oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.
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.
UK 2013 Immunisation Schedule
Immunisation (Vaccine Given)
|Between 12 and 13 months|
|2, 3 and 4 years|
|3 years and four months to 5 years|
|Around 11-13 years (girls)|
|Around 13-18 years|
- 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/IPV(polio) booster is offered to pregnant women in the temporary immunisation programme (started September 2012). Aims to counter the rise in neonatal whooping cough.
- Pneumococcal conjugate vaccine (PCV) is a separate injection and was added to the routine immunisation schedule in September 2006.
- Meningitis C (MenC) vaccine is sometimes given as a separate injection but is combined with Hib for one injection.
- Td/IPV(polio) is tetanus, low-dose diphtheria and polio vaccines combined as one injection.
- 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.
- Immunisation against human papillomavirus (HPV) was introduced in the UK for girls in 2008.
- Vaccination against rotavirus gastroenteritis is due to commence in July 2013.
- Nasal flu vaccine is offered (starting in 2014) to children aged 2, 3 and 4 years. It is planned to offer flu immunisation to all primary and secondary school children in the very near future.
Active immunisation usually stimulates the immune system (humoral and cellular immunity). Passive immunisation provides pre-formed antibody (nonspecific or antigen-specific).
Diphtheria immunisation began in 1940, pertussis in the 1950s, BCG in 1953, polio in 1958, tetanus in 1961, measles in 1968, rubella in 1970, measles, mumps and rubella (MMR) in 1988, meningitis C (MenC) in 1999 and pneumococcus in 2006. This may be important in finding the non-immune. In 2008 human papillomavirus (HPV) vaccination was introduced into the routine childhood immunisation schedule. Rotavirus and shingles vaccination were added to the programme in 2013.
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.
Live vaccines may be temporarily contra-indicated in individuals who are:
Give live vaccines either together, or separated by ≥3 weeks.
More detail on individual vaccines
See separate articles:
- BCG vaccination.
- Bordetella pertussis (whooping cough) vaccination.
- Diphtheria and diphtheria vaccination.
- Hepatitis B vaccination and prevention.
- HIB vaccination - H. influenzae type b (Hib) vaccination.
- Human papillomavirus (HPV) vaccination.
- Influenza vaccination including target groups.
- Measles, mumps and rubella (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 article Mental Capacity Act).
- 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 felt a child was 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 & references
- Immunisation against infectious disease - the Green Book (latest edition); Public Health England
- Vaccination; NHS Choices
- Whooping Cough Vaccination Programme for Pregnant Women; Dept of Health, 2012
- Introduction of Human Papillomavirus Vaccine into the national immunisation programme; Dept of Health, May 2008
- Millions more protected against disease through improved vaccination programme; Dept of Health, April 2013
- Reference guide to consent for examination or treatment (second edition); Dept of Health, 2009
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Huw Thomas
Dr Louise Newson
Prof Cathy Jackson