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Immunisation Schedule (UK)

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Active immunisation usually stimulates the immune system (humoral and cellular immunity).
Passive immunisation provides pre-formed antibody (non-specific or antigen-specific).
Diphtheria immunisation began in 1940, Pertussis in 1950s, BCG in 1953, Polio in 1958, Tetanus in 1961, Measles in 1968, Rubella in 1970, MMR 1988, Meningitis C in 1999 and Pneumococcus in 2006.1 This may be important in finding the non-immune. In 2008 human papilloma virus vaccination was introduced into the routine childhood immunisation schedule.2

UK immunisation schedule

Offer the schedule given here (see notes below).1,3

UK 2009/10 Immunisation Schedule:1
3 days
  1. BCG (if Tuberculosis in family in last 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 (PCV)
  1. One injection (Pediacel)
  2. One injection (Prevenar)
3 Months
  1. Diphtheria, tetanus, pertussis, polio and Haemophilus 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 Haemophilus influenzae type b (DTaP/IPV/Hib)
  2. Pneumococcal (PCV)
  3. Meningitis C (MenC)
  1. One injection (Pediacel)
  2. One injection (Prevenar)
  3. One injection (Neisvac C or Meningitec)
Around 12 months Haemophilus influenzae type b, Meningitis C (Hib/MenC) One injection (Menitorix)
Around 13 months
  1. Measles, mumps and rubella (MMR)
  2. Pneumococcal (PCV)
  1. One injection (Priorix or MMR II)
  2. One injection (Prevenar)
3 years and four months or
soon after
  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 types 16 and 18. HPV
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 PCV).
 

  • An acute febrile illness is a contraindication 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.
Target group of at-risk for influenza and/or pneumococcal vaccination

The national policy is that influenza vaccine (and one-off pneumococcal vaccination) should be offered to the following groups:4

  • All those aged 65 years and over
  • All those aged 6 months or over in a clinical risk group:
Influenza vaccination clinical risk groups 2008/094
Clinical risk groups Examples (decision based on clinical judgement)
Chronic Respiratory Disease
  • Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD)
  • Asthma - with disease which requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission
  • Children who have previously been admitted to hospital for lower respiratory tract disease
Chronic Heart Disease
Chronic Renal Disease
Chronic liver disease
Chronic Neurological Disease
  • Stroke
  • Transient ischaemic attack (TIA)
Diabetes
  • Type 1 diabetes
  • Type 2 diabetes requiring insulin or oral hypoglycaemic drugs
  • Diet controlled diabetes
Immunosuppression
  • Immunosupression due to disease or treatment
  • Patients undergoing chemotherapy leading to immunosuppression
  • Asplenia or splenic dysfunction
  • HIV infection
  • Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age) or for children under 20kg a dose of 1mg or more per kg per day.
    Some immunocompromised patients may have a suboptimal immunological response to the vaccine
  • Those living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality (this does not include prisons, young offender institutions, university halls of residence etc.)
  • Those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. This should be given on an individual basis at the GP’s discretion in the context of other clinical risk groups in their practice.

GPs should take into account the risk of influenza infection exacerbating any underlying disease that a patient may have, as well as the risk of serious illness from influenza itself.4 GPs should consider on an individual basis the clinical needs of their patients including individuals with:

  • Multiple sclerosis and related conditions
  • Hereditary and degenerative diseases of the central nervous system

Employers (e.g. Trusts) should offer influenza vaccination to staff directly involved in patient care as as an adjunct to good infection control procedures:4

  • Clinicians, midwives and nurses, paramedics and ambulance drivers
  • Occupational therapists, physiotherapists and radiographers
  • Primary care providers such as GPs, practice nurses, district nurses
  • Staff in nursing and care homes that look after older people
Target group of at-risk for pneumococcal vaccination3
Pneumococcal clinical risk groups those aged two months and over3
Clinical risk group Examples (base decision on clinical judgement)
Asplenia or dysfunction of the spleen e.g. homozygous sickle cell disease and coeliac disease
Chronic respiratory disease e.g. chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Patients with respiratory conditions caused by aspiration, or a neuromuscular disease (e.g. cerebral palsy) with a risk of aspiration.
Asthma is not an indication, unless continuous or frequently repeated use of systemic steroids (as defined in Immunosuppression below) is needed.
Chronic heart disease Patients requiring regular medication and/or follow-up for ischaemic heart disease, congenital heart disease, hypertension with cardiac complications, and chronic heart failure.
Chronic renal disease Includes nephrotic syndrome, chronic renal failure, renal transplantation.
Chronic liver disease Includes cirrhosis, biliary atresia, chronic hepatitis
Diabetes (requiring insulin or oral hypoglycaemic drugs) Includes type I diabetes requiring insulin or type 2 diabetes requiring oral hypoglycaemic drugs.
It does not include diabetes that is diet controlled.
Immunosuppression Due to disease or treatment, including asplenia or splenic dysfunction and HIV infection at all stages.
Patients undergoing chemotherapy leading to immunosuppression. Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone 20 mg or more per day (any age), or for children under 20 kg, a dose of ≥1 mg/kg/day.
Some immunocompromised patients may have a suboptimal immunological response to the vaccine.
Individuals with cochlear implants It is important that immunisation does not delay the cochlear implantation. Where possible, pneumococcal vaccination should be completed at least 2 weeks prior to surgery to allow a protective immune response to develop. In some cases it will not be possible to complete the course prior to surgery. In this instance, the course should be started at any time prior to or following surgery and completed according to the immunisation schedule.
Individuals with
cerebrospinal fluid leaks
This includes leakage of cerebrospinal fluid such as following trauma or major skull surgery.
Medicolegal issues
  • The importance of consent cannot be underestimated.5
  • Consent must be obtained before each injection. 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.
  • 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 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 have parental responsibility unless this is acquired under section 4 of the Children Act, either by agreement with the mother, by court order, or by marrying the mother.6
  • 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'7 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.
  • 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.


Document references
  1. DOH (UK); PL CMO (2006) 1: Important changes to the childhood immunisation programme. Department of Health.
  2. Introduction of Human Papillomavirus Vaccine into the national immunisation programme, Chief Medical Officer, PL CMO (2008)4,
  3. Immunisation against infectious disease - 'The Green Book', Department of Health (various dates)
  4. The influenza immunisation programme 2008/09, Department of Health, PL CMO (2008)
  5. NHS Immunisation Website; Patient information
  6. Children Act 2004
  7. Gillick Competence

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 2009.
Document ID: 1572
Document Version: 25
Document Reference: bgp1534
Last Updated: 29 Jan 2009
Planned Review: 29 Jan 2011

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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