Vaccination coverage for children and mothers

This indicator looks at vaccination coverage for children and mothers in the UK and internationally.

Indicator

Last updated: 29/07/2021

Effective clinical care
Primary and community care Public health Children and young people International

Background

Vaccination coverage is the best indicator of the level of protection a population will have against vaccine-preventable communicable diseases. Coverage is closely related to levels of disease; monitoring coverage identifies possible drops in immunity before levels of disease rise.


How has childhood vaccination coverage in England changed over time? 27/01/2021

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In England, vaccinations for diphtheria, tetanus, polio, pertussis and haemophilus influenza b (Hib) were offered separately between 1994 and 2006, and uptake declined slightly over this period. From 2006/07 onwards, a combined vaccination against all five diseases was introduced, and uptake subsequently improved.

The availability of a single, combined vaccination may have simplified the childhood vaccination schedule for children and parents. However, between 2006/07 and 2010/11 similar improvements in uptake were observed for the pneumococcal (PCV) vaccination and the Hib/meningococcal group C (MenC) vaccination, suggesting an overall increase in vaccination coverage, irrespective of the new delivery method. In 2017, the five-in-one vaccine was replaced by the hexavalent six-in-one vaccine that additionally offers protection against hepatitis B.

Between 1994 and 1997, there was a relatively steady rate of measles, mumps and rubella (MMR) vaccine coverage for children reaching their second birthday in England, of around 91%. In 1998, a now discredited article appeared in The Lancet which linked the MMR vaccination to autism. Uptake decreased significantly, and by 2003/04 only 79.9% of children were vaccinated. The Lancet partially retracted the paper in 2004 and fully retracted it in 2010, and coverage consequently improved, reaching 92.7% in 2013/14. However, by 2019/20 MMR coverage had fallen to 90.6%. 

To understand more recent changes in vaccination coverage, we can examine quarterly data. In the first half of 2020/21 (April to September 2020), during the coronavirus (Covid-19) pandemic, coverage was largely maintained when compared to coverage in 2019/20. However, in Q4 2020/21 (January to March 2021) coverage of the PCV booster, MMR and Hib/MenC vaccinations among children reaching their second birthday fell below 90%. In Q4 2020/21, coverage of the PCV vaccination among children reaching their first birthday was 93%, although the schedule for this vaccination changed in 2020. Children reaching their first birthday in this quarter will only have been offered one dose of the PCV vaccine, so this figure is not comparable to previous quarters (see ‘About this data’ for more details).

Coverage for all of the childhood vaccinations plateaued between 2011/12 and 2013/14, and has since declined. The World Health Organization (WHO) recommends that on a national basis at least 95% of children are immunised against vaccine-preventable diseases and these diseases are targeted for elimination or control. There is an expectation that all UK routine childhood immunisations that are evaluated up to five years of age achieve the 95% coverage in line with the WHO target. In 2020/21, for the third consecutive year, none of the routine vaccinations met this target.


How does childhood vaccination coverage vary across UK countries? 27/01/2021

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Note:  

Please see below for a guide to the abbreviations used:

  • DTaP/IPV/Hib – 1st birthday - Diphtheria, tetanus, polio, pertussis and Haemophilus influenzae b – 1st birthday

  • PCV - Pneumococcal Disease

  • DTaP/IPV/Hib – 2nd birthday Diphtheria, tetanus, polio, pertussis and Haemophilus influenzae b – 2nd birthday

  • MMR - Measles, mumps and rubella

  • Hib/MenC booster – Hib and meningitis C booster

  • PCV booster – Pneumococcal disease booster

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In 2019/20, childhood vaccination coverage for DTaP/IPV/Hib, PCV and MMR was over 90% for all UK countries. In general, there was little variation between the four nations, although England's coverage was around 3% lower than the other three.


How has the number of confirmed cases of measles in England changed over time? 29/07/2021

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Provisional data for 2020 shows a sharp decrease in the number of laboratory-confirmed measles cases, with only 79 cases confirmed. This is likely to reflect the impact of measures to control Covid-19 on the spread of other infections.

In 2019 there were 797 laboratory-confirmed measles cases in England. This was a slight decrease in cases compared to the 968 confirmed measles cases in 2018, but higher than the 265 confirmed cases in 2017. The outbreak in 2018 was linked to importations from Europe that led to some limited spread in the community, particularly among teenagers and young adults who did not receive the MMR vaccine when they were younger. There were also previous outbreaks in 2008 (1,280 cases) and 2012 (1,920 cases).

Rising cases of mumps are also a concern among young adults who did not receive the MMR vaccine when they were younger. Prior to the Covid-19 pandemic, lab-confirmed cases of mumps were increasing in England to 5,055 cases in 2019. This was the highest number of cases in a decade. In 2020, provisional data shows that the number of lab-confirmed cases of mumps fell to 3,215 (data not shown).

The UK achieved WHO measles elimination status in 2017. However, the increase in cases in 2018 led the WHO to conclude that transmission of the measles virus had been re-established, and elimination status was lost. The UK Measles and Rubella elimination strategy was launched in 2019, and includes a national ambition to achieve and sustain the WHO target of 95% coverage for two doses of the MMR vaccine in five-year-olds.

