Main points

This report presents vaccine coverage data for the routine school-aged diphtheria, tetanus and inactivated poliomyelitis (Td/IPV) immunisation programme in England for the 2023/24 academic year. These results include Td/IPV vaccine coverage estimates for children in years 9 and 10 (or the equivalent ages) measured up to the 31 August 2024.

Td/IPV vaccine coverage is presented for England at national, NHS commissioning region, and local authority (LA) level.

The main findings of this report are that:

• Td/IPV coverage for year 9 students during the 2023/24 academic year was 71.7%, which is 3.4 percentage points higher than the year 9 cohort in 2022/23
• Td/IPV coverage for year 10 students during the 2023/24 was 72.7%, which is 6.8 percentage points lower than the year 10 cohort in 2022/23
• Td/IPV coverage in year 10 students was 4.4 percentage points higher than in the 2022/23 academic year when they were in year 9
• Td/IPV coverage in year 9 students was lowest in London (64.0%) and highest in the East of England (78.6%)
• Td/IPV coverage in year 10 students was lowest in London (64.0%) and highest in the South East (79.6%)

Table 1. Td/IPV vaccination cohorts in the 2023/24 academic year

School year in 2023/24	Age in 2023/24	Dates of birth
9 (routine)	13 to 14 years	1 September 2009 to 31 August 2010
10 (routine or catch-up)	14 to 15 years	1 September 2008 to 31 August 2009

Results

Figure 1. Td/IPV coverage in adolescents in school years 9 and 10 by academic year from 2015 to 2024

Figure 1 shows the Td/IPV vaccine coverage for year 9 and year 10 students in England from 2015 to 2024. This data is also presented in text form in Table 2. Td/IPV coverage for year 9 students during the 2023/24 academic year was 71.7%, which is 3.4 percentage points higher than the year 9 cohort in 2022/23. For year 10 students, coverage was 72.7% in the 2023/24 academic year, which is 6.8 percentage points lower than the year 10 cohort in the previous year.

Table 2. Td/IPV coverage in years 9 and 10 from 2015 to 2024 [Note 1]

Academic year	Year 9 Td/IPV coverage (%)	Year 10 Td/IPV coverage (%)
2015 to 2016	83.5	74.9
2016 to 2017	83.0	81.7
2017 to 2018	85.5	82.9
2018 to 2019	87.6	86.0
2019 to 2020	57.6	86.4
2020 to 2021	76.3	80.3
2021 to 2022	69.0	79.5
2022 to 2023	68.3	79.5
2023 to 2024	71.7	72.7

Note 1. In 2015/16, only half of the year 9 and 10 cohorts were eligible for the vaccine meaning these figures are not comparable to later years. Also, over time many LAs have moved from routinely offering the vaccine in year 10 to offering it in year 9. During transitional years, some LAs offered the vaccine routinely to both year 9 and 10. This transition meant that in 2018/19, the year 9 data was incomplete, meaning some LAs were excluded from national coverage figures. Since almost all LAs now offer the vaccine in year 9, the year 10 coverage figures from 2021/22 onwards are the year 9 coverage plus additional catch-up. These changes mean that national coverage figures are not directly comparable over time and explain why coverage in the year 10 cohort may appear to decrease when compared to previous years.

Year 9 vaccine coverage

The main findings for the year 9 cohort were that:

• Td/IPV coverage for year 9 students in 2023/24 was 71.7%, which is 3.4 percentage points higher than year 9 students in the previous year
• Td/IPV coverage in year 9 students was lowest in London (64.0%) and highest in the East of England (78.6%)
• LA level coverage ranged from 31.3% (Brent) to 91.7% (West Berkshire) (this range excludes those who only offer the vaccine routinely in year 10)
• out of 150 LAs, coverage in 57 (38.0%) was less than 70%, coverage in 56 (37.3%) was between 70% and 80%, coverage in 35 (23.3%) was between 80% and 90%, and coverage in 2 (1.3%) was greater than 90%

Figure 2. Year 9 Td/IPV coverage by NHS commissioning region

Figure 2 shows the distribution of Td/IPV vaccine coverage in school year 9 by NHS commissioning region. The boxes indicate the inter-quartile range (IQR), the range between the first and third quartiles, among constituent LAs in each NHS commissioning region. The median (second quartile) is indicated by the horizontal white line within each box. Vertical black lines indicate the range of coverage values among LAs that fall within 1.5 times the IQR above the third quartile or below the first quartile. LAs with coverage outside this range are considered outliers and indicated by a black dot.

