Previous changes

June 2025 — reviewed.  A literature search was conducted in May 2025 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic has been updated in line with the current national immunization guidance from the UK Health Security Agency. Specifically, details relating to eligibility for the influenza vaccine, changes to the vaccination schedule for Meningitis B and Pneumococcal vaccine, and the new 18 months appointment for those born on or after 1 July 2024 have been added to the topic. Details relating to the use of Haemophilus influenzae b and meningitis C (Hib/MenC) vaccine have been removed as production has been stopped, and the vaccine is expected to be unavailable from the middle of 2025. There have also been minor structural changes to the topic.

May 2025 — minor update. QOF indicators updated in line with the NHS England Quality and Outcomes Framework guidance for 2025/26.

July 2024 — minor update. The use of MenQuadfi® has been added as an option for immunization against Meningococcal groups A, C, W and Y in line with the UKHSA updated guidance Meningococcal ACWY programme: information for healthcare professionals.

June 2023 — minor update. The HPV vaccination schedule has been updated in line with the updated chapter on Human papillomavirus (HPV) in the UKHSA document Immunisation against infectious disease (the Green Book) which now recommends a one-dose schedule for people aged under 25 years. 

August 2022 — minor update. UK and international immunisation schedule comparison tool has been added to the 'unknown immunization history' sections. 

March 2022 — minor update. Information that the severe combined immunodeficiency (SCID) screening result should be checked before giving BCG or rotavirus vaccines has been added to this topic in line with UK Health Security Agency (UKHSA) guideline The complete routine immunisation schedule February 2022. A recommendation that people who have not had their first dose of HPV vaccine by the time they are 15 years old should be offered two doses given at least 6 months apart has been added in line with the UK Health Security Agency letter Changing to a 2 dose NHS HPV vaccination schedule for eligible adolescents and adults starting the course after they turn 15 years old, including men who have sex with men (MSM).  

February 2022 — minor update. Information that Gardasil^®9 vaccine will replace Gardasil^® vaccine from 2022 has been added to this topic. Information added about avoiding live vaccines for children up to 12 months after birth exposed to infliximab during pregnancy. 

July 2021 — minor update. The detail on managing missed doses of meningococcal B vaccination has been updated in line with PHE advice. 

May 2021 — minor update. A recommendation that Revaxis should be used with caution in people with phenylketonuria has been added to this topic in line with the manufacturer's Summary of Product Characteristics.

January to February 2021 — reviewed. A literature search was conducted in January 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.

November 2020 — minor update. A table has been updated with information about eligibility for the HPV vaccine.

October 2020 — minor update. The routine immunization schedule has been updated to include pneumococcal conjugate vaccine (PCV) at 12 weeks and one year for children born after 1 January 2020 in line with the Public Health England document Routine childhood immunisations. Reference to the previous PCV immunization schedule for children born before this date has been removed. 

August 2020 — minor update. The age range of children who should receive the live attenuated influenza vaccine LAIV (Fluenz Tetra) has been updated in line with the NHS England letter The national flu immunisation programme 2020 to 2021 - update.

July 2020 — minor update. The scope of the topic has been updated to include children with underlying medical conditions, a table has been added with details of additional vaccinations required for people with underlying medical conditions and there has been some minor restructuring. 

June 2020 — minor update. Advice on missed doses of MenB in children aged 1-2 years has been clarified.

May 2020 — minor update. There are now two potential variations in administering MenB vaccines. The vaccination schedule for children up to 1 year of age has been updated in line with the manufacturer's SPC.

February 2020 — minor update. The vaccination schedule for pneumococcal vaccine has been updated in line with the Public Health England letter Changes to the infant pneumococcal conjugate vaccine schedule PHE, 2019. 

September 2019 — minor update. The recommendations for scheduled immunizations have been updated in line with the NHS England letter The national flu immunisation programme 2019/20 NHS England, 2019, and the chapter The UK immunisation schedule in the Public Health England (PHE) document Immunisation against infectious disease ('Green Book') PHE, 2019 to include HPV vaccination in all children aged 12-13 years and flu vaccination in children aged 2–10 years.

February 2018 — minor update. SPC added for Infanrix vaccine.

July 2017 — minor update

• Reviewed and updated following the publication of the Public Health England (PHE) recommendations on the routine immunization schedule June 2017. PHE (2017) Hexavalent combination vaccine: programme guidance. www.gov.uk [Free Full-text]. 
• The following changes have been made in response to updated PHE recommendations on the routine childhood immunization schedule:
• From autumn 2017, all babies born on or after 1 August 2017 will become eligible for a hexavalent vaccine which includes hepatitis B (HepB) for their primary immunisations. This vaccine, called Infanrix hexa®, will replace the pentavalent infant vaccines Infanrix®-IPV+Hib and Pediacel®.
• All babies born on or after 1st August 2017 will become eligible for the vaccine eight weeks after their birth. Infanrix hexa® vaccine is expected to be made available to order online through the ImmForm website (www.immform.dh.gov.uk) from 1st September 2017 and will be distributed by Movianto UK for use in the routine childhood primary immunisation schedule at 8, 12 and 16 weeks of age.
• Infants born before 1st August 2017 should complete the course with pentavalent vaccine (Pediacel® or Infanrix-IPV+Hib®). Infanrix hexa® should only be given to babies born before 1st August if there is no locally held vaccine stock and no further Pediacel® or Infanrix-IPV+Hib® can be ordered through ImmForm. It should also be given if pentavalent vaccine is not readily available - vaccination should never be delayed in order to obtain the pentavalent vaccine.

November 2016 — minor update.

• Information about the availability of the Public Health England (PHE) leaflets MenC vaccination programme , MMR vaccination and Meningitis and septicaemia: information for new university entrants have been added to this topic.
• Clinical immunosuppression has been specifically highlighted as contraindication to the administration of live vaccines in response to a Medicines and Healthcare products Regulatory Agency (MHRA) Drug safety update Live attenuated vaccines: avoid use in those who are clinically immunosuppressed MHRA, 2016.

May to July 2016 — reviewed. A literature search was conducted in May 2016 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. 

The following changes have been made in response to updated PHE recommendations on the routine childhood immunization schedule (July 2016):

• The meningococcal group B (MenB) vaccine has been included at 8 weeks, 16 weeks, and one year old.
• The MenC vaccine previously given at 12 weeks of age has been removed from the schedule.
• The influenza vaccination programme now covers children aged two to eight years old (including children in school years 1, 2, and 3).
• The dosing schedule of human papillomavirus vaccine (Gardasil®) has been changed to two doses given 6 to 24 months apart for girls 12–13 years of age.
• A dose of tetanus, diphtheria, and polio vaccine is recommended specifically at 14 years old (school year 9) rather than 13–18 years old.
• The MenC vaccine previously given at 14 years of age has been replaced by MenACWY vaccine.
• A MenACWY catch-up programme is currently underway for older adolescents and new starters at university up to the age of 25 years.
• Changes have been made to the sections on Missed doses and Unknown immunization history to reflect these amendments to the routine childhood immunization schedule and the updated PHE guidance on Vaccination of individuals with uncertain or incomplete immunisation status (July 2016).

Key structural changes to the topic include: 

• Removal of the sections on how vaccination leads to immunity and types of vaccines. This information is available in chapter 1 of the PHE publication Immunisation against Infectious Disease, commonly referred to as the 'Green Book', available at www.gov.uk. 
• Removal of the scenario 'Childhood immunization programme' and addition of a summary table of the routine immunization schedule into the Background information section.

November 2014 — three minor updates:

• Update to the text regarding co-administration of the chickenpox vaccine and the measles mumps and rubella (MMR) vaccine in line with 'The Green Book', chapter 34: Varicella.
• Update to the text regarding the dosing interval for the MMR vaccine for children under two years of age.
• Minor typographical error corrected regarding the age of administration of the HPV vaccine.
• Update to the dosing schedule for the HPV vaccine in children aged 15 years and older in line with 'The Green Book', chapter 18a: Human papillomavirus (HPV).

September 2014 — minor update to the influenza immunization schedule to include children aged two, three and four in line with 'The Green Book', chapter 11: The UK immunisation schedule.

June 2014 — two minor updates:

• Influenza — the influenza vaccine has been added to the routine immunization schedule for children aged two and three years old on the 1st. September 2013.
• Meningitis — recommendations to vaccinate new entrants to university and to offer young adults under the age of 25 years (not entering university) have been added.

May 2014 — two minor updates to the text have been made in line with government policy as discussed in Immunisation against Infectious Disease (the 'Green Book'), published by Public Health England:

• Infanrix®has been introduced alongside Pediacel as the infant primary vaccine.
• From September 2014, the number of human papillomavirus (HPV — Gardasil®) vaccines has been reduced from a three- to two-dose course for adolescent girls.

February 2014 — minor update. Removed reference to Cervarix® vaccine as Gardasil® is the HPV vaccine of choice, as recommended by the Department of Health in Immunisation against Infectious Disease (the 'Green Book'), chapter 18a: Human papillomavirus (HPV).

December 2013 — minor update. Correction of minor typographical errors.

May 2013 — minor update. The text has been amended to reflect new guidance from Public Health England in Immunisation against Infectious Disease (the 'Green Book') regarding the addition of rotavirus vaccination for infants, and the changes to the MenC vaccination schedule.

January 2013 — minor update. Change to the text to reflect Department of Health advice in Immunisation against Infectious Disease (the 'Green Book'), chapter 8: Vaccine safety and the management of adverse events following immunisation, on the use of paracetamol and ibuprofen to prevent fever at the time of vaccination.

