Vaccination Schedule (UK)

almostadoctor.co.uk/encyclopedia/vaccination-schedule

Dr Tom Leach

Routine Vaccinations
UK vaccination schedule as of May 2018

Age Diseases Vaccines

2 months Diphtheria Rotavirus DTaP/IPV/Hib/HepB (Infanrix

Tetanus Hib hexa)
Pertussis PneumococcusHep Pneumococcal Conjugate
PolioMeningitis B B vaccine (PCV)
Rotavirus (Rotarix)MenB (Bexsero)

3 months Diphtheria Polio DTaP/IPV/Hib/HepB (Infanrix

Tetanus Hib hexa)
Pertussis Rotavirus (Rotarix)
Rotavirus

4 months Diphtheria Polio DTaP/IPV/Hib/HepB (Infanrix

Tetanus Hib hexa)
PertussisMeningitis Pneumoccocus PCV vaccine
B MenB (Bexsero)

12 Hib Meningitis C MMR Hib/MenC (Menitorix)

months Pneumococcus PCVMMR

3 years Diphtheria Polio DTaP/IPV Infanrix IPV or Repevax,

and 4 Tetanus MMR MMR
months Pertussis

Girls aged Cervical Cancer HPV (Human papilloma vaccine)

12-13 – Gardasil

13- Diphtheria Polio Td/IPV (Revaxis)

18 (usually Tetanus MenACWY (Menveo or Nimenrix)
age 14)

Age 65 Pneumococcal Pneumococcal Polysaccharide

Vaccine (PPV)

Age 65+ Influenza – annually Inactivated influenza vaccine –

various brands

Age 70 Shingles Shingles (Zostavax)

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In addition, all children aged 2 to 8 years old should receive an annual Flu vaccination – this is
a live attenuated vaccination – Fluenz Tetra. It is given intranasally.

*DTaP – Diphtheria, Tetanus and Pertussis

*IPV – Inactivated poliovirus vaccine
*Td – Tetanus and Diphtheria vaccine

All the vaccinations are “inactive”, except for MMR and the flu vaccine, which are combinations
of modified live vaccines (we call these “live attenuated vaccines”).

Live attenuated vaccines are more likely to cause generalised side effects (see below), and
expert advice should be sort before administering to immunocompromised patients

Schedules vary between countries (and between states within countries). Note that in many
developed countries it is also common to vaccinate against varicella (chicken pox) in childhood.

General side effects

Swelling at the site of the injection
Fever
Malaise
Anaphylaxis (Very rare)
Symptoms of mild disease in the case of MMR
Don’t give vaccine if the child has a fever /acute illness at the planned time of
vaccination. However, if there is no fever, and a minor infection (e.g. cough or cold), it is
still appropriate to vaccinate.
Febrile Convulsions – can occur after vaccination in some patients, particularly if there is
a family history. Advice on how to reduce / prevent fever to such families may be
beneficial.
Immunocompromised children should not receive live vaccines. The exception to the
rule is that MMR can be given to children with HIV.

Other vaccinations
TB (BCG vaccination) – given at birth to babies who are likely to come into contact with TB.
This is usually when there is:
Someone known to have TB, or previously had TB within the family
The family originates (within 2 generations) from a country known to have a high TB
risk; e.g. if the child’s parents or grandparents had previously lived in Pakistan.
Routine TB vaccination no longer occurs in the UK
Hep B (Hep B vaccination) – given at birth to babies whose mother, or other close family
contacts, are Hep B positive. Advice should also e given about sharing toothbrushes and
other household items.

Levels of protection

Vaccination Provides Info

Immunity?

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Polio In most Given IM. Uses an inactive form of the virus (i.e.
(IPV vaccine) cases dead!). The live oral vaccination (OPV) no longer widely
Aka Salk used in the developed world, but does provide contact
vaccine immunity, and thus is useful in the developing world.
Immunity declines with time, but this is not necessarily
a problem in developed countires due to herd
immunity, and the basic level of protection still
afforded by previous vaccination.
The Polio virus needs a large reservoir of infected hosts
to sustain itself in a population. As a result, with
vaccination programs in the Western World, it is no
longer present in many countries. It is thought that
eventually it will be eradicated completely by world-
wide use of vaccination.
Side effects are not particularly common

DTaP In most The DTaP vaccine is now used in most developed

Diphtheria cases countries, as it uses cell products (acellular) and not
Tetanus whole cells, instead of the full cells used in the older
Pertussis DTP vaccine. This reduces the side effects of the
vaccine, but make it more expensive, so DTP is still
used in many developing countries. DTP vaccine causes
severe neurological deficits in 1 in 14,000 cases – thought
to be the result of the pertussis used. Other side
effects of the old DTP vaccine include fever, agitation,
and unusual crying patterns (continuing for hours,
often high-pitched).
Booster vaccinations (usually the Tdap vaccine) are
required every 10 years for continued immunity.
If a child has serious side effects with the DTaP vaccine,
(fever, soreness, vomiting, decreased apetitie, seizures,
anaphylaxis), then the Td vaccine is a safe alternative
for Diphtheria and Tetanus immunity, as most of the
side effects are related to the pertussis component of
the vaccine. Pertussis vaccine controversy – in the
1970’s there was a supposed link between the pertussis
vaccine and neurological complications, with
subsequent drop in vaccination rate, and epidemics of
whooping cough. It is now thought that these are rare,
are more likely to be caused by pertussis infection than
by the vaccine. However, any child with neurological
signs should not receive the vaccine until these resolve.

