Normal immunisation schedule for all people in the UK
UK 2013 Immunisation Schedule
Immunisation (Vaccine Given)
|Between 12 and 13 months||
|3 years and four months to 5 years||
|Around 12-13 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). This aims to counter the rise in whooping cough in newborn babies.
- 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 by mouth (oral vaccine) as a few drops of vaccine on the tongue.
- Measles, mumps and rubella vaccines are combined into one injection - MMR.
- Immunisation against human papillomavirus (HPV) was introduced in the UK for girls in 2008.
- Rotavirus vaccination is due to commence in the UK in July 2013.
- Nasal flu vaccine will be offered to children aged 2 in a number of pilot schemes from September 2013. The programme will be fully rolled out to all pre-school and primary school-aged children from 2014. Secondary school children may be part of pilot schemes from 2014, with full roll out planned from 2015.
How does immunisation work?
The body is given a vaccine which is a small dose of an inactive form of a germ (bacterium or virus), or a poison (toxin) made by the germ. As it is inactive, it does not cause infection. However, the body makes antibodies and/or white blood cells (immune cells) against the germ or toxin. Antibodies are proteins in the bloodstream that attack infecting germs. Once we are immunised, the antibodies and/or immune cells are ready to attack the germ if it begins to invade our body. More antibody can quickly be made from cells which have previously made the particular antibody.
For some bacteria and viruses it has been difficult to produce a vaccine, but technology is advancing and new vaccines will be available in the future.
A newborn baby has passive immunity to several diseases, such as measles, mumps and rubella, from antibodies passed from its mother via the placenta. This passive immunity of babies usually only lasts for a few weeks or months but, for measles, mumps and rubella, it lasts up to one year. Immunisation with vaccines is called active immunity and provides long-term immunity.
Immunisation has caused dramatic improvements in health; diphtheria, tetanus, whooping cough (pertussis), measles and polio are now rare in many countries. Some immunisations are offered to all people through the childhood immunisation programme. Some are offered to at-risk groups - listed below.
What if I forget about or delay immunisations?
If the usual schedule is interrupted or delayed for any reason, it can be resumed at any time. There is no need to start again. However, it is best to have the immunisations at the correct time, as the earlier the child is protected, the better. Some exceptions to this rule are:
- Whooping cough (pertussis) vaccine is not usually given to children over the age of 7 years.
- Meningitis C (MenC) vaccine. If the child starts immunisation over the age of 4 months, then only two doses of MenC are needed, four weeks apart. If the child is over 1 year old and has not had any previous doses of MenC then only one dose is needed.
- Hib vaccine. If the child is over 13 months but under 4 years, and has not had any previous doses, then only one dose is needed. Hib is not given to children aged over 4 years, as the risk of infection from this germ (bacterium) is much less than in young children and babies.
- Pneumococcal conjugate vaccine (PCV). If a child between the ages of 1 and 2 years has not had any previous dose of PCV, or only had one previous dose, then a single dose of PCV should be given. Children aged over 2 years and who are not in an at-risk group do not need to be immunised.
Which diseases are prevented with childhood immunisations?
Diphtheria is caused by the germ (bacterium) Corynebacterium diphtheriae. It causes a serious throat and chest infection. Since immunisation was started in the 1950s, diphtheria has now become rare in the UK.
Haemophilus influenzae type b (Hib) is a bacterium which can cause pneumonia and meningitis. Children under the age of 4 are most at risk. Before the introduction of the vaccine in 1992, 1 in 600 children developed some form of Hib disease before their fifth birthday. It is now rare.
Measles is caused by the measles virus. It causes a miserable feverish illness with a rash. Complications occur in some cases, such as pneumonia, convulsions or encephalitis (brain inflammation). Before the introduction of a measles vaccine in 1968, measles was a common childhood illness. It is now rare in the UK, although the incidence of measles is increasing in some areas due to some children not being immunised.
