Childhood Vaccination Coverage Statistics - 2020-21

England, 2020-21

Herd immunity only applies to diseases that are transmissible from person to person. It does not apply to diseases such as tetanus which is not passed from person to person and where a vaccine protects only the vaccinated person from disease.

The complete vaccination schedule is available here:

All vaccine coverage data reported by PHE, including vaccines not covered by this report, are available

_{^{1. John TJ, Samuel R. 2000. ‘Herd immunity and herd effect: new insights and definitions’, Eur. J. Epidemiol. 16 (7), pp601-6}}

Influenza immunisations for eligible GP patient groups

The PHE influenza surveillance team collate and report on seasonal influenza vaccine uptake for children aged 2 and 3 years on 31 August during the reporting year, reported by GP practices.

All figures presented are for flu vaccinations administered from the 1 September to the 28 February, inclusive of both dates.

Useful links
Further information on the vaccine and other groups receiving the vaccine is available from PHE via the following links:
https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-winter-2020-to-2021

https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-children-of-school-age-winter-2020-to-2021

PHE produce an annual summary of seasonal influenza activity in the UK,

Vaccine coverage is defined as:

Coverage definitions for all vaccinations from the COVER programme are available.

Seasonal Flu for children aged 2 and 3 years

This includes all children aged 2 years old and 3 years old on 31 August 2020. Patients who have had more than 1 dose of influenza vaccine are only counted once to avoid double counting as not all patients will require 2 doses of influenza vaccine.

It is calculated as follows:

2020 - January 2020, the infant vaccination schedule for pneumococcal vaccine (PCV) changed. All babies born on or after 1 January 2020 will receive their 1st dose of PCV with their other infant vaccinations at 12 weeks of age and a booster dose of this vaccine on or after their 1st birthday.

2019 - From September 2019, the national flu vaccination programme was extended to include children in school year 6 (children aged 10 years (but not 11 years or older)) on 31 August. This report focuses only on children aged 2 and 3 years.

2018 - From September 2018, the national flu vaccination programme was extended to include children in school year 5 (children aged 9) on 31 August. Children aged 2 and 3 years (but not 4 years or older) will be offered the vaccine through general practices. The delivery of flu vaccination for 4 year olds (but not 5 years or older on 31 August) changed from a GP mode of delivery to a school based programme. This report focuses only on children aged 2 and 3 years.

2017 - From Autumn 2017, all babies born on or after 1 August 2017 became eligible for a hexavalent vaccine which protects against 6 different diseases including hepatitis B (HepB) for their primary immunisations. This vaccine replaced the pentavalent infant vaccines which protect against 5 diseases but do not protect against HepB.

2016 - On 1 July 2016, the infant dose of the MenC vaccine given at 12 weeks was removed from the routine schedule. The combined Haemophilus influenzae type b and meningococcal group C (Hib/MenC) vaccine offered after the 1st birthday is the 1st MenC dose in the schedule. A 2nd dose is offered as the MenACWY vaccine at age 13 to 14 years, in school year 9.

2015 - Meningococcal B vaccine was added to the programme in September 2015. See the separate Quality Statement for more information. In addition meningococcal ACWY vaccine replaced the meningococcal C booster vaccine at around 14 years from August 2015.

2014 - The HPV schedule for 12 to 13-year-old girls (school year 8) changed from 3 to 2 doses . Childhood flu vaccine extended to include all 4 year olds.

2013 - Childhood flu (only offered to 2 and 3 year olds) and rotavirus vaccines for infants were added to the programme in 2013 and the schedule for administering the MenC vaccine changed from 2 to only a primary dose at 3 months. See the separate Quality Statement for more information.

2010 - Vaccines that were previously given separately at 12 months of age (Hib/MenC vaccine) and 13 months of age (MMR and PCV) were to be given at the same visit, between 12 and 13 months of age (i.e. within a month after the 1st birthday) . In 2010, PCV was changed to a vaccine providing direct protection against 13 strains (PCV13).

