Reasons for non-uptake of measles, mumps, and rubella catch up immunisation in a measles epidemic and side effects of the vaccine

• Published in: BMJ 1995-06, Vol.310 (6995), p.1629-1632
• Main Authors: Roberts, Richard J, Sandifer, Quentin D, Evans, Merion R, Nolan-Farrell, Maria Z, Davis, Paul M
• Format: Article
• Language: English
• Subjects: Adolescent; Attitude to Health; Child; Children; Children & youth; Childrens health; Cohort Studies; Confidence intervals; Consent forms; Disease Outbreaks; Female; Humans; Immunization, Secondary - statistics & numerical data; Male; Measles; Measles - epidemiology; Measles - prevention & control; Measles Vaccine - adverse effects; Measles-Mumps-Rubella Vaccine; Mumps; Mumps Vaccine - adverse effects; Parents & parenting; Parents - psychology; Patient Acceptance of Health Care; Public health; Questionnaires; Random Allocation; Retrospective Studies; Rubella; Rubella Vaccine - adverse effects; Rubella vaccines; Schools; Secondary schools; Side effects; Surveys and Questionnaires; Vaccination; Vaccines; Vaccines, Combined - adverse effects; Wales - epidemiology
• ISSN: 0959-8138; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.310.6995.1629

Objective —To investigate the reasons for poor uptake of immunisation (non-immunisation) and the possible side effects of measles, mumps, and rubella vaccine in a catch up immunisation campaign during a community outbreak of measles. Design —Descriptive study of reasons for non-immunisation and retrospective cohort study of side effects of the vaccine. Setting —Secondary schools in South Glamorgan. Subjects —Random cluster sample of the parents of 500 children targeted but not immunised and a randomised sample of 2866 of the children targeted. Main outcome measures —Reasons for non-immunisation; symptoms among immunised and non-immunised children. Results —Immunisation coverage of the campaign was only 43.4% (7633/17,595). The practicalproblems experienced included non-return of consent forms (6698/17,595), refusal of immunisation (2061/10,897 forms returned), and absence from school on day of immunisation (1203/8836 children with consent for immunisation). The most common reasons cited for non-immunisation were previous measles infection (145/232),previous immunisation against measles (78/232), and concern about side effects (55/232). Symptoms were equally common among immunised and non-immunised subjects. However, significantly more immunised boys than non-immunised boys reported fever (relative risk 2.31 (95% confidence interval 1.36 to 3.93)), rash (2.00 (1.10 to 3.64), joint symptoms (1.58; 1.05 to 2.38), and headache (1.31 (1.04 to 1.65)). Conclusions —Many of the objections raised by parents could be overcome by emphasising that primary immunisation does not necessarily confer immunity and that diagnosis of measles is unreliable. Measles, mumps, and rubella vaccine is safe in children aged 11-15. Key messages Parents frequently object to immunisations for their children on various grounds, including previous immunity and concern about adverse effects Previous immunisation or clinical measles was found to be a frequent reason for non-immunisation in a mass campaign Advice to parents should emphasise that primary immunisation against measles, mumps, and rubella may fail to confer immunity and that a clinical diagnosis of measles is unreliable The incidence of adverse effects of measles, mumps, and rubella vaccine in the 11-15 year age group in the United Kingdom is low