Tracking mothers’ attitudes to MMR immunisation 1996–2006
Introduction
Parental attitudes, experiences and social grade are influential in determining whether a child receives a vaccine. Personal experience and knowledge of diseases influence parental perceptions about the seriousness of diseases and the likelihood of their children being affected [1]. In countries such as the UK, where immunisation programmes have been very successful, the challenge is in maintaining high levels of vaccine coverage. In the absence of disease, the threat of that disease rapidly disappears and anxieties about the vaccine's safety may increase. A fall in vaccine coverage can lead to the return of disease as happened in the UK when rates of pertussis immunisation fell in the 1970s as a consequence of public and health professional's fears over vaccine safety [2].
In 1991, the first of a series of surveys was undertaken in England to track mothers’ attitudes and experiences of immunisations and their recall of specific information materials produced by the national immunisation information programme. The main objectives of the research, which continues to the present, are to provide information on parents’ knowledge, attitudes and experience of immunisation in England. The bi-annual survey also provides an important opportunity to measure the effect of ‘external factors’ such as the effect of the media and other peoples’ opinions on perceptions of immunisation.
The combined measles, mumps and rubella vaccine (MMR) in particular, has been the subject of tremendous controversy and intense media interest. In February 1998, an association was proposed between MMR immunisation and two serious illnesses: inflammatory bowel disease and autism [3]. A further article made additional claims that MMR vaccine was never properly tested [4]. Negative publicity continued throughout this period, peaking in 2002, with an unprecedented number of calls for the provision of single measles, mumps and rubella vaccines. In the absence of evidence to support such a policy change, the Department of Health continued to advise parents to immunise their children with MMR vaccine.
The majority of the authors of the original scientific paper linking MMR, autism and inflammatory bowel disease published a retraction of this interpretation [5]. A review of 31 independent studies concluded that there was no scientific evidence to support the link between MMR and autism [6]. Virological studies using highly sensitive and specific molecular techniques have found no evidence of persistent measles infection in autistic children [7], [8].
Here we take the opportunity to present the most comprehensive study of mothers’ attitudes to MMR vaccination as they have evolved over the last 10 years (1996–2006) incorporating the periods of time before, during and after the height of the MMR controversy.
Section snippets
Methods
The 30th wave of parental attitude research was conducted in October–November 2006. The sample size was 1016 mothers of children aged less than 36 months. Mothers who took part were nationally representative of those with children under 3 years of age. Face-to-face interviews were conducted in the home using multi-media Computer Assisted Personal Interviewing (CAPI).
Random location sampling was used, a tightly controlled form of quota sampling developed by the British Market Research Bureau [9]
Spontaneous and prompted awareness of MMR vaccine
Respondents were asked what immunisations they thought were currently available for children. After answering spontaneously, they were then shown a list of immunisations and prompted with the question “and which others of these immunisations do you think are currently available for children”.
Fig. 1 shows the level of mothers’ spontaneous awareness of MMR vaccine in the period 1996–2006. Overall, in the latest wave of research, spontaneous awareness of MMR has decreased to 77% of all
Discussion
In the UK, MMR vaccination coverage peaked during 1995, when 92% of children aged 2 years were reported as having received at least one dose of MMR [10]. In the third quarter of 2006, vaccination coverage with at least one dose by age 2 years was 85% [11]. A sustained MMR uptake rate of at least 95% is needed to prevent measles outbreaks occurring in the community. Recent experience in Ireland [12], [13] and the Netherlands [14] reminds us that measles is a severe infection that can kill even
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