Aaby P, Roth A, Ravn H, Napirna BM, Rodrigues A, Lisse IM, Stensballe L, Diness BR, Lausch KR, Lund N Randomized trial of BCG vaccination at birth to low-birth-weight children: beneficial nonspecific effects in the neonatal period?. J Infect Dis. 2011; 204:(2)245-252

Abhyankar P, O'connor DB, Lawton R The role of message framing in promoting MMR vaccination: evidence of a loss-frame advantage. Psychol Health Med. 2008; 13:(1)1-16

Baird B, Charles A, Honeyman M, Maguire D, Das P Understanding pressures in general practice.London: The King's Fund; 2016

Baker D, Garrow A, Shiels C Inequalities in immunisation and breast feeding in an ethnically diverse urban area: cross-sectional study in Manchester, UK. J Epidemiol Community Health. 2011; 65:(4)346-352

Barry D Increasing knowledge about HPV and the HPV vaccine amongst adolescents and adults through a school-based setting: A capstone project. 2013;

Bearden DJ, Feinstein A, Cohen LL The influence of parent preprocedural anxiety on child procedural pain: mediation by child procedural anxiety. J Pediatr Psychol. 2012; 37:(6)680-686

Bedford H, Donovan H We need to increase MMR vaccine uptake urgently. BMJ. 2022; 30:(376)

Bedford HE, Elliman DAC Child and adolescent immunisation in the UK: current issues. Paediatr Child Health. 2020; 30:(5)169-174

Bell S, Clarke R, Paterson P, Mounier-Jack S Parents' and guardians' views and experiences of accessing routine childhood vaccinations during the coronavirus (COVID-19) pandemic: A mixed methods study in England. PLoS One. 2020; 15:(12)

Bell S, Edelstein M, Zatoński M, Ramsay M, Mounier-Jack S ‘I don't think anybody explained to me how it works’: qualitative study exploring vaccination and primary health service access and uptake amongst Polish and Romanian communities in England. BMJ Open. 2019; 9:(7)

Biasio LR, Bonaccorsi G, Lorini C, Pecorelli S Assessing COVID-19 vaccine literacy: a preliminary online survey. Hum Vaccin Immunother. 2021; 17:(5)1304-1312

Biering-Sørensen S, Aaby P, Lund N, Monteiro I, Jensen KJ, Eriksen HB, Schaltz-Buchholzer F, Jørgensen ASP, Rodrigues A, Fisker AB Early BCG-Denmark and neonatal mortality among infants weighing <2500 g: A randomized controlled trial. Clin Infect Dis. 2017; 65:(7)1183-1190

Birmingham Community Healthcare. Immunisation Services. 2021. https// (Accessed 7th November 2021)

Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017; 6:(1)

Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395:(10227)912-920

Braun V, Clarke V Using thematic analysis in psychology. Qual Res Psychol. 2006; 3:(2)77-101

Buelow VH, Van Hook J Timely immunization series completion among children of immigrants. J Immigr Minor Health. 2008; 10:(1)37-44

Staffing crisis deepens in NHS England with 110 000 posts unfilled. 2022. https// (Accessed 27th April 2022)

Campbell H, Van Hoek AJ, Bedford H, Craig L, Yeowell AL, Green D, Yarwood J, Ramsay M, Amirthalingam G Attitudes to immunisation in pregnancy among women in the UK targeted by such programmes. Br J Midwifery. 2015; 23:(8)566-573

Centers for Disease Control and Prevention. Reminder/Recall. 2016. https// (Accessed 24th February 2022)

Chantler T, Lwembe S, Saliba V, Raj T, Mays N, Ramsay M, Mounier-Jack S “It's a complex mesh”-how large-scale health system reorganisation affected the delivery of the immunisation programme in England: a qualitative study. BMC Health Serv Res. 2016; 16:(1)

Christensen H, Reynolds R, Kwiatkowska R, Brooks-Pollock E, Dominey M, Finn A, Gjini A, Hickman M, Roderick M, Yates J Influence of commissioned provider type and deprivation score on uptake of the childhood flu immunization. J Public Health (Bangkok). 2020; 42:(3)618-624