Mumps is caused by the mumps virus. The infection typically causes inflammation and swelling of the salivary glands. Complications occur in some cases, such as pancreatitis, inflammation of the testes (orchitis), meningitis, and inflammation of the brain (encephalitis). Mumps may cause permanent deafness in one ear. Again, mumps is now rare in the UK due to immunisation.
Rotavirus is a viral infection that can cause vomiting and diarrhoea. In most cases the infection clears within a few days, but sometimes takes longer. It is easily spread from an infected person to another by close contact. Outbreaks of rotavirus that affect many people can occur - for example, in nurseries or schools. Around 18,000 children are thought to be admitted to hospital each year in England and Wales because of rotavirus infection. Most children with rotavirus infection do not need admission to hospital.
German measles (rubella) is caused by the rubella virus. It causes a mild illness with a rash. However, if a pregnant women has rubella, the virus is likely to cause serious damage to the unborn child. The child is likely to be born with multiple defects (congenital rubella syndrome). The aim of rubella immunisation is to eliminate the rubella virus from the community as much as possible. Since rubella immunisation was introduced in 1970 there has been a dramatic fall in the number of babies born with the congenital rubella syndrome.
Group C meningococcus is a bacterium which is one cause of meningitis and severe blood poisoning (septicaemia). There are other types of meningococcus, but cases of meningitis and septicaemia caused by group C have fallen since immunisation was introduced.
Whooping cough (pertussis) is caused by a bacterium called Bordetella pertussis. This causes a prolonged and distressing cough. Some infected children develop complications such as pneumonia or brain damage. There used to be regular epidemics of whooping cough in the UK before immunisation became available. It is now uncommon in the UK.
Pneumococcus is a bacterium which can cause pneumonia, meningitis and some other infections. Pneumococcal infection can affect anybody. However, young children, people aged 65 and over, and some other groups of people are at increased risk of pneumococcal infection.
Polio (poliomyelitis) is an illness caused by the polio virus. The virus first infects the gut, but then travels to the nervous system and can cause a meningitis-like illness. This may damage some nerves. This may lead to wasting of muscles and sometimes paralysis of one or more of the limbs. The illness can seriously affect breathing in some people and may even lead to death.
Tetanus is an infection caused by a bacterium called Clostridium tetani which is found in the soil. It causes severe and agonising muscle contractions and is often fatal. Due to immunisation, it is very uncommon in the UK.
Human papillomavirus (HPV) is a virus that can affect the skin and mucosa (the moist membranes lining different parts of the body, including the mouth, throat and genital area). There are over one hundred different types of HPV and about 40 of these can affect the genital area. Two types, HPV 16 and 18, are involved in the development of most of the cases of cancer of the cervix. The HPV vaccine is very effective at stopping cancer of the cervix from developing.
Further immunisations for at-risk groups
If you travel abroad
If you travel abroad it is recommended that you should be protected against the local infections if immunisations are available. Ideally, see your practice nurse or GP for advice on travel at least two months prior to your departure. Doctors and nurses are regularly updated with immunisation requirements for every country in the world.
The flu jab (seasonal influenza immunisation)
Seasonal influenza is the strain of influenza virus that arrives in the UK each autumn. The actual strain varies from year to year and a new immunisation is developed each year to protect against the prevailing strain. The current influenza vaccines contain two different types of influenza A and one type of influenza B virus.
The aim is to protect people who are more likely to develop complications from flu. You should be immunised against flu each autumn if you are aged 65 or over. Also, people of any age in any of the following at-risk groups. If you:
- Have any chronic (ongoing) lung diseases. Examples include: chronic bronchitis, emphysema, cystic fibrosis and severe asthma (needing regular steroid inhalers or tablets). It is also recommended for any child who has previously been admitted to hospital with a chest infection.
- Have a chronic heart disease. Examples include angina, heart failure or if you have ever had a heart attack.
- Have a serious kidney disease. Examples include nephrotic syndrome, kidney failure, a kidney transplant.
- Have a serious liver disease such as cirrhosis.
- Have diabetes.
- Have a poor immune system. Examples include if you are receiving chemotherapy or steroid treatment (for more than a month), if you have HIV/AIDS or if you have had your spleen removed.