2008 - A new programme to vaccinate all 12 to 13-year-old girls (school year 8) against HPV started at the beginning of the 2008-09 school year. HPV immunisation is offered to protect girls predominantly against their future risk of cervical cancer.

2006 - PCV7 vaccine was introduced to the routine childhood programme. This is given at 2 and 4 months with a booster dose around 13 months of age. Data on the primary course (given at 2 and 4 months) evaluated at 12 months of age were initially published in this bulletin in 2007-08 as experimental statistics. Coverage data for the PCV booster evaluated at 24 months were initially published in 2008-09, again, as experimental statistics.

A combined Hib/MenC booster vaccine was introduced for children at around 12 months of age. Vaccine coverage data for the Hib/MenC booster evaluated at 24 months was initially published in this bulletin in 2008-09 as experimental statistics. Coverage statistics for the Hib/MenC booster vaccination at 5 years were initially published as experimental statistics in 2011-12.

2004 - Following recommendations from JCVI that live oral polio vaccine (OPV) be replaced with inactivated polio vaccine (IPV) and acellular pertussis vaccines replaced the whole cell pertussis vaccine in the routine childhood immunisation programme, a number of vaccine changes were introduced.

DTaP/IPV/Hib replaced the DTwP-Hib and OPV vaccines previously used for primary immunisation, DTaP/IPV replaced the DTaP and OPV vaccines for the pre-school booster and Td/IPV replaced the Td and OPV vaccines for the teenage booster.

COVER data

Information on childhood immunisation coverage at ages 12 months, 24 months and 5 years are collected through the Cover of vaccination evaluated rapidly (COVER) data collection from Child Health Information Systems (CHISs) for most Local Authorities (LAs) or from General Practice (GP) systems for a small number of LAs.

Data collections are quality assured at the time of collection by PHE and further data validation and quality assurance are carried out by NHS Digital prior to publication.

PHE’s quality assurance processes include the following:

• Checks on data completeness.
• Comparisons with previous years’ data to identify and explain any large changes (eligible population and coverage).
• Comparisons with coverage figures for the same cohort of children in previous years to identify any unexpected changes.
• Where unexpected changes exist, data providers are contacted to verify and explain the data.

NHS Digital further checks include the following:

• Second check on data completeness.
• Review explanations for clarity and adequacy.
• Comparisons at a regional and local level for accuracy.
• Checks on the calculated coverage figures.

Data quality

Issues with some CHISs over recent years (including issues associated with the implementation of new IT systems) have affected the quality of some COVER data. This appendix provides a data quality summary for 2020-21 data.

Quality Statement

The Quality Statement that accompanies this publication includes further information on:

• Data sources
• Definitions
• Methods used to compile the statistics 
• Other background information readers may find useful

During the 2020-21 data collection and validation, the following data quality issues have been identified. These should be considered when interpreting the data.

Hib/MenC: Southampton LA data for Hib/MenC at 24 months is not available in 2020-21. It has been excluded because a data migration issue has undermined the accuracy. National and regional figures calculated for Hib/MenC at 24 months in 2020-21 exclude Southampton from both the numerator and the denominator.

Change of provider: South East

During 2020-21, Southern Health Care NHS Trust took over as provider for 4 LAs in the South East region; Southampton, Portsmouth, Hampshire, Isle of Wight. This transition may have had a general impact on the data reported for those LAs. 

COVER quarterly reports:

London

No significant data quality issues reported for London in 2020-21, this follows the improvement in the quality of data submitted in 2019-20.

Summary of recent historic data quality issues in London.

2017-18

• Data quality issues in some London COVER returns during 2017-18 were observed as new Hubs became responsible for generating coverage data. Changes in vaccine coverage within London for that year should be interpreted with caution.

