Peer-reviewed article
Timeliness of childhood vaccination in England: A population-based cohort study.
Suffel AM, Walker JL, Williamson E, McDonald HI, Warren-Gash C ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined vaccination timeliness for over 573,000 children born in England between 2006 and 2014, tracking when they received vaccines across the childhood immunisation schedule. The researchers found that delays in earlier vaccine doses predicted longer delays for subsequent doses, with children who received their third DTP dose more than a year late receiving the next dose 2.7 times later than on-time children. Coverage at age five was high (90% for MMR and 89% for DTP), but patterns of delay varied by ethnicity and region, particularly for Black children and those in London. The study demonstrates that primary care data can identify children at higher risk of vaccination delays.
Key points
- 573,015 children followed until age 5; 90.16% coverage for two MMR doses and 88.78% coverage for four DTP doses
- Delays in earlier vaccines predicted significantly greater delays in subsequent doses
- If third DTP dose received >1 year late, the next dose was received 2.7 times later than in on-time vaccinated children
- Children of Black ethnicity and those from London showed deviating uptake patterns
- Later scheduled vaccines showed more delay compared to earlier ones in the schedule
Limitations
The study describes patterns of vaccination timeliness in England's primary care system and identifies risk factors for delay, but cannot establish causal mechanisms for delays or evaluate interventions to improve timeliness. It does not explain why delays occur or test solutions to reduce them.
Abstract
Introduction Vaccine surveillance for children in England focuses on coverage at ages 1, 2, and 5 years. Previous studies exploring vaccine timeliness have used different arbitrary categories to define whether vaccines were received 'late' or 'on time'. This paper aims to provide more detailed and holistic information on timing and patterns of vaccine uptake across the childhood immunisation schedule in England. Methods We included all children born in England between 2006 and 2014 and registered in the Clinical Practice Research Datalink (CPRD) Aurum, a primary care electronic health record. We described vaccine uptake for representative antigens (pertussis, pneumococcus, measles) by age in days and stratified by ethnicity, region and birth cohort. Alluvial diagrams were used to illustrate common journeys through the vaccination schedule, and we applied survival analysis using accelerated failure time models (AFT) to predict age of vaccine receipt based on timing of previous doses. Results 573,015 children were followed up until their fifth birthday, when they had 90.16 % coverage for two doses of measles, mumps, rubella (MMR) vaccine and 88.78% coverage for four doses of diphtheria, tetanus, pertussis (DTP) vaccine. Overall, the later the age at which a vaccine was due, the more delay in vaccination. Children of Black Ethnicity or from London showed deviating uptake patterns. If a child received their third DTP dose more than a year later than recommended, they would receive the next dose 2.7 times later than a child who was vaccinated on time. A smaller delay was found for children who did not receive first MMR dose on time. Discussion We showed that the risk of vaccination delay increased with the age of the child and significant delay of previous doses. Primary care data can help to promptly identify children at higher risk of delayed vaccination.