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Childhood immunisation

Published by Bupa's health information team, April 2008.

This factsheet is for parents who would like information about vaccinations for their child in the UK. Advice in other countries may be different.

Immunisation, also called vaccination, is the use of vaccines to protect children against infectious diseases caused by bacteria and viruses.

About childhood immunisations
Why immunise?
Which vaccines does my child need?
How are vaccines given?
When to delay immunisation
Side-effects
Further information
Questions and answers
Related topics
Sources

About childhood immunisations

Vaccines may consist of a preparation of:

a killed virus or bacterium
detoxified toxins from a virus or bacterium (toxoid)
a weakened form of a live virus or bacterium

They all work by stimulating the immune system in the same way as the actual infection would, but without causing the full-blown disease.

Why immunise?

All of the infections that are in the immunisation programme can develop into serious illnesses with the potential to cause disability or death.

If most children are immunised, the spread of the infection in the community is significantly reduced and even unvaccinated children are at much less risk of catching the illness. This is called "herd immunity".

Some people argue that there is no longer any need to immunise children. Diseases such as polio, for example, are now almost never seen in the UK. However, these diseases haven't yet disappeared. If more people choose not to immunise their children, then the number of children at risk of catching a disease will increase and outbreaks of the disease will occur.

The only time to stop immunising children is when a disease has been completely eradicated worldwide. For example, when every country had eliminated smallpox in 1979, immunisation against the disease was stopped. It's hoped that polio will soon be eradicated and measles may follow.

Which vaccines does my child need?

Vaccines are given to children as part of the routine UK schedule to protect them against:

diphtheria
tetanus
pertussis (whooping cough)
poliomyelitis (polio)
Haemophilus influenzae type B
meningitis C
pneumococcal infection (eg pneumonia, septicaemia and meningitis)
measles
mumps
rubella (german measles)

The following vaccines are given selectively:

tuberculosis (TB)
hepatitis B
those required for foreign travel or in special circumstances - ask your GP for advice

Some vaccinations, particularly killed or toxoid vaccines, need a course of vaccines to allow your child's immune system to progressively build its defences. Booster doses are needed for some vaccines to "top up" immunity for pre-school children and teenagers (see Immunisation schedule).

DTaP/IPV/HiB

The DTaP/IPV/HiB vaccine is a combined five-in-one treatment.

D stands for diphtheria.
T stands for tetanus.
aP stands for acellular pertussis (whooping cough). This has replaced the previous whole cell vaccine.
IPV stands for inactivated polio vaccine. This has replaced the previous live vaccine.
HiB stands for Haemophilus influenzae type B.

Pneumococcal vaccine (PCV)

PCV protects against some strains of pneumococcal infection, which can cause diseases such as pneumonia, septicaemia and meningitis.

Meningococcus type C (Men C) vaccine

The Men C vaccine is against the bacteria that causes a severe form of septicaemia and/or meningitis. Your child can have it at the same time as the DTaP/IPV/HiB vaccine. It will be given as a separate injection at another site on your child's body.

MMR vaccine

The MMR vaccine is against measles, mumps and rubella. This is available as a three-in-one injection. For more information on MMR immunisation, please see Related topics.

BCG vaccine

The BCG (Bacille Calmette-Guérin) vaccine is against TB. BCG vaccination is given to those children who are most likely to catch the disease, especially in those living in areas with a high rate of TB or whose parents or grandparents were born in a country with a high prevalence of TB. Your child will have a skin test before the injection and then, if needed, he or she will have one injection in the upper arm.

Hepatitis B vaccine

Hepatitis B vaccine is given to children at high risk of catching the disease, particularly babies who are at high risk of catching it from their mother.

Human papilloma virus (HPV) vaccine

From September 2008 girls aged 12 to 13 will be routinely vaccinated with human papilloma virus (HPV) vaccine against cervical cancer. HPV is a sexually transmitted virus that causes 99 percent of invasive cervical cancer. HPV vaccine protects against the viruses that cause about 70 percent of instances of cervical cancer.

Immunisation schedule

The following table outlines when you should immunise your child against each disease. This schedule was last updated in September 2006 and will include the HPV vaccination from September 2008.