Uptake of the first dose of the MMR vaccine in five-year olds met the 95% WHO target for the first time in 2016/17, but fell to 94.5% in 2019/20 (data not shown). Coverage of the second MMR dose in five-year-olds increased in 2019/20 after falling for four consecutive years, but remains suboptimal at 86.8% – well below the 95% WHO target. In March 2019, the chief executive of NHS England warned that vaccination deniers were gaining traction on social media, and may be contributing to the decline in the uptake of the measles vaccine in recent years.


How does the UK's diphtheria, tetanus, pertussis (DTP) vaccination coverage compare internationally? 27/01/2021

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The UK's diphtheria, tetanus, pertussis (DTP) vaccination coverage has improved over time, from 91% in 2000 to 94% in 2018. Belgium, Greece, Japan, and Portugal have very high DTP vaccination rates, all showing over 98% coverage in 2018. Austria’s DTP coverage was 85% in 2018, which is the lowest of the OECD countries compared here.


How does the UK's measles vaccination coverage compare internationally? 27/01/2021

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Between 2000 and 2004, the UK's vaccination coverage for measles fell from 88% to 81%. This was in response to the safety concerns surrounding the measles, mumps and rubella (MMR) vaccine. Since 2004 the coverage rate has recovered, reaching 92% in 2018. In 2018, Portugal had the highest measles vaccination coverage (99%) whilst Canada had the lowest (90%).


How has human papilloma virus (HPV) vaccination coverage changed over time? 29/07/2021

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All girls aged 12 to 13 are offered the HPV (human papilloma virus) vaccination as part of the NHS childhood vaccination programme, and given a series of injections within a 12-month period. The vaccine protects against a group of viruses that have been linked to the development of cervical cancer, and some rarer anal and genital cancers, and cancers of the head and neck. Not all cervical cancers are caused by HPV and so the vaccine does not result in immunity to cervical cancer, only to one of its potential causes.

There has been a consistently higher uptake of the first dose of the vaccine than subsequent doses, over time in England. Uptake for the HPV vaccination in females aged 12 to 13 remained fairly static between the 2011/12 and 2013/14 school years, with an average uptake of 90.9% for the first dose and 89.7% for two doses.

In September 2014, the HPV schedule was changed from three doses to two, and since 2015/16 data has been reported as coverage for females aged 13 to 14 who will have been offered both doses. During the 2019/20 school year, all schools closed in March 2020 due to the Covid-19 pandemic and school immunisation programmes were paused. Coverage of the second dose of the HPV vaccine fell sharply, with only 65% of females aged 13 to 14 having received the vaccine, compared to 84% in the 2018/19 school year.

From the 2019/20 school year, the HPV vaccination programme has been extended to boys aged 12 to 13 years in England. This decision is based on advice from the Joint Committee on Vaccination and Immunisation (JCVI), and will help prevent more cases of HPV-related cancers in boys and girls. The data presented here for 2019/20 only cover females aged 13 to 14 who have been offered both doses of the vaccine.


How has pertussis vaccination coverage for pregnant women changed over time? 29/07/2021

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Despite high vaccine coverage since the early 1990s, in the five years prior to 2012 there were nearly 800 confirmed cases of pertussis (also known as whooping cough), where on average there were 270 babies admitted to hospital per year and four deaths. Babies under three months of age are too young to have completed a primary course of the pertussis vaccine, but the incidence of the disease is highest in infants of this age and they have the greatest risk of complications and mortality. In response to a national outbreak, the Department of Health announced that pertussis immunisation would be offered to pregnant women after 16 weeks gestation from 1 October 2012. This protects infants by boosting the short-term immunity of babies until they can be vaccinated themselves.

Pertussis vaccination coverage for pregnant women in England is not especially high. Since its introduction in October 2012, there has been an increase in uptake from 44% to a peak of 76% in December 2016. Since then, coverage has fluctuated at around 70%. In March 2021, coverage was 67% - just over 5 percentage points lower than in March 2020.


About this data

For the schedule of vaccinations please see the NHS website.

In 2017, the five-in-one vaccine (for diphtheria, tetanus, polio, pertussis and haemophilus influenza b) was replaced by the hexavalent six-in-one vaccine that additionally offers protection against hepatitis B. In 2018/19, children received either the five-in-one or six-in-one vaccine, depending on when they were vaccinated. The data presented here refers to six-in-one coverage for children reaching their first birthday and five-in-one coverage for children reaching their second birthday, as all children received this component of the vaccine.

In April 2019, it was recommended that the schedule for the pneumococcal (PCV) vaccination should be changed from a dose at 8 and 16 weeks old, followed by a booster dose at one year old, to a single dose at 12 weeks of age, followed by a booster dose at one year old. All infants born on or after 1 January 2020 are offered the new PCV vaccination schedule. The data presented here for Q4 2020/21 is the first quarter where infants reaching their first birthday will have been offered only one dose of the PCV vaccine.

For all vaccinations some caution should be exercised when comparing coverage figures over time due to data quality issues reported by some data providers. Apparent trends could reflect changes in the quality of data reported as well as real changes in vaccination coverage. Please see individual data collections for any additional information associated with these data.

International comparisons:

Definitions and comparability for the international indicators are taken directly from the OECD’s Health at a Glance 2019: OECD Indicators. Detailed information about the definitions and the source and methods for each country can be found here.

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