Figure 3. Map of year 9 Td/IPV coverage by LA [Note 2]

Note 2. Bolton and Wigan LAs only routinely offered Td/IPV vaccination in school year 10 in the 2023/24 academic year, and so in this map of year 9 coverage they are greyed out.

Figure 3 shows the geographical distribution of Td/IPV vaccine coverage at the LA level for year 9 students in England. Coverage within LAs ranged from 31.3% in Brent to 91.7% in West Berkshire (this range excludes LAs who only offer the vaccine routinely in year 10).

Year 10 vaccine coverage

The main findings for the year 10 cohort were that:

• Td/IPV coverage for year 10 students in 2023/24 was 72.7%, which is 6.8 percentage points lower than year 10 students in the previous year
• Td/IPV coverage in year 10 students was 4.4 percentage points higher than in 2022/23 when they were in year 9, suggesting ongoing catch-up activities in year 10
• Td/IPV coverage in year 10 students was lowest in London (64.0%) highest in the South East (79.6%)
• LA level coverage ranged from 31.9% (Brent) to 96.8% (Rochdale)
• out of 150 LAs, coverage in 61 (40.6%) was less than 70%, coverage in 50 (33.3%) was between 70% and 80%, coverage in 35 (23.3%) was between 80% and 90%, and coverage in 4 (2.6%) was greater than 90%

Figure 4. Year 10 Td/IPV coverage by NHS commissioning region

Figure 4 shows the distribution of Td/IPV vaccine coverage in school year 10 by NHS commissioning region. The boxes indicate the inter-quartile range (IQR), the range between the first and third quartiles, among constituent LAs in each NHS commissioning region. The median (second quartile) is indicated by the horizontal white line within each box. Vertical black lines indicate the range of coverage values among LAs that fall within 1.5 times the IQR above the third quartile or below the first quartile. LAs with coverage outside this range are considered outliers and indicated by a black dot.

Figure 5. Map of year 10 Td/IPV coverage by local authority

Figure 5 shows the geographical distribution of Td/IPV vaccine coverage at the LA level for year 10 students in England. Coverage within LAs ranged from 31.9% in Brent to 96.8% in Rochdale.

Discussion

Td/IPV vaccine coverage for year 9 in 2023/24 was 71.7%. This is higher than coverage in 2022/23 but not yet back to pre-pandemic levels. Coverage in the year 10 cohort was 73.0%, which is a small improvement on uptake recorded for this cohort in year 9 during the previous academic year, suggesting ongoing catch-up activity. When coverage was calculated for each NHS commissioning region, the estimates varied considerably.

Background information

Tetanus, diphtheria and polio vaccines are offered to all babies with the other primary immunisations at 8 weeks, 12 weeks and 16 weeks. A pre-school booster is then offered to children at 3 years and 4 months of age, and a school leaver booster (Td/IPV) is offered to adolescents aged 14 years. The school leaver booster is therefore the fifth dose of a tetanus, diphtheria and polio containing vaccine in the routine immunisation schedule and completes the course, providing long-term protection against all 3 infections.

Any missed doses of diphtheria, tetanus and polio vaccines can be caught up at any age observing the appropriate intervals between doses as detailed in the Green Book. NHS England (NHSE) commissions general practices and/or school aged immunisation providers to deliver the routine childhood immunisation programmes in England.

