The role of social determinants in vaccine uptake and burden of vaccine preventable diseases

Date of Approval: 
2016-08-24 00:00:00
Lay Summary: 
Vaccination is an effective way to prevent infectious diseases. However, individuals with certain social characteristics (for example, those living in more deprived areas, or those living alone) maybe less likely to receive vaccination. Some of these individuals could also be at higher risk of the disease the vaccine prevents, making them doubly disadvantaged. At present in England, information about social factors that affect vaccination and risk of vaccine-preventable disease is lacking. This makes it difficult to plan interventions to address these disadvantages. This study will examine the social factors that may be linked with higher shingles disease burden, and with decreased uptake of shingles vaccine. The frequency of developing shingles, and of receiving the shingles vaccine, will be compared among older individuals with different social circumstances. We will also look at factors linked with lower uptake of childhood influenza vaccine by comparing the frequency of uptake of influenza vaccine among children with different social circumstances. Identifying social factors that are associated with lower vaccination rates and (for shingles) higher burden of disease will help to design programmes to improve vaccine uptake in specific groups of individuals at higher risk.
Technical Summary: 
Addressing inequalities in vaccine uptake to prevent infections in children and in adults is a key priority for public health. In England, current surveillance methods provide little information about social factors associated with the burden of vaccine-preventable diseases or vaccine uptake. These social factors may vary for older individuals and children. This project will use linked electronic health records and a cohort study design to investigate the association between selected social factors and uptake of two vaccines introduced in England in 2013; zoster vaccine in older individuals and intranasal influenza vaccine in young children. Similarly, the association between social factors and incidence of zoster in older individuals will be investigated, to assess whether some individuals are doubly disadvantaged (less likely to receive zoster vaccine and more likely to develop zoster). A hierarchical modelling approach will be used to investigate the effects of upstream and downstream social determinants of vaccine uptake and burden. The results of this project will enhance existing surveillance methods and should help to address vaccine-related health inequities.
Health Outcomes to be Measured: 
An incident zoster diagnosis Zoster vaccine uptake Childhood intranasal influenza vaccine uptake
Application Number: 
16_168
Collaborators: 

Sara Thomas - Chief Investigator - Not from an Organisation
Albert J. van Hoek - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Anu Jain - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Harriet Forbes - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Jemma Walker - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Rohini Mathur - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sinead Langan - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )

Linkages: 
CPRD Mother-Baby Link;HES Admitted Patient Care;HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation