Patient professional reference
Offer the schedule given here (see notes below). The immunisation clinic is a good opportunity to pass on health promotion material to parents and older children. The immunisation schedule is the same across the countries of the UK[3, 4, 5, 6].
UK 2016 Immunisation Schedule
Immunisation (Vaccine Given)
|Between 12 and 13 months|
|3 years and four months |
|12-13 years (girls)|
- Diphtheria, tetanus, pertussis (whooping cough), polio and Hib are combined into one injection - the DTaP/IPV(polio)/Hib vaccine.
- Five doses of the combined diphtheria, tetanus and polio vaccine are enough to provide long-term protection through adulthood, but:
- A DTaP 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.
- 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®).
- Polio immunisation changed in 2004. The polio vaccine is now combined with DTaP/Hib or Td and given by injection. It used to be given as an oral vaccine in a few drops of vaccine on the tongue.
- 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.
Dr Hayley Willacy draws your attention to the introduction of a new vaccine for all infants born in the United Kingdom from August 1st 2017 . They will be offered a hexavalent (six components) vaccine (Hib-DTaP-hepatitis B-poliovirus). The new vaccine will replace the existing pentavalent (five component) vaccine to extend its protection against hepatitis B virus (HBV) in addition to diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type b disease. There will not be any change to the timing of the routine childhood immunisation schedule, with the hexavalent vaccine replacing the vaccine previously given at 8, 12, and 16 weeks of age.
How vaccines work
Immunity may be active or passive:
- Active immunity is protection against infectious disease produced by one's own immune system and is usually long-lasting. It is acquired by having the disease itself, or vaccination to it. It involves serum antibodies, cellular response (controlled by T lymphocytes) or a combination (eg, T cells stimulating B cells to produce antibodies). Vaccines aim to provide similar immunity to having had the illness but without the effects and risks of illness.
- Passive immunity is the transfer of antibodies from an immune individual. Most commonly this occurs from mother to baby across the placenta. It may also be induced by transfusion of blood or blood products containing immunoglobulin.
Vaccines work by inducing active immunity. They may be made from:
- Inactivated (killed) organisms (eg, pertussis and the inactivated poliomyelitis virus IPV vaccines).
- Attenuated live organisms (eg, MMR, yellow fever, nasal flu, rotavirus); or
- Inactivated toxins or other cell products from the organism - for example:
- Toxins (diphtheria and tetanus vaccines).
- Surface proteins (flu vaccine).
- Polysaccharide from the capsule (pneumococcal vaccine).
This may be important in finding the non-immune. The year in which the following vaccinations were introduced in the UK was as follows:
- 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 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 Men ACWY).
Cautions and contra-indications
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.
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).
- Individuals with a confirmed anaphylactic reaction to egg should not receive influenza or yellow fever vaccines.
- 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 may be temporarily contra-indicated in individuals who are:
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.
More detail on individual vaccines
See separate articles dealing with the following:
- 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.
- The importance of consent cannot be underestimated.
- Consent is valid provided the individual giving consent has been offered as much information as they reasonably need to make an informed decision, in a form they can understand - eg which vaccination is being given, details of the disease(s) it protects against, side-effects of the vaccination(s) and their management, and the possible consequences if vaccinations are declined.
- Consent may be written, verbal or implied (eg, bringing the child to the surgery rather than taking to school) but should be recorded on each occasion.
- Consent must be obtained before each injection. When vaccinating children aged under 16, parents should feel involved in the decision, and their concerns should be fully answered.
- Adults aged over 18 can give their own consent provided they have capacity (see separate Mental Capacity Act article). Gillick-competent 16- and 17-year-olds may also consent to their own treatment.
- In children under 16 years of age, consent should be obtained from an individual with 'parental responsibility'. The natural father of a child, who was not married to the mother at the time of the child's birth, will not automatically have parental responsibility unless the child was born after 1st December 2003, and he is named as the father on the birth certificate.
- If the parent appoints another individual (eg, a grandparent) to act in loco parentis, it is the parent's responsibility to inform the surgery about this, by letter or phone. The surgery must record this information in the patient's medical record and should not give the injection without it.
- A child aged under 16 may consent or refuse, providing they understand what is involved in the proposed procedure (referred to fully as 'Gillick-competent'). Ideally their parents will be involved. If the health professional giving the immunisation feels a child is not Gillick-competent then the consent of someone with parental responsibility should be sought.
- If a person aged 16 or 17 or a Gillick-competent child refuses treatment, that refusal should be accepted. It is unlikely that a person with parental responsibility could overrule such a refusal. It is possible that the court might overrule a young person's refusal if an application to court is made under section 8 of the Children Act 1989 or the inherent jurisdiction of the High Court.
Further reading and references
Immunisation against infectious disease - the Green Book (latest edition); Public Health England
Immunisation schedule; NHS Health Scotland
Immunisation for children; NI Direct
Vaccinations; NHS Direct Wales
Whooping Cough Vaccination Programme for Pregnant Women; Dept of Health, 2012
Hexavalent combination vaccine: programme guidance; Public Health England (July 2017)
Revised recommendations for the administration of more than one live vaccine; Public Health England (PHE). April 2015
Reference guide to consent for examination or treatment (second edition); Dept of Health, 2009
All doctors and health practitioners say the same thing.....that the Gardasil vaccine is safe, lots of doses given with no bad reactions, consequences of getting cancer can be prevented, etc. etc. I...chelles
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