UPDATED SCHEDULE FOR 2022

A guide to immunisation for

Pre-school
A guide to vaccinations
from two years old until
starting primary school

the safest way to protect your health

 Protect yourself,
protect others

If you are not sure if your child has had

all their routine vaccinations, check
their personal health record (Red Book)
or contact the GP surgery.
To get the best protection for your child,
they need to have had two doses of MMR
vaccine. For a checklist of the vaccines and
the ages at which they should ideally be
given visit www.nhs.uk/vaccinations
Contents
4 Introduction
6 Common questions about pre-school immunisations
11 Immunisations for pre-school children
11 Flu vaccine
14 DTaP/IPV or DTaP/IPV vaccine
16 MMR vaccine
20 Watch out for meningitis and septicaemia
23 Travel advice for children
24 Routine childhood immunisation programme
– a quick reference guide to your child’s immunisation

3
Introduction
This guide provides information on the routine immunisations that
are given to children before they start school to help protect them
from serious childhood diseases. It describes these diseases and
explains why young children need protection against them. It also
answers some of the most common questions about pre-school
immunisation.
If you have more questions or you want more information, talk to
your doctor, practice nurse or health visitor.

You can also visit

www.nhs.uk/
vaccinations
or call the free
NHS helpline 111

4 A guide to immunisation for pre-school

Timetable of pre-school immunisations
The first winter after your child turns two years of age he or she
becomes eligible for the nasal flu vaccine, this will be due every winter
including once your child starts school. Three immunisations are due
at about three years and four months of age. These vaccines update
the protection your child should have completed as a baby or at 12
months of age. You will receive an appointment for you to bring your
child for their pre-school immunisations.
The table below shows the pre-school immunisations your child will
be offered. These immunisations will make sure that your child has the
best protection against serious childhood diseases as they grow up.

Vaccine How and when it is given Comments

This vaccine is given at

two and three years
of age. Children who
Nasal spray are in risk groups
Flu
Each year from September and cannot have the
nasal spray will be
offered a vaccination
by injection.

Diphtheria,
tetanus, pertussis
One injection at 3 years and four This is a booster dose
(whooping cough)
months of age of these vaccines.
and polio (dTaP/IPV
or DTaP/IPV)

This is a second dose

of the MMR vaccine.
(If your child has not
Measles, mumps One injection at 3 years and four
had the first dose yet,
and rubella (MMR) months of age
it should be given now
and the second dose
one month later)

Introduction 5
Common questions about
pre-school immunisations
Why does my child need to be immunised at this age?
The pre-school immunisations – often called pre-school boosters – will
update or top up your child’s level of antibodies (which their bodies
produce to fight off disease and infection) and help to keep them
protected. Protection (immunity) against diphtheria, tetanus, whooping
cough and polio from the immunisations given to babies can fade over
time. Sometimes, complete immunity to measles, mumps or rubella
does not develop after a single dose of the MMR vaccine – so this
gives them a second chance.
When you take your child for their pre-school immunisations, it is
important to make sure all their other immunisations are up to date.
The flu vaccine will help protect your child against flu during the
winter but will need to be given every year because the viruses that
cause flu change very frequently.

How do vaccines work?

Vaccines contain a small part of the bacterium or virus that causes a
disease, or tiny amounts of the chemicals the bacterium produces.
Vaccines work by causing the body’s immune system to make
antibodies. If your child comes into contact with the infection, the
antibodies will recognise it and be ready to protect them. Because
vaccines have been used so successfully in the UK, diseases such as
polio have all but disappeared from this country.

6 A guide to immunisation for pre-school

 If your child missed any of their immunisations
as a baby or toddler, this is a good time to ask the
surgery or clinic about catch-up doses. You don’t
have to start the course of immunisations from
the beginning again but you can catch up to make
sure your child is fully protected. It is never too
late to have your child immunised.

How do we know that vaccines are safe?

Before a vaccine is allowed to be used, its safety and effectiveness
have to be thoroughly tested. After they have been licensed, the safety
of vaccines continues to be monitored. Any rare side effects that are
discovered can then be assessed further. All medicines can cause side
effects, but vaccines are among the very safest.
Research from around the world shows that immunisation is the safest
way to protect your child’s health.