November 2012 — reviewed. A literature search was conducted in September 2012 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. Changes have been made to the recommendation on immunizing children against chickenpox.

August 2012 — minor update. Text revised to reflect Department of Health recommendations in Immunisation against Infectious Disease (the 'Green Book'), chapter 18a: Human papillomavirus (HPV) to switch from Cervarix^® to Gardasil^® human papillomavirus (HPV) vaccine for the national immunization programme from September 2012.

June 2012 — minor update. Minor typographical error corrected.

November 2010 — minor update. A letter from the Chief Medical Officer included the Joint Committee on Vaccination and Immunization recommendations that, from October 2010, the vaccines currently given at 12 months (Hib/MenC) and 13 months of age (MMR, PCV) should be given at the same visit, between 12 and 13 months of age, to simplify the routine childhood immunization schedule. 

October 2010 — technical update. The management section of this topic has been simplified to improve clarity and navigation. There have been no changes to the clinical content or meaning of the recommendations.

March 2010 — minor update. Prevenar^® has been replaced by Prevenar 13^®. 

June 2009 — minor update. The Hib catch-up programme ceased on 3 March 2009. The pre-school booster has now reverted to DTaP/IPV (Infanrix-IPV^®) or dTaP/IPV (Repevax^®). This topic has been updated accordingly. 

February 2009 — minor update. Information from the Rapid Response Report from the National Patient Safety Agency added, regarding the risks of omitting Hib when administering Infanrix-IPV+Hib^®, if the powdered Hib component is not reconstituted using the contents of the pre-filled syringe. 

December 2008 — minor update. Black triangle removed from Infanrix-IPV^®, Infanrix-IPV+Hib^®, Menitorix^®, Pediacel^®, and Repevax^®. 

October 2008 — minor update to clarify dosing schedule of human papillomavirus (HPV) vaccine. 

September 2008 — minor update. New preparation of MMR vaccine, MMRVAXPRO^® replaces MMR II^®. A reference to the MMR catch-up programme 2008/2009 is also included based on The MMR catch-up programme from the Department of Health. 

August 2008 — minor update. Black triangle status removed from Prevenar^® vaccine. The introduction of the human papillomavirus vaccine into the national immunization programme to protect against the future risk of cervical cancer is summarized based on Introduction of human papillomavirus vaccine into the national immunisation programme from the Department of Health. 

March 2008 — minor update. New text added regarding potential risk of apnoea in premature infants or those with a history of respiratory immaturity. Issued March 2008.

October 2007 to February 2008 — converted from CKS guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence. There are no major changes to the recommendations. This topic has been updated from the guidelines published by the Department of Health, Immunisation against infectious disease (the 'Green Book').

March 2007— minor update to include prescriptions for Infanrix-IPV+Hib vaccine. 

October 2006 — minor update to include the new recommendations for the childhood immunization programme from the Chief Medical Officer. 

November 2005 — minor update to include new information from the Senior Medical Officer regarding changes in the supply and administration of Tuberculin PPD for Mantoux testing. 

July 2005 — updated to include new advice from the Chief Medical Officer on changes to the BCG vaccination programme. Minor updates also made to the text in the Vaccinations procedures and Suitability for vaccination sections. Information from Medicines management incorporated into Complications and prognosis and What if the vaccination history is unknown or incomplete? sections. 

September 2004 — updated to include new vaccines and advice from the Joint Committee on Vaccination and Immunization. Validated in September 2004.

January 2004 — written. Validated in March 2004 and issued in June 2004.

New evidence

Evidence-based guidelines

No new evidence-based guidelines since May 2025.

The latest Vaccine update from the UK Health Security Agency can be found here: https://www.gov.uk/government/collections/vaccine-update.

HTAs (Health Technology Assessments)

No new HTAs since 1 May 2025.

Economic appraisals

No new economic appraisals relevant to England since 1 May 2025.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 May 2025.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 May 2025.

New policies

January 2026 UKHSA Introduction of a routine varicella (MMRV) vaccination programme for children at one year and 18 months [Free full-text]

New safety alerts

No new safety alerts since 1 May 2025.

Changes in product availability

• New product ProQuad® (measles, mumps, rubella and varicella vaccine, live) powder and solvent for suspension for injection in a pre-filled syringe. Licensed for simultaneous vaccination against measles, mumps, rubella & varicella in individuals from 12 months of age, and can also be administered to individuals from 9 months of age under special circumstances (e.g. outbreaks, travel to region with high prevalence of measles). See more here.

Diphtheria

• Diphtheria is an acute infectious disease typically caused by toxigenic strains of Corynebacterium diphtheriae and Corynebacterium ulcerans, and rarely by Corynebacterium pseudotuberculosis. It is characterized by the formation of a grey, thick, fibrinous, adherent membrane (pseudomembrane) affecting the upper respiratory tract.
  • Classical respiratory diphtheria presents with membranous pharyngitis, fever, cervical lymphadenopathy, and oedema of the soft tissues ('bull neck' appearance). In some cases, the pseudomembrane can cause death due to respiratory obstruction.
  • Milder infections without toxin production present similarly to streptococcal pharyngitis and may not involve the classical pseudomembrane, particularly in people who have been vaccinated.
  • Cutaneous diphtheria appears as vesicles that become ulcerated and covered with an eschar (hard, bluish-grey, raised membrane), usually on the limbs, particularly the legs.
  • Infected people may have both respiratory and cutaneous symptoms.
  • Diphtheria toxin can also cause heart failure and paralysis by affecting the myocardium, nervous, and adrenal tissues. 
• The best evidence to support the efficacy of diphtheria-containing vaccines is that the disease has been virtually eradicated in the UK since the immunization programme began in the 1940s. 
  • In 2022, toxigenic strains of corynebacteria were isolated from 87 people in England (predominantly Corynebacterium diphtheriae). Three deaths were reported (two in people with toxicogenic Corynebacterium ulcerans). This compares with 61,000 cases of diphtheria in the UK in 1940, with 3,283 deaths.
  • However, it is more prevalent in some countries, with cases continuing to be reported in South-East Asia, South America, Africa, Oceania and India, emphasizing the need for continued vaccination in the UK to prevent outbreaks from carriers from overseas.

[UKHSA, 2025c; UKHSA, 2025d]

Haemophilus influenzae

• Haemophilus influenzae (usually the encapsulated strains) can cause serious invasive disease, especially in young children. There are six typeable capsular serotypes (a–f), with serotype b causing most clinical disease until the introduction of the vaccine against it.
  • The most common presentations of invasive disease are meningitis (60%), epiglottitis (15%), and bacteraemia without an obvious focus (10%). The remaining 15% of cases are made up of septic arthritis, osteomyelitis, cellulitis, pneumonia, and pericarditis.
  • The most common presentations of invasive disease include meningitis, epiglottitis, septic arthritis, osteomyelitis, cellulitis, pneumonia, and pericarditis.
  • Non-encapsulated strains are mostly associated with respiratory infections.
• Before vaccination against Haemophilus influenzae type B (Hib), one in 600 children developed some form of invasive Hib disease before their fifth birthday. 
  • Following the introduction of the conjugate Hib vaccine in 1992, the annual incidence of invasive disease caused by the bacteria fell rapidly; from approximately 780 reports of Hib disease in England and Wales in children under 5 years of age in 1992, to around 20 cases per year by 1998.
  • After 1999, there was a small increase in the number of Hib infections reported, but following a booster campaign in 2003, cases returned to the low levels previously achieved. 
  • During 2023 in England, there were 706 laboratory-confirmed cases of invasive H. influenzae, of which 85.4% were in people aged 15 years and over. The overall incidence of invasive H. influenzae disease was 1.24 per 100,000 population.
  • There were 16 cases of Hib disease in England in 2023, of which 81.2% occurred in people aged 15 years and over, and 18.8% in children under 5 years old. There were no deaths attributed to invasive Hib disease in 2022 or 2023.

[UKHSA, 2024a; UKHSA, 2025e]

Hepatitis B

• Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV).
  • Most new infections with HBV are sub-clinical or may only cause a flu-like illness. However, acute infection occasionally leads to sudden and severe liver damage that can be fatal.
  • Acute illness usually starts with anorexia, nausea, an ache in the right upper abdomen, fever (which, when present, is usually mild), and malaise (which may be profound). Jaundice may occur in 10% of younger children and in 30–50% of adults, with a progressive darkening of the urine and lightening of the faeces as jaundice progresses.
  • Chronic HBV infection can result in progressive liver disease, leading to cirrhosis (development of scar tissue) in some people, as well as an increased risk of liver cancer.
• The UK is a very low-prevalence country, but prevalence varies by location and among sub-populations.
  • In low-endemicity countries such as the UK, most infections are acquired in adulthood via sexual transmission or sharing of blood-contaminated needles and equipment among people who inject drugs.
  • People born in high-endemicity countries who have migrated to the UK have a higher prevalence of infection, many of whom will have been infected at birth or in early childhood. 
• In the UK, the Joint Committee on Vaccination and Immunisation (JCVI) recommends that all infants are vaccinated with a combination hepatitis B, diphtheria, tetanus, polio, pertussis, and Hib vaccine as part of the routine infant immunization programme.  

