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Understanding variation in measles-mumps-rubella immunization coverage--a population-based study
1Department of Geography, University of Southampton, Highfield, Southampton SO17 1BJ, UK. j.a.wright@soton.ac.uk
Background:
Coverage of the Measles-Mumps-Rubella combined vaccine (MMR) has declined in recent years in the UK, following adverse publicity about possible links between the vaccine, autism, and Crohn's disease. The objectives of this study were to assess geographical variation in trends in MMR coverage and to identify the factors affecting MMR uptake at population level.
Methods:
We conducted an ecological study of immunization coverage by second birthday, based on routinely collected data from 1993-2004 for England. Trends in MMR uptake were assessed in 95 District Health Authorities in England over the study period. We investigated the relationship between MMR immunization uptake and deprivation, ethnicity, education, population density, rurality, and socioeconomic class.
Results:
Since 2000, MMR coverage has declined significantly in virtually all areas of England. Population density and deprivation were both strongly correlated with low MMR uptake. The decline in coverage since 1993-94 was significantly related to the proportion of educated population and was greater in densely populated areas.
Conclusion:
Decline in MMR coverage now affects most areas of England. The lowest rates of MMR coverage remain in urban areas, particularly in inner cities, which also tend to show high levels of deprivation. Public health resources should continue to target inner city areas, as well as focus on the concerns of the better educated about vaccine safety.
Insights
Measles-Mumps-Rubella (MMR) vaccine coverage has declined across England, particularly in urban areas. Deprivation and population density correlate with lower MMR uptake, highlighting a need for targeted public health interventions.
Area of Science:
- Public Health
- Epidemiology
- Vaccinology
Background:
- Measles-Mumps-Rubella (MMR) vaccine coverage has decreased in the UK due to concerns linking the vaccine to autism and Crohn's disease.
- Assessing geographical variations and population-level factors influencing MMR uptake is crucial.
Purpose of the Study:
- To evaluate geographical trends in MMR vaccine coverage in England.
- To identify factors associated with MMR immunization uptake at a population level.
Main Methods:
- An ecological study utilizing routine immunization data from 1993-2004 for 95 District Health Authorities in England.
- Analysis of relationships between MMR uptake and socioeconomic deprivation, ethnicity, education, population density, rurality, and social class.
Main Results:
- MMR coverage has significantly declined in most English regions since 2000.
- Higher population density and deprivation levels were strongly associated with lower MMR vaccine uptake.
- Coverage decline was linked to the proportion of the educated population and was more pronounced in densely populated areas.
Conclusions:
- Declining MMR coverage is widespread across England, with the lowest rates in deprived urban areas.
- Public health efforts should prioritize inner-city regions and address vaccine safety concerns among educated populations.
- Understanding geographical disparities in MMR uptake is essential for effective public health strategies.
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