Childhood Immunisations
Routine childhood immunisation programme
The overall aim of the routine childhood immunisation programme is to protect all children against the following preventable childhood infections:
- diphtheria
- tetanus
- pertussis (whooping cough)
- Haemophilus influenzae type b (Hib)
- polio
- meningococcal serogroup C (MenC)
- measles
- mumps
- rubella
- pneumococcal
The immunisation schedule
The schedule for routine immunisations and instructions for how they should be administered are given in Table 11.1.
Primary immunisation with diphtheria, tetanus, pertussis, polio and Hib (DTaP/IPV/Hib) vaccine is given at two, three and four months of age.
Pneumococcal vaccine is given at two and four months. MenC vaccine is given at three and four months. This ensures completion of the primary course at an appropriate age to provide protection against infections such as whooping cough, pneumococcal, Hib and meningococcal serogroup C, which are most dangerous for the very young.
Every effort should be made to ensure that all children are immunised, even if they are older than the recommended age range; no opportunity to immunise should be missed.
If any course of immunisation is interrupted, it should be resumed and completed as soon as possible. There is no need to start any course of immunisation again.
| When to immunise | What vaccine is given | How it is given |
|---|---|---|
| Two months old | Diphtheria, tetanus,pertussis (whooping cough), polio and Hib (DTaP/IPV/Hib) | One injection |
| Pneumococcal (PCV) | One injection | |
| Three months old | Diphtheria, tetanus, pertussis (whooping cough), polio and Hib (DTaP/IPV/Hib) | One injection |
| MenC | One injection | |
| Four months old | Diphtheria, tetanus, pertussis (whooping cough), polio and Hib (DTaP/IPV/Hib) | One injection |
| MenC | One injection | |
| PCV | One injection | |
| Twelve months old | Hib/MenC | One injection |
| Around 13 months old | Measles, mumps and rubella (MMR) | One injection |
| PCV | One injection | |
| Three years four months to five years old | Diphtheria, tetanus, pertussis and polio (DTaP/IPV or dTaP/IPV) | One injection |
| Measles, mumps and rubella (MMR) | One injection | |
| Thirteen to 18 years old | Tetanus, diphtheria and polio (Td/IPV) | One injection |
Details of immunisation procedures are given in Chapter 4 and in the relevant disease-specific chapters.
Children should have received these vaccines by these ages:
| Age | Vaccine |
|---|---|
| By four months: | Three doses of DTaP/IPV/Hib. Two doses of PCV and MenC. |
| By 14 months: | A booster dose of Hib/MenC and PCV and the first dose of MMR. |
| By school entry: | Fourth dose of DTaP/IPV or dTaP/IPV and the second dose of MMR. |
| Before leaving school: | Fifth dose of Td/IPV. |
When babies are immunised in special care units, or children are immunised opportunistically in accident and emergency units or inpatient facilities, it is most important that a record of the immunisation is sent to the primary care trust, NHS trust or health board by return of an "unscheduled immunisation form".
Vaccination of children with unknown or incomplete immunisation status
For a variety of reasons, some children may not have been immunised or their immunisation history may be unknown. If children coming to the UK are not known to have been completely immunised, they should be assumed to be unimmunised and a full course of immunisations should be planned.
Where a child born in the UK presents with an inadequate immunisation history, every effort should be made to clarify what immunisations they may have had. A child who has not completed the routine childhood programme should have the outstanding doses as described in the relevant chapters.
Children coming to the UK who have a history of completing immunisation in their country of origin may not have been offered protection against all the antigens currently protected against in the UK. For country-specific information, please refer to http://www.who.int/immunization_monitoring/en/globalsummary/ countryprofileselect.cfm.
Children coming from developing countries, from areas of conflict or from hard-to-reach population groups may not have been fully immunised. Where there is no reliable history of previous immunisation, it should be assumed that children are unimmunised and the full UK recommendations should be followed.
Children coming to the UK may have had a fourth dose of a diphtheria/tetanus/pertussis-containing vaccine that is given at around 18 months in some countries. This dose should be discounted, as it may not provide satisfactory protection until the time of the teenage booster. The routine pre-school and subsequent boosters should be given according to the UK schedule.
Premature infants
It is important that premature infants have their immunisations at the appropriate chronological age, according to the schedule. There is no evidence that premature babies are at increased risk of adverse reactions from vaccines (Slack et al., 2001).
Selective childhood immunisation programmes
There are a number of selective childhood immunisation programmes that target children at particular risk of certain diseases, such as hepatitis B, tuberculosis, influenza and pneumococcal. For more information please see the relevant chapters.
Adult immunisation programme
Five doses of diphtheria, tetanus and polio vaccines ensure long-term protection through adulthood. Individuals who have not completed the five doses should have their remaining doses at the appropriate interval. Where there is an unclear history of vaccination, adults should be assumed to be unimmunised. A full course of diphtheria, tetanus and polio should be offered in line with advice contained in the relevant chapters.
Older adults (65 years or older) should be routinely offered a single dose of pneumococcal polysaccharide vaccine, if they have not previously received it. Annual influenza vaccination should also be offered.
Selective vaccines should also be considered for young adults unprotected against diseases including measles, mumps, rubella and meningococcal C. Other vaccinations should be considered for any adult with underlying medical conditions and those at higher risk because of their lifestyle. These vaccinations include Hib, MenC, influenza, pneumococcal and hepatitis B. For more information please see the relevant chapters.
Reference
Slack MH, Schapira D, Thwaites RJ et al. (2001) Immune response of premature infants to meningococcal serogroup C and combined diphtheria-tetanus toxoids-acellular pertussis-Haemophilus influenzae type b conjugate vaccines. J Infect Dis 184 (12): 1617-20.
This information is also available as a downloadable PDF document - "The UK Childhood Immunisation Programme"...here...