Determinants of Equity in Coverage of Measles-Containing Vaccines in Wales, UK, during the Elimination Era

Abstract

In the context of the WHO’s measles and rubella elimination targets and European Immunization Agenda 2030, this large cross-sectional study aimed to identify inequalities in measles vaccination coverage in Wales, UK. The vaccination status of individuals aged 2 to 25 years of age, alive and resident in Wales as of 31 August 2021, was ascertained through linkage of the National Community Child Health Database and primary care data. A series of predictor variables were derived from five national datasets and all analysis was carried out in the Secure Anonymised Information Linkage Databank at Swansea University. In these 648,895 individuals, coverage of the first dose of measles-containing vaccine (due at 12–13 months of age) was 97.1%, and coverage of the second dose (due at 3 years and 4 months) in 4 to 25-year-olds was 93.8%. In multivariable analysis, excluding 0.7% with known refusal, the strongest association with being unvaccinated was birth order (families with six or more children) and being born outside of the UK. Living in a deprived area, being eligible for free school meals, a lower level of maternal education, and having a recorded language other than English or Welsh were also associated with lower coverage. Some of these factors may also be associated with refusal. This knowledge can be used to target future interventions and prioritise areas for catch up in a time of limited resource.

Inequality in Immunization: Holding on to Equity as We ‘Catch Up’

“…The Special Issue features research, reviews, and commentaries that span a range of immunization topics and populations. While there is an emphasis on childhood vaccinations [ 15 , 16 , 17 , 18 ]—exploring inequalities in DTP and measles-containing vaccine (MCV) coverage [ 19 , 20 , 21 , 22 , 23 ] and patterns of inequality in unvaccinated or zero-dose children [ 24 , 25 , 26 , 27 , 28 , 29 ]—contributions also cover inequalities in adult immunization [ 30 ], including protection of pregnant women and their newborns against tetanus [ 31 ] and COVID-19 vaccination [ 32 , 33 ].…”

“…An encouraging observation while putting together this Special Issue has been the use of a variety of data sources to assess immunization inequalities. Studies have made use of traditional sources of immunization data like administrative data [ 19 , 23 , 32 ] and population surveys [ 18 , 21 , 22 , 27 , 29 , 30 ] (including Demographic and Health Surveys and/or Multiple Indicator Cluster Surveys [ 15 , 20 , 31 ]), while several other studies explored the potential of novel sources such as geospatial data [ 24 , 25 ], electronic immunization registries [ 34 ], dialogues [ 16 ], country appraisals and reports [ 35 ], and funding proposals [ 26 ]. Three review studies relied on synthesis and structured analyses drawing from a multitude of existing studies [ 17 , 33 , 36 ].…”

“…As dimensions of inequality present themselves and intersect in dynamic ways, our modes of understanding must keep up. Several studies in this Special Issue examined multiple dimensions of immunization inequality [ 18 , 19 , 21 , 27 , 29 , 31 , 33 , 36 ], while others focused on specific dimensions, such as gender barriers [ 20 , 34 ] or socioeconomic status [ 15 , 30 , 32 ].…”

Risk of vaccine preventable diseases in UK migrants: A serosurvey and concordance analysis

“…Seroprotection surveys among migrants in the UK are rare as national systems for collection of health data at the point of arrival is not as robust as in other European nations. However, a recent large-scale data linkage study conducted to identify factors associated with lower coverage of measles-containing vaccine among children and adults in Wales found strong association between not being vaccinated and being born outside the UK ( Perry et al, 2023 ). Similarly, a couple of seroprevalence studies on rubella and varicella zoster conducted in the late-2000s among pregnant women in London found low immunity among foreign-born women for these diseases ( Talukder et al, 2007 ; Hardelid et al, 2009 ).…”