Immunisation Schedule (UK)

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

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

• 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.

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:

• 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

• Tetanus Immunisation
• Diphtheria Vaccination
• Polio Vaccination
• Pertussis Vaccination
• Haemophilus Influenza type B Vaccination (HiB)
• Human Papilloma Virus Vaccine
• Meningococcal C Vaccination
• MMR Vaccination
• BCG Vaccination
• Hepatitis B Vaccination
• Influenza Vaccination
• Pneumococcal Vaccination

• 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.