UK Immunisation Schedule

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The current UK vaccination schedule is shown below. It is the same for all areas of the UK[3, 4, 5, 6].

UK 2018 Immunisation Schedule

AGE
Immunisation (Vaccine Given)
2 months
  • DTaP/IPV(polio)/Hib/HepB (diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b and hepatitis B) - 6-in-one injection (Infanrix hexa®); plus:
  • PCV (pneumococcal conjugate vaccine) - in a separate injection (Prevenar 13®).
  • Rotavirus (Rotarix®) - oral route (drops).
  • Meningitis B Bexsero®).
3 months
  • DTaP/IPV(polio)/Hib/HepB 6-in-one injection, 2nd dose (Infanrix hexa®); plus:
  • Rotavirus (Rotarix®) - oral route (drops).
4 months
  • DTaP/IPV(polio)/Hib/HepB 6-in-one injection, 3rd dose (Infanrix hexa®); plus:
  • PCV 2nd dose (Prevenar 13®) - in a separate injection.
  • Meningitis B 2nd dose (Bexsero®).
Between 12 and 13 months
  • Hib/MenC (combined as one injection) - 4th dose of Hib and 1st dose of MenC (Menitorix®); plus:
  • MMR (measles, mumps and rubella) - combined as one injection (Priorix® or M-M-RVAXPRO®); plus:
  • PCV 3rd dose (Prevenar 13®) - in a separate injection.
  • Meningitis B 3rd dose (Bexsero®).
2-8 years
  • Nasal flu spray annually (Fluenz®). For children aged 2, 3 and 4, this is usually given in the GP surgery. Children in school years 1, 2 and 3 may have this at school.
3 years and four months
  • Preschool booster of DTaP/IPV(polio). 4-in-one injection (Repevax® or Infanrix-IPV®); plus:
  • MMR 2nd dose (Priorix® or M-M-RVAXPRO®) - in a separate injection.
12-13 years (girls)
  • HPV (human papillomavirus types 16 and 18) - two injections (Gardasil®). The second injection is given 6-12 months after the first one.
14 years
  • Td/IPV(polio) booster. 3-in-one injection (Revaxis®).
  • Men ACWY: combined protection against meningitis A, C, W and Y (Nimenrix® or Menveo®).
Adults
  • Influenza (annual) and PPV (pneumococcal polysaccharide vaccine): for those aged over 65 years and also those in high-risk groups.
  • Td/IPV(polio): for those not fully immunised as a child (Revaxis®).
  • DTaP/IPV: for pregnant women from 20 weeks of gestation to protect the newborn baby against whooping cough (Boostrix-IPV® or Repevax®). 
  • Shingles (Zostavax®) vaccine: for adults aged 70 years. (Plus catch-up for adults aged 78 and 79.)

The injection that contains diphtheria, tetanus, pertussis, Hib and polio has now become hexavalent with the addition of hepatitis B vaccination. This is given as usual at 8, 12 and 16 weeks.

Other notes

  • Five doses of a diphtheria, tetanus and polio vaccine are enough to provide long-term protection through adulthood, but:
    • A DTaP/IPV booster is currently offered to pregnant women from 20 weeks of gestation (started September 2012). This aims to counter the rise in neonatal whooping cough[7].
    • Tetanus boosters may be advised if travelling to a high-risk area, or after a high-risk wound if the last booster was more than ten years ago. This is given in the 3-in-one Td/IPV(polio) (tetanus, low-dose diphtheria and polio) vaccine (Revaxis®).
  • BCG vaccination against tuberculosis (TB) is given only to those thought to be at high risk of TB. Where required in babies, it is usually given before leaving the hospital soon after birth. Referral is needed, usually to the local chest clinic to arrange vaccination for at-risk individuals after this time.

This may be important in finding the non-immune. The year in which the following vaccinations were introduced in the UK:

  • Diphtheria: 1940.
  • Pertussis: 1950s.
  • BCG: 1953.
  • Polio: 1955.
  • Tetanus: 1961.
  • Measles: 1968.
  • Rubella: 1970.
  • MMR: 1988.
  • Meningitis C (MenC): 1999.
  • Pneumococcus: 2006.
  • Human papillomavirus (HPV) vaccination: 2008 (with catch-up programmes for girls up to the age of 18 years who missed it).
  • Rotavirus: 2013.
  • Shingles: 2013 (with a catch-up programme for adults aged 71-80).
  • Children's annual flu vaccine: 2013.
  • Meningitis B and meningitis ACWY: 2015 (with catch-up for students up to the age of 25 for MenACWY).
  • DTaP/IPV(polio)/Hib/HepB: 2018

Where there is any doubt, rather than withholding vaccine, advice should be sought from an appropriate consultant paediatrician or physician, the immunisation co-ordinator or consultant in health protection.

