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The European Journal of Public Health Advance Access originally published online on October 5, 2005
The European Journal of Public Health 2006 16(2):137-142; doi:10.1093/eurpub/cki194
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© The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Infectious Diseases

Understanding variation in measles–mumps–rubella immunization coverage—a population-based study

James A. Wright1 and Clare Polack2

1 Department of Geography, University of Southampton, Highfield, Southampton SO17 1BJ, UK
2 MRCGP, Division of Medical Education, University of Southampton, UK

Correspondence: James A. Wright, tel: +44 2380 594619, fax: +44 2380 593295, e-mail: j.a.wright{at}soton.ac.uk

Background: Coverage of the Measles–Mumps–Rubella combined vaccine (MMR) has declined in recent years in the UK, following adverse publicity about possible links between the vaccine, autism, and Crohn's disease. The objectives of this study were to assess geographical variation in trends in MMR coverage and to identify the factors affecting MMR uptake at population level. Methods: We conducted an ecological study of immunization coverage by second birthday, based on routinely collected data from 1993–2004 for England. Trends in MMR uptake were assessed in 95 District Health Authorities in England over the study period. We investigated the relationship between MMR immunization uptake and deprivation, ethnicity, education, population density, rurality, and socioeconomic class. Results: Since 2000, MMR coverage has declined significantly in virtually all areas of England. Population density and deprivation were both strongly correlated with low MMR uptake. The decline in coverage since 1993–94 was significantly related to the proportion of educated population and was greater in densely populated areas. Conclusion: Decline in MMR coverage now affects most areas of England. The lowest rates of MMR coverage remain in urban areas, particularly in inner cities, which also tend to show high levels of deprivation. Public health resources should continue to target inner city areas, as well as focus on the concerns of the better educated about vaccine safety.

Keywords: censuses, geographic information systems, immunization, measles


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