The routine immunisation schedule

Contents

• The overall aim of the routine immunisation schedule is to provide protection against the following vaccine-preventable infections:
  • diphtheria
  • Haemophilus influenzae type b (Hib)
  • hepatitis B
  • human papillomavirus (certain serotypes)
  • influenza
  • measles
  • meningococcal disease (certain serogroups)
  • mumps
  • pertussis (whooping cough)
  • pneumococcal disease (certain serotypes)
  • polio
  • rotavirus
  • rubella
  • shingles
  • tetanus.
• The schedule for routine immunisations and instructions for how they should be administered are given in Table 1 below. The relevant chapters on each of these vaccine-preventable diseases provide detailed information about the vaccines and the immunisation programmes.

• The childhood immunisation schedule has been designed to provide early protection against infections that are most dangerous for the very young. This is particularly important for diseases such as whooping cough, rotavirus and those due to pneumococcal, Hib and meningococcal infections. Providing subsequent booster doses as scheduled should ensure continued protection. Further vaccinations are offered throughout life to provide protection against infections when eligible individuals reach an age where they can derive most benefit (e.g. because of an increased individual risk) or where the programme will provide optimal control of that disease for the whole population.
• Recommendations for the age at which vaccines should be administered are informed by the age-specific risk for a disease, the risk of disease complications, the ability to respond to the vaccine and the impact on spread in the population. The schedule should therefore be followed as closely as possible.
• Some individuals may be eligible for additional vaccines due to an underlying medical condition or circumstances that put them at increased risk of vaccine-preventable disease. These individuals should be vaccinated in accordance with the recommendations in Chapter 7 and the disease specific chapters.

Seasonal influenza

• The phased introduction of the childhood influenza vaccination programme began in 2013 with the inclusion of children aged two and three years in the routine programme. Each year, more school age groups are being added to the programme, and those eligible should be vaccinated each winter, usually between October and January, although vaccination may still be of some benefit if given later.
• The annual letters on the influenza programme should be consulted for age eligibility:
  • England
  • Northern Ireland
  • Scotland
  • Wales.

Schedule flexibility

• The schedule recommended by the Joint Committee on Vaccination and Immunisation incorporates the minimum intervals between subsequent doses of vaccines. As immunological memory from priming dose(s) are likely to be maintained in healthy individuals, increasing that interval will usually lead to a more pronounced response to the later dose.
• Therefore, where any course of immunisation is interrupted, there is normally no need to start the course again—it should simply be resumed and completed as soon as possible. Where vaccination was commenced some time previously however, the product received may have changed and the relevant chapter should therefore be consulted.
• Immunisations should not be given before the scheduled age unless there is a clear clinical indication for this. The first dose of primary immunisations can be given from six weeks of age if required in certain circumstances e.g. travel to an endemic country. Administering the first set of primary immunisations before 6 weeks of age is not recommended routinely, as it may result in a sub-optimal response to the vaccine which could undermine good control.
• Measles, mumps, and rubella (MMR) vaccine can be given from six months of age, for example during a local outbreak or if travelling to an endemic country. Any dose of MMR given below the age of one year should be discounted however as residual maternal antibodies may reduce the response to the vaccine. Two further doses of MMR will be required at the appropriate ages.
• Delaying primary infant immunisations beyond eight weeks risks leaving babies unprotected against serious infections that can be very severe in the very young, e.g. whooping cough. It is not necessary to wait for the six to eight week baby examination to be carried out to give the eight week primary immunisations.
• Every effort should be made to ensure that all children and adults are immunised, even if they are older than the scheduled age; no opportunity to immunise should be missed. The type of vaccine and number of doses recommended depends on the age of the individual as some vaccines are not indicated after a certain age. In most instances, this is because the ability to benefit from vaccination is reduced because of lower risk (e.g. whooping cough), or lower effectiveness (e.g. for shingles). The exception is rotavirus vaccine, where vaccination at an older age is more likely to be associated with an adverse event (intussusception); therefore rotavirus vaccine should not be started if the infant is aged 15 weeks or older and not given at all if aged 24 weeks or older.

Recording of immunisation

• Following immunisation, all the patient’s clinical records including the GP held record and, if a child, the record on the Child Health Information System (CHIS) and the Personal Child Health Record (Red Book) should be updated with all the relevant details (see Chapter 4).
• When babies are immunised in special care units, or children and adolescents are immunised opportunistically in accident and emergency units or inpatient facilities, it is important that a record of the immunisation is entered onto the relevant CHIS and sent to the patient’s GP for entry onto the practice-held patient record. Details should also be recorded in the child’s Personal Child Health Record (Red Book) in a timely manner.
• Details of vaccines given in other areas e.g. schools, maternity services, should also be sent to the patient’s GP.