Intended for healthcare professionals


Child vaccination rates drop in England as MMR uptake falls for fourth year

BMJ 2018; 362 doi: (Published 18 September 2018) Cite this as: BMJ 2018;362:k3967
  1. Jacqui Wise
  1. London

Coverage has declined in nine of 12 vaccinations given routinely to children in England, latest figures show.1

The report from NHS Digital shows that coverage of the measles, mumps, and rubella (MMR) vaccine for children reaching their 2nd birthday fell for the fourth successive year. Uptake was 91.2% in England in 2017-18, down from 91.6% in 2016-17 and the lowest level since 2011-12.

The World Health Organization’s target for MMR vaccination is 95%. The latest figures come as outbreaks of measles continue around Europe. More than 41 000 children and adults were infected with measles in the first six months of 2018, and at least 37 people have died, WHO has said.2

Uptake of the MMR vaccine fell in six of the nine regions in England. London has the lowest coverage, unchanged from 2016-17 at 85.1%. The North East region has the highest coverage, at 94.5%.

Children are scheduled to receive their first dose of MMR vaccine after their 1st birthday and a second dose between 3 years 4 months and age 5. The report shows that coverage of the MMR first dose as measured at age 5 reached the recommended target level of 95% for the first time in 2016-17 but fell slightly to 94.9% in 2017-18. However, uptake of the second MMR dose by age 5 was 87.2%, which is below the WHO target required to sustain elimination of these diseases in the long run.

The report shows that uptake of the “5-in-1” vaccine at 12 months fell for the fifth successive year and is at its lowest level since 2008-09. In 2017-18, 93.1% of children reaching their 1st birthday had received all three doses of the combined vaccine for diphtheria, pertussis, tetanus, polio, and Hib disease, down from 94.7% in 2012-13. In 2017-18 only two of the nine regions in England—the North East and the South West—reached the target of 95% coverage for the 5-in-1 vaccine at one year.

A vaccine to protect babies against rotavirus infection was the only vaccination whose uptake increased in 2017-18, rising by 0.5% to 90.1%.

Commenting on the latest figures, David Elliman, immunisation expert for the Royal College of Paediatrics and Child Health, said, “Although the UK has high uptake rates for the routine vaccinations, excluding influenza, they are not high enough to maintain herd immunity. The consistent fall in uptake over a number of years is worrying.

“It may be due to a number of factors. Difficulties with data collection, particularly in London, may be a factor. General practice, where most of the preschool immunisations are given, is under immense pressure, and there is a shortage of practice nurses who actually give the vaccines.

“There is no evidence, in the UK, of any increase of concerns about vaccination. Communication between IT systems in the NHS, use of reminders, and staffing of general practice should be addressed.”


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