Childhood Vaccination Coverage Statistics - 2020-21

England, 2020-21

This document is designed to accompany the main publication report. 

The publication reports childhood vaccination statistics for England in 2020-21, and relates to routine and selective vaccinations offered to all children up to the age of 5 years.

The statistics show the number of children vaccinated as a proportion of the eligible population (coverage), and are derived from information collected by Public Health England (PHE) through the Cover of vaccination evaluated rapidly (COVER) and Seasonal Influenza programmes.

The statistics from this publication also contribute to indicators for the government’s Public Health Outcomes Framework (PHOF)

This document includes contextual information, the methods used to compile the statistics and other background information readers may find useful.

Summary

• Most of the vaccination data used in this report are collected annually from Child Health Record Departments (CHRDs) and NHS England local teams.
• Data are extracted from Child Health Information Systems (CHISs), computerised systems storing clinical records supporting health promotion and prevention activities for children, including immunisation. These CHISs are increasingly consolidating over time as larger CHIS hubs, leading to a decrease in the number of CHISs over time.
• COVER data was submitted via NHS Digital’s SDCS.
• Data on seasonal flu are collected from GP practices.
• Data are quality assured at the time of collection by PHE for both the COVER and flu datasets.
• Further data validation and quality assurance of COVER data is carried out by NHS Digital prior to publication. (See Appendix D for more detailed information on validation).

1) Cover of Vaccination Evaluated Rapidly (COVER)

• Information on childhood immunisation coverage at ages 1, 2 and 5 years, collected through the UK COVER collection by PHE.
• Aggregated data are collected from CHISs. In England, COVER data for 2020-21 have been collected for Upper Tier Local Authorities (LAs) using the COVER data collection form
• Further information on the COVER collection can be found in our list of administrative sources. 

PHE also undertake quarterly collections of provisional COVER data, which provide early indications of vaccine coverage trends and are an important means of identifying any data quality issues prior to the annual collection. 

2) Seasonal Flu

• Information on children aged 2 to 10 immunised against seasonal flu are collected by PHE.
• Data is collected from GP practices through PHE’s ImmForm2  system.
• Patient age is identified by their age on the 31 August of the vaccinating year e.g. a patient aged 2 on the 31 August 2020 will be included in the aged 2 cohort.
• Data for ages 2 and 3 years is included in this report.
• Data collections are quality assured at the time of collection by the collecting agency.

• Further information on PHE’s seasonal influenza collection can be found at the following links:

  https://www.gov.uk/government/collections/vaccine-uptake#seasonal-flu-vaccine-uptake:-figures

  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/932683/ImmForm_User_Guide_2020_21.pdf

  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1006038/Letter_annual_flu_2021_2022_20210727.pd

NHS Digital validates and analyses the COVER data using spreadsheets (Microsoft Excel) and automated processes developed in SAS³.

All figures in the report are presented as simple counts or percentages (rounded to 1 decimal place). Coverage (see ‘Definitions’ section, below) is reported for the following routine childhood vaccinations:

• Diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP/IPV/Hib), known as the 5-in1. Since August 2017, 5-in-1 replaced by the 6-in-1 which additionally protects against HepB (DTaP/IPV/Hib/HepB).
• Diphtheria, tetanus, pertussis, polio (DTaP/IPV)
• Pneumococcal conjugate vaccine (PCV)
• Haemophilus influenzae type b and Meningococcal group C  (Hib/MenC)
• Measles/mumps/rubella (MMR)
• Meningococcal group B (MenB)
• Rotavirus

Vaccination data for selective neonatal hepatitis B (HepB) and Bacillus Calmette–Guérin (BCG) are reported by LA responsible population.

Some LAs were unable to supply vaccination data for 1 or both of these selective neonatal programmes.

HepB data collection is discussed in the main report, along with BCG Vaccination, in the ‘Selective Neonatal Vaccinations Programmes’ chapter. It would be inadvisable to draw conclusions from either of these sets of data at national or regional level.

Coverage for the seasonal flu vaccination offered to children aged 2 and 3 years is also reported. The data reported in this report is obtained from the published seasonal influenza data published by PHE.

Definitions

Immunised: Where a course consists of more than 1 dose of vaccine, administered at set intervals, immunised means having had all doses required for a full course. However, for some vaccines (i.e. Hib/MenC and PCV) the number of doses required to complete a course is age dependent. For example, a child who was not given the recommended 2 doses of PCV before 12 months but did receive a PCV booster dose after the 1st birthday will still be considered appropriately vaccinated for their age.

Eligible population: Different eligible populations are used for calculating coverage for different vaccinations. For the routine childhood vaccinations in this report, the eligible population is defined as the total number of children in the LA responsible population, reaching their nth birthday in the collection year (see next page for more information on the LA responsible population). Coverage is calculated for 3 separate cohorts (children reaching their 1st, 2nd and 5th birthdays in the collection year) and so the eligible population differs for each cohort.

