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Theme 1: Electronic Health Record Research

This theme focuses on the innovative use of linked anonymised electronic health records to enhance vaccine epidemiology studies. 

The increasing availability of very large linked electronic health datasets raises exciting new opportunities for vaccine-related research.  Anonymised data used in this work programme include UK general practice records, hospitalisation data, mortality data from death certificates, child health records, socioeconomic indicator data and ongoing laboratory surveillance data.  Linked data add information that are unavailable in single data sources, for example by bringing together vaccination uptake from primary care records with later hospital morbidity data.  The linkages also ensure more complete capture of events that can present in different health settings, pinpoint the timing of vaccination and clinical events, and allow examination of pathways of care. 

We are developing and applying new methods to interrogate these large linked datasets.  There are four broad areas of work:

  • Ongoing assessment of the burden of vaccine-preventable conditions;
  • Detailed examination of vaccine uptake, with identification of subgroups who have lower levels of vaccine coverage;
  • Estimation of the effectiveness of vaccines in routine use;
  • Post-licensure monitoring to demonstrate continued safety of vaccines (in collaboration with the Medicines and Healthcare products Regulatory Agency).


  • Inequalities in vaccine uptake and disease burden
    We are using the linked data to explore social determinants of vaccine uptake and vaccine-preventable disease incidence for a number of UK vaccines.  The results will clarify the extent to which immunisation policy in England benefits people from all backgrounds.   
  • Impact of rotavirus vaccination
    We are monitoring the changing burden of gastrointestinal disease in multiple health settings after introduction of oral rotavirus vaccine into the infant immunisation programme, and assessing the effectiveness of the vaccine against a range of outcomes.
  • Vaccines given in pregnancy
    We are refining existing pregnancy algorithms to optimise identification of trimesters of pregnancy in linked electronic health records. The resulting algorithm will be used in several projects, to assess determinants of maternal vaccine uptake and in detailed safety and effectiveness analyses for these vaccines.
  • Methodological work on vaccine safety
    We are reviewing studies worldwide that are conducting near “real-time” vaccine safety surveillance, for early detection of adverse events using electronic health records.  The results will inform development and validation of novel approaches for active monitoring of newly introduced vaccines.  

Lead researchers

Helen McDonald

Honorary Research Fellow

London School of Hygiene & Tropical Medicine

Liam Smeeth

Professor of Clinical Epidemiology

London School of Hygiene & Tropical Medicine

Nick Andrews

Senior Statistician

Public Health England