National rates and disparities in childhood vaccination and vaccine-preventable disease during the COVID-19 pandemic: English sentinel network retrospective database study

Abstract

ObjectivesTo describe rates and variation in uptake of pneumococcal and measles, mumps and rubella (MMR) vaccines in children and associated change in vaccine-preventable diseases (VPDs) across the first and second waves of the COVID-19 pandemic.MethodsRetrospective database study of all children aged <19 registered with a general practice in the Oxford Royal College of General Practitioners Research and Surveillance Centre English national sentinel surveillance network between 2 November 2015 and 18 July 2021.ResultsCoverage of booster dose of pneumococcal vaccine decreased from 94.5% (95% CI 94.3% to 94.7%) at its height on International Organization for Standardization (ISO) week 47 (2020) to 93.6% (95% CI 93.4% to 93.8%) by the end of the study. Coverage of second dose of MMR decreased from 85.0% (95% CI 84.7% to 85.3%) at its height on ISO week 37 (2020) to 84.1% (95% CI 83.8% to 84.4%) by the end of the study. The break point in trends for MMR was at ISO week 34 (2020) (95% CI weeks 32–37 (2020)), while for pneumococcal vaccine the break point was later at ISO week 3 (2021) (95% CI week 53 (2020) to week 8 (2021)). Vaccination coverage for children of white ethnicity was less likely to decrease than other ethnicities. Rates of consultation for VPDs fell and remained low since August 2020.ConclusionChildhood vaccination rates started to fall ahead of the onset of the second wave; this fall is accentuating ethnic, socioeconomic and geographical disparities in vaccine uptake and risks widening health disparities. Social distancing and school closures may have contributed to lower rates of associated VPDs, but there may be increased risk as these measures are removed.

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

“…However, there is heterogeneity within these results according to geographical area of interest 31. We found that children from black and mixed/other ethnic backgrounds were less likely to receive timely vaccination, broadly consistent with findings from studies of COVID-19 vaccination uptake which have shown lowest uptake among people from black ethnic backgrounds 32 33. Additional qualitative evidence suggests women from minority ethnic backgrounds were more likely to find it difficult to access and felt less safe accessing vaccinations for their babies during the COVID-19 pandemic 34…”

Future reporting of vaccine uptake needs to include any change in ethnic or socioeconomic disparities

“…uptake of the MMR vaccine in England [2]. The need for this strategic focus accords with our estimates, which further identify widening disparities in childhood vaccine uptake [3].…”

“…Coverage of the second dose of MMR decreased from 85.0% (95% CI 84.7% to 85.3%) at its height in September 2020 to 84.1% (95% CI 83.8% to 84.4%) by July 2021. Importantly, decreases in vaccine coverage varied by ethnicity, socioeconomic status and population density with a greater decline in non-white ethnicities, the most deprived socio-economic groups and in conurbations [3].…”

Recurrent or unusual infections in children – when to worry about inborn errors of immunity

“…The WHO reported in May 2020 that 68 lower income countries had reduced or suspended immunisation programmes, while in the United Kingdom the immunisation rate for measles, mumps and rubella decreased by 20% at one point, although rates have recovered since. 42 , 43 Coverage of UK children with PCV13 fell from 94.5% in 2020 to 93.6% in July 2021. Measles, mumps and rubella immunisation coverage fell from 85.0% to 84.1% over the same period.…”