We don’t hear about most of these diseases any more,

so are these immunisations really necessary?
Because of the effective immunisation programmes in the UK, the
number of children catching these diseases is now very low. But if
children do not continue to be immunised, the diseases will come
back, as seen recently in some parts of Europe. Many of these diseases
are still around in other parts of the world and your child may be at
risk if you travel with your family. With more people coming to visit
this country, there is always a risk that your child could come into
contact the infections.

Common questions about pre-school

Cancers caused
immunisations
by HPV 7
Will there be any side effects from the vaccines?
Any side effects that occur are usually mild. Your child may get a little
redness, swelling or tenderness where the injection was given that will
disappear on its own. Some children may get a fever that can be treated
with paracetamol liquid. Read the instructions on the bottle carefully
and give your child the correct dose for their age. If necessary, give them
a second dose four to six hours later. If your child’s temperature is still
high after they have had a second dose of paracetamol liquid, speak to
your doctor or call the free NHS helpline 111.

Remember: Never give medicines that contain

aspirin to children under 16.

I’m worried that my child may have allergies. Can they be

vaccinated?
Asthma, eczema, hay fever, food intolerances and allergies should
not prevent your child having the vaccines in the routine childhood
immunisation programme. If your child has needed intensive care due
to asthma or egg allergic anaphylaxis then further advice should be
sought. If you have any questions, speak to your doctor, practice nurse
or health visitor.

Remember: An anaphylactic reaction is a severe

and immediate allergic reaction that needs urgent
medical attention.
Are some children allergic to vaccines?
Very rarely, children can have an allergic reaction soon after
immunisation. This may be a rash or itching affecting part or all of the
body. The doctor or nurse giving the vaccine will know how to treat
this. It is not a reason to withhold further immunisations.

8 A guide to immunisation for pre-school

Even more rarely, children can have a severe reaction, within a few
minutes of the immunisation, which causes breathing difficulties and
can cause the child to collapse. This is called an anaphylactic reaction
and occurs in only about one in a million immunisations. The people
who give immunisations are trained to deal with anaphylactic reactions
and children recover completely with prompt treatment.

Are there any reasons why my child should not

be immunised?
There are very few children who cannot be immunised.
■ In general, a vaccine should not be given to children who have had
a confirmed anaphylactic reaction to a previous dose of the same
vaccine.
There are a very small number of children who may not be able to
have one or more of the routine vaccines for health reasons. Your
health visitor, practice nurse or doctor will ask you about the relevant
conditions. You can also discuss with them if you are worried about a
specific vaccine.

What about the MMR and nasal spray flu vaccine? Are
there any other reasons why my child should not receive
these vaccines?
The MMR and nasal flu vaccines are live attenuated vaccines (that
is, they contain viruses that have been weakened). Children who are
‘immunosuppressed’ may not be able to receive live vaccines.
Children who are immunosuppressed include those:
■ whose immune system is suppressed because they are undergoing
treatment for a serious condition such as a transplant or cancer, or
■ who have any condition which affects the immune system, such as
severe primary immunodeficiency.
If this applies to your child, you must tell your doctor, practice nurse or
health visitor before the immunisation. They will get specialist advice.

Common questions about pre-school immunisations 9

What if my child is ill on the day of the appointment?
If your child has a minor illness without a fever, such as a cold,
they should have their immunisations as normal.
If your child is ill with a fever, put off the immunisation until the
child has recovered. This is to avoid the fever being associated
with the vaccine, or the vaccine increasing the fever your child
already has.
If your child:
■ has a bleeding disorder, or
■ has had a fit not associated with fever
Speak to your doctor, practice nurse or health visitor before
your child has any immunisation.

What are fits?

Fits are also called seizures or convulsions. Some are associated
with fever and some are not.
In the first five years of a child’s life, the commonest type of fit
is caused by fever (this may be called a febrile seizure or febrile
convulsion). Sometimes immunisation is followed by a fever
that may cause a febrile seizure. Most children who have febrile
seizures recover fully.
When a seizure occurs within a short time after immunisation, it
might not have been caused by the vaccine or the fever. It could
be due to an underlying medical condition.
If the surgery is closed or if you can’t contact your doctor, go
straight to the nearest hospital emergency department.