Coupland C, Harcourt S, Vinogradova Y, Smith G, Joseph C, Pringle M, Hippisley-Cox J Inequalities in uptake of influenza vaccine by deprivation and risk group: time trends analysis. Vaccine. 2007; 25:(42)7363-7371

Critical Appraisal Skills Programme. CASP Qualitative Checklist. 2018. https// (Accessed 21st January 2022)

Critical Appraisal Skills Programme. CASP Checklists. 2021a. https// (Accessed 19th February 2022)

Critical Appraisal Skills Programme. Critical Appraisal Skills Programme. 2021b. https//!history/cnxo (Accessed 20th February 2022)

Crocker-Buque T, Edelstein M, Mounier-Jack S Interventions to reduce inequalities in vaccine uptake in children and adolescents aged <19 years: a systematic review. J Epidemiol Community Health. 2017; 71:(1)87-97

Are Patients Being Heard? The Friends and Family Test Reviewed. 2014. https// (Accessed 27th February 2022)

Health visitor shortage: Vulnerable Face Postcode Lottery a not Enough Specialists to Meet Rising Demand. 2022. https// (Accessed 4th April 2022)

Delkhosh M, Negarandeh R, Ghasemi E, Rostami H Maternal concerns about immunization over 0–24 month children: a qualitative research. Issues Compr Pediatr Nurs. 2014; 37:(4)235-249

Desai AN, Majumder MS What Is Herd Immunity?. JAMA. 2020; 324:(20)

Edelstein M, Müller M, Ladhani S, Yarwood J, Salathé M, Ramsay M Keep calm and carry on vaccinating: is anti-vaccination sentiment contributing to declining vaccine coverage in England?. Vaccine. 2020; 38:(33)5297-5304

Eichler K, Wieser S, Brügger U The costs of limited health literacy: a systematic review. Int J Public Health. 2009; 54:(5)313-324

Esposito S, Principi N, Cornaglia G Barriers to the vaccination of children and adolescents and possible solutions. Clin Microbiol Infect. 2014; 20:(1)25-31

Forster AS, Rockliffe L, Chorley AJ, Marlow LAV, Bedford H, Smith SG, Waller J Ethnicity-specific factors influencing childhood immunisation decisions among Black and Asian Minority Ethnic groups in the UK: a systematic review of qualitative research. J Epidemiol Community Health. 2017; 71:(6)544-549

Geana MV, Anderson S, Ramaswamy M COVID-19 vaccine hesitancy among women leaving jails: A qualitative study. Public Health Nurs. 2021; 38:(5)892-896

Griffith R What is Gillick competence?. Hum Vaccin Immunother. 2016; 12:(1)244-247

Grol R, Dalhuijsen J, Thomas S, Veld C, Rutten G, Mokkink H Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ. 1998; 317:(7162)858-861

Gunaratne K, Coomes EA, Haghbayan H Temporal trends in anti-vaccine discourse on Twitter. Vaccine. 2019; 37:(35)4867-4871

Gust D, Brown C, Sheedy K, Hibbs B, Weaver D, Nowak G Immunization attitudes and beliefs among parents: beyond a dichotomous perspective. Am J Health Behav. 2005a; 29:(1)81-92

Gust DA, Kennedy A, Shui I, Smith PJ, Nowak G, Pickering LK Parent attitudes toward immunizations and healthcare providers the role of information. Am J Prev Med. 2005b; 29:(2)105-112

Gust DA, Kennedy A, Wolfe S, Sheedy K, Nguyen C, Campbell S Developing tailored immunization materials for concerned mothers. Health Educ Res. 2008; 23:(3)499-511

Harvey H, Reissland N, Mason J Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: A systematic review and meta-analysis. Vaccine. 2015; 33:(25)2862-2880

