Marszalek Milena, Firman Nicola, Wilk Marta, Gutierrez Ana, Smith Kelvin, Dezateux Carol
Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.
BMJ Open. 2025 May 2;15(5):e097559. doi: 10.1136/bmjopen-2024-097559.
There is a lack of information about household factors associated with delayed measles, mumps and rubella (MMR) vaccination. We examined whether timeliness of first MMR (MMR1) receipt is associated with sharing a household with an older child with non-receipt of MMR1 independent of household composition and size.
Longitudinal observational study using linked electronic health records.
North East London, UK.
The index cohort comprised 71 509 children (51.0% males) eligible to receive MMR1 between 1 January 2014 and 28 February 2020.
The primary outcome was MMR1 receipt between 12 months and 24 months of age. The explanatory variable was non-receipt of MMR1 between age 12 months and 24 months in the oldest child sharing the same household. We examined the likelihood of MMR1 receipt in index children sharing a household with an older child with non-receipt of MMR1 between 12 months and 24 months using logistic regression to estimate ORs and 95% CIs before and after adjustment for individual-level, household-level and area-level covariates. We carried out sensitivity analyses excluding households with an age interval between oldest and youngest child greater than 5 years.
59 851 (83.6%) index children received MMR1 between 12 months and 24 months of age. After adjustment for household composition and size, MMR1 receipt was less likely in index children sharing a household with an older child with non-receipt of MMR1 between 12 months and 24 months of age: OR: 0.19 (95% CI: 0.18, 0.20). This association strengthened after excluding households with an age interval greater than 5 years: OR: 0.14 (0.13, 0.15).
There is strong concordance within households of delay in MMR1 receipt independent of household size and composition. Lack of timely protection within households increases the risk of measles outbreaks. There is a need for household-based interventions to improve MMR1 timeliness.
关于与麻疹、腮腺炎和风疹（MMR）疫苗接种延迟相关的家庭因素，目前信息匮乏。我们研究了首次接种MMR（MMR1）的及时性是否与家中有未接种MMR1的大龄儿童有关，且独立于家庭构成和规模。
使用关联电子健康记录的纵向观察性研究。
英国伦敦东北部。
索引队列包括2014年1月1日至2020年2月28日期间有资格接种MMR1的71509名儿童（51.0%为男性）。
主要结局是在12个月至24个月龄之间接种MMR1。解释变量是同住一个家庭中最年长儿童在12个月至24个月龄之间未接种MMR1。我们研究了在12个月至24个月龄之间与未接种MMR1的大龄儿童同住一个家庭的索引儿童接种MMR1的可能性，使用逻辑回归在对个体水平、家庭水平和地区水平协变量进行调整前后估计比值比（OR）和95%置信区间（CI）。我们进行了敏感性分析，排除了家中最年长儿童与最年幼儿童年龄间隔大于5岁的家庭。
59851名（83.6%）索引儿童在12个月至24个月龄之间接种了MMR1。在对家庭构成和规模进行调整后，与12个月至24个月龄之间未接种MMR1的大龄儿童同住一个家庭的索引儿童接种MMR1的可能性较小：OR为0.19（95%CI：0.18，0.20）。在排除年龄间隔大于5岁的家庭后，这种关联增强：OR为0.14（0.13，0.15）。
在家庭中，MMR1接种延迟情况具有很强的一致性，且独立于家庭规模和构成。家庭内部缺乏及时保护会增加麻疹爆发的风险。需要采取基于家庭的干预措施来提高MMR1接种的及时性。