2018-19

• Data quality issues relating to complexities in data flows between providers and CHISs were reported in London data in 2018-19. This is attributed to the data improvement work that is occurring due to the wider digital strategy being implemented. Changes in vaccine coverage within London in 2018-19 should be interpreted with caution.

Bacillus Calmette–Guérin (BCG) vaccination

The BCG immunisation programme is a risk-based programme recommended for individuals at higher risk of exposure to TB.

In addition to this risk-based approach, all infants (0-12 months) living in an area with an incidence above 40/100,000 should be offered the BCG vaccine.

Detailed information on the BCG programme can be found in the ‘Green Book’.

BCG Data can be found in Table 11a in the data tables.

In 2020-21 a universal BCG programme was offered by LAs with a 3-year average annual TB rate equal or greater than 40 per 100,000 population.

In 2020-21 5 LAs offered a universal BCG programme based on the criteria above, all based in London (Brent, Ealing, Hounslow, Newham and Redbridge).

An estimated coverage figure is only reported for these LAs running a universal programme.

Slough, which previously offered a universal programme, has not done so since 2017-18.

From April 2015, as part of the COVER programme, neonatal BCG was included in the data extraction template from local CHISs, alongside extraction of coverage data for other vaccines offered under the age of 5 years.

This provides an opportunity for BCG vaccine coverage to be estimated only for local authorities offering a universal neonatal programme.

It is not possible to calculate LA level coverage for the selective programme offered in the rest of England as the number of eligible children is not defined in the CHISs.

COVER collections for BCG data have only recently been established and data are of variable quality. A shortage of BCG vaccine that started in May 2015 and may have persisted in some areas into 2016 is likely to have impacted on coverage for those evaluated in 2017-18 (born between 1 April 2016 and 31 March 2017).

From June 2016, an alternative BCG vaccine was supplied by PHE to enable the continuation of the neonatal programme.

Neonatal hepatitis B (HepB) vaccination

Information on neonatal hepatitis B (HepB) vaccination can be found in the ‘Green Book’:

Following the introduction of universal antenatal testing for hepatitis B (and subsequent vaccination of babies born to mothers who are chronically infected with HBV) in April 2000, PHE has been collecting coverage data on infants born to hepatitis B positive mothers at their 1st and 2nd birthdays.

Since April 2005, this data collection has been integrated into the routine COVER programme and has been a statutory requirement since 2006.

HepB coverage statistics have been published in this bulletin since 2010 and have been published at LA level since 2015-16.

The data presented in Tables 11b and 11c in the Data Tables represents reported vaccine coverage for infants born to mothers who are chronically infected with HBV who received 5 doses of HepB vaccine when assessed at 1 year of age (2 monovalent and 3 hexavalent), and coverage for 6 doses of HepB vaccine (3 monovalent and 3 hexavalent) in such infants when assessed at 2 years of age in the year (2020-21).

Given that some or all of the data required on infants born to hepatitis B positive mothers could not be supplied for all LAs, it would be inadvisable to draw conclusions from these data at national or regional level.

Further details of the LAs for which full data could not be supplied are available in the HepB Excel Tables (11b and 11c).

For the 2020-21 collection, HepB data reported for the 150 Upper Tier Local Authorities were derived as follows:

For the 12 month cohort, 146 LAs submitted a full data set.

For the 24 month cohort, 146 LAs submitted a full data set.

Neonatal Hepatitis B (HepB) vaccination

Despite the issues mentioned with neonatal hepatitis B data, it remains important that these data continue to be reported for a number of reasons;

• The Joint Committee for Vaccination and Immunisation (JCVI) recommended a universal infant hepatitis B programme, which was implemented from autumn 2017 (see appendix G). In addition to HepB doses received at 2, 3 and 4 months through this routine programme, infants born to hepatitis B positive mothers will continue to receive doses at birth and 1 month, as well as a booster dose at 12 months.
• Official and National Statistics are important drivers for improvements locally in systems and care pathways which include data reporting. Feedback from stakeholders has been positive.
• PHE’s hepatitis team is undertaking a mapping exercise to help local teams identify gaps in the infant hepatitis B pathway, including reporting of data. Published data helps to identify those gaps and to engage local teams to address them resulting in improving data quality.
• The data has been invaluable in monitoring and evaluating the impact of various interventions – for example dry blood spot testing service for infants at 12 months old; GP payments for HepB vaccinations and testing.