10 A guide to immunisation for pre-school

Immunisations for
pre-school children
Flu vaccine
What is flu?
Flu is an infectious disease with symptoms that come on very quickly.
A bad bout of flu can be much worse than a heavy cold. In children,
it causes fever, stuffy nose, dry cough, sore throat, aching muscles
and joints, and extreme tiredness that can last several days. Flu can
lead to painful ear infection, bronchitis and pneumonia – these may
be severe.

What causes flu and how do you catch it?

Flu is caused by influenza viruses that infect the windpipe and lungs.
When an infected person coughs or sneezes, they spread the flu
virus in tiny drops of saliva over a wide area. These droplets can then
be breathed in by other people or they can be picked up by touching
surfaces where the droplets have landed.

How is the vaccine given and how does it work?

The vaccine is given as a nasal spray up each nostril. It is quick and
painless. The vaccine contains viruses that have been weakened to
prevent them from causing flu but will help your child to build up
immunity, so that when they come into contact with the flu virus
they are unlikely to get ill.

Immunisations for pre-school children 11

My child had a flu vaccination last year, why do
they need another one this year?
The viruses that cause flu change very frequently, so the vaccine
has to be changed to match the viruses and may differ from
year to year. The vaccine your child gets this year may well be
different from the one they had last year, and next year’s may be
different again.

Which children are eligible for flu vaccination?

Children who are two and three years old are offered
flu vaccination at their GP practice (provided they are aged 2 or
3 on the 31 August of the current flu season). Primary school-
aged children are also offered flu vaccination at school.
The programme immunises children against flu because, by doing
this, we may be able to stop them passing flu to their parents,
grandparents and other family members.
In addition, children with certain medical conditions who are
aged between 2 and 18 years are offered flu vaccine.

Does the vaccine cause any side effects?

Serious side effects are uncommon but many children can
develop a runny or blocked nose, headache, some tiredness
or loss of appetite that last for a short period. The vaccine is
absorbed quickly in the nose so, even if your child sneezes
immediately after having had the spray, there’s no need to worry
that it hasn’t worked.
The nasal flu vaccine is called Fluenz tetra, you can view
the Patient Information Leaflet at www.medicines.org.uk/emc/
product/3296/pil

12 A guide to immunisation for pre-school

Are there any children who shouldn’t have the
nasal vaccine?
Children may not be able to have the nasal vaccine if they:
■ are currently wheezy or have been wheezy in the past 72 hours,
they should be offered a suitable inactivated influenza vaccine to
avoid a delay in protection
■ have needed intensive care due to
■ asthma
■ egg allergic anaphylaxis
■ have a condition that severely weakens their immune system.
Children who are at high risk from flu due to some medical
conditions or treatments and cannot have the nasal vaccine, will be
offered a flu jab instead.
In these circumstances the advice of a specialist should be sought.

I believe the nasal vaccine contains products derived from

pigs (porcine gelatine), which means my child can’t have it
because of our beliefs.
The nasal vaccine contains a highly processed form of gelatine (derived
from pigs), which is used in a range of many essential medicines. The
nasal vaccine provides good protection against flu, particularly in young
children.
This nasal vaccine not only protects your child against disease but, if
enough children are vaccinated, the disease won’t spread from one
person to another, and so their friends and family are also protected.
Some faith groups accept the use of porcine gelatine in medical
products, others don’t – the decision is, of course, up to you. For further
information about porcine gelatine and the nasal flu vaccine see www.
gov.uk/government/publications/vaccines-and-porcine-gelatine
There are also translated versions in Arabic, Bengali, Gujarati, Panjabi,
and Urdu available.

Immunisations for pre-school children 13

dTaP/IPV or DTaP/IPV vaccine
Booster given at 3 years 4 months
This vaccine boosts the immunisations that were given to your child
at two, three and four months of age. It protects against diphtheria,
tetanus, pertussis (whooping cough) and polio.

What is diphtheria?
Diphtheria is a serious disease that usually begins with a sore throat
and can quickly develop to cause breathing problems. It can damage
the heart and nervous system and, in severe cases, it can kill.