[UKHSA, 2025f; UKHSA, 2025g]

Human papillomavirus

• Human papillomavirus (HPV) is a double-stranded DNA virus, with at least 100 types having been documented in humans (around 40 of these infect the genital tract).
  • Genital HPV infections are transmitted through sexual contact with an infected person. 
  • Non-sexual routes of HPV transmission include vertical transmission from mother to newborn baby.
• HPV is the most important cause of cervical cancer (detectable in more than 99% of cases), and the two high-risk HPV types 16 and 18 are responsible for almost 60% and more than 15% of all cervical cancers in Europe, respectively. HPV is also associated with other cancers, including those of the vulva, vagina, penis, and anus, and some cancers of the head and neck. 
  • The time span between infection with HPV and the development of cervical pre-cancerous and cancerous lesions is 1–10 years. 
  • Each year, around 3300 new cases of cervical cancer are diagnosed in the UK. Between 2017 and 2019, cervical cancer accounted for around 2% of all new cancer cases in females, with the highest incidence rates in females aged 30 to 34.
  • Compared with heterosexual men, gay, bisexual and other men who have sex with men (GBMSM) are more likely to be infected with HPV and have a higher burden of HPV related disease and adverse outcomes.
  • For more information, see the CKS topics on Cervical cancer and HPV and Cervical screening.
• Low-risk HPV types such as 6 and 11 are responsible for genital warts, which are the most commonly diagnosed viral sexually transmitted infection in the UK.
  • Although not life-threatening, genital warts may cause significant morbidity.
  • Warts may appear from 3 weeks to 8 months after primary infection, and treatment may remove the warts but may not eliminate infection, putting the person at risk of recurrence and further viral transmission in the future.
• HPV vaccines are highly effective at preventing infection with HPV types covered by the vaccines. Gardasil^®9 is the nine-valent vaccine used in the UK childhood immunization programme, and it covers HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
  • The vaccine is over 99% effective at preventing pre-cancerous lesions associated with HPV types 16 and 18 in young women, and protection is maintained for at least 10 years.
  • Gardasil^® is 99% effective in preventing genital warts associated with HPV types 6 and 11 in young women. 
  • Evidence on HPV vaccination in males is more limited, but indicates that the vaccine is safe and efficacious against genital HPV infection and high-grade anal intraepithelial lesions.

[CRUK, 2021; UKHSA, 2023a]

Measles

• Measles (a morbillivirus of the paramyxovirus family) is an acute viral infection.
  • Clinical features may include malaise, coryza, conjunctivitis, cough, Koplik spots (red spots with a bluish-white centre on the oral mucosa), erythematous, maculopapular rash, and fever.
  • Complications include otitis media, pneumonia, diarrhoea, convulsions, or rarely, post-infectious encephalitis (which occurs at around 1 week after the onset of the rash). Sub-acute sclerosing panencephalitis (SSPE) is a rare, fatal, late complication.
  • Measles infection is associated with an age-related case–fatality ratio, which is highest in children under 1 year of age, teenagers and adults, and lowest in children aged 1–9 years.
  • For more information, see the CKS topic on Measles.
• Historical evidence shows that the measles vaccine is effective. As uptake of the vaccine has increased, the incidence of measles has fallen correspondingly, and vice versa. 
  • Before the measles vaccine was introduced in 1968, notifications of measles infection in England and Wales varied between 160,000 and 800,000 each year, with peaks every 2 years, and around 100 deaths per annum. By the late 1980s, notifications had reduced to 50,000–100,000 due to low vaccination coverage. When the combined measles, mumps, and rubella (MMR) vaccine was introduced in 1988 and coverage exceeded 90%, notifications fell substantially. 
  • In the late 1990s and early 2000s, national vaccine coverage at 2 years of age dropped to below 80% due to concern around the discredited link between the vaccine and autism. In 2006, endemic transmission was re-established, and catch-up campaigns targeted children and teenagers who had missed doses of the vaccine.
  • In 2016, the WHO declared the UK had eliminated endemic measles. In England, vaccine coverage of the first MMR dose reached the WHO 95% target for the first time in 2016/17. However, annual vaccine coverage estimates for MMR at 2 years of age have been decreasing slowly since 2013/14, and measles transmission was re-established in the UK in 2018.
  • The latest measles notification statistics for England and Wales cover the period of the COVID pandemic, which describe 669 cases in 2020 and a projected 360 for 2021. Prior to the pandemic, there were 2,421 notifications in 2019 and 2,557 in 2018.

[UKHSA, 2019; UKHSA, 2022a]

Meningococcal infection

• Meningococcal infection commonly presents as meningitis or septicaemia, or both, and is caused by Neisseria meningitidis. 
  • Less commonly, meningococcal infection may present with pneumonia, myocarditis, endocarditis, pericarditis, arthritis, conjunctivitis, urethritis, pharyngitis, or cervicitis.
  • Meningococci are distinguished by their antigenic grouping. The most common serogroups which cause invasive disease in the UK are B, C, W, and Y.
  • Children under five years of age have the highest incidence of meningococcal disease, with peak incidence in those under one year old. A secondary peak in incidence is also observed among 15–19 year-olds.
  • Approximately 5–10% of cases result in fatality, and survivors may experience severe long-term complications such as hearing loss, severe visual impairment, communication problems, limb amputation(s), seizures, and brain damage.
  • For more information, see the CKS topic on Meningitis - bacterial meningitis and meningococcal disease.
• The best evidence on the effectiveness of meningococcal vaccines is provided by steep declines in notified cases following their introduction:
  • Following the introduction of the MenC vaccine in 1999, an approximate 96% decline in cases of meningitis caused by the group C serogroup was observed.
  • In 2015, a four-component MenB vaccine (4CMenB) was included in the routine UK infant immunization schedule (initially given at 8 weeks, 16 weeks, and one year). An analysis of vaccine effectiveness conducted using data collected during the first 3 years of the program indicated a 75% reduction in the incidence of MenB among vaccine-eligible cohorts in comparison with the expected incidence.
    • The adjusted vaccine effectiveness (prevention of invasive group B meningococcal disease) against MenB for infants up to 1 year old who had completed the two-dose priming schedule was 52.7%. For children up to 2 years old who had completed the two-dose priming schedule with an additional booster dose at 1 year, the adjusted vaccine effectiveness was 59.1%.
    • Secondary analysis excluding positive cases of MenB infection due to strains that the vaccine does not protect against indicated that the effectiveness may be slightly higher, at 64.4% and 71.2%, respectively.
    • An updated analysis of the outcomes of meningococcal serogroup B disease six years after the 4CMenB vaccine was implemented indicated that the peak age of children with MenB disease shifted from 5–6 months prior to implementation, to 1–3 months with much lower case numbers (328 cases per year shifting to 148 cases per year). However, the analysis did not identify evidence of less severe disease among vaccinated children who developed MenB disease when compared with unvaccinated children.
  • In 2025, the infant immunization schedule was revised so that the second dose of MenB vaccine is now administered at 12 weeks. 
  • In 2015, a MenACWY conjugated vaccine replaced the MenC conjugate vaccine previously given at 14 years of age. A 69% reduction in observed MenW cases compared with predicted MenW cases was noted among the first cohort to be offered this vaccine.
  • In the UK, the overall incidence of invasive meningococcal disease (IMD) is very low at less than 1 per 100,000 population per annum.
  • In England in 2023/24, there were 341 cases of laboratory confirmed IMD. Of these, 88.3% were due to meningococcal group B disease (MenB), 5% MenW, 4.4% MenY, and 0.9% MenC. Eight deaths were recorded, indicating a provisional case fatality ratio of 2.3%.

[Campbell, 2017; Ladhani, 2020; Mensah, 2023; UKHSA, 2025h; UKHSA, 2025i; UKHSA, 2025j; UKHSA, 2025k]

Mumps

•  Mumps is an acute paramyxovirus infection. 
  • It usually presents with unilateral or bilateral parotid swelling, but may be asymptomatic, and can be preceded by several days of non-specific symptoms such as fever, headache, malaise, myalgia, and anorexia.
  • Complications include pancreatitis, oophoritis, orchitis (rarely, it may cause male infertility), aseptic meningitis, and encephalitis.
  • Very rarely, mumps may cause permanent unilateral or bilateral sensorineural deafness (estimates vary from 1 in 3400 to 1 in 20,000 infections).
  • For more information, see the CKS topic on Mumps.
• Morbidity from mumps has decreased significantly since the introduction of the measles, mumps, and rubella (MMR) vaccine, a single dose of which confers 61–91% protection against mumps.
  • Two doses of MMR vaccine are required to provide protection at the individual and population level.
  • Before the introduction of the MMR vaccine in 1988, about 1200 hospital admissions annually were due to mumps, and mumps was the most common cause of viral meningitis in children.
  • In 2020, there were an estimated 3738 laboratory-confirmed cases of mumps in England and Wales, although this decreased in comparison with 2019 (n=5718 — decrease likely related to COVID-19 public health restrictions), confirmed cases have risen since 2018 (n=1088).
  • Recent cases and outbreaks have largely involved adolescents and young adults (more than 50% of confirmed cases among those aged 15–24 years).

[UKHSA, 2013a; UKHSA, 2025l]

Varicella

• Varicella (chickenpox) is an acute, highly infectious disease caused by the varicella zoster virus that occurs most commonly in young children.
  • A mild prodromal illness consisting of one to two days of fever and malaise may precede the rash although it may be absent, particularly in young children in whom the rash can be the first symptom. Vesicles often begin to appear on the face and scalp, spreading to the trunk and abdomen but are sparse on the limbs. After three or four days, the vesicles dry with a granular scab and are usually followed by further crops.
  • Vesicles may be so few as to be missed or so numerous that they become confluent, covering most of the body. This may be prolonged in immunosuppressed patients. For more information see the CKS topic on Chickenpox. 
  • Herpes zoster (shingles) is caused by the reactivation of an individual’s varicella virus. For more information see the CKS topic on Shingles.
• The two-dose vaccination schedule provides about 98% protection in children and about 75% protection in adolescents and adults. In both age groups, most of the breakthrough infections are modified and vaccinated individuals who contract varicella have fewer lesions and less systemic upset than unvaccinated individuals.