Contra-indications

All vaccines are contra-indicated in those who have had:

  • A confirmed anaphylactic reaction to a previous dose of a vaccine containing the same antigens; or
  • A confirmed anaphylactic reaction to another component contained in the relevant vaccine - eg, neomycin, streptomycin or polymyxin B (which may be present in trace amounts in some vaccines).

Note:

  • Individuals with a confirmed anaphylactic reaction to egg should not receive influenza or yellow fever vaccines. True egg allergy is very rare: a large dataset across Europe found a rate of confirmed egg allergy of 0.2%, up to 0.5% in the UK[8].
  • For the small number of individuals who have a history of confirmed anaphylactic reaction after any egg-containing food, specialist advice should be sought with a view to immunisation under controlled conditions.
  • Individuals with a confirmed anaphylactic reaction to latex should not receive vaccines supplied in vials or syringes containing latex (eg, caps/stoppers/plungers) although the risk is very small.

Live vaccines

Live vaccines may be temporarily contra-indicated in individuals who are:

  • Immunosuppressed (transplant patients, those receiving chemotherapy or with HIV) - seek expert advice.
  • Pregnant.

Recommendations for giving live vaccines together (or otherwise) were updated in 2015[9]. Live vaccines may be given together or at any time before or after each other, EXCEPT as follows:

  • Yellow fever and MMR must be given at least four weeks apart and should not be given together.
  • Varicella and zoster vaccines may be given at the same time as the MMR vaccine but if not given on the same day, there should be ≥4 weeks between them.
  • Tuberculin skin test (Mantoux test) and MMR: after a Mantoux test, MMR should be delayed until the skin test has been read. If the person has had an MMR, there should be ≥4 weeks before a Mantoux test is done.

There are separate articles which deal with the following in more detail:

  • The usual issues of consent in childhood and Gillick competency apply. See separate Consent to Treatment in Children (Mental Capacity and Mental Health Legislation) article.
  • In general the vast majority of parents provide consent on behalf of their children.
  • There have, however, been a number of interesting cases where parents (either one, or both) have refused to vaccinate their children:
    • A vegan mother refused to vaccinate her children for fear of introducing 'toxins' into their bodies: the High Court ruled against her in April 2017[11].
    • Parents who had separated had agreed, while together, not to vaccinate their children against the MMR. Once estranged, the father wanted the children to receive the vaccines against the mother's wishes. The court ruled, in 2013, that the children should be fully vaccinated[12].
    • In 2017 a mother, who had declined to have her children vaccinated, had them taken into care (for a number of reasons unrelated to their healthcare). Once in care, the local authority made a court application to have the vaccines administered. The court agreed[13].
  • In France, parents will be legally obliged to have their children vaccinated from 2018.
  • In Italy, some state schools will not accept children who have not received routine vaccinations.
  • The flu vaccine is offered to all people over 65.
  • The shingles vaccine is offered to anyone aged 70.
  • The vaccine against streptococcus pneumonia is offered to anyone aged 65.
  • Pregnant women are offered the flu vaccine at any point during the pregnancy.
  • Pregnant women are offered the whooping cough vaccine from 16 weeks onwards.

Further reading and references

  1. UK Vaccination Schedule: Oxford Vaccine Group

  2. Immunisation against infectious disease - the Green Book (latest edition); Public Health England

  3. NHS complete routine immunisation schedule; GOV.UK

  4. Immunisation schedule; NHS Health Scotland

  5. Immunisation for children; NI Direct

  6. Vaccinations; NHS Direct Wales

  7. Whooping Cough Vaccination Programme for Pregnant Women; Dept of Health (2012)

  8. Burney P, Summers C, Chinn S, et al; Prevalence and distribution of sensitization to foods in the European Community Respiratory Health Survey: a EuroPrevall analysis. Allergy. 2010 Sep65(9):1182-8. doi: 10.1111/j.1398-9995.2010.02346.x. Epub 2010 Feb 22.

  9. Revised recommendations for the administration of more than one live vaccine; Public Health England (PHE). April 2015

  10. Reference guide to consent for examination or treatment (second edition); Dept of Health, 2009

  11. Children to be vaccinated against vegan mother’s wishes; Marilyn Stowe website, April 2017

  12. Father’s application for a declaration and specific issue order for his children to receive the MMR vaccination; Family Law Week, 2013 (archived content)

  13. Permission to Vaccinate [2017] EWHC 125 (Fam): Application by a local authority under the inherent jurisdiction for a declaration that it was in SL’s best interests to receive two immunisations; Family Law Week

Dear all,I am scheduled to receive the third shot of Twinrix this week, however I find myself in Tunisia (Sousse). I was unable to find this particular combined vaccine (against Hepatitis A + B),...

captain15603
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