This prospective cohort study was carried out to estimate uptake of the combined measles, mumps, and rubella vaccine (MMR) and single antigen vaccines. The researchers also examined factors associated with uptake and reasons for not using MMR. The study focused on data from the millennium cohort study, a longitudinal study of children born in the UK from September 2000 to January 2002. The analysis included 14,578 children at age 3 for whom information was available on MMR uptake. The main outcome measures used in the study were based on the children?s immunisation status at 3 years old, classified into 3 groups: immunised with MMR, immunised with at least one of the single antigen vaccines, and unimmunised. The results found (direct from source): ? 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 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 £52,000 ( 69,750, $102 190)), maternal age (reaching 3.04, 2.05 to 4.50, for 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. The authors conclude that the study findings show: - Many parents make a conscious decision not to have their child immunised with MMR, with a substantial proportion opting to use single antigen vaccines - Socioeconomic and cultural patterns in uptake differ for parents choosing the single antigen vaccines and those not immunising at all - Interventions to improve uptake should be designed to meet the needs of different groups Limitations to the study cited by the researchers include the fact that the timing of the vaccinations was not taken into account and the lack of an agreed standard for reporting immunisation status. Furthermore, there was conflicting evidence about the reliability of computerised immunisation records and primary care records compared with parents? reports. They also add that the results may be unique to the cohort studied as from 1998 considerable media attention was given to the safety of MMR vaccine with a peak of negative coverage around the time when cohort parents were likely to be making decisions about their child?s vaccinations. A related editorial says that to improve uptake of the MMR vaccine, recognising and targeting differences between population groups are the priorities. (Source: NeLM Headline News)


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