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The national measles, mumps, and rubella (MMR) catch-up programme, launched in April, 2013, aims to increase vaccine uptake in groups with low immunisation rates. Cover of Vaccination Evaluated Rapidly (COVER) provides routine data for monitoring of national and local immunisation coverage; however, records are not held at the individual level and cannot be used to examine vaccine catch up or individual-level characteristics associated with uptake. We examined predictors of catch up with MMR in a contemporary cohort of children targeted by the catch-up programme. We used data from the most recent UK cohort, the Millennium Cohort Study (MCS). Families of children born in the UK in 2000–02 were contacted via opt-out letters; data were collected from 18 818 children, of whom 18 296 were singletons. At ages 3 and 5 years, participants were followed up by letter, telephone (when possible), and a visit. 12 989 (71%) singleton children from the initial cohort responded to all three sweeps. We analysed data for 751 (6%) children who were unimmunised with the MMR at age 3 years. We estimated unadjusted risk ratios (RRs) and 95% CIs for partial (received one MMR) and full (two MMRs) catch up by age 5 years (baseline: remaining unimmunised) according to various social, economic, and demographic characteristics and reasons reported by parents for not immunising their child at age 3 years. Significantly associated variables in univariable analyses (p<0·10) were entered into multivariable models for partial and full catch up, by a forward stepwise technique. 440 of 751 children (60·3%, 95% CI 56·2–64·3) remained unvaccinated; 127 (16·1%, 13·3–19·3) partially and 184 (23·6%, 20·1–27·5) fully caught up. In multivariable models, children from families who did not speak English at home were nearly five times more likely to partially catch up than were children living in homes where only English was spoken (RR 4·68, 95% CI 3·63–6·03); full catch up was also more likely in this group (1·90, 1·08–3·32). Children were more likely to fully catch up if they were from Pakistani or Bangladeshi (2·40, 1·38–4·18) or other ethnic origins (1·88, 1·08–3·29) compared with if they were white British; living in socially rented accommodation compared with owner occupiers (1·86, 1·34–2·56); and living outside compared with inside London (1·95, 1·32–2·89). Full catch up was less likely if parents reported medical reasons (RR 0·43, 95% CI 0·25–0·74) or a conscious decision (0·33, 0·23–0·48) for not immunising at age 3 years (compared with practical reasons). Parents of children who partially or fully caught up with MMR experienced practical barriers to receiving immunisation (such as missing an appointment) and were from ethnic minority or disadvantaged groups. Time to uptake could be minimised in these families by reducing practical barriers—eg, by providing information in community languages and offering vaccination in alternative settings. Families who continued to reject MMR were from more advantaged backgrounds and made a conscious decision to not immunise early on. Families should be given opportunities to discuss concerns with health professionals, who in turn should be trained for effective communication about immunisation. Our findings refer to a period with high parental concerns around the safety of the vaccine and low incidence of measles. Predictors of catch up in families with young children might differ during times of measles outbreaks. Still, professionals striving to increase MMR uptake should consider these findings in light of the characteristics of their local populations. The Centre for Paediatric Epidemiology and Biostatistics is supported in part by the MRC in its capacity as the MRC Centre of Epidemiology for Child Health. Research at the UCL Institute of Child Health and Great Ormond Street Hospital for Children receives a proportion of the funding from the Department of Health's NIHR Biomedical Research Centres funding scheme. AP is funded by a MRC fellowship.