[UKHSA, 2024b]

Pertussis

• Pertussis (whooping cough) is a bacterial infection caused by Bordetella pertussis.
  • Following an initial catarrhal stage, an irritating cough gradually becomes a paroxysmal cough, usually within 1–2 weeks. The paroxysms are often followed by the characteristic 'whoop', or by vomiting. In young infants, apnoea may occur after coughing spasms instead of the 'whoop'. Pertussis can also present as a persistent cough without the other typical symptoms in adults and older children.
  • Severe complications and deaths are most common in infants younger than 6 months of age. Possible complications include pneumonia, cerebral hypoxia resulting in brain damage, or weight loss due to repeated vomiting.
  • Minor complications can involve subconjunctival haemorrhage, epistaxis, facial oedema, oral ulceration, and suppurative otitis media.
  • For more information, see the CKS topic on Whooping cough.
• Historical evidence has shown that the pertussis vaccine is effective. Following the introduction of vaccination programmes, the incidence of pertussis declined sharply, only to rise in the 1970s when coverage fell due to safety concerns about the whole-cell vaccines in use at the time, and fall again when high vaccination coverage was resumed.
  • Prior to the introduction of pertussis vaccination in the 1950s, average annual notifications of pertussis in the UK exceeded 120,000 cases. From 2009, vaccine coverage exceeded 95%, but has decreased slightly in recent years (remaining above 90%). 
  • Despite high vaccine coverage, a national outbreak of pertussis was declared in April 2012, which initially largely affected adolescents, possibly due to waning immunity from the acellular vaccine in this age group, and then extended to young infants prior to their first vaccinations.
  • As a result, in 2012, an immunization programme for pregnant women was introduced to protect infants from birth until they can receive their own vaccinations. This resulted in a decline in pertussis incidence among infants under 3 months of age, from approximately 230 per 100,000 in 2012 to 50 per 100,000 in 2019. Cumulative deaths in infants with confirmed pertussis also decreased from 63 between 2000–2012, to 20 between 2013–2023 (mainly among the infants of women who had not been vaccinated in pregnancy). During this period, the maternal pertussis vaccine was estimated to be 90% effective at preventing infant disease and hospitalisation, and 91% effective at preventing infant death.
  • A national pertussis outbreak was declared in May 2024 following an increase in cases, including hospitalisations, which started in December 2023. During 2024, there were 14,894 notifications of laboratory confirmed cases of pertussis in England and Wales, including 11 deaths, compared with 856 notifications and 1 death in 2023.

[UKHSA, 2024c; UKHSA, 2025m; UKHSA, 2025n]

Pneumococcal disease

• Pneumococcal disease is caused by infection with Streptococcus pneumoniae (an encapsulated Gram-positive coccus). It can present as:
  • Non-invasive disease — sinusitis, otitis media, or pneumonia.
  • Invasive pneumococcal disease (IPD) — bacteraemia, sepsis, bacteraemic pneumonia, or meningitis. This is a major cause of morbidity and mortality, especially in the very young, the elderly, and the immunocompromised.
• More than 90 types of encapsulated S. pneumoniae have been characterized, and prior to the vaccination programme, around 70% of IPD was caused by the 10 most prevalent serotypes.
• The best evidence for the efficacy of the pneumococcal conjugate vaccines (PCVs) used in the childhood immunization schedule is the steep declines observed in IPD caused by the serotypes covered by the vaccines.
  • In 2006, the UK introduced the 7-valent PCV, which resulted in a rapid and sustained reduction in IPD due to the PCV7 serotypes. In 2010, the vaccine was replaced by a 13-valent PCV, which led to further reductions in the additional serotypes in PCV13.
  • A 65% decrease in IPD incidence was observed between 2020–2021, largely attributed to COVID-19 public health restrictions, with a subsequent increase as restrictions eased.
  • Since 2020, the childhood immunization schedule has included two doses of PCV13. The vaccination schedule was updated in 2025, meaning that the first dose is now administered at 16 weeks and the second at 1 year.
• For more information, see the CKS topic on Immunizations - pneumococcal.

[UKHSA, 2025o; UKHSA, 2025k]

Poliomyelitis

• Poliomyelitis is a viral infection (type 1, 2, or 3) that attacks the nervous system.
  • The infection is most often not clinically apparent but may present with a range of symptoms. Acute disease may present with fever, malaise, headache, limb pain, and gastrointestinal disturbances, often with stiffness of the neck and back (with or without paralysis).
  • It is estimated that 1 in 200 infections leads to irreversible paralysis, usually in the legs, though the incidence of paralysis varies by the age of the infected person (highest in adults), the polio virus type and the social conditions.
  • Poliomyelitis-related paralysis can be fatal when breathing muscles are affected.
• Historical evidence has shown the poliomyelitis vaccine to be effective. Today, the disease is on the verge of worldwide eradication, with only isolated cases still occurring in a few countries.
  • With the introduction of a poliomyelitis vaccine in the UK in 1956, the number of cases decreased to very low levels. The last reported case of natural poliomyelitis infection acquired in the UK was in 1984. 
  • The World Health Organization declared the European region to be certified polio-free in 2002, meaning that indigenous poliomyelitis infection had been eliminated.
  • Although global eradication is almost complete, and the risk of importation of wild poliovirus to the UK is low, circulating vaccine–derived poliovirus continues to be detected in the UK. The risk of polio infection and outbreaks therefore remain, particularly where vaccination coverage is low, highlighting the importance of continued population vaccination.

[UKHSA, 2025p; WHO, 2025]

Rotavirus

• Rotavirus infection causes a highly contagious gastroenteritis that usually lasts from 3–8 days. 
  • Rotavirus is a highly contagious ribonucleic acid (RNA) virus mainly transmitted by the faecal-oral route, though respiratory transmission may also occur.
  • People with rotavirus usually present with mild fever, severe diarrhoea, vomiting, and stomach cramps. Rotavirus infection may lead to dehydration.
  • In the UK, rotavirus infection occurs mostly from January to March.
  • Although people of any age can become infected with rotavirus, most infections occur in children between 1 month and 4 years of age.
    • Most children will have at least one episode of rotavirus before the age of 5 years.
    • About 130,000 children visit their GP each year with rotavirus gastroenteritis, and an estimated 12,700 are admitted to hospital.
  • Deaths from rotavirus in the UK are rare; about three to four deaths each year are attributable to rotavirus.
• Rotarix^® (the rotavirus vaccine offered as part of the UK childhood immunization programme since 2013) is over 85% effective at protecting against severe rotavirus gastroenteritis in infants up to 2 years of age.
  • Between January and May 2025, there were a cumulative 3895 laboratory-confirmed reports of rotavirus infection in England, which was 48% higher than the 5-season average for the same period (2633 reports).

[UKHSA, 2015; UKHSA, 2025q]

Rubella

• Rubella (German measles) is a mild infectious disease caused by a togavirus.
  • Clinical features include a low-grade fever, malaise, nasal congestion and runny nose, mild conjunctivitis and post-auricular or sub-occipital gland lymphadenopathy. An erythematous rash, usually seen on the face and neck and behind the ears, is usually transitory.
  • Maternal infection in the first 8–10 weeks of pregnancy may have serious consequences: fetal damage occurs in up to 90% of infants, resulting in multiple defects including cataracts, deafness, cardiac abnormalities, microcephaly, intrauterine growth restriction, and inflammatory lesions of the brain, liver, lungs, and bone marrow.
  • Complications in the non-pregnant population are rare, but can include thrombocytopenia, post-infectious encephalitis, arthritis and arthralgia.
  • For more information, see the CKS topic on Rubella.
• Since universal immunization against rubella with the measles, mumps, and rubella vaccine (MMR) was introduced in 1988 for children, the number of notified rubella infections has fallen dramatically: 
  • The WHO confirmed that the UK achieved elimination status for rubella in 2016, and this has since been maintained.
  • There were three confirmed cases of rubella infection in England and Wales in 2019, with no further cases reported up to 2021. 

[UKHSA, 2013b; UKHSA, 2022b; UKHSA, 2023b]

Tetanus

• Tetanus is an acute infectious disease caused by tetanus toxin, which is produced when infection occurs with the anaerobic, spore-forming bacillus Clostridium tetani.
  • Characteristic symptoms are muscle rigidity superimposed with painful contractions of skeletal muscle. The muscle stiffness usually involves the jaw (lockjaw) and neck, and then becomes generalized.
  • Tetanus spores are present in soil and may be transmitted through a minor wound. Therefore tetanus can never be eradicated.
  • The case-fatality ratio ranges from 10–90%, and is highest in infants and the elderly.
• The best evidence for the efficacy of the tetanus vaccine is the decline in the prevalence of the disease since immunization was introduced. It is now a rare disease.
  
  • Although cases are likely under-reported, there were four notifications of tetanus and no deaths from the disease in England in 2022.

[UKHSA, 2022c; UKHSA, 2025r]

What is the immunization schedule for children younger than 1 year of age?

