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}

• 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.

This is effectively the same list as above, with the additional at risk groups of cochlear implants and CSF leaks.

• Tetanus Vaccination
• Diphtheria Vaccination
• Polio Vaccination
• Pertussis Vaccination
• Haemophilus Influenza type B Vaccination (HiB)
• Meningococcal C Vaccination
• MMR Vaccination
• BCG vaccination
• Hepatitis B Vaccination
• Influenza Vaccination
• Pneumococcal Vaccination.

• 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.