Impact of the COVID-19 pandemic on timeliness and equity of measles, mumps and rubella vaccinations in North East London: a longitudinal study using electronic health records

Abstract

ObjectivesTo quantify the effect of the COVID-19 pandemic on the timeliness of, and geographical and sociodemographic inequalities in, receipt of first measles, mumps and rubella (MMR) vaccination.DesignLongitudinal study using primary care electronic health records.Setting285 general practices in North East London.ParticipantsChildren born between 23 August 2017 and 22 September 2018 (pre-pandemic cohort) or between 23 March 2019 and 1 May 2020 (pandemic cohort).Main outcome measureReceipt of timely MMR vaccination between 12 and 18 months of age.MethodsWe used logistic regression to estimate the ORs (95% CIs) of receipt of a timely vaccination adjusting for sex, deprivation, ethnic background and Clinical Commissioning Group. We plotted choropleth maps of the proportion receiving timely vaccinations.ResultsTimely MMR receipt fell by 4.0% (95% CI: 3.4% to 4.6%) from 79.2% (78.8% to 79.6%) to 75.2% (74.7% to 75.7%) in the pre-pandemic (n=33 226; 51.3% boys) and pandemic (n=32 446; 51.4%) cohorts, respectively. After adjustment, timely vaccination was less likely in the pandemic cohort (0.79; 0.76 to 0.82), children from black (0.70; 0.65 to 0.76), mixed/other (0.77; 0.72 to 0.82) or with missing (0.77; 0.74 to 0.81) ethnic background, and more likely in girls (1.07; 1.03 to 1.11) and those from South Asian backgrounds (1.39; 1.30 to 1.48). Children living in the least deprived areas were more likely to receive a timely MMR (2.09; 1.78 to 2.46) but there was no interaction between cohorts and deprivation (Wald statistic: 3.44; p=0.49). The proportion of neighbourhoods where less than 60% of children received timely vaccination increased from 7.5% to 12.7% during the pandemic.ConclusionsThe COVID-19 pandemic was associated with a significant fall in timely MMR receipt and increased geographical clustering of measles susceptibility in an area of historically low and inequitable MMR coverage. Immediate action is needed to avert measles outbreaks and support primary care to deliver timely and equitable vaccinations.

The Impact of the Coronavirus Pandemic on Vaccination Coverage in Latin America and the Caribbean

“…Large studies have shown that the coronavirus pandemic negatively impacted routine vaccination rates in countries around the world [25][26][27][28]. Consistent with previous research, the decrease in coverage in LAC countries and territories likely stems from service disruptions, a lack of vaccine availability, the population's fear of visiting health centers, and the diversion of resources to pandemic-related activities [25][26][27][28][29][30]. This being acknowledged, the fact that eight LAC countries and territories had no decreases in DPTcv3 coverage suggests that some countries may have been able to quickly recover from service disruptions in early 2020 due to their strong immunization programs [25], relatively mild income inequality, or other factors.…”

“We're potentially worsening health inequalities”: Evaluating how delivery of the 2022 London polio booster campaign was tailored to Orthodox Jewish families to reduce transmission vulnerability

“…Just 79% of children in northeast London received their first measles, mumps and rubella (MMR) vaccine on time prior to the COVID-19 pandemic, with timeliness decreasing most in City & Hackney during the pandemic ( Firman, 2022 ). In October–December 2022, Hackney GP surgeries recorded practice-level hexavalent vaccine coverage rates by 12 months of age as low as 16.7% and 23.4% ( United Kingdom Health Security Agency, 2023a ).…”

Implementation of a quality improvement programme using the Active Patient Link call and recall system to improve timeliness and equity of childhood vaccinations: protocol for a mixed-methods evaluation

“…8 We have recently assessed the impact of the COVID-19 pandemic in north east London (NEL), and found a 4% decrease in MMR timeliness in 2020 compared with the previous year, and marked inequalities between children living in the least and most deprived areas. 9 …”

“…This is consistent with findings from a study of general practices in England, however, this did not include many practices in London, which has historically the lowest childhood vaccination rates in the UK 8. We have recently assessed the impact of the COVID-19 pandemic in north east London (NEL), and found a 4% decrease in MMR timeliness in 2020 compared with the previous year, and marked inequalities between children living in the least and most deprived areas 9…”