Elsevier

Vaccine

Volume 26, Issue 13, 20 March 2008, Pages 1675-1680
Vaccine

Residential mobility and uptake of childhood immunisations: Findings from the UK Millennium Cohort Study

https://doi.org/10.1016/j.vaccine.2008.01.031Get rights and content

Summary

It has been hypothesised that lower vaccine uptake in childhood among some groups, such as children of lone parents or from larger families, may be due to their higher levels of residential mobility. This paper aimed to explore this association in a large cohort of children born in the UK at the turn of the century. Using multi-variable Poisson regression we found that children who lived in families which had moved during pregnancy or more frequently were more likely to be partially immunised with the primary immunisations and unimmunised against measles, mumps and rubella. Mobility was not associated with being unimmunised with the primary vaccines, or with single measles, mumps and rubella antigen vaccine use. These findings suggest that policies are needed to encourage the building and maintenance of relationships between health care professionals and parents, before and after they move, and better use of IT systems to aid follow-up of mobile families.

Introduction

In the UK in 2005/2006 uptake of the childhood vaccines did not meet target levels [1]. Understanding why levels are suboptimal should inform how policy and practice could be developed to increase them.

Immunisation uptake is socially distributed, with a tendency for it to be lower in more deprived areas [2], [3], [4], lone parents [2], [4], [5], and large families [2], [4], [6], [7]. Low immunisation uptake in these groups might be partially explained by their high levels of mobility [4], [7]. Vaccine uptake is lower among travelling communities, although this is in part due to their active rejection of immunisation [8]. A small study of admissions to an acute paediatric ward in Manchester found that mobility (frequently moving or being homeless) was the most commonly reported reason given by parents for falling behind on their child's immunisations [9]. A study of primary immunisation uptake in an inner London district found that living in temporary housing was associated with lower uptake [10]. However, to our knowledge, no study has explored the association of residential mobility with immunisation uptake in a recent population sample. We investigated the association between frequency and timing of moving and uptake of the primary immunisations and MMR, in a large, nationally representative and contemporary cohort.

Section snippets

Participants

We examined data from the Millennium Cohort Study (MCS), a longitudinal study of children born in the UK between September 2000 and January 2002. A stratified clustered sampling design was employed to over-represent children living in the smaller three UK countries and disadvantaged areas and from ethnic minority groups [11]. The first contact with the cohort was at age 9 months, when information was collected on 72% of those approached, giving a sample size of 18,819 babies, of whom 18,296

Results

At age 9 months 95.2% (95% confidence interval (CI): 94.7, 95.7%) of children were fully immunised with the primary immunisations, 3.5% (95% CI: 3.2, 3.9%) partially immunised, and 1.3% (95% CI: 1.1,1.6%) unimmunised. 88.6% (95% CI: 87.5, 89.7%) of the cohort were immunised with MMR by age 3, whilst 6.1% (95% CI: 5.5, 6.9%) were unimmunised, and 5.2% (95% CI: 4.6, 5.9%) had received at least one of the single antigen vaccines.

Being unimmunised with the primary immunisations was not associated

Interpretation

We found that children were more likely to be partially immunised with the primary vaccines and less likely to be immunised against measles, mumps and rubella if their mother had moved during pregnancy. Moving residence during this time may impede the development of important relationships with health professionals. Children were also more likely to be partially immunised with the primary vaccines and less likely to be immunised against measles, mumps and rubella if their mother had moved twice

Acknowledgements

We would like to thank all the Millennium Cohort families for their participation, and the director of the Millennium Cohort Study and colleagues in the management team at the Centre for Longitudinal Studies, Institute of Education, University of London. We would also like to acknowledge the contribution to this work of the late Professor Neville Butler who was a member of the MCS Child Health Group.

Funding: This work was undertaken at GOSH/UCL Institute of Child Health who received a

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1

Other members of the Millennium Cohort Study Child Health Group include Carol Dezateux, Catherine Peckham, Tim J. Cole, Lucy Griffiths, Summer Sherburne Hawkins, Suzanne Bartington, Jugnoo Rahi and Phillippa Cumberland of the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London.

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