• At 8 weeks of age — one dose of vaccine for diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B vaccine (DTaP/IPV/Hib/HepB — Infanrix hexa^® or Vaxelis^®); one dose of meningococcal group B disease (MenB) vaccine (MenB — Bexsero^®); and one dose of rotavirus vaccine (Rotarix^®).
  • Note: the first dose of rotavirus vaccine should only be given after checking for a severe combined immunodeficiency (SCID) screening result, and the vaccine should not be given to infants born to mothers who received immunosuppressive therapy with biologics during pregnancy.
• At 12 weeks of age — one dose of DTaP/IPV/Hib/HepB, one dose of MenB vaccine, and one dose of rotavirus vaccine.
• At 16 weeks of age — one dose of DTaP/IPV/Hib/HepB and one dose of pneumococcal conjugate vaccine (PCV — Prevenar 13^®).
  • Note: if PCV was administered at 12 weeks, and the infant has not received their first dose of MenB vaccine, the MenB vaccine should be administered at 16 weeks.

What advice should I give to parents or carers of children younger than 1 year of age?

• Explain the benefits of vaccination, in particular, that it helps prevent serious illness in children, especially potentially severe diseases such as meningitis, whooping cough, and tetanus. 
  • Information about vaccinations (including the UK childhood immunization schedule, vaccine safety, risks and benefits, and individual vaccines) is available on the NHS website.
• Reassure that vaccinations are safe, and serious adverse effects are very rare. Pain, swelling, and reddening at the site of injection are most common and systemic adverse effects, should they occur, are usually limited to mild fever.
• The Infanrix^® vaccine may contain traces of neomycin, polymyxin, and polysorbate 80 that are used during the manufacturing process. In children who have a hypersensitivity, the vaccine is contraindicated.
• Live vaccines may be contraindicated for infants born to mothers who received immunosuppressive biologic therapy during pregnancy, or for those who are breastfed while the mother is receiving immunosuppressive biologics.
  • The rotavirus vaccine should not be given to infants of women who received any immunosuppressive biologic therapy during pregnancy.
  • Regulatory guidance states that live vaccines are contraindicated in children up to 12 months after birth if they have been exposed to infliximab during pregnancy, or if they are breastfed while the mother is receiving this medication.
  • Where live vaccines other than the rotavirus vaccine are indicated following immunosuppressive biologic therapy in pregnancy or breastfeeding, particularly the Bacillus Calmette-Guérin (BCG) vaccine, discussion with a specialist advice service is recommended. The UK Teratology Information Service provide advice relating to exposures in pregnancy, and the Breastfeeding Medicines Advice Service provide advice relating to exposures in breastfeeding. 
• Advise parents or carers not to routinely give paracetamol or ibuprofen to prevent fever around the time of vaccination unless the meningitis B (MenB) vaccine (Bexsero^®) is being given. However, if pain or fever is problematic after the child has been vaccinated, then paracetamol or ibuprofen may be used. For more information, see the CKS topic on Analgesia - mild-to-moderate pain.
• If the MenB vaccine (Bexsero^®) is being given as part of the routine immunization schedule, advise the parent/carer to administer oral infant paracetamol suspension (120 mg/5 mL) to infants up to 6 months of age. For most babies, advise the following dosing schedule (be aware that the suggested dosage schedule is outside the current paracetamol licence):
  • Dose 1 — 2.5 mL (60 mg) as soon as possible after vaccination.
  • Dose 2 — 2.5 mL (60 mg) 4–6 hours after the first dose.
  • Dose 3 — 2.5 mL (60 mg) 4–6 hours after the second dose.
• If the infant was born at less than 32 weeks' gestation and currently weighs less than 4 kg, prescribe paracetamol according to their weight at the time of immunization. For more information, see the British National Formulary for Children.
• Offer parents or carers written information, such as the UK Health Security Agency (UKHSA) patient information leaflets What to expect after vaccinations and Using paracetamol to prevent and treat fever after MenB vaccination.

What should I do if a child younger than 1 year of age has missed doses?

• If there is interruption to the full primary course of immunizations, complete it without delay (doses already given do not need to be repeated). For children younger than 1 year of age, this consists of:
  • Three doses of diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type B, and hepatitis B vaccine (DTaP/IPV/Hib/HepB) spaced at least 4 weeks apart.
    • For infants up to 1 year of age with incomplete primary courses of DTaP/IPV, or DTaP/IPV/Hib vaccines, any missing primary doses can be given as DTaP/IPV/Hib/HepB with Hib/MenC and/or monovalent hepatitis B vaccines given at 4-week intervals as required to complete the courses.
  • One dose of pneumococcal conjugate vaccine (PCV).
  • Two doses of meningococcal group B vaccine (MenB) spaced 4 weeks apart.
    • Infants who do not attend for their routine appointment at 3 months of age and consequently miss the second dose of MenB vaccine should be offered the vaccine at the earliest opportunity or at their next visit to the practice.
    • These infants should then follow the routine schedule and receive a booster dose in their second year of life. The booster dose is recommended to be given around the time of the first birthday, but if primary doses have been given late, a minimum 4-week interval between primary and booster doses should be observed.
  • Two doses of rotavirus vaccine spaced 4 weeks apart.
    • The first dose of rotavirus vaccine should only be given to children older than 6 weeks and younger than 15 weeks old, and the second dose should only be given to infants younger than 24 weeks old to minimize the risk of bowel intussusception.
• For the latest information on catch-up recommendations, see the Information for immunisation practitioners and other health professionals from the UK Health Security Agency (UKHSA). 
• For an algorithm outlining the requirements for children who have missed vaccination doses, see the UKHSA document Vaccination of individuals with uncertain or incomplete immunisation status.

What should I do if a child younger than 1 year of age has not been immunized or has an unknown immunization status?

• Plan to provide catch-up vaccinations to ensure protection quickly (with the minimum number of visits in the shortest possible timescale).
• If the child presents without a reliable immunization history, attempt to clarify what vaccines they have had wherever possible. 
  • Children born outside the UK may have received some or all of the vaccinations that would be expected in the UK. For further information, see the UK and international immunisation schedules comparison tool by the UK Health Security Agency.
  • If the primary course has been started but not completed, it should be continued. There is no need to repeat doses. For more information, see the section on Missed doses.
• If the history cannot be clarified, assume that the child has not been vaccinated. Give the following vaccinations (to be completed before the age of 1 year):
  • Three doses of diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B vaccine (DTaP/IPV/Hib/HepB) spaced 4 weeks apart.
  • One dose of pneumococcal conjugate vaccine (PCV).
  • Two doses of meningococcal group B (MenB) vaccine ideally spaced 8 weeks apart.
    • MenB can be given 4 weeks apart to ensure the immunization schedule is completed prior to the child's first birthday (for example, when it is started at 10 months old).
  • Two doses of rotavirus vaccine spaced 4 weeks apart.
    • The first dose of rotavirus vaccine should only be given to infants older than 6 weeks and younger than 15 weeks of age, and the second dose should be given before 24 weeks of age, to minimize the risk of bowel intussusception.
• Give boosters and subsequent vaccinations following the UK routine immunization schedule.
  • Leave at least 4 weeks between DTaP/IPV/Hib/HepB and MenB doses.
• For an algorithm outlining the requirements for children who have not been immunized or have an unknown immunization status, see the UK Health Security Agency document Vaccination of individuals with uncertain or incomplete immunisation status.

How should I administer vaccines in a child under 1 year of age?

• Obtain and document verbal consent from a person with parental responsibility at the time of vaccination.
• Ensure that: 
  • There are no contraindications to the vaccine (for example, the presence of significant immunosuppression before administering live attenuated vaccines).
  • The parent or carer has been fully informed about the vaccine and the vaccination procedure.
  • Possible adverse effects have been discussed, and the parent or carer is aware of how to manage them. Offer written information, for example, the leaflet What to expect after vaccinations published by the UK Health Security Agency (UKHSA).
• Check that the vaccine is correct, has been stored appropriately, and has not expired. 
• When administering the vaccine:
  • Wash the site with soap and water if it is visibly dirty. 
  • Most vaccines are given by intramuscular (IM) injection. If the child has a bleeding disorder, use the subcutaneous (SC) route for vaccines normally given by the IM route, as this reduces the risk of bleeding. 
    • Use a 25 mm 23-gauge (blue) or 25-gauge (orange) needle for IM administration (a 16 mm 25-gauge needle may be appropriate for preterm or very small infants).
    • Give IM and SC immunizations into the anterolateral aspect of the thigh. Give MenB vaccine (Bexsero^®) in the left thigh, ideally on its own. If an additional vaccine is required on the same day, use separate legs if possible, or inject at sites at least 2.5 cm apart.
    • Do not give immunizations into the buttocks. 
  • Rotavirus vaccine (Rotarix^®) is given orally.
    • To administer the vaccine, seat the child in a reclining position and administer the entire contents of the oral applicator into the child’s mouth (towards the inner cheek).
    • If the baby spits out or regurgitates most of the vaccine, another single dose can be given (at the same visit). 
  • Record the date of administration, vaccine and product name, batch number, expiry date, dose administered, route and site of administration, and whether the vaccine was administered under Patient Specific Directions or Patient Group Directions for each vaccine.
• Observe the child after vaccination to detect immediate adverse effects. Ensure any bleeding has stopped, and check for any symptoms of anaphylaxis before they leave the premises.
  • Anaphylaxis is extremely rare, and usually becomes apparent within minutes. By the time the site has been checked for bleeding and documentation has been completed, most reactions will have become apparent. For more information, see the CKS topic on Angio-oedema and anaphylaxis.
  • Record the details of any observed or reported adverse reactions. For more information, including details about how to report adverse reactions, see the CKS topic on Adverse drug reactions.

What is the immunization schedule for children 1–2 years of age?

• At 1 year old (from 52 weeks and not before), give the following vaccines:
  • Pneumococcal — PCV (Prevenar 13^®).
  • Meningococcal group B — MenB (Bexsero^®).
  • Measles, mumps, rubella and varicella — MMRV (Pro-Quad^® or Priorix-Tetra^®).
• At 18 months, give the following vaccines:
  • Diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B virus (HepB) — DTaP/IPV/Hib/HepB (Infanrix hexa^® or Vaxelis^®)
  • MMR (Pro-Quad^® or Priorix-Tetra^®).

