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Firman N, Marszalek M, Gutierrez A, Homer K, Williams C, Harper G, Dostal I, Ahmed Z, Robson J, Dezateux C. Impact of the COVID-19 pandemic on timeliness and equity of measles, mumps and rubella vaccinations in North East London: a longitudinal study using electronic health records. BMJ Open 2022; 12:e066288. [PMID: 36456017 PMCID: PMC9723415 DOI: 10.1136/bmjopen-2022-066288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To quantify the effect of the COVID-19 pandemic on the timeliness of, and geographical and sociodemographic inequalities in, receipt of first measles, mumps and rubella (MMR) vaccination. DESIGN Longitudinal study using primary care electronic health records. SETTING 285 general practices in North East London. PARTICIPANTS Children born between 23 August 2017 and 22 September 2018 (pre-pandemic cohort) or between 23 March 2019 and 1 May 2020 (pandemic cohort). MAIN OUTCOME MEASURE Receipt of timely MMR vaccination between 12 and 18 months of age. METHODS We used logistic regression to estimate the ORs (95% CIs) of receipt of a timely vaccination adjusting for sex, deprivation, ethnic background and Clinical Commissioning Group. We plotted choropleth maps of the proportion receiving timely vaccinations. RESULTS Timely MMR receipt fell by 4.0% (95% CI: 3.4% to 4.6%) from 79.2% (78.8% to 79.6%) to 75.2% (74.7% to 75.7%) in the pre-pandemic (n=33 226; 51.3% boys) and pandemic (n=32 446; 51.4%) cohorts, respectively. After adjustment, timely vaccination was less likely in the pandemic cohort (0.79; 0.76 to 0.82), children from black (0.70; 0.65 to 0.76), mixed/other (0.77; 0.72 to 0.82) or with missing (0.77; 0.74 to 0.81) ethnic background, and more likely in girls (1.07; 1.03 to 1.11) and those from South Asian backgrounds (1.39; 1.30 to 1.48). Children living in the least deprived areas were more likely to receive a timely MMR (2.09; 1.78 to 2.46) but there was no interaction between cohorts and deprivation (Wald statistic: 3.44; p=0.49). The proportion of neighbourhoods where less than 60% of children received timely vaccination increased from 7.5% to 12.7% during the pandemic. CONCLUSIONS The COVID-19 pandemic was associated with a significant fall in timely MMR receipt and increased geographical clustering of measles susceptibility in an area of historically low and inequitable MMR coverage. Immediate action is needed to avert measles outbreaks and support primary care to deliver timely and equitable vaccinations.
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Affiliation(s)
- Nicola Firman
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Milena Marszalek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ana Gutierrez
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kate Homer
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Crystal Williams
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Gill Harper
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Isabel Dostal
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Zaheer Ahmed
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - John Robson
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Carol Dezateux
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Srivastava T, Shen AK, Browne S, Michel JJ, Tan ASL, Kornides ML. Comparing COVID-19 Vaccination Outcomes with Parental Values, Beliefs, Attitudes, and Hesitancy Status, 2021-2022. Vaccines (Basel) 2022; 10:vaccines10101632. [PMID: 36298497 PMCID: PMC9611997 DOI: 10.3390/vaccines10101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the availability of safe and effective COVID-19 vaccines, vaccine acceptance has been low, particularly among parents. More information is needed on parental decision-making. We conducted a prospective cohort study from October 2021 to March 2022 among 334 parents in a large urban/suburban pediatric primary care network and linked longitudinal survey responses about attitudes and beliefs on vaccination, social norms, and access to vaccination services for COVID-19 to electronic health-record-derived vaccination outcomes for their eldest age-eligible children in June 2022. The odds of accepting two doses of COVID-19 vaccine for their child was higher in respondents who indicated the COVID-19 vaccine would be very safe (aOR [CI]: 2.69 [1.47−4.99], p = 0.001), as well as those who previously vaccinated their child against influenza (aOR [CI]: 4.07 [2.08−8.12], p < 0.001). The odds of vaccinating their child were lower for respondents who attended suburban vs. urban practices (aOR [CI]: 0.38 [0.21−0.67], p = 0.001). Parents in the cohort were active users of social media; the majority (78%) used their phone to check social media platforms at least once per day. Our findings suggest that healthcare providers and policymakers can focus on improving vaccination coverage among children living in suburban neighborhoods through targeted mobile-based messaging emphasizing safety to their parents.
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Affiliation(s)
- Tuhina Srivastava
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard David Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Angela K. Shen
- Leonard David Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Medical Bioethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Correspondence: ; Tel.: +1-(301)-467-7770
| | - Safa Browne
- Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jeremy J. Michel
- General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- ECRI Guidelines Trust, ECRI, Plymouth Meeting, Philadelphia, PA 19462, USA
| | - Andy S. L. Tan
- Leonard David Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Melanie L. Kornides
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard David Institute for Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pediatrics, Division of Adolescent Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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