Hawker JI, Olowokure B, Wood AL, Wilson RC, Johnson R Widening inequalities in MMR vaccine uptake rates among ethnic groups in an urban area of the UK during a period of vaccine controversy (1994–2000). Vaccine. 2007; 25:(43)7516-7519

Healy CM, Rench MA, Montesinos DP, Ng N, Swaim LS Knowledge and attitiudes of pregnant women and their providers towards recommendations for immunization during pregnancy. Vaccine. 2015; 33:(41)5445-5451

Heffernan C The ‘new normal’: delivering childhood immunisations during the COVID-19 pandemic. Pract Nurs. 2020; 31:(9)390-393

Hendrix KS, Finnell SME, Zimet GD, Sturm LA, Lane KA, Downs SM, Lane K, Downs S Vaccine message framing and parents' intent to immunize their infants for MMR. Pediatrics. 2014; 134:(3)e675-e683

Hoffman BL, Felter EM, Chu KH, Shensa A, Hermann C, Wolynn T, Williams D, Primack BA It's not all about autism: the emerging landscape of anti-vaccination sentiment on Facebook. Vaccine. 2019; 37:(16)2216-2223

Holmström R BIG STORY: THE COMPLICATIONS OF HESITATION. Community Pract. 2021; 94:(2)14-17

Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon MP, Griffiths F, Nicolau B, O'Cathain A The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Educ Inf. 2018; 34:(4)285-291

HSJ Solutions. Trust develops a skill-mix capacity model for utilisation of staff nurses to support delivery of the universal ante-natal contact and new baby reviews, improving outcomes for parents and children. 2018. http// (Accessed 24th April 2022)

Hutt P, Gilmour S Tackling Inequalities in General Practice.London: The King's Fund; 2010

State of Health Visiting in England.London: iHV; 2021

Institute of Health Visiting. We need to act now to improve childhood vaccine uptake. 2022. https// (Accessed 6th April 2022)

Health Literacy: A Prescription to End Confusion.Washington: National Academy Press; 2004

Jacob N, Coetzee D Missed opportunities for immunisation in health facilities in Cape Town, South Africa. S Afr Med J. 2015; 105:(11)917-921

Jacobson Vann JC, Szilagyi P Patient reminder and recall systems to improve immunization rates. Cochrane Database Syst Rev. 2005; 2005:(3)

Jones AM, Omer SB, Bednarczyk RA, Halsey NA, Moulton LH, Salmon DA Parents' source of vaccine information and impact on vaccine attitudes, beliefs, and nonmedical exemptions. Adv Prev Med. 2012; 2012

Update: How is the COVID-19 crisis affecting the NHS?. 2021. https// (Accessed 25th April 2022)

Kennedy A, Basket M, Sheedy K Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles survey. Pediatrics. 2011a; 127:(1)S92-S99

Kennedy A, LaVail K, Nowak G, Basket M, Landry S Confidence about vaccines in the United States: understanding parents' perceptions. Health Aff. 2011; 30:(6)1151-1159

Kennedy S, Dixon D, Field P, Gallagher P, Rosen D Improving the Quality of Care in General Practice.London: The Kings Fund; 2011c

Kraszewski S Improving immunisation uptake in babies and toddlers. Pract Nurs. 2017; 28:(7)300-306

Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G Communicating with parents about vaccination: a framework for health professionals. BMC Pediatr. 2012; 12:(1)

Luthy KE, Beckstrand RL, Asay W, Hewett C Vaccinating parents experience vaccine anxiety too. J Am Assoc Nurse Pract. 2013; 25:(12)667-673

Lwembe S, Green SA, Tanna N, Connor J, Valler C, Barnes R A qualitative evaluation to explore the suitability, feasibility and acceptability of using a ‘celebration card’ intervention in primary care to improve the uptake of childhood vaccinations. BMC Fam Pract. 2016; 17:(1)

Pandemics: Risks, Impacts, and Mitigation. 2017. https//

MacDonald NE Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015; 33:(34)4161-4164