Coverage⁴: Coverage is defined as the number of persons immunised as a proportion of the eligible population. The formula for the calculation of coverage is:

Specific and detailed formulae and links for all the coverage statistics presented in this report are provided in Appendix B of the publication. This includes definitions of the numbers of eligible persons immunised and specifies the number of doses of different vaccines that an individual is required to have by a particular age in order to be considered immunised.

LA responsible population: 2020-21 is the 5th year that all data has been collected using LA responsible population. Coverage figures are supplied for patients registered with GPs based in that LA and for unregistered patients who were resident in that LA. The LA responsible population is therefore different from the estimated resident population figures produced by the Office of National Statistics (ONS) for each LA. For the COVER collection, the LA responsible population is usually derived from the population registers held on CHISs.

In previous years, for LAs that shared the same geographical boundaries as the old Primary Care Trusts (PCTs), i.e. were coterminous, the LA responsible population was estimated to be the same as the old PCT responsible population. Where LA and PCT boundaries were not coterminous, data suppliers were asked to supply figures for the LA responsible population if these were available.

Where data suppliers were not able to provide data for the LA responsible population, NHS Digital estimated LA figures by apportioning PCT data on the basis of population. Details of the apportioning methodology can be found in the quality statement of the 2015-16 report. All data received from 2016-17 onwards is supplied at LA responsible level, negating the need to use estimation.

Please note that the local, regional and national statistics reported in publications prior to 2016-17 were based on an LA dataset that included some estimated data (from supplied PCT data), and estimated figures were clearly marked with an “e” in the data tables which accompany those publications.

This year most of the Public Health Outcomes Framework (PHOF) 3.03 indicators will be sourced from the National Statistics reported in this publication. 

Mapping LA COVER data to create Local Team data

COVER statistics for NHS England Local Teams (LT) have been produced by aggregating LA data using the mapping list used by the PHE COVER team. This can be found on the ‘LA to LT lookups’ worksheet on the accompanying Excel data tables file.

Cumbria LA does not map to the latest LT configuration, so the 2017 LT mapping is used in that area. This does not match the current commissioning regions (1 April 2020), so data is not reported for commissioning regions.

Flu data has been calculated directly from GP practice level data, and mapped directly to STP. The methodology is described in the Flu annual publication.

Due to the different data sources, the methods used in aggregating Local Team data are different between the COVER and Flu data.

_{3. Statistical Analysis System (SAS) is an integrated system of software products which enables functions such as data management, statistical analysis and quality improvement.}

_{4. Prior to the 2009-10 publication, this report used the term ‘uptake’ to describe the percentage of the eligible population who are vaccinated. It was decided to replace the term ‘uptake’ with ‘coverage’ in 2009-10 as this is more widely used in reporting the proportion of a target population known to have received the appropriate vaccine(s).}

These are established collections based on total populations rather than a sample.

COVER data

For the COVER collection, submissions were made by data suppliers (CHISs) on behalf of all 151 Upper Tier Local Authorities (LA). In 2020-21 Hackney’s LA submissions included data for City of London LA, so 150 submissions were received, representing data from all 151 Local Authorities.

Some caution should be exercised when comparing coverage figures over time due to data quality issues reported by some data suppliers in recent years. Apparent trends could reflect changes in the quality of data reported as well as real changes in vaccination coverage. While this issue will be more apparent at a local level, it will also have an impact on the national figures.

Similarly some caution should also be exercised when comparing coverage between different areas where data quality issues have been reported.

Any missing data are clearly marked within the data tables.

Data quality issues are discussed in more detail in Appendix D of the publication, in the section on Data collection, validation and quality.

Flu data

For seasonal influenza vaccinations in children aged 2 and 3, coverage data are based on submissions made for GP practices. The data represents 97.2% of GP practices in England in 2020-21⁶.

The LA and Local Team Flu data presented in this report are provided already calculated by the PHE Flu team. Government Office Region level data has been calculated by NHS Digital from the LA level data.

_{6. Data Source: Public Health England – Seasonal flu vaccine uptake in GP patients, final data from 1 Sept 2020 to 28 Feb 2021: by Local Authority. https://www.gov.uk/government/statistics/seasonal-flu-vaccine-uptake-in-gp-patients-winter-2020-to-2021}

Data on immunisations are made available as soon as possible after they have been compiled and validated (usually in the September following the end of the financial year to which the data relate).

Learn more about the NHS Digital publication series. 

This publication includes a PDF report, Excel data tables, CSV files, and an interactive dashboard.

The underlying data is published in the Data Tables, which are available as Excel files and CSV files, on NHS Digital’s childhood vaccination publication.