What advice should I give to parents or carers of children 1–2 years of age?

• Explain the benefits of vaccination, in particular that it helps prevent serious illness in children, especially potentially severe diseases such as meningitis, tetanus, and measles. Information about vaccinations (including the UK childhood immunization schedule, vaccine safety, risks and benefits, and individual vaccines) is available on the NHS website.
• Reassure that vaccinations are safe, and serious adverse effects are very rare. Pain, swelling, and reddening at the site of injection are most common and systemic adverse effects, should they occur, are usually limited to mild fever.
• The Infanrix^® vaccine may contain traces of formaldehyde, neomycin, and polymyxin, which are used during the manufacturing process. In children who have a hypersensitivity, the vaccine is contraindicated.
• Advise that children with egg allergy can be given the measles, mumps, rubella, and varicella (MMRV) vaccination.  The two MMRV vaccines are considered clinically equivalent and interchangeable, although Priorix-Tetra® may be preferred for children who do not accept porcine gelatine.
• Advise that children with egg allergy may however, be at increased risk of having a reaction to some influenza vaccines. For more information, see the CKS topic on Immunizations - seasonal influenza.
• Advise parents or carers not to give paracetamol or ibuprofen to prevent fever around the time of vaccination. However, if pain or fever is problematic after the child has been vaccinated then paracetamol or ibuprofen may be used. For more information, see the CKS topic on Analgesia - mild-to-moderate pain.
• Offer parents or carers written information, such as the UK Health Security Agency patient information leaflet What to expect after vaccinations.

What should I do if a child 1–2 years of age has missed doses?

• After 14 months of age, a child should have completed their primary vaccinations and some boosters, including at least three doses of diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B vaccine (DTaP/IPV/Hib/HepB), two doses of pneumococcal conjugate vaccine (PCV), three doses of meningococcal group B vaccine (MenB), two doses of rotavirus vaccine, and one dose of measles, mumps, and rubella vaccine (MMR). Children born before 1 July 2024 may also have received one dose of Hib/meningococcal group B vaccine (Hib/MenB).
• Doses already given do not need to be repeated (that is, the primary immunization schedule should be continued, not restarted).
  • Missed dose of DTaP/IPV/Hib/HepB — continue with full primary immunization, spacing the remaining doses 4 weeks apart.
    • For children who have had primary vaccines without Hep B, there is no need to catch up on this antigen alone unless at high risk. 
  • Missed dose of PCV — give a single dose of PCV (at least 1 month after any previous doses, if applicable).
    • All unimmunized or incompletely immunized children require one dose of PCV over the age of 1 year. 
  • Missed dose of MenB (for children born on or after the 1st May 2015) — children who received less than two doses of MenB in the first year of life should receive two doses of MenB in their second year of life at least 4 weeks apart.
  • Missed dose of MMRV — give a single dose of MMRV, followed by a second dose usually at 18 months old.
    • Note: in some circumstances it may be appropriate to give the second dose of MMRV early after an interval of at least 4 weeks (even where the child is younger than 18 months). Examples include: if the child is likely to travel regularly to a country with a high incidence of measles, or if there are currently cases of measles in the area. 
  • Missed dose of rotavirus vaccine — do not give catch-up doses at 1–2 years of age.
• For the latest information about catch-up recommendations, see the Information for immunisation practitioners and other health professionals from the UK Health Security Agency (UKHSA).
• For an algorithm outlining the requirements for children who have missed vaccination doses, see the UKHSA document Vaccination of individuals with uncertain or incomplete immunisation status.

What should I do if a child 1–2 years of age has not been immunized or has an unknown immunization status?

• Plan to provide catch-up vaccinations to ensure protection quickly (with the minimum number of visits in the shortest possible timescale).
• If the child presents without a reliable immunization history, attempt to clarify what vaccines they have had, wherever possible. 
  • Children born outside the UK may have received some or all of the vaccinations that would be expected in the UK. For further information, see the UK and international immunisation schedules comparison tool by the UK Health Security Agency. 
• If the primary course has been started but not completed, it should be continued. There is no need to repeat doses. For more information, see the section on Missed doses.
• If the history cannot be clarified, assume that the child has not been vaccinated. Give the following vaccinations:
  • Three doses of diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B (DTaP/IPV/Hib/HepB) spaced 4 weeks apart.
  • Two doses of meningococcal group B (MenB) vaccine, usually spaced 8 weeks apart.
    • MenB can be given 4 weeks apart to ensure the immunization schedule is completed prior to the child's second birthday (for example, when it is started at 22 months old).
  • One dose of pneumococcal conjugate vaccine (PCV).
  • One dose of Hib/MenC vaccine (where stocks are available).
  • One dose of measles, mumps, rubella, and varicella (MMRV) vaccine.
• Rotavirus vaccination is not required at 1–2 years of age.
• Boosters and subsequent vaccination should be continued in line with the UK routine immunization schedule.
  • Leave at least 4 weeks between DTaP/IPV/Hib/HepB and MenB doses.
• For an algorithm outlining the requirements for children who have not been immunized or have an unknown immunization status, see the Public Health England document Vaccination of individuals with uncertain or incomplete immunisation status.

How should I administer vaccines in children 1–2 years of age?

• Obtain and document verbal consent from a person with parental responsibility at the time of vaccination.
• Ensure that: 
  • There are no contraindications to the vaccine (for example, the presence of significant immunosuppression when administering live attenuated vaccines).
  • The parent or carer has been fully informed about the vaccine and the vaccination procedure.
  • Possible adverse effects have been discussed, and the parent or carer is aware of how to manage them. Consider offering written information, for example, the leaflet What to expect after vaccinations published by the UK Health Security Agency (UKHSA).
• Check that the vaccine is correct, has been stored appropriately, and has not expired. 
• When administering the vaccine:
  • Wash the site with soap and water if it is visibly dirty. 
  • Most vaccines are given by intramuscular (IM) injection. If the child has a bleeding disorder, use the subcutaneous (SC) route for vaccines normally given by the IM route, as this reduces the risk of bleeding. 
    • Use a 25 mm 23-gauge (blue) or 25-gauge (orange) needle for IM administration. 
    • Give IM and SC immunizations into the anterolateral aspect of the thigh or the deltoid area of the upper arm. Give MenB vaccine (Bexsero^®) into the left thigh, ideally on its own. If an additional vaccine is required on the same day, use separate limbs if possible, or inject at sites at least 2.5 cm apart. 
    • Do not give immunizations into the buttocks.
  • Record the date of administration, vaccine and product name, batch number, expiry date, dose administered, route and site of administration, and whether the vaccine was administered under Patient Specific Directions or Patient Group Directions for each vaccine.
• Observe the child after vaccination to detect immediate adverse reactions. Ensure any bleeding has stopped and check for any symptoms of anaphylaxis before they leave the premises.
  • Anaphylaxis is extremely rare, and usually becomes apparent within minutes. By the time the site has been checked for bleeding and documentation has been completed, most reactions will have become apparent. For more information, see the CKS topic on Angio-oedema and anaphylaxis.
  • Record the details of any observed or reported adverse reactions. For more information, including details about how to report adverse reactions, see the CKS topic on Adverse drug reactions.

What is the immunization schedule for children from 2 years up to 10 years of age?

• At 2–10 years old, each year from September, give live attenuated influenza vaccine (LAIV — Fluenz^®). If LAIV is contraindicated (for example, the presence of significant immunosuppression) or the child is in a clinical risk group, use inactivated influenza vaccine.
  • For more information, see the CKS topic on Immunizations - seasonal influenza.
• For children born before 1 July 2024, at 3 years 4 months old, administer:
  • Diphtheria, tetanus, pertussis, and polio vaccine (DTaP/IPV — Repevax^®).
  • Measles, mumps, rubella, and varicella vaccine (MMRV — ProQuad^® or Priorix-Tetra^®). One dose will be offered to any children aged from 3 years 4 months to under 6 years on 31 December 2025 (date of birth on or after 1 January 2020 to 31 August 2022) with no history of chickenpox disease or two doses of varicella vaccination. There are no safety concerns with giving the vaccine to a child who has already had chickenpox infection or previous varicella vaccination.
• For children born on or after 1 July 2024, at 3 years 4 months old, administer:
• • Diphtheria, tetanus, pertussis, and polio vaccine (DTaP/IPV — Repevax^®).

What advice should I give to parents or carers of children from 2 years up to 10 years of age?

• Explain the benefits of vaccination, in particular that it helps prevent serious illness in children, especially potentially severe diseases such as meningitis, tetanus, and measles.
  • Information about vaccinations (including the UK childhood immunization schedule, vaccine safety, risks and benefits, and individual vaccines) is available on the NHS website.
• Reassure that vaccinations are safe, and serious adverse effects are very rare. Pain, swelling, and reddening at the site of injection are most common and systemic effects, should they occur, are usually limited to mild fever.
• Advise that children with egg allergy can be given the measles, mumps, and rubella (MMR) vaccination. However, children with egg allergy may be at increased risk of having a reaction to some influenza vaccines. For more information, see the CKS topic on Immunizations - seasonal influenza.
• Advise parents or carers not to give paracetamol or ibuprofen to prevent fever around the time of vaccination. However, if pain or fever is problematic after the child has been vaccinated, then paracetamol or ibuprofen may be used. For more information, see the CKS topic on Analgesia - mild-to-moderate pain.
• Offer parents or carers written information, such as the UK Health Security Agency patient information leaflet What to expect after vaccinations. 