The MenB vaccination was introduced from 1 September 2015 for infants due to receive their primary immunisations starting at 8 weeks of age on or after 1 September 2015 (i.e. those born on or after 1 July 2015)¹².

The vaccine is offered alongside other routine immunisations at 8 and 16 weeks of age, with a booster dose at 12 months.

A limited one-off catch-up programme was also delivered targeting infants born in May (1 dose only) and June 2015 (2 doses).

In 2016-17, the MenB primary, evaluated at 12 months, was included in the report for the first time as experimental statistics. It has been included in the main body of the report, badged as National Statistics, since 2017-18.

In 2017-18, MenB booster data, evaluated at 24 months, was included in the report for the first time as experimental statistics. It has been included in the main body of the report, badged as National Statistics, since 2018-19.

_{12. Quarterly coverage statistics were first published by PHE in February 2016 and related to the September – December 2015 quarter.}

From autumn 2017, all babies born on or after 1 August 2017 have been eligible for a hexavalent vaccine which protects against 6 diseases (diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and disease caused by Haemophilus influenzae type b) for their primary immunisations.

This vaccine, called Infanrix hexa®, replaces the pentavalent infant vaccines Infanrix®-IPV+Hib and Pediacel®, which protected against 5 diseases.

Hepatitis B is the additional disease that is now also protected against.

Hepatitis B Background

Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). Most new infections with HBV are sub-clinical or may only cause a flu-like illness.

However, acute infection occasionally leads to sudden and severe liver damage which can be fatal.

Chronic HBV infection can result in progressive liver disease, leading to cirrhosis (development of scar tissue) in some patients and an increased risk of developing liver cancer.

In 1992, the World Health Assembly recommended that every country should have a universal hepatitis B immunisation programme by 1997¹⁴.

As the UK is a low prevalence and low incidence country for hepatitis B however, introducing a universal hepatitis B programme using a monovalent hepatitis B vaccine would not have been cost-effective. 

Recently, infant combination hepatitis B vaccines (which also protect against diphtheria, tetanus, polio, pertussis and Hib) have become available in the UK.

In 2014, therefore, the Joint Committee of Vaccination and Immunisation (JCVI) re-evaluated the benefits and cost-effectiveness of a universal hepatitis B infant immunisation programme in the UK and subsequently recommended the use of the hexavalent DTaP/IPV/Hib/HepB combination vaccine for all infants subject to securing the vaccine at a cost-effective price.

By providing hepatitis B vaccine as part of the combined infant vaccine, as well as being protected against diphtheria, tetanus, pertussis, polio and Hib, infants will now have the benefit of protection against hepatitis B virus.

_{14. World Health Organization, Immunization, Vaccines and Biologicals. Hepatitis B.} 

Data Transfer and collection from April 2019

• New COVER Information Standard published in April 2019
• Following a successful pilot, the collection of COVER data in 2019-20 has been transferred from PHE to NHS Digital’s Strategic Data Collection Service (SDCS) and merged with the current SDCS practice level vaccine coverage collection (formerly collected via the Child Immunisation Unify2 data collection)
• Analysis and reporting of the quarterly COVER report remains with PHE
• Analysis and reporting of the annual vaccine coverage report is now published as a joint PHE / NHS Digital report
• From 2019-20 the COVER collection will include both LA and GP level coverage data

PHE

• Used as the authoritative source of figures for annual coverage data when referring to immunisation programmes at all levels within England.
• Used to report UK vaccine coverage data to the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF).
• Locally, Screening and Immunisation teams use the report to review statistics for their local populations and compare against regional and national statistics.