What is tetanus?
Tetanus is a disease affecting the nervous system which can lead to
muscle spasms, cause breathing problems and can kill. It is caused
when germs that are found in soil and manure get into the body
through open cuts or burns. Tetanus cannot be passed from person
to person.

What is pertussis (whooping cough)?

Whooping cough is a disease that can cause long bouts of coughing
and choking making it hard to breathe. Whooping cough can last for
up to ten weeks. It is not usually so serious in older children, but in
babies it is very serious and can kill.

What is polio?
Polio is a virus that attacks the nervous system which can cause
permanent paralysis of the muscles. If it affects the chest muscles or
the brain, polio can kill.

14 A guide to immunisation for pre-school

Are there any side effects from this vaccine?
Your child may have some redness, swelling or tenderness where they
had the injection, but this will usually disappear in a few days.
A hard lump may appear in the same place but this will also go, usually
over a few weeks. Occasionally, children may be unwell and irritable
and develop a temperature, headache, sickness and swollen glands.
The booster offered at this age is Boostrix-IPV for further information
see the Patient Information leaflet at www.medicines.org.uk/emc/
product/5302/pil

Immunisations for pre-school children 15

MMR vaccine
Booster given at 3 years 4 months
The MMR vaccine protects against measles, mumps and rubella. Since
1988, when the MMR vaccine was introduced in the UK, the numbers
of cases of measles, mumps and rubella have dramatically reduced.

What is measles?
Measles is caused by a very infectious virus. Nearly everyone who
catches it will have a high fever, a rash and generally be unwell.
Children often have to spend about five days in bed and could
be off school for ten days. Adults are likely to be ill for longer.
The complications of measles affect one in every 15 children. The
complications include chest infections, fits, encephalitis (infection of
the brain), and brain damage. Measles can kill.

How is it spread?
Measles is one of the most infectious diseases known. A cough or a
sneeze can spread the measles virus over a wide area. Because it’s so
infectious, the chances are your child will get measles if he or she is
not protected and comes near to someone who has measles. Over
95% of children need to be immunised to prevent measles from
circulating and causing outbreaks.

What is mumps?
Mumps is caused by a virus which can lead to fever, headache, and
painful, swollen glands in the face, neck and jaw. It can result in
permanent deafness, viral meningitis (infection of the lining of the
brain) and encephalitis. Rarely, it causes painful swelling of the testicles
in males and the ovaries in females. Mumps lasts about seven to ten
days. Before the MMR vaccine was introduced, mumps was the most
common cause of viral meningitis in children under 15.

16 A guide to immunisation for pre-school

How is it spread?
Mumps is spread in the same way as measles. It is about as
infectious as flu.

What is rubella?
Rubella (German measles) is a disease caused by a virus. In children
it is usually mild and can go unnoticed. It causes a short-lived rash,
swollen glands and a sore throat. Rubella is very serious for unborn
babies. It can seriously damage their sight, hearing, heart and
brain. This condition is called congenital rubella syndrome (CRS).
Rubella infection in the first three months of pregnancy causes
damage to the unborn baby in up to nine out of ten cases. In many
of the cases, pregnant women caught rubella from their own, or
their friends’, children.

How is it spread?
Rubella is spread in the same way as measles and mumps.
It is about as infectious as flu.

Why does my child need two doses of MMR vaccine?

Even though measles and mumps are uncommon in the UK,
children who are not protected are still at risk of catching the
infections. Your child needs a second dose of MMR because the
vaccine doesn’t always work fully the first time. Some children who
have only one dose of the vaccine might not be protected against
one or more of the diseases.
Thanks to immunisation, the number of cases of measles, mumps
and rubella have been reduced. However these diseases have not
gone away and there have been outbreaks of measles in recent
years. Two doses of the MMR vaccine are routinely given across
Europe as well as in the US, Canada, Australia and New Zealand.
Immunising your child with two doses of the MMR vaccine will give
them the best protection.

