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BMJ. 2008 Apr 5;336(7647):754-7. doi: 10.1136/bmj.39489.590671.25. Epub 2008 Feb 28.

Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study.

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Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London WC1N 1EH.



To estimate uptake of the combined measles, mumps, and rubella vaccine (MMR) and single antigen vaccines and explore factors associated with uptake and reasons for not using MMR.


Nationally representative cohort study.


Children born in the UK, 2000-2.


14,578 children for whom data on immunisation were available.


Immunisation status at 3 years defined as "immunised with MMR," "immunised with at least one single antigen vaccine," and "unimmunised."


88.6% (13,013) were immunised with MMR and 5.2% (634) had received at least one single antigen vaccine. Children were more likely to be unimmunised if they lived in a household with other children (risk ratio 1.74, 95% confidence interval 1.35 to 2.25, for those living with three or more) or a lone parent (1.31, 1.07 to 1.60) or if their mother was under 20 (1.41, 1.08 to 1.85) or over 34 at cohort child's birth (reaching 2.34, 1.20 to 3.23, for > or =40), more highly educated (1.41, 1.05 to 1.89, for a degree), not employed (1.43, 1.12 to 1.82), or self employed (1.71, 1.18 to 2.47). Use of single vaccines increased with household income (reaching 2.98, 2.05 to 4.32, for incomes of > or = 52,000 pounds sterling (69,750 euros, $102,190)), maternal age (reaching 3.04, 2.05 to 4.50, for > or =40), and education (reaching 3.15, 1.78 to 5.58, for a degree). Children were less likely to have received single vaccines if they lived with other children (reaching 0.14, 0.07 to 0.29, for three or more), had mothers who were Indian (0.50, 0.25 to 0.99), Pakistani or Bangladeshi (0.13, 0.04 to 0.39), or black (0.31, 0.14 to 0.64), or aged under 25 (reaching 0.14, 0.05 to 0.36, for 14-19). Nearly three quarters (74.4%, 1110) of parents who did not immunise with MMR made a "conscious decision" not to immunise.


Although MMR uptake in this cohort is high, a substantial proportion of children remain susceptible to avoidable infection, largely because parents consciously decide not to immunise. Social differentials in uptake could be used to inform targeted interventions to promote uptake.

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