low. In light of Italian National Vaccination Plan 2012–2014 recommendations, the aim of this study was to assess levels of immunization and factors influencing adherence to vaccinations needed for HCWs in Puglia region, South Italy. The study was conducted using an interview-based standardized anonymous questionnaire administered to hospital employees in the period November 2009-March 2011. A total of 2198 health professionals responded in 51/69 Apulian hospitals (median age: 45 years; 65.2% nurses, 22.6% doctors and 12.2% other hospital personnel). Vaccination coverage was 24.8% for influenza, 70.1% for hepatitis B, 9.7% for MMR, 3.6% for varicella, and 15.5% for Td booster. Receiving counselling from occupational health physicians (OHPs) was associated with influenza (OR = 1.8; 95%CI = 1.5–2.2; P < 0.001), hepatitis B (OR = 4.9; 95%CI = 3.9–6.3; P < 0.001), varicella (OR = 43.7; 95%CI = 18.9–101.7; P < 0.001), MMR (OR = 8.8; 95%CI = 4.1–18.6; P < 0.001) and tetanus (OR = 50.5; 95%CI = 30.1–88.3; P < 0.001) vaccine uptake. OHPs should be trained with standard guidelines specific for healthcare settings and HCWs’ risk groups to facilitate their crucial role in improving vaccine coverage among HCWs and increase awareness on the duty to protect both employees and patients.

Parental decision-making in uptake of the MMR vaccination: a systematic review of qualitative literature.

Controversy has surrounded MMR vaccination in the aftermath of Wakefield's 1998 paper suggesting links between MMR and the development of pervasive developmental disorder in children. The paper sparked off media debate and contributed to a lack of parental trust in health-care providers and reduction in MMR uptake. This review aims to identify and evaluate research on the subject, with a view to present the reasons behind, and influences on parental decision-making in relation to MMR. Systematic search strategy identified 14 relevant papers on which thematic analysis was performed. Themes identified were categorized as follows: perceptions of risk; roles and responsibility; experience and knowledge. There were limited changes in parental decision-making factors over the time period despite an increase in uptake. Many studies fail to differentiate between accepters and rejecters, making it difficult to draw out clear conclusions. Policymakers need to adapt information provided to address these concerns. Future research should focus more on distinguishing between accepters and rejecters to determine which factors can alter outcome.

Arrived safely? Audit of documentation of successful transfer into adult care of young people attending paediatric rheumatology clinics

Arrived safely? Audit of documentation of successful transfer into adult care of young people attending paediatric rheumatology clinics

Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: a three-arm cluster randomised controlled trial in primary care.

Levels of measles in England and Wales are at their highest for 18 years, and strategies targeting the different groups of parents who do not vaccinate their children continue to be needed. Decision aids for decisions regarding childhood immunisation appear to be effective in achieving an increase in vaccine uptake but their cost effectiveness is unknown. To assess the cost effectiveness of a web-based decision aid to increase uptake of the MMR vaccine. Economic evaluation conducted alongside a cluster randomised controlled trial using urban GP practices in the north of England. Fifty GP practices in the north of England were randomised to one of three trial arms: decision aid, leaflet, usual practice. A total of 220 first-time parents (child aged 3-12 months) were recruited. Parents self-reported their contacts with the NHS and other previous/expected resource utilisation; associated costs were calculated. Vaccine-uptake data were collected from GP practices. A cost-effectiveness analysis was undertaken and provided the incremental cost per first-vaccine uptake. Multiple imputation was used to account for missing data and findings were adjusted for baseline differences in parents' levels of decisional conflict regarding MMR vaccination. Of the 220 first-time parents recruited to the study, 179 completed the baseline and post-intervention questionnaires. MMR uptake was highest for those receiving the decision aid (42 out of 42, 100%) versus usual practice (61 out of 62, 98%) and leaflet arm (69 out of 75, 92%), and was associated with lower cost (-£9.20 versus usual practice and -£7.17 versus leaflet). The decision aid has a high chance of being cost effective, regardless of the value placed on obtaining additional vaccinations. It also appears to offer an efficient means of decision support for parents.