When to immunise	Vaccine	How it is given	First dose or booster?
2 months	DTaP/IPV/HiB (diptheria, tetanus, acellular pertussis, polio, Haemophilus influenzae type B)	5-in-1 injection	First dose of course
	PCV (Pneumococcal conjugate vaccine)	Injection	First dose of course
3 months	DTaP/IPV/HiB	5-in-1 injection	Second dose of course
	Men C (meningococcus type C)	Injection	First dose of course
4 months	DTaP/IPV/HiB	5-in-1 injection	Third dose of course
	Men C	Injection	Second dose of course
	PCV	Injection	Second dose of course
12 months	HiB/Men C	Injection	Booster
Around 13 months	MMR (measles, mumps, rubella)	3-in-1 injection	First dose of course
	PCV	Injection	Booster
3 years and 4 months to 5 years	MMR	3-in-1 injection	Booster
	DtaP/IPV/HiB	5-in-1 injection	Booster
13 to 18 years	Td/IPV (tetanus, diphtheria, polio)	Injection	Booster

How are vaccines given?

Most vaccines will be given by injection, usually into the muscle or fat of your child's outer thigh or upper arm.

A nurse or GP at a health centre or GP surgery will probably give your child the vaccines.

When to delay immunisation

As a general rule, your child can receive all the standard immunisations unless he or she has a fever at the time the injection is due. The vaccines could increase the fever and make it difficult to identify side-effects.

If you are worried about how your child will react to the vaccine, or if he or she has had previous reactions, talk to your GP, practice nurse or health visitor.

When not to immunise

Live vaccines, such as MMR and BCG, shouldn't be given if your child:

is being treated for cancer or has been treated for cancer in the last six months
has a weak immune system
is on immunosuppressant medicines
has had a bone marrow transplant in the last six months

You should also check with your GP if your child has any other condition where their immune system is not working fully, or if your child is taking a course of steroids, for example for asthma.

Incorrect reasons to delay immunisation

You don't have to delay getting your child immunised if your child:

has a minor illness, without a fever, such as a cough or cold, or has had contact with someone with an infectious disease
has a family history of side-effects to a vaccine, inflammatory bowel disease or autism
has a history of allergy, inflammatory bowel disease or autism
has already had an illness similar to that covered by a combined vaccine (for example, if your child has had mumps, he or she should still have the MMR vaccine)
is being treated with antibiotics, topical steroids or replacement corticosteroids
was a premature or very small baby, or if they were jaundiced after birth
is being breastfed or if you are pregnant
has a stable neurological condition, such as cerebral palsy
has asthma, hay fever or eczema
is over the immunisation age recommended in the schedule - he or she can have catch-up vaccinations at any later date
is due to have, or has recently had, surgery

Side-effects

The side-effects your child may get depend on which vaccine he or she has been given. If they do occur, the side-effects are usually only minor. For example, some redness and swelling at the injection site is fairly common. Other side-effects include:

a fever
a slightly raised temperature
some sickness and/or diarrhoea
swollen glands
a small lump at the site of the injection, which may last for a few weeks
irritability

To lower your child's temperature and relieve any discomfort, you can give your child a painkiller that he or she would normally take for a headache.

A severe reaction from a vaccine is very rare. Symptoms of a severe reaction include:

a very high temperature
a fit, called a febrile convulsion
a rash
difficulty with breathing
floppiness or lethargy
inconsolable crying which may be high-pitched and unusual

You should let your GP know if you notice any of these symptoms.

Are vaccines safe?

The vast majority of paediatricians (doctors specialising in children's health), infectious disease and public health experts, GPs, health visitors and other health professionals who work with children support the routine immunisations as the best defence against potentially dangerous diseases.

Some controversies have been highlighted in recent years however, such as the use of the preservative thiomersal in the manufacture of vaccines. Purely as a precaution, and a general move to reduce children's exposure to mercury, wherever possible, thiomersal has been phased out from vaccines. There are now no thiomersal-containing vaccines in the routine childhood immunisation programme.

There has also been speculation over a link between the MMR vaccine and autism. But there is now a large body of scientific evidence available, based on the records of millions of MMR vaccinations, that shows there is no link between MMR and autism.

For more information on MMR immunisation, please see Related topics.

Further information

The Green Book
Department of Health
020 7210 4850
www.doh.gov.uk
NHS immunisation information
http://www.immunisation.nhs.uk