Immunisations: children

In Scotland, vaccine uptake for the childhood immunisation programme is reported quarterly by Public Health Scotland and is based on extracts taken from the Scottish Immunisation Recall System (SIRS), for the calendar year in March and for the financial year in June.

Further information and a complete list of the childhood immunisation statistics are available from Public Health Scotland’s Childhood Immunisation Statistics. This includes updates on immunisation uptake rates by age and deprivation, and by Scotland, NHS Board and Local Authority level covering the 6-in-1 primary course (for diphtheria, tetanus, pertussis, poliomyelitis (polio), Haemophilus influenzae type b (Hib) and Hepatitis B), Pneumococcal Conjugate Vaccine (PCV), rotavirus, Meningococcal B (MenB), measles, mumps and rubella (MMR), Haemophilus influenzae type b/Meningococcal C (Hib/MenC) vaccines and relevant second doses and boosters. Rates for the flu vaccine uptake are published separately.

In 2022, with the exception of the rotavirus, uptake rates for vaccines given before age 12 months were around 95%. By 24 months of age, 93.9% of children had received their first dose of the MMR vaccine.

ScotPHO Profile indicators for childhood immunisations are as follows:

• Immunisation uptake at 24 months for the for 5 in 1 (Diphtheria, Pertussis, Tetanus, Polio, Hib) and 6-in-1 (from 1st October 2017), which also protects against Hepatitis B: 3-year rolling average number and percentage of children of this age.
  • Data available by intermediate zone, HSC locality, HSC partnership, Council area and Health board in 3-year aggregate data.
• Immunisation uptake at 24 months for - MMR (measles, mumps and rubella): 3-year rolling average number and percentage of children of this age.
  • Data available by intermediate zone, HSC locality, HSC partnership, Council area and Health board in 3-year aggregate data.

Information on each of these diseases/viruses can be found on Public Health Scotland's A to Z of topic areas. 

Immunisations: Inequalities in uptake in children

Deprivation is one factor that can influence a parent/guardian’s decision to immunise their child. Data by Scottish Index of Multiple Deprivation (SIMD)(2020v2) quintiles for year-end 2022 and report show (Table 1):

• A deprivation effect for all these vaccines; rates increase across deprivation quintiles from the most to the least deprived
• The deprivation effect is more evident for vaccines delivered at older ages, apart from rotavirus vaccine at 12 months*
• Uptake for all vaccines is below 95% for the most deprived quintile at all ages, and only below 95% for the least deprived quintile for the MMR2 vaccine at 5 years 

* Rotavirus vaccination is unique in the routine childhood immunisation schedule in that its administration is bound by strict age limits. This means that overall uptake is lower and deprivation can potentially have more of an impact 

Uptake rates for both the MMR1 vaccine by 24 months and the six-in-one vaccine by 5 months as children age show that children in more deprived areas are more likely to be vaccinated later than children in less deprived areas.

The COVID-19 Wider Impacts Dashboard also provides information on inequalities in uptake of childhood vaccines by SIMD. Recent research by McQuaid et al (2022) shows that uptake improved across deprivation levels during the pandemic, but inequalities persisted.

A range of information on immunisation uptake rates across the world is available on the UNICEF and WHO websites. These provide comparable information for countries across the world, including the UK. There are still inequalities in immunisation rates across the world, with the UK comparing favourably.

Immunisations: Factors affecting uptake in children

MMR vaccine

• Single parenthood, area deprivation, high birth order and family size/living in a household with other children have been found to be associated with lower uptake. Prior to the falsehoods published and retracted about associations between autism and the MMR vaccine in 1998, uptake was lower among single parent families, larger families and those in more socially deprived areas. The decline in uptake that occurred as a result of these unfounded claims, due to a conscious decision by parents, was faster in more affluent areas and those with more highly educated residents, although the overall social gradient in uptake persisted (Pearce et al, 2008). MMR vaccine rates have now recovered.
• Anderberg et al (2011) similarly found a faster decline in MMR vaccine uptake after its negative publicity in areas where a larger fraction of parents were educated past 18 years of age. There was also an overspill effect as the same areas reduced their relative uptake of uncontroversial childhood immunisations. Income was also found to have a similar but more modest effect on uptake rates; higher income was associated with faster declines in uptake rates. This study also found a lower uptake in never married mothers, and that ethnicity and the presence of older siblings have an effect.
• Atkinson et al (2005) proposed that an outbreak of measles in 2001 in London, was largely dependent on low usage of the MMR vaccine in more affluent areas, marking a reversal of health inequalities.

A resurgence of ‘vaccine hesitancy’, now listed as one of the World Health Organization’s 10 threats to global health has led to concerns that measles may become endemic again. BMJ offers debate on solutions.