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Immunisation Schedule (UK)

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

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 in 1999 and pneumococcus in 2006.1 This may be important in finding the non-immune. In 2008 human papillomavirus (HPV) vaccination was introduced into the routine childhood immunisation schedule.2

Current UK immunisation schedule3,4

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 2011 Immunisation Schedule:4
3 days
  1. BCG (if there has been tuberculosis in the family in the previous 6 months);
  2. Hepatitis B vaccine if mother is HBsAg +ve.
 
2 months
  1. Diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP/IPV/Hib).
  2. Pneumococcal conjugate vaccine (PCV).
  1. One injection (Pediacel®).
  2. One injection (Prevenar13®).
3 months
  1. Diphtheria, tetanus, pertussis, polio and H. influenzae type b (DTaP/IPV/Hib).
  2. Meningitis C (MenC).
  1. One injection (Pediacel®).
  2. One injection (NeisVac-C® or Meningitec®).
4 months
  1. Diphtheria, tetanus, pertussis, polio and H. influenzae type b (DTaP/IPV/Hib).
  2. Pneumococcal conjugate vaccine (PCV).
  3. Meningitis C (MenC).
  1. One injection (Pediacel®).
  2. One injection (Prevenar 13®).
  3. One injection (NeisVac-C® or Meningitec®).
Between 12 and 13 months
  1. Measles, mumps and rubella (MMR).
  2. Pneumococcal conjugate vaccine (PCV).
  3. H. influenzae type b, meningitis C (Hib/MenC).
  1. One injection (Priorix® or MMR II®).
  2. One injection (Prevenar 13®)
  3. One injection (Menitorix®).
3 years and 4 months to 5 years
  1. Diphtheria, tetanus, pertussis and polio (dTaP/IPV or DTaP/IPV).
  2. Measles, mumps and rubella (MMR).
  1. One injection (Repevax® or Infanrix-IPV®).
  2. One injection (Priorix® or MMR II®).
Girls aged 12 to
13 years
  • Cervical cancer caused by human papillomavirus (HPV) types 16 and 18.
  • HPV (Cervarix®) Three injections: (the second 1-2 months and third 6 months after first injection).
13-18 years
  • Tetanus, diphtheria and polio (Td/IPV).
  • One injection (Revaxis®).
Over 65 (and at-risk groups <65)
  • Annual influenza vaccination.
  • One-off pneumococcal polysaccharide vaccine (PPV) - including children over 2 years old (≥2 months after last dose of pneumococcal conjugate vaccine (PCV).
 
  • An acute febrile illness is a contra-indication to any vaccine.
  • Give live vaccines either together, or separated by ≥3 weeks.
  • Caution with live vaccines in patients who are immune-deficient (transplants, cancer chemotherapy, HIV infection) - seek expert advice.

More detail on individual vaccines

See separate articles:

Medicolegal issues5,6

  • 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 - e.g. which immunisation is being given, details of the disease(s) it protects against, side-effects of the immunisation(s) and their management, and the possible consequences if immunisations are declined.
  • Consent may be written, verbal or implied (e.g. 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. This may necessitate the advice of a community paediatrician or consultant in communicable disease control.
  • Adults aged over 18 can give their own consent provided they have capacity (see Mental Capacity Act). Children aged 16 or 17 are similarly presumed to be able to consent to their own treatment (Family Law Reform Act 1969) if they have capacity but, under some circumstances, their decisions can be overridden by a person with parental responsibility or by a court.7
  • 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. Parental responsibility can be acquired (see section 4 of the Children Act, 1989) either by (written) agreement with the mother, by court order, or by subsequently marrying the mother.8 Parental responsibility can also be given to other individuals by court 'parental responsibility orders' or 'residence orders'.
  • If the parent appoints another individual (e.g. 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 under 16 may consent or refuse, providing they are 'Fraser competent' (commonly known as 'Gillick competent', except that Mrs Gillick objected to the use of her name, so it is more properly known by the name of the judge who made the ruling). Fraser competent children should nevertheless be encouraged to involve the individual with parental responsibility in the decision.7
  • When in doubt, always involve a specialist. The Children Act allows parental responsibility to be overriden in the best interests of a 'Fraser incompetent' child in an emergency, but this is unlikely to arise in the situation discussed here.
  • Individuals giving consent should also be informed about how the immunisation data will be stored on the practice's system and centrally (data protection and Caldicott guidance).

Document references

  1. PL CMO (2006) 1: Important changes to the childhood immunisation programme, Dept of Health
  2. Introduction of Human Papillomavirus Vaccine into the national immunisation programme, Chief Medical Officer, PL CMO (2008)4
  3. About vaccinations, NHS Choices
  4. Immunisation against infectious disease - 'The Green Book', Dept of Health (various dates)
  5. Consent, Immunisation against infectious disease, The Green Book, Dept of Health, 2006
  6. Consent - Dept of Health Website; (detailed information regularly updated)
  7. Reference guide to consent for examination or treatment (second edition 2009), Dept of Health
  8. Children Act 2004

Internet and further reading

Acknowledgements

EMIS is grateful to Dr Huw Thomas for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2011.
Document ID: 1572
Document Version: 30
Document Reference: bgp1534
Last Updated: 17 Jan 2011
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