McDonald HI, Tessier E, White JM, Woodruff M, Knowles C, Bates C, Parry J, Walker JL, Scott JA, Smeeth L Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England, January to April 2020. Euro Surveill. 2020; 25:(19)1-6

McGeown H, Heffernan C, Gibson K Perspectives from CQC ‘outstanding’ practices: how to have good uptake of vaccination services. Pract Nurs. 2018; 29:(3)135-139

Moher D, Liberati A, Tetzlaff J, Altman DG Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010; 8:(5)336-341

Montagni I, Ouazzani-Touhami K, Mebarki A, Texier N, Schück S, Tzourio C Acceptance of a Covid-19 vaccine is associated with ability to detect fake news and health literacy. J Public Health (Bangkok). 2021; 43:(4)695-702

National Institute for Health and Care Excellence. Immunisations: reducing differences in uptake in under 19s. 2009. https// (Accessed 4th February 2022)

NHS. NHS Vaccinations and When to Have Them. 2019. https// (Accessed 3rd January 2022)

NHS Digital. Childhood Vaccination Coverage Statistics – England 2018-19. 2019. https// (Accessed 12th November 2021)

NHS England. Child Immunisations (GP) Quarterly Collections: Guidance. 2018. https// (Accessed 7th November 2021)

NHS England, NHS Improvement. Interim findings of the Vaccinations and Immunisations Review – September 2019. 2019. https// (Accessed 6th February 2022)

Office for National Statistics (ONS). Live Births. 2022. https// (Accessed 19th February 2022)

Parliamentary Office of Science and Technology. Childhood Vaccination Programme. 2013. https// (Accessed 21st November 2021)

Paterson P, Schulz W, Utley M, Larson H Parents' experience and views of vaccinating their child against influenza at primary school and at the general practice. Int J Environ Res Public Health. 2018; 15:(4)

Pebody RG, Green HK, Andrews N, Boddington NL, Zhao H, Yonova I, Ellis J, Steinberger S, Donati M, Elliot AJ Uptake and impact of vaccinating school age children against influenza during a season with circulation of drifted influenza A and B strains, England, 2014/15. Euro Surveill. 2015; 20:(39)

Pereira JA, Quach S, Heidebrecht CL, Quan SD, Kolbe F, Finkelstein M, Kwong JC Barriers to the use of reminder/recall interventions for immunizations: a systematic review. BMC Med Inform Decis Mak. 2012; 12:(1)

Plunkett A, Tong J Sepsis in children. BMJ. 2015; 350

Public Health England. UK Measles and Rubella Elimination Strategy 2019. 2019. https// (Accessed 6th February 2022)

Disparities in the Risk and Outcomes of COVID-19.London: PHE; 2020

The Rotavirus Vaccination Programme. Information for Healthcare Practitioners.London: PHE; 2021a

Public Health England. Health Visiting and School Nursing Service Delivery Model. 2021b. https// (Accessed 24th April 2022)

Ramsay ME Measles: the legacy of low vaccine coverage. Arch Dis Child. 2013; 98:(10)752-754

Raneri A, Matusitz J Source Representation in the Communication of Childhood Immunisation. Child Care Pract. 2015; 21:(2)114-127

Rodewald LE, Szilagyi PG, Humiston SG, Barth R, Kraus R, Raubertas RF A randomized study of tracking with outreach and provider prompting to improve immunization coverage and primary care. Pediatrics. 1999; 103:(1)31-38

Rough E UK Vaccination Policy. House of Commons Briefing Paper no. 9076.London: House of Commons; 2021

Santorelli G, West J, Mason D, Cartwright C, Inamdar L, Tomes C, Wright J Factors associated with the uptake of the UK routine childhood immunization schedule in a bi-ethnic population. Eur J Public Health. 2020; 30:(4)697-702

Saxena S, Skirrow H, Bedford H Routine vaccination during covid-19 pandemic response. BMJ. 2020; 369:(1)

Schmidt AL, Zollo F, Scala A, Betsch C, Quattrociocchi W Polarization of the vaccination debate on Facebook. Vaccine. 2018; 36:(25)3606-3612