Further analysis may be available on request, subject to resource limits and compliance with disclosure control requirements. Note that the data held by NHS Digital cannot be disaggregated below LA level.

An interactive dashboard is provided as part of the data resources for this publication. The dashboard is designed to make data more meaningful by allowing local, regional and national comparisons over time.

Learn more about the dashboard.

Versions of this statistical publication are available on both NHS Digital’s and The National Archives websites dating back to 1997-98⁷.

The bulletin was originally published by the Department of Health and Social Care (DHSC). Responsibility for the publication transferred to the Health and Social Care Information Centre (HSCIC) after its formation in 2005. The HSCIC is now known as NHS Digital.

_{7. Copies of previous editions published by NHS Digital can be accessed via the following link: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-immunisation-statistics
Prior to 2004/05 this bulletin was published by the Department of Health. These editions can be found at: http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/en/Publicationsandstatistics/Statistics/StatisticalWorkAreas/Statisticalhealthcare/DH_4086491.}

Changes in the UK Immunisation Programme

A number of changes to the immunisation programme have been made since 2003 and these are detailed in full in Appendix C of the publication. Changes in the schedule need to be considered when interpreting trend data. Importantly, when a new vaccine is first introduced, implementation and recording/reporting issues may affect completeness. The same issue may also occur when the number of doses required or the timing of doses is changed.

In 2013-14, the introduction of influenza vaccination for healthy children began with vaccines offered to all children aged 2 and 3 years of age.

Coverage of children aged 2 and 3 is included in this report. Coverage for the school-delivered programme, targeting children aged 4 and over, is reported elsewhere. The data collection window is 1st September to 28th February.

From July 2013 an infant rotavirus vaccination was introduced and a reduction from 2 to 1 dose of MenC to be offered in the 1st year of life. MenC was subsequently removed from the schedule in 2016. Protection is still offered against MenC through the Hib/MenC vaccine administered at 12-13 months.

A more recent change to the immunisation schedule in 2015 was the introduction of infant MenB vaccine.

Coverage data for another recent change, the replacement in 2015 of the adolescent MenC vaccine with the MenACWY vaccine, are not evaluated in this report. 

Read a copy of the most recent formal immunisation schedule (Autumn 2020). 

Rotavirus vaccine

A vaccine to protect babies against rotavirus was introduced into the childhood immunisation schedule from July 2013. The rotavirus vaccine is offered routinely to all babies at the age of 8 weeks and again at 12 weeks when they attend for their 1st and 2nd routine childhood immunisations. Opportunities for children to catch up missed doses are limited as rotavirus vaccine cannot be given beyond 6 months of age.

The quality and completeness for the rotavirus data have improved to allow them to be included under the National Statistics designation within this publication since 2016-17.

Meningococcal group B (MenB) vaccine

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). 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).

This report contains data for MenB primary (12 months) and MenB booster (24 months) vaccinations.

DTaP-IPV-Hib-HepB vaccine (6-in-1)

The most recent change to the primary immunisation schedule is the replacement of the pentavalent vaccine (DTaP/IPV/Hib) with a hexavalent vaccine which includes hepatitis B (DTaP/IPV/Hib/HepB) for all babies born on or after 1 August 2017.

This universal hepatitis B immunisation programme is implemented in addition to the selective programme targeting high risk babies.

Further information about the announcement of the hexavalent vaccine and the formal immunisation schedules are available. 

In the 2019-20 publication, this vaccine has been reported differently for the 12 month, 24 month and 5 year age cohorts.

12 months
Reported as DTaP/IPV/Hib/HepB (6-in-1) as all were eligible for the 6-in-1 in 2020-21.

24 months
Reported as DTaP/IPV/Hib/HepB (6-in-1) as all were eligible for the 6-in-1 in 2020-21.

5 years
Reported as DTaP/IPV/Hib (5-in-1), the vast majority of children will have received the 5-in-1 vaccine.

In future publications, the hexavalent vaccine will be reported when all children in the reported age cohort have been eligible for the vaccine. For the 5 year cohort this will be 2023-24.

Changes to the COVER data collection

Changes to the COVER collection form were made by PHE from April 2013 to enable collection by Local Authority. The data collection form has also been subject to amendments to reflect changes to the routine schedule when vaccines have been added, amended or withdrawn.

Statistics on the number of persons receiving BCG vaccinations were previously published in this bulletin until the KC50 data collection was suspended following a review in 2013. Neonatal BCG coverage data are now collected as part of the COVER programme in accordance with an updated COVER Information Standards Notice (ISN) published in November 20148. Data on BCG vaccination coverage are published, along with HepB data, in the ‘Selective neonatal vaccination programmes’ chapter of the main report. Subsequent updates to the ISN were made in November 2017, April 2019 and February 2020⁹.

Time Series

The report shows trends in vaccine coverage and where possible seeks to explain these. The main Excel Data Tables contain historical data, which enable examination of trends in vaccination coverage.

