Vaccine Coverage among Children with and without Intellectual Disabilities in the UK: Cross Sectional Study

Abstract

Background Universal childhood vaccination programmes form a core component of child health policies in most countries, including the UK. Achieving high coverage rates of vaccines is critical for establishing ‘herd immunity’ and preventing disease outbreaks. Evidence from the UK has identified several groups of children who are at risk of not being fully immunised. Our aim was to determine whether children with intellectual disabilities constitute one such group. Methods Secondary analysis of parental report data on child vaccination collected in the UK’s Millennium Cohort Study when the children were 9 months, 3 years, 5 years and 14 years old. Results With one exception (MMR coverage at age 5) vaccination coverage rates were lower for children with intellectual disabilities (when compared to children without intellectual disability) for all vaccinations at all ages. Complete coverage rates were significantly lower for children with intellectual disabilities at ages 9 months (unadjusted PRR non-vaccination = 2.03 (1.14–3.60), p < 0.05) and 3 years (unadjusted PRR = 2.16 (1.06–4.43), p < 0.05), but not at age 5 years (unadjusted PRR = 1.91 (0.67–5.49)). HPV vaccination was lower (but not significantly so) at age 14 (PRR = 1.83 (0.99–3.37), p = 0.054). Adjusting PRRs for between group differences in family socio-economic position and other factors associated with coverage reduced the strength of association between intellectual disability and coverage at all ages. However, incomplete vaccination remained significantly elevated for children with intellectual disabilities at ages 9 months and 3 years. There were no statistically significant differences between parents of children with/without intellectual disability regarding the reasons given for non-vaccination. Conclusions Children with intellectual disabilities in the UK are at increased risk of vaccine preventable diseases. This may jeopardise their own health, the health of younger siblings and may also compromise herd immunity.

Potentially preventable hospitalisations of people with intellectual disability in New South Wales

“…Vaccination rates among people with intellectual disability have been little investigated. A recent study found that vaccination coverage among UK children with intellectual disability were lower than among other children, 26 and vaccination coverage for hepatitis B and influenza among children and adolescents with intellectual disability in Taiwan was also lower than for those without intellectual disability 27,28 . A recent review that more broadly examined vaccination status in people with disability found that knowledge in this area was inadequate 29 .…”

MMR Vaccine Attitude and Uptake Research in the United Kingdom: A Critical Review

“…The first category consisted of largely quantitative studies: nine surveys or analyses focusing only on uptake of the MMR vaccine, and potential inequalities or predictive demographic factors therein. Some of the studies used private longitudinal health data such as the Millennium Cohort Study of ~19,000 children born in 2000–1 [ 31 , 32 ] or the Secure Anonymised Information Linkage (SAIL) databank of 800,000 children living in Wales [ 33 ]. Others used public National Health Service (NHS) health data through the Child Health Information Systems [ 34 , 35 , 36 ], the Scottish Immunisation and Recall System (SIRS) [ 37 ], primary care data of the Clinical Practice Research Datalink (CPRD) [ 38 ] or the Cover of Vaccination Evaluated Rapidly (COVER) dataset produced by Public Health England (PHE) [ 39 ].…”

“…Perry et al [ 36 ] found that children of asylum seekers in Wales had lower rates of uptake compared to the general population, albeit with some variation between different areas of Wales due to limitations in the outreach resources of each local health authority. Emerson et al [ 31 ] focused on children with intellectual disabilities and found that they were at increased risk for low uptake, although this may be partially explained by the inverse association between intellectual disabilities and family socioeconomic position. Osam et al [ 38 ] used primary care data from 400,000 mother–baby pairs and found that maternal mental illness, even when adjusting for deprivation factors, had a significant negative effect on routine MMR vaccine uptake.…”

MMR Vaccine Attitude and Uptake Research in the United Kingdom: A Critical Review

“…Perry et al [34] found that children of asylum seekers in Wales had lower rates of uptake compared to the general population, albeit with some variation between different areas of Wales due to limitations in the outreach resources of each local health authority. Emerson et al [29] focused on children with intellectual disabilities and found that they were at increased risk for low uptake, although this may be partially explained by the positive association between intellectual disabilities and lower family socioeconomic position. Osam et al [36] used primary care data from 400,000 motherbaby pairs and found that maternal mental illness, even when adjusting for deprivation factors, had a significant negative effect on routine MMR vaccine uptake.…”