Wolfson Institute of Population Health, Queen Mary University of London, London, UK
Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
BMJ Open. 2022 Dec 1;12(12):e066288. doi: 10.1136/bmjopen-2022-066288.
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.
Longitudinal study using primary care electronic health records.
285 general practices in North East London.
Children born between 23 August 2017 and 22 September 2018 (pre-pandemic cohort) or between 23 March 2019 and 1 May 2020 (pandemic cohort).
Receipt of timely MMR vaccination between 12 and 18 months of age.
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.
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 (=33 226; 51.3% boys) and pandemic (=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.
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.
量化 COVID-19 大流行对首次麻疹、腮腺炎和风疹（MMR）疫苗接种及时性以及在地理和社会人口方面的不平等的影响。
使用初级保健电子健康记录的纵向研究。
伦敦东北部的 285 家普通诊所。
2017 年 8 月 23 日至 2018 年 9 月 22 日之间出生的儿童（大流行前队列）或 2019 年 3 月 23 日至 2020 年 5 月 1 日之间出生的儿童（大流行队列）。
在 12 至 18 个月大时及时接种 MMR 疫苗。
我们使用逻辑回归来估计及时接种疫苗的优势比（95%置信区间），调整了性别、贫困、种族背景和临床委托组。我们绘制了及时接种疫苗的比例的专题地图。
与大流行前队列（=33226 人；51.3%为男孩）相比，及时 MMR 接种率从 79.2%（78.8%至 79.6%）下降至 75.2%（74.7%至 75.7%），大流行期间及时 MMR 接种率下降了 4.0%（95%CI：3.4%至 4.6%）。调整后，大流行队列中的及时接种可能性较低（0.79；0.76 至 0.82），来自黑人（0.70；0.65 至 0.76）、混血/其他（0.77；0.72 至 0.82）或缺失（0.77；0.74 至 0.81）种族背景的儿童，女孩（1.07；1.03 至 1.11）和南亚背景的儿童（1.39；1.30 至 1.48）更有可能及时接种疫苗。居住在最不贫困地区的儿童更有可能及时接受 MMR（2.09；1.78 至 2.46），但在两个队列和贫困之间没有相互作用（Wald 统计量：3.44；p=0.49）。在大流行期间，不到 60%的儿童及时接种疫苗的社区比例从 7.5%上升到 12.7%。
COVID-19 大流行与 MMR 及时接种率显著下降以及麻疹易感性的地理集聚程度增加有关，而该地区的麻疹疫苗接种率历来较低且不平等。需要立即采取行动，以避免麻疹爆发，并支持初级保健提供及时和公平的疫苗接种。