G142(P) MMR Vaccine: No jab, no school or your child, your choice

IntroductionIn March 2012 there was Measles outbreak in Gwynedd because of poor MMR vaccination uptake rates.AimsTo review MMR vaccine uptake in primary and secondary schools in Caerphilly Borough and to...

Is the MMR vaccination programme failing to protect women against rubella infection?

In recent years the number of pregnant women susceptible to rubella has increased markedly. In the West Midlands the proportion has risen from 1·4% in 2004 to 6·9% in 2011. Locally, the proportion of non-immune women ranges from 1·6% in those born prior to 1976 to 17·8% in those born since 1986. The latter group comprises those given MMR in their second year with no further booster doses. The number of non-immune women will continue to rise as a consequence of low MMR uptake in the late 1990s. Repeat testing of samples with values <10 IU/ml and the need to vaccinate women postnatally have increased the workload of laboratory and maternity units. Screening for rubella in pregnancy has no advantages for the current pregnancy and it may be time to review the universal MMR vaccination programme which in turn would remove the need for continuing this practice.

Attitudinal and Demographic Predictors of Measles-Mumps-Rubella Vaccine (MMR) Uptake during the UK Catch-Up Campaign 2008–09: Cross-Sectional Survey

Background and ObjectiveContinued suboptimal measles-mumps-rubella (MMR) vaccine uptake has re-established measles epidemic risk, prompting a UK catch-up campaign in 2008–09 for children who missed MMR doses at scheduled age. Predictors of vaccine uptake during catch-ups are poorly understood, however evidence from routine schedule uptake suggests demographics and attitudes may be central. This work explored this hypothesis using a robust evidence-based measure.DesignCross-sectional self-administered questionnaire with objective behavioural outcome.Setting and Participants365 UK parents, whose children were aged 5–18 years and had received <2 MMR doses before the 2008–09 UK catch-up started.Main Outcome MeasuresParents' attitudes and demographics, parent-reported receipt of invitation to receive catch-up MMR dose(s), and catch-up MMR uptake according to child's medical record (receipt of MMR doses during year 1 of the catch-up).ResultsPerceived social desirability/benefit of MMR uptake (OR = 1.76, 95% CI = 1.09–2.87) and younger child age (OR = 0.78, 95% CI = 0.68–0.89) were the only independent predictors of catch-up MMR uptake in the sample overall. Uptake predictors differed by whether the child had received 0 MMR doses or 1 MMR dose before the catch-up. Receipt of catch-up invitation predicted uptake only in the 0 dose group (OR = 3.45, 95% CI = 1.18–10.05), whilst perceived social desirability/benefit of MMR uptake predicted uptake only in the 1 dose group (OR = 9.61, 95% CI = 2.57–35.97). Attitudes and demographics explained only 28% of MMR uptake in the 0 dose group compared with 61% in the 1 dose group.ConclusionsCatch-up MMR invitations may effectively move children from 0 to 1 MMR doses (unimmunised to partially immunised), whilst attitudinal interventions highlighting social benefits of MMR may effectively move children from 1 to 2 MMR doses (partially to fully immunised). Older children may be best targeted through school-based programmes. A formal evaluation element should be incorporated into future catch-up campaigns to inform their continuing improvement.