The NHS adolescent immunisation programmes in England are primarily school based and are delivered routinely by NHSE commissioned school aged vaccination providers. Adolescents who are home schooled, those who attend a small minority of schools that do not offer the routine vaccination programmes, and those eligible, but not in education, should be offered their vaccinations in alternative settings, such as community clinics. Data on whether children were vaccinated in school or at alternative settings is not universally included in the school vaccination figures submitted by data providers.

In 2021/22, the routine offer of Td/IPV vaccine to the year 9 cohort was implemented alongside catch up for the year 10 cohort in most LAs. Only a small number of NHSE commissioned school-aged immunisation providers, covering 4 LAs continue to offer the Td/IPV programme to year 10 students routinely.

Since March 2020, the coronavirus (COVID-19) pandemic has led to some disruption of school-based immunisation programme delivery and the impact has varied by region and LA. The biggest impact was observed in the 2019/20 academic year when all schools were closed in the first national lockdown. Throughout the 2020/21 academic year, school attendance rates in England were lower than normal. In January 2021, schools were closed to all, except children of key workers and vulnerable children, with a phased reopening of secondary schools from March 2021. Staff absences in both schools and school age immunisation services also added to the disruption.

Vaccine coverage in 2020/21 improved significantly but was still not back up to pre-pandemic levels. In the 2021/22 academic year, school attendance rates in England remained lower than normal until the ‘Living with COVID-19’ guidance was implemented from February 2022 and all restrictions were lifted. In September 2021, the offer of COVID-19 vaccination was extended to all children aged 12 to 15 years and was delivered in secondary schools and other settings. In addition, the influenza immunisation programme was extended to all children in secondary schools. School-aged immunisation services were instrumental in supporting the delivery of all of these programmes under very challenging circumstances. It is likely that all of these factors, combined, impacted on the delivery of the routine adolescent immunisation programmes including the Td/IPV programme.

Prior to the academic year 2020/21, vaccine coverage reports were published by Public Health England (PHE).

Methods

NHSE-commissioned school age immunisation providers collect school-level vaccine coverage data, which is then aggregated up to LA-level and submitted to UKHSA either directly by the providers, or by NHSE Regional Public Health Commissioning Teams via the ImmForm website. Where possible, regional teams also include additional data for adolescents resident in the LA but not linked to any school. Data providers may also submit data on vaccinations delivered through community clinics or GP practices and this can then be added to the school vaccination figures.

The numerator is defined by the number of adolescents in each cohort who had received a dose of the Td/IPV vaccine by 31 August 2024. Providers must use updated data sources to identify all eligible children in the locality for the academic year. This can be calculated from school student records for all types of schools or units, plus children schooled at home, or from Child Health Information Systems.

The denominator is defined by the total number of eligible adolescents in each cohort regardless of programme delivery.

LA-level Td/IPV vaccine coverage data up to 31 August 2024 was manually uploaded by data providers to the ImmForm website retrospectively, from 1 September 2024 to 1 October 2024. The target population for the programme is defined by school age cohorts born between 1 September 2008 and 31 August 2010 (Table 1). This means that it includes those adolescents in school years 9 and 10 in the 2023/24 academic year. Coverage for the year 10 cohort was intended to capture both vaccines delivered during the 2022/23 academic year (when the students were in year 9) and routine or catch-up vaccines delivered in 2023/24.

For this report, the Isles of Scilly LA is merged with Cornwall LA due to small numbers.

Full details of the data collection process and definitions can be found in the user guide.

Programme delivery

The JCVI recommends that the Td/IPV vaccine is offered to students in year 9 or 10; however, the routine delivery schedule varies by local authority depending on local requirements and resources. In the 2023/24 academic year, Td/IPV was routinely offered to year 9 in 113 local authorities, year 10 in 2 local authorities, both year 9 and 10 in 27 local authorities and an alternative schedule was used in 9 local authorities. Out of the 151 local authorities, 2 were unable to offer the vaccine to all eligible students in year 9 and 10.