Impact of tailored intervention on low MMR vaccine coverage in a multilingual area in Stockholm

Background

Vaccination coverage for MMR (Measles, Mumps, and Rubella) has traditionally been high in Sweden, with up to 97 % for children at the age of two years old. Nevertheless, there have been local pockets of lower coverage, such as Child Health Clinics (CHC) in Spånga-Tensta and Rinkeby in Stockholm, with a multilingual population. Qualitative interview studies conducted in these areas explored reasons for the lower MMR uptake, and an intervention was initiated by the Public Health Agency of Sweden in close collaboration with regional Child Health Service in 2015. This study analysed differences in trends in MMR vaccine coverage in Stockholm before and after the intervention.

Methods

The study population was children registered at CHC in Region Stockholm. Children’s MMR vaccination data from 1 January 2009 to 31 December 2018 were extracted from the region Stockholm’s Takecare journal system. We compared vaccination coverage in Rinkeby and Spånga-Tensta with that of the other 62 combined CHCs. Survival analysis was performed to illustrate trends in the vaccine coverage over time.

Results

The analysis confirmed the lower vaccine coverage in Rinkeby and Spånga-Tensta compared to the rest of the CHCs. The intervention period was 2015-2017, and an increase of 10 % in both CHCs was observed for the birth cohort born in 2015 compared to the previous birth cohort. The positive trend in Spånga-Tensta continues throughout the study period. However, in CHC in Rinkeby, a decline of MMR vaccine coverage was observed for the birth cohort born in 2017 and 2018, with an 8-9 % decrease compared with those born in 2016.

Conclusions

Long-term follow-up of vaccine coverage is essential to assess trends and the impact of interventions. While a 10% increase in MMR coverage was observed during the intervention period, the absence of a randomised controlled trial limits causal inferences, underscoring the need for rigorous evaluation in future studies.

Key messages

• Long-term follow-up of vaccine coverage is crucial to detect trends, evaluate intervention impact, and address emerging disparities in uptake.

• Tailored, multi-component interventions can significantly improve MMR vaccine coverage in multilingual communities.