UK immunisation schedule

Current UK immunisation schedule^{1 2}

The current UK vaccination schedule is shown below. It is the same for all areas of the UK.^{3 4 5 6}

UK 2020 Immunisation Schedule

What was new in 2018?

The injection that contains diphtheria, tetanus, pertussis, Hib and polio became 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.

• HPV immunisation for boys was introduced at 12-13 years, as for girls. There is no catch-up programme for boys aged over 13, as there was for girls on the introduction of the female HPV vaccination programme. This is on the basis that female vaccination has resulted in significant herd immunity for boys.⁸

What's new in 2020?

For infants born after 1st January 2020, pneumococcal vaccination is a two-dose schedule at 12 weeks and 12 months. For infants born before 1st January 2020, the three-dose schedule at 8 weeks, 16 weeks and 12 months remains in place.

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 (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.

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.⁹

• 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 2015.¹⁰ 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 11}

• 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.

• 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 2017.¹²

  • Parents who had separated had agreed, while together, not to vaccinate their children against 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.¹³

  • 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.¹⁴

• In France, parents became legally obliged to have their children vaccinated from 2018.

• In Italy, some state schools will not accept children who have not received routine vaccinations.

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.