Sealey K Increasing uptake of LAIV in school-based immunisation sessions: A pilot study. British Journal of School Nursing. 2017; 12:(2)79-87

Smith LE, Webster RK, Weinman J, Amlôt R, Yiend J, Rubin GJ Psychological factors associated with uptake of the childhood influenza vaccine and perception of post-vaccination side-effects: A cross-sectional survey in England. Vaccine. 2017; 35:(15)1936-1945

Sridhar S, Maleq N, Guillermet E, Colombini A, Gessner BD A systematic literature review of missed opportunities for immunization in low- and middle-income countries. Vaccine. 2014; 32:(51)6870-6879

Stefanoff P, Mamelund SE, Robinson M, Netterlid E, Tuells J, Bergsaker MAR, Heijbel H, Yarwood J Tracking parental attitudes on vaccination across European countries: The Vaccine Safety, Attitudes, Training and Communication Project (VACSATC). Vaccine. 2010; 28:(35)5731-5737

The National Audit Office. Investigation into Pre-School Vaccinations. 2019. https// (Accessed 17th November 2021)

Trade Union Congress. Number of GPs Down By Nearly 1 000 Since 2015 Despite Rise In Demand, TUC Analysis Shows. 2019. https// (Accessed 2nd March 2022)

UK Health Security Agency. UK Immunisation Schedule: The Green Book, Chapter 11. 2020. https// (Accessed 21st November 2021)

UK Health Security Agency. Flu Vaccination Programme 2021 To 2022: Briefing for Schools – October 2021 Update. 2021a. https// (Accessed 3rd January 2022)

UK Health Security Agency (UKHSA). Vaccine Update. 2021b. https// (Accessed 26th February 2022)

UK Health Security Agency (UKHSA). Around 1 in 10 children starting school at risk of measles. 2022. https// (Accessed 6th April 2022)

UK Parliament. Arm's Length Bodies (Triennial Reviews) Statement UIN HCWS170. 2015. https// (Accessed 1st April 20 222)

van Lier A, van de Kassteele J, de Hoogh P, Drijfhout I, de Melker H Vaccine uptake determinants in The Netherlands. Eur J Public Health. 2014; 24:(2)304-309

Vujovich-Dunn C, Leask J, Menning L, Guy R, King C Systematic Reviewo Of Global Vaccine Hesitancy Trends in Childhood Immunisations (Systematic Review).: University of New South Wales; 2020

Wagner KS, van Wijgerden JCJ, Andrews N, Goulden K, White JM Childhood vaccination coverage by ethnicity within London between 2006/2007 and 2010/2011. Arch Dis Child. 2014; 99:(4)348-353

Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P RETRACTED: ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998; 351:(9103)637-641

Wicker S, Maltezou HC Vaccine-preventable diseases in Europe: where do we stand?. Expert Rev Vaccines. 2014; 13:(8)979-987

Wiley KE, Massey PD, Cooper SC, Wood N, Quinn HE, Leask J Pregnant women's intention to take up a post-partum pertussis vaccine, and their willingness to take up the vaccine while pregnant: A cross sectional survey. Vaccine. 2013; 31:(37)3972-3978

Wilkinson D, McBride AKS Clinical ethics: consent for vaccination in children. Arch Dis Child. 2022; 107:(1)3-4

Wilkinson E Is anti-vaccine sentiment affecting routine childhood immunisations?. BMJ. 2022; 376

Williams N, Woodward H, Majeed A, Saxena S Primary care strategies to improve childhood immunisation uptake in developed countries: systematic review. JRSM Short Rep. 2011; 2:(10)1-21

Williamson SL, Gadd E, Pillay T, Toldi G Non-specific effects of BCG vaccination on neutrophil and lymphocyte counts of healthy neonates from a developed country. Vaccine. 2021; 39:(14)1887-1891

Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999; 318:(7182)527-530

Premature Death Among People with Severe Mental Disorders (information Sheet).: World Health Organization; 2015