Department of Health and Social Care (DHSC)

• Use the report together with provisional quarterly COVER data published by PHE to inform the development and evaluation of government policy on immunisation and to assess the delivery of different immunisations in the national programme.
• Used to help inform vaccine policy decisions, such as national and regional catch-up programmes for specific immunisations.
• Used to input to public and parliamentary business & input to the Public Health Outcomes Framework (PHOF).

NHS England and Local Teams

• Used in conjunction with provisional quarterly COVER data as the authoritative source of figures for annual coverage data when referring to the immunisation programme at their area level.
• A local team reported using the statistics to highlight potential quality issues to a Clinical Commissioning Group (CCG) and provide a basis for discussions between relevant stakeholders around local performance.

Local Authorities (LAs)

• Used to monitor local performance.

Organisation for Economic Co-operation and Development (OECD)

• Seasonal flu statistics are supplied to OECD to be used in the OECD Health Database and Health Care Quality Indicator project.

Other publications

• Data from this report is published in the following:
• Child Health Profiles published in ChiMat: https://www.gov.uk/guidance/child-and-maternal-health-data-and-intelligence-a-guide-for-health-professionals
• Fingertips (Public Health Profiles):  https://fingertips.phe.org.uk/

Unknown users

• The publication is free to access via the NHS Digital website, therefore many users will access the report without being known to NHS Digital.
• It is important to put mechanisms in place to try to understand how these additional users are using the statistics and gain feedback on how we can make the data more useful.

Feedback

• Feedback on this publication can be sent to the following email address: [email protected]

Previous editions of this publication (2004-05 onwards): https://digital.nhs.uk/data-and-information/publications/statistical/nhs-immunisation-statistics

Previous editions of this publication (prior to 2004-05: https://webarchive.nationalarchives.gov.uk/20120503222908/http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/StatisticalWorkAreas/Statisticalhealthcare/DH_4086491

Quarterly COVER programme data (PHE): https://www.gov.uk/government/collections/vaccine-uptake

Background information on COVER data collection: https://www.gov.uk/government/publications/cover-of-vaccination-evaluated-rapidly-cover-programme-information-standards 

‘Immunisation against Infectious Diseases – the Green Book’, Public Health England: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book

Further immunisation information for health professionals and immunisation practitioners: https://www.gov.uk/government/collections/immunisation

Data and reports for England on the coverage for all vaccinations routinely offered under the national immunisation programme: https://www.gov.uk/government/collections/vaccine-uptake 

Statistics relating to hepatitis B (from PHE): https://www.gov.uk/government/collections/hepatitis-b-guidance-data-and-analysis 

More information on the seasonal flu vaccination: https://www.gov.uk/government/collections/annual-flu-programme

Data on seasonal flu vaccine coverage amongst people with long-term medical conditions: https://www.gov.uk/government/statistics/announcements/seasonal-influenza-vaccine-uptake-in-gp-patients-winter-season-2019-to-2020

Quarterly PHE Health Protection Reports and Communicable Disease Reports on the COVER programme for childhood immunisation: https://www.gov.uk/government/collections/health-protection-report-latest-infection-reports

Routine childhood immunisation data at GP Practice and CCG levels (experimental management information from NHS England): http://www.england.nhs.uk/statistics/statistical-work-areas/child-immunisation/

The numbers of vaccinations GP Practices are paid for administering (not coverage data) published as part of the GP Contract Services publication series: https://digital.nhs.uk/data-and-information/publications/statistical/gp-contract-services

For further information on the diseases summarised below see the ‘Immunisation against Infectious Diseases – the Green Book’

Diphtheria A highly contagious and potentially fatal disease that usually affects the nose, throat and air passages, and may also affect the skin.