IntroductionThe current outbreak of Hepatitis A and the recent Shigella outbreak in men who have sex with men (MSM) highlight the importance of faeco-orally transmitted organisms in this population. This may suggest that outbreaks could be predicted or prevented.MethodsWe compared the age, sex and travel history of notifications of Hepatitis A with notifications of Shigella in South London between January 2010 and November 2016. We also reviewed documentation of previous outbreaks of Hepatitis A in MSM in London.ResultsMale and female cases of Hepatitis A had similar age profiles and a similar proportion reported recent travel. In contrast, Shigella cases peaked in males aged 30–39 with no travel history. Case notes for Hepatitis A notifications since January 2013 suggested fewer than five in MSM. Although this review suggested very few cases in recent years, outbreaks of Hepatitis A among MSM in London were documented in the late 1990s and in 2003. The second outbreak was associated with strains that caused concurrent outbreaks in MSM across Europe. Public health response to these outbreaks recommended health promotion and opportunistic immunisation.DiscussionHepatitis A outbreaks occur sporadically in a transnational population of MSM. Few cases may occur between outbreaks and preventative actions may be deprioritised. However, group immunity is likely to be highest after an outbreak and then wane in the absence of immunisation, increasing the risk of another outbreak. Health promotion and immunisation may be valuable outside of outbreak contexts.

IntroductionFrom late 2016, Hepatitis A virus (HAV) infection in MSM increased in incidence in the UK and has reached outbreak status. By February 2017, 42 confirmed or suspected cases had been reported in London. An outbreak committee was convened by Public Health England and as part of this work data was gathered to ascertain current levels of vaccination and future needs in MSM attending GUM/HIV clinics.MethodsClinical leads for GUM and HIV services in London were e-mailed a survey asking about past HAV vaccination policy, requirements for vaccine, logistics of vaccine provision, acute HAV infection reporting and contact tracing policy.Results14/17 (82%) NHS Trusts, representing 23 clinics responded to the survey.Abstract P195 Table 1HAV Vaccination Provision for MSM in GUM and HIV clinics in LondonNever stopped in GUMStopped in GUM in last 2 yearsStopped in GUM in last 2–10 yearsStopped in GUM >10 years ago3/23 (13%)6/23 (26%)7/23 (30%)7/23 (30%)Offered to all HIV+ patientsOffered to selected HIV+ patients only20/23 (87%)3/23 (13%)4/23 (17%) GUM clinics restarted routine vaccination in 2017. Only 3 HIV clinics were able to estimate background HAV immunity in their MSM as being 70–90% immune/vaccinated. The barriers to roll out of vaccination were identified as cost/funding (17/23 74%); logistics of provision (11/23 48%) and vaccine supply difficulties (7/23 30%). All clinics would contact trace acute HAV cases internally, 6/23 (23%) would notify the Health Protection Team by phone and the rest would notify using the BASHH/PHE notification form.DiscussionThe provision of HAV vaccination for MSM in London GUM clinics has been variable, leading to a significant proportion of MSM potentially remaining non-immune. The main barriers to vaccination have been funding, logistics and vaccine supply. If the outbreak is to be halted, these barriers need to be overcome.

•Reactive vaccination to a measles outbreak implemented in a vaccine-rejecting community.•We estimated the number of MMR doses given in 2011 during the outbreak.•The number of doses increased during the outbreak compared to previous years.•Children already vaccinated were more amenable to reactive vaccination.•A few parents changed their mind and vaccinated their children for the first time. Following a measles outbreak in a vaccine-rejecting community between April and September 2011 in South-East England, local health agencies implemented a two-pronged measles–mumps–rubella (MMR) immunisation campaign from August to October offered at the local general practice where most cases were registered. The campaign included (a) accelerated vaccination of children earlier than scheduled (1st dose at 6–11 months, or 2nd dose at 18–39 months), (b) catch-up of those aged over 18 months who had had no MMR immunisations or were late for second MMR. We investigated the impact of the outbreak and campaign on the number of MMR doses given. In January 2012, we collected information on MMR vaccination for children registered at the practice aged 6 months–16 years on 1 August 2011, through the child health information system. We counted the number of MMR doses administered in 2011 and compared it to 2008–2010 data. We estimated the proportion vaccinated among the children eligible for the accelerated and catch-up campaign. The local practice administered 257 MMR doses in 2011, a 114% increase on the average for 2008–2010. Among children eligible for earlier MMR vaccination 5/26 (19%) received a first dose, and 34/57 (60%) a second dose. Among children eligible for catch-up, 20/329 (6%) received their first MMR and 39/121 (32%) their second. Of 1538 children, the proportion completely unimmunised for MMR declined by 3 percentage-points after the outbreak. Uptake of MMR vaccination significantly increased during the outbreak following the immunisation campaign. Those amenable to MMR vaccination seem to have benefited from the campaign more than those with no previous vaccinations. Future evaluations should address what made a few parents change their mind and have their children vaccinated for the first time during the outbreak.

