Peer-reviewed article
Adherence to the paediatric immunisation schedule in England
Jorgen Bauwens, Simon de Lusignan, Julian Sherlock, Filipa Matos Ferreira, Nino Künzli et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how well children in England followed the NHS immunisation schedule between 2008 and 2018, looking at over 1 million children and 6 million vaccinations. Researchers found that 75% of first vaccine doses were given at the right time, but only about half of follow-up doses were timely. Many children received second and third doses either too soon or too late after the previous dose. The timeliness of vaccinations improved slightly in less deprived areas, but gender and NHS region had little effect on adherence.
Key points
- 75% of first doses were administered within the recommended timeframe; 19% too late and 6% too early
- Only about half of subsequent doses were given at the correct time
- 36% of second doses were given too soon after the first dose, while 13% were too late
- Third doses were timely in 45% of cases, too soon in 37%, and too late in 18%
- Immunisation adherence improved slightly with decreasing deprivation, but gender and regional differences were negligible except for HPV vaccine
Limitations
The study describes patterns of adherence but does not explain the causes of delayed or early vaccination or evaluate any intervention to improve adherence. It also does not measure whether poor adherence resulted in actual gaps in disease protection or outbreaks.
Abstract
Both adequate coverage and adherence to paediatric immunisation schedules are required for optimal protection against vaccine preventable diseases. We studied the timeliness of routine paediatric vaccinations according to the NHS's immunisation schedule and potential factors of schedule adherence. Immunisation data was obtained from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We collected vaccine types, doses, and dates for all routine paediatric vaccines between 2008 and 2018: DTaP/IPV/Hib/HepB, DTaP/IPV/Hib, DTaP/IPV, dTaP/IPV, Td/IPV, MMR, PCV, MenB, MenC, MenACWY, Hib/MenC, RV, HPV. Adherence to the immunisation schedule was calculated for each vaccine and dose. Differences in adherence between genders, NHS regions, and IMD quintiles were analysed. Our study included 6'257'828 vaccinations in 1'005'827 children. Seventy-five percent of first doses were administered within one (for vaccines scheduled in the first year of life) or two months (for vaccines scheduled later in life) following the recommended age, 19% too late and 6% too early. About half of the subsequent doses were given timely. The time between first and second doses was too short for 36% of vaccinations while 13% of second doses were administered too long after the first dose. Third doses were administered timely for 45%, too short for 37%, and too long for 18% of vaccinations. Differences in immunisation schedule adherence between girls and boys were negligible, except for HPV, and differences between the four main NHS regions were small. Overall, immunisation schedule adherence improved slightly with decreasing deprivation according to the Index of Multiple Deprivation. Efforts are required to improve the timeliness of paediatric vaccinations and to assure adequate protection against vaccine preventable diseases. We propose developing a compound measure combining coverage and adherence to provide a better indication of the protection against vaccine preventable diseases in a community.