MMR vaccine 17
Are there any side effects from the second (pre-school)
dose of the MMR vaccine?
It is much less common to have side effects after the second dose than
after the first dose. When side effects do happen, they are usually
very mild.
■ The three different viruses in the vaccine act at different times and
produce the following side effects after the first dose of vaccine.
■ Six to ten days after the immunisation, about one in ten children
may develop a mild fever and some develop a measles-like rash
and go off their food. This can happen when the measles part of
the vaccine starts to work, and is normal.
■ About one in every 1000 immunised children may have a fit caused
by a fever. This is called a ‘febrile convulsion’, and can be caused
by any fever. However, if a child who has not been immunised gets
measles, they are five times more likely to have a fit.
■ Rarely, children may get mumps-like symptoms (fever and swollen
glands) about three weeks after their immunisation as the mumps
part of the vaccine starts to work.
■ Very rarely, children may get a rash of small bruise-like spots in
the six weeks after the vaccination. This is usually caused by the
measles or rubella parts of the vaccine. If you see spots like these,
take your child to the doctor to be checked. He or she will tell you
how to deal with the rash. As this rash could be confused with
the rash caused by septicaemia you should contact your doctor
urgently if your child is also unwell.
■ Fewer than one child in a million develops encephalitis
(inflammation of the brain) after MMR vaccine. However, if a child
catches measles, the chance of developing encephalitis is about
one in 1000.
■ Some years ago, there were stories suggesting a link between the
MMR vaccine and autism. Research since then has proved that no
such link exists.

18 A guide to immunisation for pre-school

MMR is a live vaccine. Does this mean my child can pass
the infection to other people?
No, your child will not be infectious. It contains weakened versions
of live measles, mumps and rubella viruses. Because the viruses
are weakened, people who have had the vaccine cannot infect
other people.

Does the vaccine contain gelatine?

In the UK we have two MMR vaccines. Both work very well, one
contains porcine gelatine and the other doesn’t. If you want your child
to have the porcine gelatine free vaccine discuss it with your practice
nurse or GP.
You can view the MMR vaccine Patient Information leaflets at:
■ Priorix: www.medicines.org.uk/emc/product/1159/pil
■ MMRVaxpro: www.medicines.org.uk/emc/product/6307/pil

Egg allergies
The MMR vaccine can safely be given to children who have had a
severe allergy (anaphylactic reaction) to egg. If you have any concerns,
talk to your practice nurse, health visitor or doctor.

Remember
If your child has not had an MMR vaccination
before, they should have the first dose now and
the second dose after one month.

MMR vaccine 19
Watch out for meningitis
and septicaemia
What are meningitis and septicaemia?
Meningitis is infection of the lining of the brain. The same germs
that cause meningitis may cause septicaemia (blood poisoning). Both
meningitis and septicaemia are very serious in young children and the
signs can come on quickly. If you suspect meningitis or septicaemia
get help urgently. Although your child was immunised as an infant
against Hib, MenB, MenC and some forms of pneumococcal bacteria,
all of which cause meningitis and septicaemia, these vaccines will not
protect them against other types of meningitis and septicaemia. So it’s
important to know the signs and symptoms.

What are the signs and symptoms of meningitis

and septicaemia?
Early symptoms of meningitis and septicaemia are mild and are similar
to the symptoms of flu (for example, fever, vomiting, being irritable
and pain in the back or joints). But the most important signs of
meningitis to look out for in children are:
■ a stiff neck (check that your child can kiss their knee, or touch their
forehead with their knees)
■ a bad headache (this alone is not a reason to get medical help)
■ a dislike of bright lights
■ vomiting
■ fever
■ drowsy, less responsive and confused
■ stiff with jerky movements (convulsions/fits), and
■ a rash.

20 A guide to immunisation for pre-school

The main signs of septicaemia are:
■ sleepiness, less responsive, vacant or confused (a late sign)
■ severe pains and aches in the arms, legs and joints
■ very cold hands and feet
■ shivering
■ rapid breathing
■ red or purple spots that don’t fade when you press them
(do the glass test explained below)
■ vomiting
■ a fever, and
■ diarrhoea and stomach cramps.

What should I do?

If your child develops one or more of the symptoms described above,
get medical help urgently. If you can’t get in touch with your doctor,
or are still worried after getting advice, trust your instincts and take
your child to the nearest hospital with an emergency department.