What should I do if a child over 2 years and less than 10 years of age has missed doses?

• Doses already given do not need to be repeated (the primary immunization should be continued, not restarted). Give the following:
  • Missed dose of DTaP/IPV/Hib/HepB — continue with full primary immunization, spacing the remaining doses 4 weeks apart, then proceed with diphtheria, tetanus, pertussis, poliomyelitis booster vaccine (DTaP/IPV) after a period of at least 1 year.
    • For children who have had primary vaccines without Hep B, there is no need to catch up on this antigen alone unless at high risk. 
  • Missed DTaP/IPV — give one dose immediately, provided it is at least 1 year after the third dose of DTaP/IPV/Hib/HepB. 
  • Missed pneumococcal conjugate vaccine (PCV) — no vaccine required unless the child is at increased risk.
  • Missed measles, mumps, rubella, and varicella (MMRV) vaccine, or second dose — ensure the child has had two doses of MMRV. If two doses are required, space them at least 4 weeks apart.
    • For children born before 1 July 2024 who have not yet reached the age of 3 years and 4 months, ensure they have had their first dose of MMRV and then give the second dose at 3 years and 4 months of age in line with the routine immunization schedule. Note: in certain circumstances, it may be more appropriate to give the second dose of MMRV earlier, after an interval of 4 weeks. Examples include: if the child is unlikely to return for their second dose at 3 years and 4 months of age; if the child is likely to travel regularly to a country with a high incidence of measles; or if there are currently cases of measles in the area. 
    • If an early second dose is given, the dose usually given at 3 years and 4 months of age should be omitted.
• For the latest information on catch-up recommendations, see the UK Health Security Agency (UKHSA)  Information for immunisation practitioners and other health professionals. 
• For an algorithm outlining the requirements for children who have missed vaccination doses, see the UKHSA document Vaccination of individuals with uncertain or incomplete immunisation status.

What should I do if a child from 2 years up to 10 years of age has not been immunized or has an unknown immunization status?

• Plan to provide catch-up vaccinations to ensure protection quickly (with the minimum number of visits in the shortest possible timescale).
• If the child presents without a reliable immunization history, attempt to clarify what vaccines they have had wherever possible. 
  • Children born outside the UK may have received some or all of the vaccinations that would be expected in the UK. For further information, see the UK and international immunisation schedules comparison tool by the UK Health Security Agency.
• If the primary course has been started but not completed, it should be continued. There is no need to repeat doses. For more information, see the section on Missed doses.
• If the history cannot be clarified, assume that the child has not been vaccinated. Give the following vaccinations:
  • Three doses of diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B vaccine (DTaP/IPV/Hib/HepB), spaced 4 weeks apart. If DTaP/IPV/Hib/HepB is not available, DTaP/IPV can be given. 
  • Two doses of measles, mumps, rubella, and varicella (MMRV) vaccine, spaced 4 weeks apart.
• The first booster of DTaP/IPV can be given from 1 year after completing the primary course of immunizations. Subsequent boosters should be in line with the UK routine immunisation schedule.
• For an algorithm outlining the requirements for children who have not been immunized or have an unknown immunization status, see the UK Health Security Agency document Vaccination of individuals with uncertain or incomplete immunisation status.

How should I administer the vaccine in a child over 2 years and under 10 years of age?

• Obtain and document verbal consent from a person with parental responsibility at the time of vaccination.
• Ensure that: 
  • There are no contraindications to the vaccine (for example, the presence of significant immunosuppression before administering live attenuated vaccines).
  • The parent or carer has been fully informed about the vaccine and the vaccination procedure.
  • Possible adverse effects have been discussed, and the parent or carer is aware of how to manage them. Consider offering written information, for example, the leaflet What to expect after vaccinations published by the UK Health Security Agency (UKHSA).
• Check that the vaccine is correct, has been stored appropriately, and has not expired. 
• When administering the vaccine:
  • Wash the site with soap and water if it is visibly dirty. 
  • Most vaccines are given by intramuscular (IM) injection. If the child has a bleeding disorder, use the subcutaneous (SC) route for vaccines normally given by the IM route, as this reduces the risk of bleeding. 
    • Use a 25 mm 23-gauge (blue) or 25-gauge (orange) needle for intramuscular administration.
    • Give IM and SC immunizations into the anterolateral aspect of the thigh or the deltoid area of the upper arm. If an additional vaccine is required on the same day, use separate limbs if possible, or inject at sites at least 2.5 cm apart. 
    • Do not give immunizations into the buttocks. 
  • Record the date of administration, vaccine and product name, batch number, expiry date, dose administered, route and site of administration, and whether the vaccine was administered under Patient Specific Directions or Patient Group Directions for each vaccine.
• Observe the child after vaccination to detect immediate adverse reactions. Ensure any bleeding has stopped and check for any symptoms of anaphylaxis before they leave.
  • Anaphylaxis is extremely rare, and usually becomes apparent within minutes. By the time the site has been checked for bleeding and documentation has been completed, most reactions will have become apparent. For more information, see the CKS topic on Angio-oedema and anaphylaxis.
  • Record the details of any observed or reported adverse reactions. For more information, including details about how to report adverse reactions, see the CKS topic on Adverse drug reactions.

What is the immunization schedule for children and young people from 10 years to 25 years of age?

• Aged up to 16 years from 1 September 2025, each year from September, give live attenuated influenza vaccine (LAIV — Fluenz Tetra). If LAIV is contraindicated (for example, the presence of significant immunosuppression) or the child is in a clinical risk group, use inactivated influenza vaccine.
• Aged 12–13 years, give HPV vaccine (Gardasil^®9). 
• At 14 years of age (school year 9), give:
  • Tetanus, diphtheria, and polio vaccine (Td/IPV — Revaxis^®).
  • Meningococcal groups A, C, W, and Y vaccine (MenACWY — Nimenrix^®, Menveo^®, or MenQuadfi^®).
• The MenACWY vaccine is available to adolescents and young adults who missed their school offer until their 25th birthday. See the UK Health Security Agency collection on the Meningococcal ACWY vaccination programme for up-to-date information on eligibility.

What advice should I give to children and young people from 10 years to 25 years of age?

• Explain the benefits of vaccination, in particular that it helps prevent serious illnesses such as tetanus and meningococcal disease.
  • Information about vaccinations (including the UK childhood immunization schedule, vaccine safety, risks and benefits, and individual vaccines) is available on the NHS website.
  • A leaflet is available for university entrants to explain about meningococcal disease and the importance of the MenACWY vaccine. 
• Reassure that vaccinations are safe, and serious adverse effects are very rare. Pain, swelling, and reddening at the site of injection are most common and systemic effects, should they occur, are usually limited to mild fever.
• The Revaxis^® vaccine should be used with caution in people with phenylketonuria as it contains 10 micrograms of phenylalanine per 0.5 ml dose, equivalent to 0.17 micrograms/kg for a 60 kg person.
• Advise that people with egg allergy can be given the measles, mumps, rubella, and varicella (MMRV) vaccination. However, people with egg allergy may be at increased risk of having a reaction to some influenza vaccines. For more information, see the CKS topic on Immunizations - seasonal influenza.
• Advise the person or their parents not to give paracetamol or ibuprofen to prevent fever around the time of vaccination. However, if pain or fever is problematic after vaccination, then paracetamol or ibuprofen may be used. For more information, see the CKS topic on Analgesia - mild-to-moderate pain.

What should I do if a child or young person from 10 years to 25 years of age has missed doses?

After 10 years of age, not all vaccinations are necessary, as the period of risk for some childhood diseases will have passed. Doses already given do not need to be repeated; that is, primary immunization should be continued, not restarted.

• Missed dose of diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type b vaccine (DTaP/IPV/Hib/) — complete the primary course (total of three doses) by substituting DTaP/IPV/Hib with tetanus, diphtheria, and polio (Td/IPV), spaced 4 weeks apart. A further two booster doses of Td/IPV will then be required, one dose 5 years after completing the primary course, followed by another dose after ideally a further 10 years (minimum of 5 years).
• Missed dose of diphtheria, tetanus, pertussis, poliomyelitis booster vaccine (DTaP/IPV) — give a dose of Td/IPV 5 years after completing the primary course, followed by another dose of Td/IPV after ideally a further 10 years (minimum of 5 years).
• Missed pneumococcal conjugate vaccine (PCV) — no vaccine required unless the person is at high risk. For more information, see the Scenario: Additional childhood immunizations and the CKS topic on Immunizations - pneumococcal.
• Missed meningococcal group C (MenC) or MenACWY vaccine — give a single dose of MenACWY to all people:
  • Aged 10–25 years with an incomplete MenC vaccination history.
  • Aged 13–25 years who have not yet received the MenACWY vaccine.
  • For further information about eligibility for vaccination under the current catch-up scheme, see the UK Health Security Agency (UKHSA) information on the MenACWY vaccination programme.
• Missed measles, mumps, rubella, and varicella vaccine (MMRV) — ensure the person has had two doses in total, spaced at least 4 weeks apart. 
• Missed human papillomavirus (HPV — Gardasil^®9) vaccine — give a single dose of HPV vaccine to all people aged under 25 years. 
  • People who are immunosuppressed at the time of vaccination and those who are living with HIV, including those on antiretroviral therapy, should be offered a 3-dose schedule (spaced 2 and then 4 months apart).
  • People aged 25 years or over should receive a two-dose schedule (spaced 6 to 24 months apart). If the course has been interrupted, it should be resumed but not repeated even if more than 24 months have elapsed since the first dose.
• For the latest information about catch-up recommendations, see the UKHSA information for immunisation practitioners and other health professionals.
• For an algorithm outlining the requirements for people who have missed vaccination doses, see the UKHSA document Vaccination of individuals with uncertain or incomplete immunisation status.

