Childhood immunisation programme
Vaccines are routinely offered to everyone in the UK free of charge via the NHS childhood immunisation programme. The NHS supports the WHO recommendation of a 95 per cent national immunisation target rate.16,17,18,19,20
However, NHS Digital noted that in 2017-18, “coverage declined in nine of the 12 routine vaccinations measured at ages 12 months, 24 months or five years in England compared to the previous year.” In addition, MMR vaccination at the age of 2 decreased four years in a row, with vaccine coverage in 2017-18 at 91.2 per cent, the lowest level since 2011-12.21
The childhood vaccination programme (see table 1) includes several combined vaccines:17
· the 6-in-1 vaccine (DTaP/IPV/Hib/HepB) – diphtheria, tetanus, pertussis (whooping cough), polio, Hib (Haemophilus influenzae type b), and hepatitis B vaccine given as three doses in early infancy;
· the 4-in-1 pre-school booster - diphtheria, tetanus, whooping cough, and polio;
· the 3-in-1 is a booster vaccine – tetanus, diphtheria, and polio for teenagers
· the MMR vaccination requires two doses – at 1 year and pre-school.
Human papilloma virus (HPV) vaccination was introduced into the routine programme for teenage girls a decade ago. In the summer of 2018, health ministers announced that adolescent boys would also be included in the programme. This is likely to start in the 2019-2020 school year.22,23,24
To support neonates’ pertussis protection, pregnant women are offered the vaccination, ideally from weeks 15-32 of the pregnancy. It is estimated that “babies born to women vaccinated at least a week before birth had a 91 per cent reduced risk of becoming ill with whooping cough in their first weeks of life, compared to babies whose mothers had not been vaccinated.”25
Many vaccines can be offered on a catch-up basis, but the Rotarix rotavirus vaccine is licensed only for use in infants aged 6 to 24 weeks.
Table 1: Routine NHS Childhood Immunisation programme – vaccines and age when recommended:17,18,19,20
|
|
8 wks | 12 wks | 16 wks | 1 yr | 2yrs to 11 yrs | 3yrs 4mths | From 11 yrs | 12-13 yrs | 14 yrs+ |
| 6-in-one injection | Y | Y | Y | ||||||
| Pneumococcal or ‘pneumo jab’ injection (PCV) | Y | Y | Y | ||||||
| Rotavirus vaccine (oral) | Y | Y | |||||||
| Men B injection | Y | Y | Y | ||||||
| Hib/Men C injection | Y | ||||||||
| MMR injection | Y | Y | |||||||
| Flu vaccine (routine immunisation) – nasal spray usually, but injection if more practicable |
annually England: 2-8 years; Scotland: 2 yrs to end of primary school; Wales: 2-3 years + school to Year 6 N Ireland: from 2 years |
||||||||
| 4-in-1 pre-school booster | Y | ||||||||
| HPV vaccine (2-3 injections) | Y (Scot, Wales, N Ire) | Y (Eng) | |||||||
| 3-in-1 (Td/IPV) teenage booster injection |
Y (13-18 |
Y 14 |
|||||||
| injection |
Scot) (13-15 Wales) |
(Eng) |
|||||||
| MenACWY injection |
|
Y |
Other vaccinations may be given outside of the routine schedule, especially where there is an increased risk of the person being exposed to the infection (eg TB) or because of their own health status (see table 2).
Table 2: ‘Optional’ vaccines where there is increased risk or impaired health status: 17,18,19,20
| Vaccine | Age range | Dosing |
| Chickenpox injection | >1 year to adult | Children need two doses 4-8 weeks apart |
| BCG (tuberculosis) injection | From birth to 16 years | |
| Flu vaccination (England) |
6 months to 2 years –– injection 9-17 years – nasal spray |
Offered annually Injection: September-November Nasal spray: September |
| Flu vaccination (Scotland) |
Children of all ages outside of routine immunisation age (2-11 years) Nasal spray recommended in preference to injection. |
Offered annually 2nd dose needed 4 weeks after 1st dose for children under 9 years having flu vaccine for first time – · with health condition or given by injection |
| Hepatitis B injection | From birth upwards if born to infected mother: | 6 doses - at birth, 4 weeks and 1 year in addition to the standard ‘6-in-1’ jab at 8, 12, and 16 weeks |