Peer-reviewed article
Ethnic inequities in childhood influenza vaccination coverage in England 2013-2021: An observational cohort study.
Zhang CX, Quigley MA, Bankhead C, Varughese R, Parekh N et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined childhood influenza vaccination rates among different ethnic groups in England from 2013 to 2021. Overall vaccination coverage was low, under 60% in most seasons, and significantly lower in London. Children from ethnic minority backgrounds, particularly those with Caribbean, African, Pakistani, and Bangladeshi heritage, had substantially lower vaccination coverage than White British children, and these gaps persisted and sometimes widened over time.
Key points
- Influenza vaccination coverage in 2-3 year-olds in England was below 60% for most seasons, and below 50% in London
- Children born to mothers of Caribbean ethnicity had the lowest coverage at 20-27% across seasons
- Most ethnic minority groups had lower coverage than White British children across all seasons studied
- Ethnic inequities in coverage persisted between 2013 and 2021, with some gaps widening over time
- The study calls for place-based and participatory approaches involving policy makers, commissioners, and healthcare staff to address these inequities
Limitations
The study used linked primary care records and cannot identify the specific reasons behind the observed inequities or explain why different ethnic groups have different vaccination uptake. It also relied on maternal ethnicity data recorded in primary care, which may not capture all relevant demographic factors.
Abstract
Background Children aged 2-3 years have been eligible for the seasonal influenza vaccination in primary care since its introduction into England's routine childhood immunisation schedule in 2013. Persistent ethnic inequities have been found for all other vaccines in the routine childhood immunisation schedule, so inequities in influenza vaccination coverage must also be explored to facilitate the success of the programme. Methods We linked mother and child primary care records using the Clinical Practice Research Datalink Aurum database (CPRD Aurum) and calculated seasonal influenza vaccination coverage in 2-3 year-olds by maternal ethnicity across England and in London between 2013 and 2021. We estimated risk ratios comparing each ethnic group to the White British group using modified Poisson regression. Results Influenza vaccination coverage in 2-3 year-olds is low in England (<60 % for the majority of influenza seasons) and even lower in London (<50 %). Ethnic inequities in coverage were persistent between 2013 and 2021. Most ethnic groups had lower coverage than the White British group across all influenza seasons, and children born to mothers of Caribbean ethnicity had the lowest coverage (20-27 % across seasons). Other ethnic groups including Any other Black, African or Caribbean background (25-36 %), Pakistani (26-40 %), White and Black Caribbean (28-42 %), Any other White background (30-44 %), Any other ethnic group (31-45 %) and Bangladeshi (31-41 %, except 54 % in 2020-21) also experienced low coverage. Inequities widened over time for various minority ethnic groups, including those already experiencing the lowest coverage. Conclusions Place-based and participatory approaches are needed to understand the drivers behind ethnic inequities in childhood influenza vaccination. Top-down and bottom-up action is also urgently needed from policy makers, commissioners, integrated care boards, primary care networks, local public health teams and healthcare staff to redress the inequities identified.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Routine childhood influenza vaccination programme (offered to children aged 2-3 years in primary care)
- Population
- Children aged 2-3 years in England, stratified by maternal ethnicity
Key finding
Overall influenza vaccination coverage in 2-3 year-olds was below 60% in England for most seasons
CX et al. · Europe PMC · 29 Sept 2025