Immunisation Schedule
The UK routine immunisation programme protects against multiple infectious diseases from birth through adulthood. Managed by UKHSA and guided by the Joint Committee on Vaccination and Immunisation (JCVI). Includes primary infant vaccinations (6-in-1, rotavirus, MenB, PCV13), childhood boosters, HPV, and adult programmes (flu, shingles, COVID-19).
Key Facts
6-in-1 vaccine (Infanrix hexa): diphtheria, tetanus, pertussis, polio, Hib, hepatitis B — given at 8, 12, 16 weeks MenB (Bexsero): 8 weeks, 16 weeks, 12 months; give paracetamol prophylactically to reduce fever Rotavirus (Rotarix): oral live vaccine at 8 and 12 weeks; must be given before 24 weeks of age MMR: 12 months and 3 years 4 months (pre-school booster); live vaccine HPV (Gardasil 9): all 12–13-year-olds (Year 8); single dose since 2023 MenACWY: 14 years (Year 9) — protects for university entry Influenza: annual nasal spray (Fluenz) for 2–17-year-olds; injectable for ≥65s, at-risk groups, pregnant women Shingles (Shingrix): recombinant vaccine; offered at 65 years and immunosuppressed from 50 years
Overview
Key Facts
The UK immunisation schedule is one of the most comprehensive globally. Uptake targets are 95% for herd immunity (WHO). The Green Book provides detailed guidance for all vaccines.
Epidemiology
- UK childhood vaccination uptake: ~90–95% (declining in some areas)
- MMR uptake fell after Wakefield fraud (1998); now recovering
- HPV vaccination: expected to eliminate cervical cancer within decades
- COVID-19 vaccination programme: largest in UK history
Key Principles
- Live vaccines: MMR, BCG, rotavirus, nasal flu, oral typhoid, yellow fever, varicella — contraindicated in immunosuppression and pregnancy
- Inactivated vaccines: safe in immunosuppression but may have reduced efficacy
- Minimum intervals: must be observed between doses of same vaccine; no maximum interval
- Multiple live vaccines: give simultaneously or ≥4 weeks apart
- Green Book: definitive UK reference for all immunisation queries
Pathophysiology of Vaccination
- Active immunisation: antigen exposure → B-cell and T-cell activation → memory cells → rapid response on re-exposure
- Live vaccines: attenuated pathogen replicates → strong, durable immune response
- Inactivated/subunit vaccines: non-replicating antigen → requires adjuvants and boosters for adequate response
- Conjugate vaccines: polysaccharide linked to protein carrier → T-cell dependent response effective in infants (e.g. MenB, PCV, Hib)
Clinical Presentation
Vaccine-Preventable Disease Presentations
- Measles: fever, cough, coryza, conjunctivitis, Koplik spots, maculopapular rash
- Pertussis: paroxysmal cough, inspiratory whoop, post-tussive vomiting
- Meningococcal disease: non-blanching purpuric rash, meningism, septic shock
- Rotavirus: severe watery diarrhoea in infants, dehydration
- HPV-related: cervical cancer, genital warts
Vaccine Adverse Effects
- Common: injection site pain, fever, irritability (especially MenB)
- Rare: febrile convulsion (~1 in 3,000 after MMR), anaphylaxis (~1 in 1,000,000)
- Specific: intussusception after rotavirus (very rare; 1–2 per 100,000)
Red Flags
- Anaphylaxis post-vaccination (adrenaline 1:1000 IM)
- Fever >39°C in neonate post-vaccination
- Encephalopathy within 7 days of pertussis-containing vaccine (extremely rare)
Differential Diagnosis
| Diagnosis | Key Features | Investigation |
|---|---|---|
| Vaccine reaction | Temporal relationship, self-limiting | Clinical observation |
| Coincidental infection | Symptoms beyond expected vaccine reaction | Septic screen if unwell |
| Kawasaki disease | Persistent fever >5 days, conjunctivitis, rash, extremity changes | ESR, CRP, echo |
| Immune thrombocytopenia | Petechiae/bruising post-MMR (rare) | FBC, blood film |
Diagnosis / Investigation
Pre-Vaccination
- Check contraindications: immunosuppression, pregnancy, severe allergy to previous dose/component
- Immunoglobulin levels: if suspected immunodeficiency
Post-Vaccination (if concerns)
- Antibody titres: to confirm seroconversion in immunocompromised
- Hepatitis B surface antibody: check response after HBV vaccination in healthcare workers (anti-HBs ≥10 mIU/mL)
- Yellow Card reporting: report suspected adverse reactions to MHRA
Special Situations
- HIV patients: check CD4 count — live vaccines if CD4 >200
- Post-transplant: re-vaccination schedule needed
- Asplenic patients: ensure MenACWY, PCV13/PPV23, Hib, influenza
Management
UK Routine Childhood Schedule (2024)
8 weeks: 6-in-1 (1st), rotavirus (1st), MenB (1st) 12 weeks: 6-in-1 (2nd), rotavirus (2nd), PCV13 (1st) 16 weeks: 6-in-1 (3rd), MenB (2nd) 12 months: Hib/MenC booster, MMR (1st), MenB (3rd), PCV13 (2nd) 3 years 4 months: dTaP/IPV (pre-school booster), MMR (2nd) 12–13 years: HPV (Gardasil 9 — single dose) 14 years: MenACWY, Td/IPV (school leaver booster)
Adult Programme
- Influenza: annually for ≥65, at-risk, pregnant, healthcare workers
- Pneumococcal (PPV23): ≥65 (single dose)
- Shingles (Shingrix): 65 years; 2 doses at 0 and 2 months
- COVID-19: per JCVI seasonal recommendations
Special Groups
- Pregnancy: pertussis (from 16 weeks gestation), influenza, COVID-19
- Asplenia: MenACWY, Hib, PCV13, PPV23, annual influenza
- HIV/immunosuppressed: avoid live vaccines if severely immunosuppressed; inactivated vaccines safe
- Healthcare workers: hepatitis B, influenza, MMR, varicella (if non-immune)
Catch-Up
- Missed vaccines should be given as soon as identified — no need to restart courses
Prognosis
- UK immunisation programme prevents an estimated 5,000 deaths/year
- MMR: >99% effective after 2 doses
- HPV vaccination: projected to eliminate cervical cancer in vaccinated cohorts
- Hib disease reduced by >99% since vaccine introduction
- MenB: ~75% effective against MenB disease
- Vaccine hesitancy: WHO top 10 global health threats — declining uptake risks outbreaks
Other Relevant Information
UK Childhood Immunisation Schedule Summary
| Age | Vaccines |
|---|---|
| 8 weeks | 6-in-1, Rotavirus, MenB |
| 12 weeks | 6-in-1, Rotavirus, PCV13 |
| 16 weeks | 6-in-1, MenB |
| 12 months | Hib/MenC, MMR, MenB, PCV13 |
| 3y 4m | dTaP/IPV, MMR |
| 12–13y | HPV |
| 14y | MenACWY, Td/IPV |
Live vs Inactivated Vaccines
| Live Vaccines | Inactivated/Subunit |
|---|---|
| MMR | 6-in-1 |
| BCG | MenB |
| Rotavirus | PCV13 |
| Nasal flu (Fluenz) | Injectable flu |
| Yellow fever | Hepatitis A/B |
| Varicella | HPV |
| Oral typhoid (Ty21a) | Shingrix |