The ‘glass test’

Press the side of a clear drinking glass firmly
against the rash so you can see if the rash fades
and loses colour under pressure. If it doesn’t
change colour, contact your doctor immediately.
On dark skin, check inside the eyelids or roof of
the mouth where the spots may be more visible.

Watch out for meningitis and septicaemia 21

Where can I get more
information?
The following charities provide information, advice and support:
www.nhs.uk/conditions/meningitis

Meningitis Research Foundation

Free helpline 080 8800 3344
(9am to 10pm weekdays,
10am to 8pm weekends and holidays)
www.meningitis.org

Meningitis Now
24 hour helpline
0808 80 10 388
www.meningitisnow.org
If you would like more information about MMR please visit
www.nhs.uk/conditions/vaccinations/mmr-vaccine
If you would like more information on vaccinations including the
MMR vaccine please visit: www.nhs.uk/conditions/vaccinations/NHS-
vaccinations-and-when-to-have-them

22 A guide to immunisation for pre-school

Travel advice for children
If your child is going abroad, make sure their routine
immunisations are up to date. Your child may also need
extra immunisations and you may also need to take
other precautions.
Contact your doctor’s surgery or a travel clinic
well in advance for up-to-date information on
the immunisations your child may need.

For more information

You can get more information on the NHS
at www.nhs.uk and the Travel Health pro
website: http://travelhealthpro.org.uk

23
Routine childhood immunisation
programme from February 2022
Most vaccines are given as an injection in the thigh or
upper arm. Rotavirus vaccine is given as drops to be
swallowed and influenza vaccine as a nasal spray.

Vaccine Damage Payment Scheme

Current immunisations are extremely safe but, very rarely, an
individual may suffer from a problem after vaccination.
The Vaccine Damage Payment Scheme is designed to ease the
present and future burdens of the person who, on that very rare
occasion, may be affected by the vaccination.
There are several conditions that need to be met before a
payment can be made. If you need more information, please visit
www.gov.uk/vaccine-damage-payment

Vaccine Damage Payments Unit

Department for Work and Pensions
Palatine House, Lancaster Road
Preston PR1 1HB
Phone: 01772 899944
E-mail: [email protected]
If you want advice on immunisation, speak to your doctor,
practice nurse, health visitor or pharmacist, or call the
NHS helpline 111.
For more information visit www.nhs.uk/conditions/vaccinations

24 A guide to immunisation for pre-school

When Diseases protected against Vaccine given

Diphtheria, tetanus, pertussis (whooping cough),

DTaP/IPV/Hib/HepB
polio, Haemophilus influenzae type b (Hib) and
or 6-in-1 vaccine
hepatitis B
Eight weeks old
Meningococcal group B (MenB) MenB

Rotavirus gastroenteritis 4 Rotavirus

Diphtheria, tetanus, pertussis, polio, Hib and

DTaP/IPV/HibHepB
hepatitis B

Pneumococcal
Twelve weeks old
Pneumococcal (13 serotypes) conjugate
vaccination (PCV)

Rotavirus 4 Rotavirus

Diphtheria, tetanus, pertussis, polio, Hib and

DTaP/IPV/Hib/HepB
Sixteen weeks old hepatitis B

MenB MenB

Hib and MenC Hib/MenC

One year old Pneumococcal booster PCV

on or after the child’s
first birthday Measles, mumps and rubella (German measles) MMR 2

MenB MenB booster

Eligible paediatric
Influenza (each year from September) LAIV2,3
age group1

Diphtheria, tetanus, pertussis and polio TdaP/IPV

Three years and sixteen
weeks old or soon after MMR (check first
Measles, mumps and rubella
dose given)2

Cancers caused by human papillomavirus (HPV) HPV (two doses

Boys and girls aged twelve
Cancers and genital warts caused by specific human 6-24 months
to thirteen years
papillomavirus (HPV) types apart)

Td/IPV (check
Fourteen years old Tetanus, diphtheria and polio
MMR status)
(school year 9)
Meningococcal groups A, C, W and Y disease MenACWY

