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To investigate the uptake of the first dose measles, mumps and rubella (MMR) vaccine and factors associated with not receiving this vaccine.
Cross-Generational Cohort Study with prospective linkage to primary care and hospital health records.
Urban and rural settings in Ireland recruited in 2001–2003 with five years follow-up.
749 singleton children with immunisation information collected from the Health Service Executive (HSE). These are 70% of the original cohort who could be matched to HSE data.
Main Outcome Measures
Children immunised or not with the first dose of MMR by 2007.
MMR uptake was 88.8% overall, with 91.6% in the East of Ireland (urban) and 83.8% in the West (rural). Odds ratios, adjusted for the other factors and the cluster affect of region, for the child not receiving MMR were significant for the following independent factors; having a mother who had ever visited an alternative practitioner, OR 2.65 (1.76 to 3.98), a degree level educated mother OR 1.48 (1.07 to 2.04), an unmarried mother OR 1.97 (1.09 to 3.36), a mother who was a smoker OR 1.32 (1.04 to 1.69) or a lone parent OR 1.14 (1.13 to 1.15). Families that had 3 or more children in the household before the birth of the cohort child, OR 2.64 (1.42 to 4.91), had an income of less than £300/week OR 1.60 (1.35 to 1.91), who lived in the West of Ireland, OR 2.7 (2.47 to 2.96), or had a male child, OR 1.76 (1.74 to 1.78) were also significant factors.
These novel prospective data confirm that in addition to factors associated with disadvantage, other health practices and beliefs may influence immunisation uptake. Furthermore, the determinants are heterogeneous. In light of the controversy around the MMR vaccine, attitudes of parents are highly relevant. This information can be used to design more focused parent information and immunisation services to target differing families whose children are at increased risk of measles infection. More work is needed to investigate parental beliefs as to why boys are less likely to receive the MMR. Specific interventions are vital if the target of 95% uptake of MMR is to be reached and measles is to be eradicated from the European region by 2010.