World Health Organization. Ten Threats to Global Health in 2019. 2019. https// (Accessed 8th November 2021)

World Health Organization. Guiding principles for immunization activities during the COVID-19 pandemic. 2020. https// (Accessed 15th November 2021)

World Health Organization. Reducing Missed Opportunities for Vaccination (MOV). 2022. https// (Accessed 25th February 2022)

Wright K, Golder S, Lewis-Light K What value is the CINAHL database when searching for systematic reviews of qualitative studies?. Syst Rev. 2015; 4:(1)

Zürcher SJ, Kerksieck P, Adamus C, Burr CM, Lehmann AI, Huber FK, Richter D Prevalence of Mental Health Problems During Virus Epidemics in the General Public, Health Care Workers and Survivors: A Rapid Review of the Evidence. Front Public Health. 2020; 8:(560389)

Exploring how the uptake of childhood immunisations can be improved in England: A systematic review

02 February 2024
Volume 5 · Issue 1



Childhood immunisations protect communities against preventable and infectious diseases. Coverage for childhood immunisations in the UK is declining and coverage for the MMR vaccine stands at 85.5%, significantly below the target set by the Department of Health and Social Care to achieve herd immunity and prevent sustained disease transmission.


Three medical databases were searched using PICO, supported by the application of inclusion and exclusion criteria and critical appraisal.


Reminder and recall activities are identified as a cost-effective method for improving childhood immunisation uptake but targeted, individualised and family-centred interventions should be utilised to promote access to childhood immunisations for underserved populations. Vaccination data should remain up to date and a child's vaccination status should be reviewed and meaningfully discussed at every healthcare contact and staff involved in immunisation should have access to appropriate education, training and support.


Understanding how to provide services and improve vaccine coverage for patients who frequently are not brought is identified as an opportunity for further research, as well as analysing the role of public health teams in identifying local inequalities and supporting GP practices to design and deliver bespoke interventions for their community. It is recommended that communication emphasises the safety and effectiveness of vaccines, while highlighting a child's susceptibility or risk to developing complications. Further research is needed to evaluate how best to communicate this to ensure that the information provided is clear and factual and comprehensible to all parents and carers.

Childhood immunisations protect infants, children and the wider community from infectious diseases that would otherwise be common in childhood (Parliamentary Office of Science and Technology, 2013). Every child in the UK is offered free immunisations as part of the National Immunisation Programme, which offers protection against 14 preventable and infectious diseases (Birmingham Community Healthcare, 2021). The Department of Health regularly amends the childhood immunisation schedule based on recommendations from The Joint Committee on Vaccination and Immunisation (JCVI), an independent scientific advisory body (Parliamentary Office of Science and Technology, 2013; UK Health Security Agency [UKSHA], 2020).

Sepsis is the leading cause of child morbidity and mortality, and immunisation remains the principal method of primary sepsis prevention (Plunkett and Tong, 2015). After immunisation, children are far less likely to contract the infection they have been vaccinated against and once enough people in the community are immunised, the infection can no longer spread so dies out (NHS England, 2018). Herd immunity occurs when a significant proportion of the population becomes immune (either through infection and recovery, or by vaccination) to a disease, making transmission from person-to-person unlikely and offering protection to the rest of the population. The proportion of a community which must be protected to achieve herd immunity differs between diseases, for example, measles ‘requires more than 95% of the population to be immune to stop sustained disease transmission and achieve herd immunity’ (Desai and Majumder:2113). Evidence has shown that some vaccinations, such as the Bacillus Calmette-Guérin (BCG) vaccine against tuberculosis (TB), can reduce (neonatal) mortality from infections other than TB ‘in a non-specific or pathogen agonistic manner’ (Aaby et al, 2011; Biering-Sørensen et al, 2017; Williamson et al, 2021:1887), providing additional benefits.

Register now to continue reading

Thank you for visiting Journal of Child Health and reading some of our peer-reviewed resources for children’s health professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month