Pearce Anna, Law Catherine, Elliman David, Cole Tim J, Bedford Helen
Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London WC1N 1EH.
BMJ. 2008 Apr 5;336(7647):754-7. doi: 10.1136/bmj.39489.590671.25. Epub 2008 Feb 28.
To estimate uptake of the combined measles, mumps, and rubella vaccine (MMR) and single antigen vaccines and explore factors associated with uptake and reasons for not using MMR.
Nationally representative cohort study.
Children born in the UK, 2000-2.
14,578 children for whom data on immunisation were available.
Immunisation status at 3 years defined as "immunised with MMR," "immunised with at least one single antigen vaccine," and "unimmunised."
88.6% (13,013) were immunised with MMR and 5.2% (634) had received at least one single antigen vaccine. Children were more likely to be unimmunised if they lived in a household with other children (risk ratio 1.74, 95% confidence interval 1.35 to 2.25, for those living with three or more) or a lone parent (1.31, 1.07 to 1.60) or if their mother was under 20 (1.41, 1.08 to 1.85) or over 34 at cohort child's birth (reaching 2.34, 1.20 to 3.23, for > or =40), more highly educated (1.41, 1.05 to 1.89, for a degree), not employed (1.43, 1.12 to 1.82), or self employed (1.71, 1.18 to 2.47). Use of single vaccines increased with household income (reaching 2.98, 2.05 to 4.32, for incomes of > or = 52,000 pounds sterling (69,750 euros, $102,190)), maternal age (reaching 3.04, 2.05 to 4.50, for > or =40), and education (reaching 3.15, 1.78 to 5.58, for a degree). Children were less likely to have received single vaccines if they lived with other children (reaching 0.14, 0.07 to 0.29, for three or more), had mothers who were Indian (0.50, 0.25 to 0.99), Pakistani or Bangladeshi (0.13, 0.04 to 0.39), or black (0.31, 0.14 to 0.64), or aged under 25 (reaching 0.14, 0.05 to 0.36, for 14-19). Nearly three quarters (74.4%, 1110) of parents who did not immunise with MMR made a "conscious decision" not to immunise.
Although MMR uptake in this cohort is high, a substantial proportion of children remain susceptible to avoidable infection, largely because parents consciously decide not to immunise. Social differentials in uptake could be used to inform targeted interventions to promote uptake.
评估麻疹、腮腺炎和风疹联合疫苗（MMR）及单一抗原疫苗的接种率，并探究与接种率相关的因素以及未接种MMR疫苗的原因。
具有全国代表性的队列研究。
2000 - 2002年在英国出生的儿童。
14578名有免疫接种数据的儿童。
3岁时的免疫状况，分为“接种MMR疫苗”、“接种至少一种单一抗原疫苗”和“未接种疫苗”。
88.6%（13013名）儿童接种了MMR疫苗，5.2%（634名）儿童接种了至少一种单一抗原疫苗。如果儿童与其他孩子同住一个家庭（对于与三个或更多孩子同住的情况，风险比为1.74，95%置信区间为1.35至2.25）、单亲家庭（风险比为1.31，95%置信区间为1.07至1.60），或者其母亲在队列儿童出生时年龄小于20岁（风险比为1.41，95%置信区间为1.08至1.85）或大于34岁（对于40岁及以上的母亲，风险比达到2.34，95%置信区间为1.20至3.23）、受教育程度较高（对于拥有学位的母亲，风险比为1.41，95%置信区间为1.05至1.89）、未就业（风险比为1.43，95%置信区间为1.12至1.82）或自营职业（风险比为1.71，95%置信区间为1.18至2.47），则这些儿童更有可能未接种疫苗。单一疫苗的接种率随家庭收入增加（对于收入达到或超过52000英镑（69750欧元，102190美元）的家庭，风险比达到2.98，95%置信区间为2.05至4.32）、母亲年龄增加（对于40岁及以上的母亲，风险比达到3.04，95%置信区间为2.05至4.50）以及母亲受教育程度提高（对于拥有学位的母亲，风险比达到3.15，95%置信区间为1.78至5.58）而上升。如果儿童与其他孩子同住（对于与三个或更多孩子同住的情况，风险比达到最低0.14，95%置信区间为0.07至0.29）、母亲是印度裔（风险比为0.50，95%置信区间为0.25至0.99）、巴基斯坦裔或孟加拉裔（风险比为0.13，95%置信区间为0.04至0.39）或黑人（风险比为0.31，95%置信区间为0.14至0.64），或者年龄在25岁以下（对于14 - 19岁的儿童，风险比达到最低0.14，95%置信区间为0.05至0.36），则这些儿童接种单一疫苗的可能性较小。在未接种MMR疫苗的父母中，近四分之三（74.4%，1110名）做出了“有意识的决定”不进行接种。
尽管该队列中MMR疫苗的接种率较高，但仍有相当一部分儿童易感染可避免的疾病，主要原因是父母有意识地决定不进行接种。接种率的社会差异可用于为促进接种的针对性干预措施提供参考。