Throughout the main report, coverage statistics for 2020-21 are compared with previous years and where applicable time series data are shown.

The time series for MMR vaccine coverage evaluated at 2 years are extended back to 1988, the year the MMR vaccine was first introduced and when current definitions for measuring coverage came into effect.

Completed DTaP/IPV/Hib vaccine primary course coverage at 1 year are presented back to 2006-07. Historical interpretation of time series data in the main report section has been assisted by experts in PHE.

Local and regional comparisons

The statistics are presented at a national and regional level and by Upper Tier Local Authority (LA). Due to the different sources and methods by which the LA data have been derived (see definition of LA responsible population under Definitions in section ‘Methods Used to Compile the Statistics’), some caution should be exercised when comparing coverage figures over time.

Statistics are also presented by NHS England Local Team10 in the COVER data tables (tables 8d, 9d and 10d). These are derived from LA data supplied by PHE and have been calculated using the most appropriate Local Team geography - see 'Notes and definitions' and 'LA to LT Lookups' tabs within the data tables for more information.

Flu data reported at Local Team level (please see data tables 12c) is aggregated directly from GP Practice level data collected via ImmForm.

Comparison with other UK countries

The Childhood Vaccination Coverage Statistics, England publication series has included additional annual coverage statistics for other countries in the UK since 2009-10. This report includes the following coverage statistics for all UK countries:

• At 12 months: DTaP/IPV/Hib/HepB, PCV, Rotavirus, MenB
• At 24 months: DTaP/IPV/Hib/HepB, Hib/MenC, PCV booster, MMR1¹¹, MenB booster
• At 5 years: DTaP/IPV/Hib, DTaP/IPV, MMR1, MMR2¹¹, Hib/MenC

Vaccination data for Northern Ireland, Scotland and Wales are also available through the following links:

Northern Ireland

Scotland

Wales

Comparisons with countries outside the UK

Outside the UK, national vaccination policies differ and countries use different methods to calculate vaccine coverage, therefore direct comparison with countries outside the UK is not always appropriate. However, the World Health Organization (WHO) and UNICEF attempt to determine the most accurate and up-to-date estimates of immunisation coverage for different countries through their joint annual reporting form submission from national experts. These estimates of national immunisation coverage are reported on the WHO website. 

Information on research undertaken to examine comparability of vaccination coverage amongst European countries can be found on the VENICE Project website. 

_{8. Source: http://webarchive.nationalarchives.gov.uk/+/http://www.isb.nhs.uk/documents/isb-0089/amd-8-2014/index_html}

_{9.  https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/dcb0089-cover-of-vaccination-evaluated-rapidly-cover}

_{10. From 1st April 2015 Local Team data has been reported replacing Area Team.}

_{11. MMR1 is used to indicate at least 1 dose of MMR has been received. MMR2 indicates that 2 doses of MMR have been received (anytime from 12 months up to the child’s 5th birthday).}  

The data used in the publication are aggregated LA level data gathered by PHE as part of their management of the immunisation programme. These are the only sources of the data required for the report.

In February 2020, the revised COVER Information Standard¹² was published following approval from the Data Coordination Board (DCB).

All data collections used in this publication are subject to the Burden Advice and Assessment Service (BAAS) procedure (previously known as Review of Central Returns (ROCR)) and licensed by BAAS. The BAAS is now known as the Challenging Burden Service (CBS).

This is to ensure that data collections do not duplicate other collections, minimise the cost to all parties and have a specific use for the data collected.

_{12. https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/dcb0089-cover-of-vaccination-evaluated-rapidly-cover} 

The standard NHS security and confidentiality policies have been applied in the production of these statistics¹³.

The data is received in aggregate form from the COVER team and the Flu team at PHE via the secure NHSmail system.

An annual risk assessment is undertaken prior to publication which addresses any potential issues around disclosure in accordance with the Anonymisation Standard for Publishing Health and Social Care Data.

Disclosure controls have been applied to the neonatal hepatitis B data in tables 11b and 11c, in accordance with the standard and are as follows:

• Suppress all data (number of children eligible, number vaccinated and coverage) where the number eligible is 1 or 2 (cells with 2 are suppressed as otherwise it would be clear all suppressed cells have a value of 1).
• Where the number of eligible children is greater than 0 and the number of children vaccinated is 0 or 1 suppress the number of children vaccinated and the coverage (cells with 1 need to be suppressed as otherwise it would be clear that all suppressed cells have a value of 0).

The eligible populations in 3 LAs are very small and in these instances their data have been combined and reported under other LAs.

Data for the Isles of Scilly are reported under Cornwall, City of London data are reported under Hackney and Rutland is reported under Leicestershire.

Statistics in this report are therefore presented by 148 Upper Tier Local Authorities for all routine vaccinations.