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 Hib Yes Uses cell products, often known as the conjugate
(95-100% vaccine. Side effects are rare. Hib causes meningitis,
of cases) pneumonia and epiglottitis. The incidence of all these
conditions has dramatically declined since the
introduction of the vaccination in the 1980’s.

MMR Yes (99% Contains three live viruses. The second dose is not a
cases after ‘booster’ but is another dose of the vaccine to hopefully
2 doses) provide immunity to those that did not develop it the
first time around (5-10% of cases). Measles is now
considered eradicated in many western countries.
There is absolutely no link with autism.
Side effects:
Rash, fever, loss of apetitie about 10 days after jab
(due to measles virus). Lasts 2-3 days
Swollen lymph nodes (due to mumps virus). Lasts
3-4 days
Stiff swollen joints [RARE] (due to rubella vaccine) –
lasts 3 days

Contraindications
Immunodeficiency of non-HIV origin
Allergy to neomycin or kanamycin
Allergy to egg products – vaccine should still be given
but with medical supervision and recuss equipment
present.

PCV Yes – but Uses bacterial proteins. Does provide immunity, but
Pneumococcus see info only against 7 of ~90 pneumococcal strains.

MenC Another conjugate vaccine containing bacterial

products. Protects against Meningitis C, but not other
forms of Meningitis. Possible side-effects just involve
fever and soreness at injection site.

Side effects can still occur in acellular, conjugate and inactive vaccinations – however
these are usually related to the immune response, and not to the vaccination products
themselves. They are usually self limiting, and may last from a few hours to a few days. They will
include things like:

Fever
Soreness (at the injection site)
Aching limbs
Drowsiness
Also – always be wary of allergy / anaphylaxis!

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Live vaccines
Essentially cause a ‘mild’ form of the disease they are designed to protect against.
They are more likely to give lifelong protection than inactivated versions, but are also higher
risk, with a greater range and incidence of side effects, and a small chance, in some individuals,
that they can develop a full-blown version of the disease they were vaccinated against.

Live vaccines will tendto produce life-long immunity after 1-2 doses.

Many people will have few (if any) side effects, whilst some may experience symptoms
consistent with a mild form of the disease. Rarely, they can cause severe symptoms, usually in
‘at risk’ patients (e.g. immunocompromised), and thus such individuals may not be vaccinated,
and instead, rely on ‘herd immunity’ for their protection.

Herd Immunity
Infectious disease relies on a chain of individuals to infect. If this chain is broken (i.e. the
disease comes into contact with an immune individual), then the disease cannot be passed on.

The higher the proportion of the population that is immune, the lower the
likelyhood of an infected individual coming into contact with another susceptible
host.
Thus if the ‘chain is broken’, unvaccinated individuals are also protected to some extent
due to the reduced pool of infected individuals from which to contract the disease.
The herd immunity threshold is the percentage of individuals that need to be vaccinated
for herd immunity to be an effective method of protecting the rest of the population. This
value varies according to the disease, but is typically 75-95%.
Thus, in a simple scenario, if a government wishes to eradicate a disease from their
population, and they intend to vaccination everybody, they need a vaccine that is
only 75-95% effective. On the other hand, they could have a vaccine that is 100%
effective, and they need only vaccinate 75-95F of the population.
In reality, they will likely use a mixture of the above two scenarios, as a small
proportion of the population (i.e. those with serious disease / immunocompromised
etc) cannot be vaccinated.

Children are particularly good at carrying disease and infecting others. This is partly related to
their physiology, partly due to their levels of hygiene (e.g. hand washing behaviours, sticking
things in their mouths etc) and partly because they come into contact with so many other
individuals (e.g. at school and nursery). Vaccination schemes in children also reduce the
incidence of disease in the adult population, as the infectious agents have a vastly reduced pool
of hosts.

Contact Immunity
This is possible with some live vaccines. In the vaccinated individual, the live virus is able to
replicate, and be passed onto others, who then also receive the benefits, as if they had been
vaccinated. The most widely used of these vaccines is the OPV polio vaccine.
The main problem with using live viruses, is that some vaccinated individuals may develop
severe symptoms of the disease they have been vaccinated against. And with the contact
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immunity phenomenon, even those who have not been vaccinated, but who ‘catch’ the virus
from a vaccinated individual may develop the disease. The risk however, is very small, and is
usually confined to immunosupressed individuals.

References
Complete routine immunisation schedule

Read more about our sources

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