[1] See Green book chapter 19 at www.gov.uk/government/publications/influenza-the-green-book-chapter-19

or www.nhs.uk/conditions/vaccinations/child-flu-vaccine. [2] The live attenuated influenza vaccine (LAIV) and
one of the two brands of MMR vaccine contains porcine gelatine. [3] If LAIV (live attenuated influenza vaccine)
is contraindicated and child is in a clinical risk group, use inactivated flu vaccine. [4] Check SCID screening
outcome before giving Rotavirus

25
Additional vaccines for individuals with underlying medical conditions

Medical condition Diseases protected against Vaccines required

MenACWY
Asplenia or splenic dysfunction Meningococcal groups A, B, C, W and Y MenB
(including sickle cell and coeliac Pneumococcal PCV13 (up to two years of age)
disease) Influenza PPV (from two years of age)
Annual flu vaccine
PCV13 (up to two years of age)
Cochlear implants Pneumococcal
PPV (from two years of age)
Chronic respiratory and heart PCV13 (up to two years of age)
conditions (such as severe Pneumococcal
PPV (from two years of age)
asthma, chronic pulmonary Influenza
disease, and heart failure) Annual flu vaccine
Chronic neurological conditions PCV13 (up to two years of age)
(such as Parkinson’s or motor Pneumococcal
PPV (from two years of age)
neurone disease, or learning Influenza
disability) Annual flu vaccine
PCV13 (up to two years of age)
Pneumococcal
Diabetes PPV (from two years of age)
Influenza
Annual flu vaccine
PCV13 (up to two years of age)
Pneumococcal (stage 4 and 5 CKD)
Chronic kidney disease (CKD) PPV (from two years of age)
Influenza (stage 3, 4 and 5 CKD)
(including haemodialysis) Annual flu vaccine
Hepatitis B (stage 4 and 5 CKD)
Hepatitis B
PCV13 (up to two years of age)
Pneumococcal
PPV (from two years of age)
Influenza
Chronic liver conditions Annual flu vaccine
Hepatitis A
Hepatitis A
Hepatitis B
Hepatitis B
Hepatitis A Hepatitis A
Haemophilia
Hepatitis B Hepatitis B
PCV13 (up to two years of age)1
Immunosuppression due Pneumococcal
PPV (from two years of age)
to disease or treatment2 Influenza
Annual flu vaccine
MenACWY
Complement disorders Meningococcal groups A, B, C, W and Y MenB
(including those receiving Pneumococcal PCV13 (to any age)
complement inhibitor therapy) Influenza PPV (from two years of age)
Annual flu vaccine
[1] To any age in severe immunosuppression
[2] C
 onsider annual influenza vaccination for household members and those who care for people with these conditions
[3] Check SCID screening outcome before giving BCG

26 A guide to immunisation for pre-school

 Selective immunisation programmes

Target group Age and schedule Disease Vaccines required

Babies born to hepatitis B At birth, four weeks and Hepatitis B

Hepatitis B
infected mothers 12 months old1,2 (Engerix B/BvaxPRO)

Infants in areas of the

country with TB incidence Around 28 days after birth3 Tuberculosis BCG
≥ 40/100,000

Infants with a parent or

grandparent born in a high Around 28 days after birth3 Tuberculosis BCG
incidence country3

During flu season

Inactivated flu vaccine
At any stage of pregnancy Influenza
Pregnant women dTaP/IPV
during flu season Pertussis
(Boostrix-IPV)
From 20 weeks gestation5

[1] Take blood for HBsAg at 12 months to exclude infection

[2] In addition 6-in-1 vaccine is given at 8, 12 and 16 weeks
[3] Where the annual incidence of TB is ≥ 40/100,000 –
see gov.uk/government/publications/tuberculosis-tb-by-
country-rates-per-100000-people
[4] Check SCID screening outcome before giving BCG
[5] Can be given from 16 weeks but usually offered
after the anomaly scan
Produced by
UK Health Security Agency

© Crown copyright 2023

C22PSC34EN 1p 100K APR 2023 (APS)
UK Health Security Agency gateway number: 2022632
This edition features the February 2022 immunisation schedules.
If you need more copies of this leaflet, please visit, www.healthpublications.gov.uk/Home to
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