Childhood Immunisation

Definition | Immunisation Schedule | Aetiology of Vaccine-Preventable Diseases | Risk Factors for Not Immunising | Management of Missed Immunisations | References

Definition

Childhood immunisation is a critical public health intervention aimed at protecting children from a variety of serious and potentially life-threatening infectious diseases. Vaccinations work by stimulating the immune system to develop immunity without causing the illness. In the UK, the childhood immunisation programme follows a specific schedule that ensures children receive vaccines at the optimal time for maximum protection.

Immunisation Schedule

The UK childhood immunisation schedule is regularly updated to ensure children are protected from infectious diseases. The current schedule (as of 2024) includes the following vaccinations:

8 Weeks:

• 6-in-1 Vaccine (DTaP/IPV/Hib/HepB): Protects against diphtheria, tetanus, whooping cough (pertussis), polio, Haemophilus influenzae type B, and hepatitis B.
• Pneumococcal (PCV) Vaccine: Protects against pneumococcal infections.
• Rotavirus Vaccine: Protects against rotavirus, a common cause of diarrhoea and vomiting.
• MenB Vaccine: Protects against meningococcal group B bacteria.

12 Weeks:

• 6-in-1 Vaccine (Second dose): Boosts protection from the first dose.
• Rotavirus Vaccine (Second dose): Further protection against rotavirus.

16 Weeks:

• 6-in-1 Vaccine (Third dose): Final dose of the 6-in-1 vaccine.
• Pneumococcal (PCV) Vaccine (Second dose): Further protection against pneumococcal infection.
• MenB Vaccine (Second dose): Further protection against meningococcal group B.

1 Year:

• Hib/MenC Vaccine: Protects against Haemophilus influenzae type B and meningococcal group C.
• Pneumococcal (PCV) Booster: Boosts earlier protection against pneumococcal infections.
• MMR (Measles, Mumps, and Rubella) Vaccine: Protects against measles, mumps, and rubella.
• MenB Booster: Boosts protection against meningococcal group B.

2 to 10 Years (Annual):

• Children’s Flu Vaccine: Given as a nasal spray each year to protect against seasonal flu.

3 Years and 4 Months:

• 4-in-1 Pre-school Booster (DTaP/IPV): Protects against diphtheria, tetanus, whooping cough (pertussis), and polio.
• MMR (Second dose): Further protection against measles, mumps, and rubella.

12 to 13 Years (Girls and Boys):

• HPV Vaccine: Protects against human papillomavirus (HPV) types 16 and 18, which can cause cervical cancer and other cancers. Now offered to both girls and boys.

14 Years:

• 3-in-1 Teenage Booster (Td/IPV): Protects against tetanus, diphtheria, and polio.
• MenACWY Vaccine: Protects against meningococcal groups A, C, W, and Y.

Aetiology of Vaccine-Preventable Diseases

The immunisation schedule aims to prevent several serious infections, including:

• Diphtheria: A bacterial infection that affects the throat and can lead to breathing difficulties, heart failure, and death.
• Tetanus: Caused by bacteria in soil, tetanus can lead to muscle stiffness, spasms, and potentially fatal complications.
• Polio: A viral infection that can cause paralysis and permanent disability.
• Measles, Mumps, Rubella (MMR): These viral infections can cause serious complications such as pneumonia, meningitis, and congenital defects in unborn babies.
• Pneumococcal Disease: Causes infections such as pneumonia, sepsis, and meningitis.
• Rotavirus: A common cause of severe diarrhoea in young children.
• Meningitis: Caused by bacteria such as meningococcal groups B, C, A, W, and Y, it can lead to severe infections of the brain and spinal cord, with potential long-term damage or death.

Risk Factors for Not Immunising

• Children who miss scheduled vaccines are at a higher risk of contracting vaccine-preventable diseases.
• Parents who opt out of vaccinating due to misconceptions about vaccine safety increase the risk of outbreaks in the community.
• Children with weakened immune systems, such as those undergoing chemotherapy or with HIV, rely on herd immunity to protect them from diseases like measles and rubella.

Management of Missed Immunisations

If a child has missed one or more vaccines, catch-up vaccinations should be arranged as soon as possible. Healthcare providers will tailor a catch-up schedule based on the child's age and which vaccines were missed. The child should not restart the schedule but continue from where they left off.

• Discuss with a healthcare provider: For children who miss immunisations, healthcare providers can create a personalised catch-up schedule.
• Extra doses: In some cases, an additional dose may be recommended to ensure full immunity, particularly for vaccines given over multiple doses (e.g., 6-in-1 vaccine).
• Public health interventions: In cases of outbreaks, such as measles, unvaccinated children may be prioritised for immediate immunisation to prevent the spread of the disease.

References

1. NHS (2023). Immunisation Schedule for Children. Available at: NHS Website
2. NICE (2024). Immunisation Guidance for Healthcare Providers. Available at: NICE Guidance
3. Public Health England (2023). Green Book on Immunisation against Infectious Disease. Available at: PHE Green Book