Elsevier

Vaccine

Volume 24, Issues 47–48, 17 November 2006, Pages 6823-6829
Vaccine

Incomplete immunisation uptake in infancy: Maternal reasons

https://doi.org/10.1016/j.vaccine.2006.06.039Get rights and content

Abstract

We examined uptake of primary immunisations in infancy and the reasons given by mothers for either incompletely or not immunising their infants. We used data from the Millennium Cohort Study, a cohort of 18,819 infants born between September 2000 and January 2002 in the UK. 95.6% infants were reported to be fully immunised, 3.3% partially immunised and 1.1% unimmunised. Mothers most frequently cited medical reasons (45%) for partial immunisation (n = 697), but beliefs or attitudes (47%) for no immunisation (n = 228). An understanding of maternal reasons for incomplete immunisation status may assist in identifying appropriate interventions to maximise uptake.

Introduction

Childhood immunisation continues to be one of the most effective preventive health measures worldwide [1]. Its value has been emphasised in recent government policy documents, which stress the need to maintain high coverage and to boost uptake among groups where it may be sub-optimal [2], [3], [4].

In contrast with some countries where it is mandated, in the UK there is no requirement for children to be immunised, and parents are invited to make an informed decision about their child's immunisation. Parental attitudes towards the safety of vaccines and seriousness of the diseases they prevent are important in determining immunisation uptake [5], [6]. However, it is clear that a combination of factors influence parental decisions [7] and the relationship between perceptions and behaviour is complex; even parents who have vaccinated their children express concerns about vaccine safety [8]. Similarly, the assumption that a bad personal experience of an infectious disease might result in willingness to accept vaccines, is not always correct [9]. Reasons given by parents for not immunising children include: vaccine safety concerns [6], [10], inadequate information provided by health professionals [10], a preference for homeopathy [11], and the parents’ concern that they would feel personally responsible if immunisation resulted in a serious adverse effect [12]. Adverse experiences attributed to the non-empathic stance of healthcare professionals, have also contributed to the incomplete uptake [13]. A model of the decision-making process has been developed that represents parental experiences of choosing not to immunise their children [14]. The ‘risk perception’ concept is influenced by a feeling of dread or lack of control experienced by parents towards immunisation, as well as their trust of ‘risk managers’ which in the case of immunisation includes the government and medical profession [8].

Although several studies have investigated parental perceptions and attitudes towards immunisation, recent work has largely focussed on MMR vaccine: limited contemporary evidence exists about parental perspectives regarding primary immunisations, i.e., the first vaccines at 2, 3 and 4 months of age in the UK. Moreover, other than a few, small studies carried out in the UK mainly with respect to the pertussis vaccine [12], [15], there is a paucity of research on whether risk factors and attitudes differ among parents who decline immunisation for their children and those whose children do not complete an immunisation course. We have previously reported that mothers of infants with partial and no immunisation are differentiated by age and education [16]. In this paper, we focus on the reasons given by mothers for these immunisation outcomes in infancy in a nationally representative study.

Section snippets

Methods

The Millennium Cohort Study (MCS) is the latest of Britain's national longitudinal cohort studies. The study aims to describe the diverse circumstances of children born in the new Millennium and includes information on parents’ backgrounds, as well as the baby's health and development. The cohort comprises infants born between September 2000 and January 2002 from all four UK countries. The sample was stratified by country and electoral ward type to adequately represent children from ethnic

Results

Overall 17,544 (95.6%) of 18,488 infants were reported to be fully immunised, 712 (3.3%) partially immunised and 232 (1.1%) unimmunised. Immunisation uptake in England and Wales was significantly lower than for Scotland and Northern Ireland. Within England, a low uptake was found particularly in London, and the South West, North West and South East regions (Table 1).

Overall, 79.8% of mothers consulted the PCHR and details of immunisation were recorded, 1.3% consulted the PCHR and no information

Discussion

This is the first large-scale, UK study to explore the incompleteness of immunisation uptake, as well as the reasons given by mothers for partial and no immunisations in infancy. In this cohort, the reported uptake of complete immunisations among infants in the UK was high, meeting recommendations that at least 95% of children receive three doses of diphtheria, tetanus and pertussis in the first year of life [18]. Important differences were observed between partially immunised and unimmunised

Acknowledgements

We would like to thank all the Millennium Cohort families for their participation and Professor Heather Joshi, Director of the Millennium Cohort Study and her colleagues in the Millennium Cohort Study Management Team at the Centre for Longitudinal Studies, Institute of Education, University of London. The other members of the Millennium Cohort Study Child Health Group who contributed to this work were: Suzanne Bartington, Tim Cole, Carol Dezateux, Lucy Jane Griffiths, Summer Sherburne Hawkins,

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    1

    Other members of the Millennium Cohort Study Child Health Group: Suzanne Bartington (Research Assistant), Prof. Tim Cole (Professor), Prof. Carol Dezateux, Dr. Lucy Jane Griffiths (Senior Research Fellow), Summer Sherburne Hawkins (Research Fellow), Dr. Catherine Law (Reader), Dr. Jugnoo Rahi (Clinical Senior Lecturer), Dr. Suzanne Walton (Clinical Research Fellow).

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