UK immunisation schedule

Current UK immunisation schedule^{1 23}

The current UK vaccination schedule is shown below. It is the same for all areas of the UK.^{4 5 6 7}

UK 2023 Immunisation Schedule - for patients not at increased risk ³

Selective UK immunisation programme⁸

Additional vaccines for those with underlying medical conditions⁸

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 16 weeks of gestation. This aims to counter the rise in neonatal whooping cough.⁹

  • 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.

Update June 2024:

On 24 June 2024, the government announced the introduction of the new RSV vaccine which will be offered to all patients between the ages of 75 and 79, and all pregnant women over 28 weeks of gestation. This will be rolled out from 1 September 2024. This appears to be the same in all the home nations.¹⁰

Vaccine introduction dates

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 for girls and 2019 for boys.

• 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.

Cautions and contra-indications²

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.¹¹

• 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. 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.

Individual vaccines

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

• BCG vaccination.

• Bordetella pertussis (whooping cough) vaccination.

• Diphtheria and diphtheria vaccination.

• Hepatitis B vaccination and prevention.

• Hib vaccination - H. influenzae type b (Hib) vaccination.

• HPV vaccination.

• Influenza vaccination including target groups.

• MMR vaccination.

• Meningococcal vaccines - meningococcal C vaccination.

• Pneumococcal vaccine including target groups.

• Polio and polio vaccination.

• Rotavirus and rotavirus vaccination.

• Shingles and shingles vaccination.

• Tetanus and tetanus vaccination.

Medicolegal issues^{2 12}

• The usual issues of consent in childhood and Gillick competency apply. See the 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.

• In France, parents became legally obliged to have their children vaccinated from 2018.¹³

• 12 European countries have some mandatory vaccinations for children. ¹⁴

• Many other countries, including the United States, mandate some childhood vaccinations for school entry. ¹⁵

What vaccines are offered to older people?

• The flu vaccine is offered to all people over 65.

• The shingles vaccine is offered to anyone aged 70.

• The vaccine against Streptococcus pneumoniae is offered to anyone aged 65.

Vaccines offered to pregnant women

• 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.

Vaccine uptake in the general population

The National Institute for Health and Care Excellence (NICE) has recently created guidelines to encourage vaccine update in the general population.¹⁶

They have advised that all GP practices should have a vaccine lead to make sure that:

• Vaccination records for all their patients are up to date.

• All patients that need a vaccine are told they need one.

• All patients know how to book a vaccine appointment and where to go for them.

• Patients are reminded about vaccines if they forget to book one by letter, phone or text.

NICE has advised to seek out barriers to uptake such as (this list is not exhaustive):

• Inflexible and inconvenient clinic times and locations.

• Uncertainty about whether vaccines are needed (including how severe the diseases are or how likely it is that someone will be exposed to the disease).

• Previous negative experiences of vaccination.

• Lack of trust in the government, drug companies and the healthcare system.

• Religious or cultural views that are against vaccination (this may relate to specific vaccinations - for example, the human papillomavirus (HPV) vaccine.

Within the guidance, there is advice on opportunistic vaccinations such as in those attending antenatal appointments or during health checks. When people eligible for vaccination have been identified opportunistically, healthcare professionals should:

• Discuss any outstanding vaccinations with them (or their family members or carers, as appropriate) and offer vaccination immediately.

• Encourage them to book an appointment to discuss the vaccinations or an appointment for vaccination.

• Think about referring a child's parents or carers to the health visitor or school nurse, as age appropriate.

To help make it easier for people to get their vaccinations, practices can:

• Change times of clinics (evenings or weekends).

• Give options of where patients can get their vaccine, such as mobile units or community centres as well as their GP surgery.