Co-administration of routine paediatric vaccines in England often deviates from the immunisation schedule

Jorgen Bauwens; Simon de Lusignan; Julian Sherlock; Filipa Ferreira; Nino Künzli; Jan Bonhoeffer

doi:10.1016/j.jvacx.2021.100115

Co-administration of routine paediatric vaccines in England often deviates from the immunisation schedule

Vaccine X. 2021 Sep 15:9:100115. doi: 10.1016/j.jvacx.2021.100115. eCollection 2021 Dec.

Authors

Jorgen Bauwens^{1

2}, Simon de Lusignan^{3

4}, Julian Sherlock³, Filipa Ferreira³, Nino Künzli^{1

5}, Jan Bonhoeffer²

Affiliations

¹ University of Basel, Switzerland.
² University of Basel Children's Hospital, Switzerland.
³ Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom.
⁴ Royal College of General Practitioners, United Kingdom.
⁵ Swiss Tropical and Public Health Institute, Switzerland.

Abstract

Vaccine co-administration can facilitate the introduction of new vaccines in immunisation schedules and improve coverage. We analysed real life data to quantify the extent of routine paediatric vaccine co-administrations as recommended and as never recommended in the immunisation schedule in England, and assessed factors for recommended and never recommended vaccine co-administrations. Immunisation data for all scheduled routine paediatric vaccines between 2008 and 2018 was obtained from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We included 6'257'828 doses administered to 1'005'827 children. Twenty-one percent of vaccines were given separately, 79% were co-administered. Sixty-four percent of vaccines scheduled for co-administration were co-administered as recommended while 15% were administered separately. Among all vaccine co-administrations, 75% happened as recommended in the schedule, 4% were never recommended, while 21% deviated from the schedule. Vaccine co-administration according to the schedule varied greatly between vaccines. Forty-eight percent of English children received at least one of their vaccine co-administrations not as recommended in the immunisation schedule, with 19% of children receiving none of their co-administered vaccines as recommended. Late administration of one or more vaccines increased the odds for deviated co-administrations (OR 1.60) and strongly increased the odds for never recommended co-administrations (OR 5.34). Differences between genders, NHS regions, and IMD quintiles were statistically significant but small. Suboptimal co-administration rates for routine paediatric vaccines are a missed opportunity and should be optimised by concerted public health action.

Keywords: COVER, Cover of Vaccination Evaluated Rapidly; Children; Co-administration. Immunisation Schedule; DTaP/HepB/IPV/Hib, Diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b conjugate vaccine; DTaP/IPV or dTaP/IPV, Diphtheria and tetanus toxoids and acellular pertussis adsorbed, and inactivated poliovirus vaccine; DTaP/IPV/Hib, Diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus, and Haemophilus influenzae type b conjugate vaccine; GP, General Practitioner; HPV, Human papillomavirus vaccine; Hib/MenC, Haemophilus influenzae type b conjugate, and bivalent meningococcal conjugate vaccine; IMD, Index of Multiple Deprivation; IQR, Interquartile Range; MMR, Measles, mumps, and rubella vaccine; MenACWY, Quadrivalent meningococcal conjugate vaccine; MenB, Serogroup B meningococcal vaccine; MenC, Serogroup C meningococcal vaccine; Minors; OR, Odds Ratio; PCV, Pneumococcal conjugate vaccine; PHE, Public Health England; RCGP, Royal College of General Practitioners; RSC, Research and Surveillance Centre; RV, Rotavirus vaccine; Td/IPV, Tetanus and diphtheria toxoids and inactivated poliovirus vaccine; Vaccination; Vaccines.