title: Effect of socioeconomic deprivation on uptake of measles, mumps and rubella vaccination in Liverpool, UK over 16 years: a longitudinal ecological study.
abstract: Suboptimal uptake of the measles, mumps and rubella (MMR) vaccine by certain socioeconomic groups may have contributed to recent large measles outbreaks in the UK. We investigated whether socioeconomic deprivation was associated with MMR vaccine uptake over 16 years. Using immunization data for 72,351 children born between 1995 and 2012 in Liverpool, UK, we examined trends in vaccination uptake. Generalized linear models were constructed to examine the relative effect of socioeconomic deprivation and year of birth on MMR uptake. Uptake of MMR1 by age 24 months ranged between 82·5% in 2003 [95% confidence interval (CI) 81·2-83·7] and 93·4% in 2012 (95% CI 92·7-94·2). Uptake of MMR2 by age 60 months ranged between 65·3% (95% CI 64·4-67·4) in 2006 and 90·3% (95% CI 89·4-91·2) in 2012. In analysis adjusted for year of birth and sex, children in the most deprived communities were at significantly greater risk of not receiving MMR1 [risk ratio (RR) 1·70, 95% CI 1·45-1·99] and MMR2 (RR 1·36, 95% CI 1·22-1·52). Higher unemployment and lower household income were significantly associated with low uptake. Contrary to concerns about lower MMR uptake in affluent families, over 16 years, children from the most socioeconomically deprived communities have consistently had the lowest MMR uptake. Targeted catch-up campaigns and strategies to improve routine immunization uptake in deprived areas are needed to minimize the risk of future measles outbreaks.
authors.affiliation: Department of Clinical Infection,Microbiology & Immunology,Institute of Infection and Global Health,University of Liverpool,Liverpool,UK.
authors.forename: D
authors.initials: D
authors.lastname: Hungerford
authors.affiliation: Department of Public Health and Policy,University of Liverpool,Liverpool,UK.
authors.forename: P
authors.initials: P
authors.lastname: Macpherson
authors.affiliation: Public Health, Salford City Council,Unity House Civic Centre,Chorley Road,Swinton,UK.
authors.forename: S
authors.initials: S
authors.lastname: Farmer
authors.affiliation: Health Protection,Cheshire and Merseyside,Public Health England North West,Liverpool,UK.
authors.forename: S
authors.initials: S
authors.lastname: Ghebrehewet
authors.affiliation: Public Health England/NHS England Merseyside,Screening and Immunisation Lead,Liverpool,UK.
authors.forename: D
authors.initials: D
authors.lastname: Seddon
authors.affiliation: Field Epidemiology Services,Public Health England,Liverpool,UK.
authors.forename: R
authors.initials: R
authors.lastname: Vivancos
authors.affiliation: Health Protection,Cheshire and Merseyside,Public Health England North West,Liverpool,UK.
authors.forename: A
authors.initials: A
authors.lastname: Keenan
mesh_terms: D002675:Child, Preschool; D004739:England; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D022542:Measles-Mumps-Rubella Vaccine
keywords: Analysis of data; MMR vaccination; epidemiology; measles (rubeola); public health