- Have certain serious diseases of the nervous system, such as multiple sclerosis, or have had a stroke in the past.
- Live in a nursing home or other long-stay residential care accommodation.
In addition to the main at-risk groups of people listed above:
- You should be immunised if you are the main carer for an elderly or disabled person whose welfare may be at risk if you fall ill with influenza.
- Staff involved in direct patient care may be offered a flu jab from their employer.
- Pregnant women. Even if you are otherwise healthy it is now recommended that all pregnant women receive the influenza immunisation.
From September 2013 all children aged 2 years will be offered a nasal flu immunisation. This programme will be extended to all pre-school and primary school aged children from 2014. Secondary school children may be part of pilot schemes from 2014, with full roll out planned from 2015.
Pneumococcus is a germ (bacterium) that can cause pneumonia and meningitis. Immunisation against pneumococcus with the pneumococcal conjugate vaccine (PCV) became part of the routine childhood immunisation programme in the summer of 2006.
In addition, people who are at increased risk of infection with this bacterium should be immunised. For children under 5 years old this is with the (routine) PCV plus a one-off dose of pneumococcal polysaccharide vaccine (PPV) as soon as possible after the second birthday. For people aged over 5 years, it is with a one-off dose of PPV.
You are at increased risk, and should be immunised, if you:
- Are aged 65 or over.
- Do not have a spleen or if your spleen does not work properly.
- Have an ongoing (chronic) serious lung disease. Examples include chronic bronchitis, emphysema, and cystic fibrosis. It is only recommended for those with very severe asthma who need frequent courses of steroid tablets.
- Are a child who has previously been admitted to hospital with pneumonia.
- Have a chronic heart disease. Examples include congenital heart disease, angina, heart failure or if you have ever had a heart attack.
- Have a serious chronic kidney disease. Examples include nephrotic syndrome, kidney failure or if you have had a kidney transplant.
- Have a chronic liver disease such as cirrhosis or chronic hepatitis.
- Have diabetes which requires insulin or tablets to control it.
- Have a poor immune system. Examples include if you are receiving chemotherapy or steroid treatment (for more than a month), if you have HIV/AIDS or if you have previously had your spleen removed.
- Have a cochlear implant.
- Have a cerebrospinal fluid (CSF) shunt (a shunt to drain the fluid that surrounds the brain).
Immunisation against tuberculosis (the BCG vaccine)
The BCG vaccine (BCG stands for bacillus Calmette-Guérin) is offered to the following people in the UK:
- All infants (0-12 months old) living in areas of the UK where there is a high rate of tuberculosis (TB). That is, areas where the incidence of TB is 40 cases per 100,000 people per year or greater.
- Infants whose parents or grandparents were born in a country with a high rate of TB. That is, countries where the incidence of TB is 40 cases per 100,000 people per year or greater.
- The following groups of people who have not previously been immunised:
- Children (under 16 years) who have come to live in the UK from countries where TB is common (at least 40 cases per 100,000 people per year).
- Children between the ages of 6-16 years who have a parent or grandparent who was born in a country where the incidence of TB is 40 cases per 100,000 people per year or greater.
- Children under 16 years old who are close contacts of an individual who has active TB affecting their lungs.
- Children under 16 years old who were born in, or have lived for more than three months in, a country where the incidence of TB is 40 cases per 100,000 people per year or greater.
- People at an increased risk due to their job. For example, health workers, prison staff, etc.
Note: until 2005, all schoolchildren in the UK were routinely given the BCG vaccine at about the age of 13. The policy changed in autumn 2005 and those now immunised are in the groups listed above. The policy change was due to the changing patterns of TB in the UK.
Rates of the disease are now very low in many parts of the country and children living in these areas have a very low risk of infection. However, in other areas, rates of TB are increasing. This is why the BCG vaccine is now mainly targeted at babies living in areas where there is an increasing rate of TB cases. Your doctor or midwife will be able to tell you if you live in an area with a high rate of TB.
