Ward-level analysis of MMR1 uptake by demographic characteristics in an under-vaccinated region of England
Author(s): ,
Diane Pople
Imperial College London
Neil Ferguson
Imperial College London
Christophe Fraser
Imperial College
PHE ePoster Library. Pople D. 03/20/18; 205864; 12424
Diane Pople
Diane Pople
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Abstract BackgroundMeasles is targeted for elimination in Europe and achieving WHO-recommended uptake of measles-containing-vaccine is a key tool to reach this goal. This target specifies both national and regional targets for uptake in children, and national COVER surveillance data include figures for reported for CCG and Local Authority areas. Analysis of uptake predictors, on a spatial granularity below this, is appropriate to inform effective local interventions, within those administrative geographies, to increase routine immunisation participation and thus address shortfalls vs the regional target.MethodsWard-level data from the Child Health Information System, Census and Indices of Deprivation are analysed to identify demographic characteristics (individual and community) associated with under-vaccination in Great Yarmouth & Waveney PCT. For categorical demographic variables, dimension reduction techniques are used to generate ward characteristic measurements suitable for use in logistic regression, which incorporate few a priori assumptions and enable the discovery of non-monotone correlations.ResultsUnder-vaccination is associated with the extremes of education, specifically the combined presence in the ward of those with no qualifications and those with university qualifications, and wards with higher proportions of black-ethnicity residents. Although ward deprivation was the single characteristic with the strongest uptake correlation, it was not a significant predictor in the regression model. ConclusionsInterventions to improve adherence with the recommended immunisation schedule should consider specific activities tailored to the identified groups, in terms of both those targeted and in the choice of materials used. The under-vaccination association with educational extremes indicates multiple communication materials may be necessary, to mirror the abilities and expectations of these very differently-educated groups. We note the combined presence of both these extremes in the predictor of under-vaccination may indicate a dynamic whereby these groups influence each other, and further work could investigate the influence of 'lay experts' in vaccination decisions. Funding ESRC studentship
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