Key Facts

The UK immunisation programme is one of the most comprehensive in the world. It is coordinated by the UK Health Security Agency (UKHSA) and follows the Green Book (Immunisation Against Infectious Disease). High uptake is essential for individual protection and herd immunity.

Epidemiology

UK childhood vaccination uptake for primary immunisations is approximately 91-93% (below the 95% WHO target for herd immunity). MMR uptake has been recovering since the Wakefield fraud but remains below 95% in some areas. Vaccine-preventable disease outbreaks (measles, pertussis) occur when uptake drops.

Aetiology

The schedule is designed to protect against the most serious childhood infections at the age of greatest vulnerability. Vaccines stimulate adaptive immunity (humoral and cellular) without causing the disease.

Pathophysiology

Vaccine types:

• Inactivated/killed: DTaP, IPV, HepB — cannot cause infection; need multiple doses
• Live attenuated: MMR, rotavirus, BCG, nasal flu — weakened pathogen; contraindicated in immunosuppression
• Conjugate: PCV13, MenB, MenACWY, Hib — polysaccharide linked to protein carrier for T-cell response
• Toxoid: Diphtheria, tetanus — inactivated toxin
• mRNA/viral vector: COVID-19 vaccines (not part of routine childhood schedule but relevant historically)

Common Post-Vaccination Reactions

• Injection site: Pain, redness, swelling (50%+)
• Systemic: Fever, irritability, poor feeding (especially after MenB — paracetamol recommended prophylactically)
• MMR: Fever and rash at 7-10 days ('mini measles') — not infectious
• Rotavirus: Mild diarrhoea

Red Flags

• Anaphylaxis post-vaccination — 1 in 1,000,000; treat per resuscitation protocol
• High fever >40°C — unusual; investigate for intercurrent illness
• Hypotonic-hyporesponsive episode — rare reaction to pertussis component; usually self-limiting
• Intussusception post-rotavirus — very rare (~1-6 per 100,000); present within 7 days

Bedside

• Post-vaccination monitoring: Observe for 15 minutes after vaccination
• Temperature: If febrile post-vaccination

Bloods

• Not routinely needed
• Antibody levels: Check in immunocompromised patients to assess vaccine response
• Immunoglobulin levels: If primary immunodeficiency suspected (poor vaccine response, recurrent infections)

Special Tests

• COVER (Cover of Vaccination Evaluated Rapidly): PHE programme monitoring vaccine uptake

Non-pharmacological

• Informed consent: Parents should receive information leaflet before each vaccination
• Correct technique: IM injection (anterolateral thigh in infants, deltoid in older children)
• Cold chain management: Vaccines stored at 2-8°C; do not freeze

Pharmacological

• Paracetamol prophylaxis: Recommended for MenB vaccination (120mg at vaccination, then at 4-6h and 4-6h later for infants 2-3 months)
• Catch-up schedules: For missed or delayed vaccinations — Green Book provides detailed guidance
• Immunocompromised children: Live vaccines contraindicated; may need additional doses of inactivated vaccines; specialist advice from immunology

Referral Criteria

• Suspected immunodeficiency (recurrent infections, poor vaccine response) — immunology
• Severe adverse reaction (anaphylaxis) — allergy assessment; report via Yellow Card
• Parents with vaccine concerns — address with evidence-based information; do not refuse registration

• Vaccine efficacy: DTaP ~85-90% after primary course; MMR ~93% after 1 dose, ~97% after 2 doses; MenB ~88% against MenB strains
• Herd immunity threshold: Measles ~95%; pertussis ~92-94%
• Eradication successes: Smallpox eradicated globally; polio eliminated from most countries
• UK measles outbreaks: Occur when MMR uptake drops below 95% — emphasises importance of maintaining high uptake
• Adverse events: Serious reactions extremely rare; benefits far outweigh risks for all routine vaccines

UK Childhood Immunisation Schedule (2024/25)

Live vs Inactivated Vaccines