Children who would previously have been offered BCG through the schools' programme will now be screened for risk factors, tested and immunised as appropriate.
Hepatitis B immunisation
This is advised for people who are at increased risk of contracting hepatitis B. For example:
- Workers who are likely to come into contact with blood products, or are at increased risk of needlestick injuries, assault, etc. For example, nurses, doctors, dentists, medical laboratory workers, prison wardens, etc. Also, staff at residential centres where there is a risk of scratching or biting by residents.
- People who inject street drugs, and the sexual partners and children of those people.
- People who change sexual partners frequently.
- People who live in close contact with someone infected with hepatitis B. (You cannot catch hepatitis B from touching people or normal social contact. However, close regular contacts are best immunised.)
- People who regularly receive blood transfusions (for example, for haemophilia).
- People with certain kidney or liver diseases.
- People who live in residential accommodation for those with learning difficulties. People who attend day centres for people with learning difficulties may also be offered immunisation.
- Families adopting children from countries with a high or intermediate prevalence of hepatitis B when the hepatitis B status of the child is unknown. (It is, however, advisable for the child to be tested for hepatitis B.)
- Foster carers or if you live with foster children.
- Prison inmates.
- Travellers to countries where hepatitis B is common, who place themselves at risk when abroad. The risk behaviour includes sexual activity, injecting drug use, undertaking relief work and/or participating in contact sports. Also, if you may need a medical or dental procedure in these countries and the procedure may not be done with sterile equipment.
- Babies who are born to infected mothers.
Immunisation against chickenpox (varicella)
A vaccine is offered to healthcare workers (doctors, nurses, etc) who have not previously had chickenpox and so are not immune and may catch chickenpox. (About 1 adult in 10 has not had chickenpox as a child.) If you are not sure if you have had chickenpox then a blood test can check if you have previously had it.
The aim is to protect healthcare workers from developing chickenpox, but also patients. If chickenpox does not occur in any healthcare staff, this protects patients with a poor immune system (such as people with leukaemia) who may catch chickenpox from a healthcare worker who may be developing a chickenpox infection without realising it.
Close contacts of people with a poor immune system who are not immune to chickenpox should also have this immunisation. For example, brothers and sisters of a child with leukaemia who have not previously had chickenpox. Infection with chickenpox can be very serious for people with a poor immune system.
The vaccine is also sometimes given to patients who may develop a weakened immune system in the future. For example, those who are likely to need high doses of steroid tablets. Your doctor will be able to give more information about this.
In some special circumstances other immunisations are considered. For example, workers who handle animals may be offered rabies immunisation. Those in close contact with people who have certain forms of meningitis may be offered specific immunisations. Discuss with your doctor or practice nurse if you think you fall into one of these groups.
Adults - are you fully immunised?
Some adults are not fully immunised against polio and tetanus. These immunisations were first introduced into the UK in the late 1950s. If you were born before then you might not have received full protection from these illnesses. Your practice nurse will be able to advise you if you are unsure.
Who should NOT be immunised?
There are very few reasons why people should not receive their full course of immunisations. Immunisations are generally very safe and effective. The main reasons for a person not to have a vaccine is if they have had a severe allergic reaction to a previous dose of that vaccine or to an ingredient in the vaccine that was also present in a different vaccine.
Live vaccines (for example, the BCG vaccine) are not usually given to women who are pregnant.
See the separate leaflets on individual immunisations for more details.
Information on immunisation from the NHS
Further reading & references
- Immunisation against infectious disease - the Green Book; Dept of Health (latest edition)
- Routine childhood immunisations from November 2010, Dept of Health
- Pregnant women to be offered whooping cough vaccination, Dept of Health, 28 September 2012
- Immunizations - childhood; NICE CKS, November 2012
- Millions more protected against disease through improved vaccination programme; Dept of Health, April 2013
|Original Author: Dr Tim Kenny||Current Version: Dr Louise Newson||Peer Reviewer: Prof Cathy Jackson|
|Last Checked: 02/05/2013||Document ID: 4275 Version: 44||© EMIS|
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.