https://www.nhs.uk/conditions/diphtheria/

Haemophilus influenzae type b (Hib) A bacterial infection that can cause a number of serious illnesses such as pneumonia, blood poisoning and meningitis, especially in young children.

https://www.nhs.uk/conditions/hib/

Hepatitis B (HBV) A serious and potentially life-threatening viral infection that attacks the liver and can cause both acute and chronic disease.

https://www.nhs.uk/conditions/hepatitis-b/

Human-papilloma virus (HPV) A family of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat. It can cause warts as well as abnormal tissue growth and other changes to cells, which can lead to cervical and other cancers.

https://www.nhs.uk/conditions/human-papilloma-virus-hpv/

Influenza (Seasonal flu) A highly infection illness cause by a flu virus. The virus infects the lungs and upper airways causing a sudden high temperature and general aches and pains.

https://www.nhs.uk/conditions/flu/

Measles A highly infectious viral illness. It causes a range of symptoms including fever, coughing and distinctive red-brown spots on the skin and can lead to serious complications.

https://www.nhs.uk/conditions/measles/

Meningococcal disease The disease can cause meningitis (infection of the protective membranes that surround the brain and spinal cord) and septicaemia (bacterial infection of the blood.

https://www.nhs.uk/conditions/vaccinations/men-acwy-vaccine/

Mumps A highly contagious viral infection that usually affects children. The most common symptom is a swelling of the parotid glands, located on 1 or both sides of the face.

https://www.nhs.uk/conditions/mumps/

Pertussis (whooping cough) An bacterial infection in the lining of the airways.

https://www.nhs.uk/conditions/whooping-cough/

Pneumococcal disease Acute infections cause by the Streptococcus pneumoniae bacterium, which enters the human body through the nose and mouth.

https://www.nhs.uk/conditions/vaccinations/pneumococcal-vaccination/

Polio (Poliomyelitis) Caused by a highly infectious virus. For most people polio is a mild illness with flu type symptoms F. It can be potentially fatal if it attacks the nerve cells that help muscles to function and can cause severe muscle paralysis (paralytic polio).

https://www.nhs.uk/conditions/polio/

Tetanus A serious acute condition (serious but short-lived) that is cause by infection with a bacterium known as Clostridium tetani. It causes severe muscle spams and stiffness and is potentially fatal if untreated.

https://www.nhs.uk/conditions/tetanus/

Tuberculosis (TB) A bacterial infection spread by inhaling tiny droplets of saliva from the coughs or sneezes of an infected person.

https://www.nhs.uk/conditions/tuberculosis-tb/

Rotavirus A highly infection virus that typically affects babies and young children, causing diarrhoea, sometimes with vomiting, abdominal pain and fever.

https://www.nhs.uk/conditions/vaccinations/rotavirus-vaccine/

Rubella (German measles) A viral infection that can cause a high temperature (fever) of 38C (100.4F) or over, and a distinctive red-pink rash. In most causes rubella is a mild condition, but it can be serious in pregnant women because it can harm the unborn baby.

https://www.nhs.uk/conditions/rubella/

Changes to infant PCV schedule for babies born on or after 1 January 2020

From 1 January 2020, the infant vaccination schedule for pneumococcal vaccine (PCV) changed. All babies born on or after 1 January 2020 will receive their 1st dose of PCV with their other infant vaccinations at 12 weeks of age and a booster dose of this vaccine on or after their 1st birthday.

Children in the 12 month cohort in 2020-21 were born between 1 April 2019 and 31 March 2020. This means that most of these children will have received 2 doses of PCV but the youngest quarter will have only had 1 dose. It is therefore not possible to provide an accurate estimate of coverage for completed courses of PCV vaccine at 12 months this year. PCV data for the 12 month cohort is not included in this report.

This change will not affect calculation of coverage of the PCV booster evaluated at 24 months of age.