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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 and Meningitis C in 1999. This may be important in finding the non-immune.
In 2006 pneumococcal vaccine was introduced into the routine childhood immunisation schedule. 1
There is a catch-up programme planned and there is enough vaccine for children born between 5 September 2004 and 3 August 2005 can be vaccinated opportunistically now, rather than waiting for schedule.1
Offer the schedule given here from 4th September 2006 (see notes below).1 2
UK immunisation schedule: (from 4th September 2006)1 |
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| 3 days |
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| 2 months |
|
|
| 3 Months |
|
|
| 4 Months |
|
|
| Around 12 months | Haemophilus influenzae type b, Meningitis C (Hib/MenC) | One injection (Menitorix) |
| Around 13 months |
|
|
| 3 years 4 months - 5 years |
|
|
| 13-18 years | Tetanus, diphtheria and polio (Td/IPV) | One injection (Revaxis) |
| Over 65 (and at risk groups <65) |
|
|
- 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 follow should be offered annual infuenza vaccinations and one-off pneumococcal vaccination:
- Chronic respiratory disease including, COPD, bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD), and asthma (requiring continuous or repeated use of inhaled or oral steroids, or previous exacerbations requiring hospitalisation), and children previously hospitalised with a lower RTI.2
- Chronic heart disease including congenital heart disease, hypertension with cardiac complications, chronic heart failure and individuals requiring regular medication and/or follow-up for ischaemic heart disease.
- Chronic renal disease including nephrotic syndrome, chronic renal failure, renal transplantation.
- Chronic liver disease including cirrhosis.
- Diabetes mellitus requiring insulin or oral hypoglycaemic drugs.
- Immunosuppression due to disease or treatment including asplenia or splenic dysfunction, HIV infection at all stages, patients undergoing chemotherapy leading to immunosuppression, individuals treated with systemic steroids for more than a month equivalent to 20mg/day (any age) or 1mg/kg/day in children.
The following should also be offered influenza vaccinations:
- Those living in long-stay residential care homes or other long-stay care facilities (does not include prisons, young offender institutions, university halls of residence etc).
- Main carers if elderly or disabled person's welfare at risk if the carer falls ill.
Pneumococcal Clinical Risk Groups for Children1 |
|
| Clinical risk group | Examples (base decision on clinical judgement) |
| Asplenia or dysfunction of the spleen | eg homozygous sickle cell disease and coeliac disease |
| Chronic respiratory disease | eg 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 20mg or more per day (any age), or for children under 20kg, a dose of ≥1mg/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. |
This is effectively the same list as above, with the additional at risk groups of cochlear implants and CSF leaks.
- The importance of consent cannot be underestimated. 3
- 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.4
- 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'5 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
- DOH (UK) PL CMO (2006) 1: Important changes to the childhood immunisation programme
- Department of Health; The Green Book. Immunisation Against Infectious Disease 2006
- Immunisation UK Website
- Children Act 2004
- Gillick Competence
Internet and further reading
- DOH Adult Immunisation Update (Pneumococcus/Flu) 2003
- DOH. Protecting Healthcare workers from Hep. B.
- Guidance for Health Care Workers- Prevention of Blood Borne infections (Hep B and HIV)
DocID: 1572
Document Version: 21
DocRef: bgp1534
Last Updated: 28 Sep 2006
Review Date: 27 Sep 2008
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
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