Introduction:Outbreaks of hepatitis A virus (HAV) have previously been described in men who have sex with men (MSM). BASHH only recommends HAV vaccination for MSM during outbreaks. A UK cluster of HAV cases was identified and, by 27/2/2017, London had 45 probable and confirmed cases in MSM. London sexual health commissioning is in flux with new arrangements imminent.Methods:For individual notified cases, Health Protection Teams (HPT) routinely assess source, offer infection control advice to the case and organise vaccination of household and sexual contacts. A London outbreak control team (OCT) comprised epidemiologists, commissioners and providers of immunisation and sexual health services, health promotion partners and communications. The OCT scoped possible additional interventions to control the outbreak.Results:The OCT recommended: Awareness raising re risk behaviour: Distribute a nationally commissioned leaflet with safer sex advice to cases and to genitourinary medicine (GUM) clinics, plus relevant content on digital platforms. Liaison with providers, commissioners: Inform GPs. Survey current practice in GUM for HAV immunisation. Vaccinate MSM opportunistically in GUM clinics (if had a new or casual partner in last 3 months). Link with existing health promotion networks: Working with gay venues, to get understanding and cooperation.Set up vaccination clinics near the popular venuesDiscussion:It is challenging to set up an immunisation programme in a large city with complex commissioning relationships at short notice. Consideration should be given to vaccination between outbreaks to reduce the proportion susceptible, or ‘outbreak ready’ plans included in sexual health commissioning arrangements.

Objectives To examine predictors of partial and full measles, mumps and rubella (MMR) vaccination catch-up between 3 and 5 years. Design Secondary data analysis of the nationally representative Millennium Cohort Study (MCS). Setting Children born in the UK, 2000–2002. Participants 751 MCS children who were unimmunised against MMR at age 3, with immunisation information at age 5. Main outcome measures Catch-up status: unimmunised (received no MMR), partial catch-up (received one MMR) or full catch-up (received two MMRs). Results At age 5, 60.3% (n=440) children remained unvaccinated, 16.1% (n=127) had partially and 23.6% (n=184) had fully caught-up. Children from families who did not speak English at home were five times as likely to partially catch-up than children living in homes where only English was spoken (risk ratio 4.68 (95% CI 3.63 to 6.03)). Full catch-up was also significantly more likely in those did not speak English at home (adjusted risk ratio 1.90 (1.08 to 3.32)). In addition, those from Pakistan/Bangladesh (2.40 (1.38 to 4.18)) or ‘other’ ethnicities (such as Chinese) (1.88 (1.08 to 3.29)) were more likely to fully catch-up than White British. Those living in socially rented (1.86 (1.34 to 2.56)) or ‘Other’ (2.52 (1.23 to 5.18)) accommodations were more likely to fully catch-up than home owners, and families were more likely to catch-up if they lived outside London (1.95 (1.32 to 2.89)). Full catch-up was less likely if parents reported medical reasons (0.43 (0.25 to 0.74)), a conscious decision (0.33 (0.23 to 0.48)), or ‘other’ reasons (0.46 (0.29 to 0.73)) for not immunising at age 3 (compared with ‘practical’ reasons). Conclusions Parents who partially or fully catch-up with MMR experience practical barriers and tend to come from disadvantaged or ethnic minority groups. Families who continue to reject MMR tend to have more advantaged backgrounds and make a conscious decision to not immunise early on. Health professionals should consider these findings in light of the characteristics of their local populations.