What should I do if a child or young person from 10 years to 25 years of age has not been immunized or has an unknown immunization status?

• Plan to provide catch-up vaccinations to ensure protection quickly (with the minimum number of visits in the shortest possible timescale).
• If the person presents without a reliable immunization history, attempt to clarify what vaccines they have had wherever possible.
  • People born outside the UK may have received some or all of the vaccinations that would be expected in the UK. For further information, see the UK and international immunisation schedules comparison tool by the UK Health Security Agency (UKHSA).
• If the history cannot be clarified, assume that the person has not been vaccinated. Give the following vaccinations:
  • Three doses of diphtheria, tetanus, poliomyelitis vaccine (Td/IPV) spaced 4 weeks apart. 
  • Two doses of measles, mumps, rubella, and varicella (MMRV) vaccine spaced at least 4 weeks apart.
  • One dose of meningococcal groups A, C, W, and Y vaccine (MenACWY) to people aged 10–25 years with an unknown MenC vaccination history, or aged 13–25 years whose MenACWY vaccine status is unknown.
  • Human papillomavirus (HPV — Gardasil^®9) vaccine:
    • For all immunocompetent people aged under 25 years, give one dose of HPV vaccine.
    • For those who are immunosuppressed at the time of vaccination and those who are living with HIV, including those on antiretroviral therapy, give a 3-dose schedule (spaced 2 and then 4 months apart).
    • For gay, bisexual or other men who have sex with men aged 25 to 45 years, give a two-dose course (spaced 6 to 24 months apart).
• Two additional booster doses of Td/IPV are required, the first 5 years after the primary course is completed and the second ideally 10 years (a minimum of 5 years) after the first booster.
• For an algorithm outlining the requirements for people who have not been immunized or have an unknown immunization status, see the UKHSA document Vaccination of individuals with uncertain or incomplete immunisation status.

How should I administer vaccines in a child or young person from 10 years to 25 years of age?

• Obtain and document verbal consent at the time of vaccination for people aged over 16 years. For younger people, it is usual to get consent from a person with parental responsibility.
  • Adults over 18 years of age are presumed to be competent to consent to treatment provided they can comprehend and retain the information they are given, they believe it, and they can consider the facts and make an informed decision.
  • Young people of 16 and 17 years of age are also presumed to be competent using the same criteria as older adults.
  • Younger people can also give consent if they fully understand what is involved, but ideally, a person with parental responsibility should also be involved.
• Ensure that: 
  • There are no contraindications to the vaccine (for example, the presence of significant immunosuppression before administering live attenuated vaccines).
  • The person, parent, or carer has been fully informed about the vaccine and the vaccination procedure.
  • Possible adverse reactions have been discussed, and the person, parent, or carer is aware of how to manage them. 
• Check that the vaccine is correct, has been stored appropriately, and has not expired. 
• When administering the vaccine:
  • Wash the site with soap and water if it is visibly dirty. 
  • Most vaccines are given by intramuscular (IM) injection. If the person has a bleeding disorder, use the subcutaneous (SC) route for vaccines normally given by the IM route, as this reduces the risk of bleeding. 
    • Use a 25 mm 23-gauge (blue) or 25-gauge (orange) needle for IM administration. 
    • Give IM and SC immunizations into the anterolateral aspect of the thigh or the deltoid area of the upper arm. If an additional vaccine is required on the same day, use separate limbs if possible, or inject at sites at least 2.5 cm apart. 
    • Do not give immunizations into the buttocks. 
  • Record the date of administration, vaccine and product name, batch number, expiry date, dose administered, route and site of administration, and whether the vaccine was administered under Patient Specific Directions or Patient Group Directions for each vaccine.
• Observe the person after vaccination to detect immediate adverse reactions. Ensure any bleeding has stopped and check for any symptoms of anaphylaxis before they leave.
  • Anaphylaxis is extremely rare, and usually becomes apparent within minutes. By the time the site has been checked for bleeding and documentation has been completed, most reactions will have become apparent. For more information, see the CKS topic on Angio-oedema and anaphylaxis.
  • Record the details of any observed or reported adverse reactions. For more information, including details about how to report adverse reactions, see the CKS topic on Adverse drug reactions.

Which children require additional immunizations?

• Most children will not usually require additional vaccinations other than those provided by the childhood immunization programme. This is a summary and is not comprehensive. For more information, consult Immunisation against infectious disease (The Green Book).
• Give additional vaccinations if the child: 
  • Has comorbidities that make them susceptible to certain preventable diseases (for example, pneumococcal disease, influenza). See Table 2 for information on the additional vaccines required for people with underlying medical conditions.  
  • Is, or has been, exposed to an environment where infection with a preventable disease is more likely (for example, tuberculosis, hepatitis B).
  • Is going to travel to an area outside the UK that is endemic with a preventable disease (for example, hepatitis A, typhoid, and yellow fever). For more information, see the CKS topic on Immunizations - travel.
• Tuberculosis (TB) — vaccination with Bacillus Calmette–Guérin (BCG) is now targeted at children most at risk, including:
  • Infants younger than 1 year of age who live in areas of the UK with an annual incidence of TB of 40 per 100,000 or greater. For country-specific data, see the World Health Organization's Tuberculosis country profiles.
  • Infants younger than 1 year of age who have a parent or grandparent born in a country with an annual incidence of TB of 40 per 100,000 or greater.
  • Children 1–5 years of age who are previously unvaccinated and have a parent or grandparent born in a country with an annual incidence of TB of 40 per 100,000 or greater.
  • Children 6–16 years of age who are tuberculin-negative, previously unvaccinated, and have a parent or grandparent born in a country with an annual incidence of TB of 40 per 100,000 or greater.
  • Children under 16 years of age who are tuberculin-negative, previously unvaccinated, and are contacts of a case of sputum smear-positive pulmonary or laryngeal TB.
  • Children under 16 years of age who are tuberculin-negative, previously unvaccinated, and were born, or have lived for at least 3 months, in a country with an annual incidence of TB of 40 per 100,000 or greater.
  • If a child requires vaccination against TB, refer according to local policy and service provision.
    • Note: the BCG vaccine should only be given after checking for a severe combined immunodeficiency (SCID) screening result.
• Hepatitis B — children considered to be at high risk of exposure to hepatitis B include those:
  • Born to a mother or living with parents or close household contacts known to have hepatitis B.
  • Whose parents are people who inject drugs, or are likely to progress to injecting drugs (for example, those who are currently smoking heroin or crack cocaine).
  • Whose parents frequently change sexual partners (for example, males who have sex with men, or male or female sex workers).
  • Who receive regular blood transfusions (for example for haemophilia).
  • In residential or day care for people with severe learning disability (decisions on immunization should be made on the basis of a local risk assessment).
  • Who are at high risk of requiring medical or dental procedures when travelling to visit relatives in countries where there is a moderate or high prevalence of hepatitis B.
  • For further information on hepatitis B vaccination, see the CKS topics on Hepatitis B and Immunizations - travel.
• For information on vaccination of people with underlying medical conditions at risk of pneumococcal disease, hepatitis B or influenza, see the CKS topics on Immunizations - pneumococcal, Hepatitis B, and Immunizations - seasonal influenza.

Table 2. Additional vaccines required for people with underlying medical conditions.

How should I administer vaccines in children requiring additional immunization?

• Obtain and document verbal consent from a person with parental responsibility at the time of vaccination.
  • Adults over 18 years of age are presumed to be competent to consent to treatment provided they can comprehend and retain the information they are given, they believe it, and they can consider the facts and make an informed decision.
  • Young people 16 and 17 years of age are also presumed to be competent using the same criteria as older adults.
  • Younger people can also give consent if they fully understand what is involved, but ideally, someone with parental responsibility should also be involved.
• Ensure that: 
  • There are no contraindications to the vaccine (for example, the presence of significant immunosuppression before administering live attenuated vaccines).
  • The person, parent, or carer has been fully informed about the vaccine and the vaccination procedure.
  • Possible adverse reactions have been discussed, and the person, parent, or carer is aware of how to manage them. Consider offering written information, for example, the leaflet What to expect after vaccinations published by the UK Health Security Agency (UKHSA).
• Check that the vaccine is correct, has been stored appropriately, and has not expired. 
• When administering the vaccine:
  • Wash the site with soap and water only if it is visibly dirty.
  • The varicella vaccine is given by deep subcutaneous injection (Varivax^® can also be given intramuscularly).
  • Bacillus Calmette–Guérin (BCG) is usually given by intradermal injection at designated centres.
  • For more information on the administration of the hepatitis B, influenza, and pneumococcal vaccinations, see the CKS topics on Hepatitis B, Immunizations - seasonal influenza, and Immunizations - pneumococcal.
  • Record the date of administration, vaccine and product name, batch number, expiry date, dose administered, and site of administration for each vaccine.  
• Observe the person after vaccination to detect immediate adverse reactions. Ensure any bleeding has stopped and check for any symptoms of anaphylaxis before they leave.
  • Anaphylaxis is extremely rare, and usually becomes apparent within minutes. By the time the site has been checked for bleeding and documentation has been completed, most reactions will have become apparent. For more information, see the CKS topic on Angio-oedema and anaphylaxis.
  • Record the details of any observed or reported adverse reactions. For more information, including details about how to report adverse reactions, see the CKS topic on Adverse drug reactions.