Those at risk
Immunisation protects individuals and populations from many serious and potentially deadly diseases. High vaccination rates provide increased probability of immunity throughout the population (herd immunity), which is particularly important for protecting individuals who cannot be vaccinated and can also lead to the elimination of some diseases. Even when a disease is no longer common in the UK, without sustained high rates of vaccination it is possible for these diseases to return as demonstrated by the 2019 measles outbreaks.
Public Health England data showed that, although coverage remains high, children’s vaccine uptake has been slowly decreasing since 2012-13. This means that some children have missed out and may remain vulnerable to serious or even fatal infections that are vaccine preventable.
National evidence suggests that in general, lower socioeconomic status was associated with lower coverage as well as later attainment of vaccination, and completion of primary and booster courses.
North Tyneside are achieving high levels of immunisation when viewed borough wide. However, we know that there is practice level variation resulting in pockets of children within the borough who are unvaccinated. These children may go to the same school or socialise closely increasing the risk of local outbreaks of disease.
Evidence nationally, suggests that there is no simple relationship between ethnicity and coverage. However, coverage did appear to be more consistently lower than White-British children in certain ethnic groups, for example Black Caribbean, Somali, White Irish, and White Polish populations.
Nationally children with learning disability were less likely to be fully immunised than their peers in the general population. There is limited evidence around vaccine coverage among looked after children (LAC) nationally, but what is available suggests these children are less likely to be vaccinated.
Inadequate vaccine coverage in under-vaccinated groups is often demonstrated by outbreaks among these communities. There have been measles outbreaks in Europe between 2005 and 2008 in Roma & Sinti, Traveller, and Steiner communities. It is difficult to determine vaccination coverage levels in traveller populations, as many may face barriers to engagement with health services. Estimated uptake rates for MMR and polio vaccines among Gypsy Travellers in 2010 suggested far lower rates than in the England population; possibly below 50% in some areas.
Migrant communities also exhibit more outbreaks of vaccine-preventable disease, suggesting inadequate coverage. In a recent measles outbreak in West Yorkshire, there were more cases in areas with a higher density of new migrants.
Though relatively few in number, studies have consistently shown that children of lone parents were less likely to receive or complete childhood primary vaccinations. Having a large family reduces the likelihood of vaccination against MMR or the primary course for younger children, independent of lone parent status where this was also adjusted for.
The Millennium Cohort Study also provided evidence of vaccination inequality for young and old mothers. Having a mother aged under 20 at birth, was significantly associated with being unimmunised against MMR [30], while having a mother aged at least 40 years old was associated with being unimmunised with the primary course (2,3,4 months), although their children were less likely to be partially immunised.