General practice factors and MMR vaccine uptake: structure, process and demography

Despite the fall in MMR uptake between 1998 and 2004, some general practices managed to sustain remarkably high MMR coverage. The aim of the study was to identify general practice factors associated with high MMR vaccine coverage. The study population included 257 general practices in Cumbria and Lancashire in 2005. Practice level MMR coverage data for 2002-04 were obtained from the child health information systems of eight Primary Care Trusts (PCTs) and linked to information on practice structure, census indicators for deprivation and ethnicity data at lower level super output area and information from a questionnaire survey of practice nurses. Mean MMR uptake was 86.4% with a range from 59 to 98%. Twenty-eight per cent (74/257) practices achieved the Department of Health higher target payment level of 90%. The uptake was not associated with practice size, the number of general practitioners (GPs) or practice nurses. There was no correlation between uptake and deprivation or the percentage of non-white population. There was a strong negative association between MMR uptake and barriers to housing and services (r = -0.230, P < 0.001). On the basis of a questionnaire response rate of 75.9%, having a strategic approach to MMR with clear objectives was associated with MMR uptake of 90% or above (odds ratio, 3.76, 1.26-12.04). There was no association between immunization by GP, practice nurse or health visitor. There are no easily identifiable characteristics of high-uptake MMR practices although having a strategic approach to MMR is important. Practices in rural areas should endeavour to ensure easy access to child vaccination. High uptake can be achieved by practices in deprived areas. Further research is needed to identify practice system factors associated with high MMR uptake.

The Millennium Cohort Study Child Health Group Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study

. Pearce A., Law C., Elliman D., Cole T. J. &amp; Bedford H. ( 2008 ) , 336 , 754 – 757 . DOI: 10.1136/bmj.39489.590671.25 . Objectives To estimate uptake of the combined measles, mumps, and rubella vaccine (MMR) and single antigen vaccines and explore factors associated with uptake and reasons for not using MMR.Design Nationally representative cohort study.Setting Children born in the UK, 2000–2002.Participants A total of 14 578 children for whom data on immunization were available.Main outcome measures Immunization status at 3 years defined as ‘immunized with MMR’, ‘immunized with at least one single antigen vaccine’, and ‘unimmunized’.Results In total, 88.6% (13 013) were immunized with MMR and 5.2% (634) had received at least one single antigen vaccine. Children were more likely to be unimmunized if they lived in a household with other children (risk ratio 1.74, 95% confidence interval 1.35 to 2.25, for those living with three or more) or a lone parent (1.31, 1.07 to 1.60) or if their mother was under 20 (1.41, 1.08 to 1.85) or over 34 at cohort child's birth (reaching 2.34, 1.20 to 3.23, for ≥40), more highly educated (1.41, 1.05 to 1.89, for a degree), not employed (1.43, 1.12 to 1.82), or self‐employed (1.71, 1.18 to 2.47). Use of single vaccines increased with household income (reaching 2.98, 2.05 to 4.32, for incomes of ≥£52 000 (€69 750, $102 190)), maternal age (reaching 3.04, 2.05 to 4.50, for ≥40) and education (reaching 3.15, 1.78 to 5.58, for a degree). Children were less likely to have received single vaccines if they lived with other children (reaching 0.14, 0.07 to 0.29, for three or more), had mothers who were Indian (0.50, 0.25 to 0.99), Pakistani or Bangladeshi (0.13, 0.04 to 0.39), or black (0.31, 0.14 to 0.64), or aged under 25 years (reaching 0.14, 0.05 to 0.36, for 14–19). Nearly three‐quarters (74.4%, 1110) of parents who did not immunize with MMR made a ‘conscious decision’ not to immunize.Conclusions Although MMR uptake in this cohort is high, a substantial proportion of children remain susceptible to avoidable infection, largely because parents consciously decide not to immunize. Social differentials in uptake could be used to inform targeted interventions to promote uptake.

Does primary immunisation status predict MMR uptake?

Objective:To investigate the relationship between primary immunisation status and MMR uptake.Design:Nationally representative Millennium Cohort Study.Setting:Children born in the UK, 2000–2002.Participants:14 578 children with immunisation data.Main outcome measures:MMR status at 3...

Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study

Objectives To estimate uptake of the combined measles, mumps, and rubella vaccine (MMR) and single antigen vaccines and explore factors associated with uptake and reasons for not using MMR.Design Nationally...