About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
Key points
- Routine vaccinations begin at 8 weeks with the 6-in-1 (DTaP/IPV/Hib/HepB), rotavirus, and MenB
- MMR is given at 12–13 months and boosted at 3 years 4 months
- Live vaccines: MMR, rotavirus, BCG, live attenuated influenza (LAIV), varicella. Contraindicated in immunocompromised patients
- MenACWY replaced MenC in the adolescent programme — given at 14 years
- HPV vaccine: offered to all children aged 12–13 years (one dose from September 2023)
Overview
The UK childhood immunisation programme is one of the most comprehensive in the world, providing protection against a wide range of serious infectious diseases. The schedule is set by the Joint Committee on Vaccination and Immunisation (JCVI) and detailed in the Green Book (Immunisation against infectious disease). Understanding the schedule, the distinction between live and inactivated vaccines, and key contraindications is essential for clinical practice and UKMLA preparation.
The Routine UK Childhood Immunisation Schedule
8 weeks: 6-in-1 (DTaP/IPV/Hib/HepB) — 1st dose | Rotavirus (oral, live) — 1st dose | MenB — 1st dose
12 weeks: 6-in-1 (DTaP/IPV/Hib/HepB) — 2nd dose | Rotavirus (oral, live) — 2nd dose | Pneumococcal (PCV13) — 1st dose
16 weeks: 6-in-1 (DTaP/IPV/Hib/HepB) — 3rd dose | MenB — 2nd dose
12–13 months: Hib/MenC booster | PCV13 booster | MMR — 1st dose | MenB booster
2–10 years (annual): Live attenuated influenza vaccine (LAIV, nasal spray) — annual
3 years 4 months: DTaP/IPV (4-in-1 pre-school booster) | MMR — 2nd dose
12–13 years: HPV vaccine (one dose — Gardasil 9)
14 years: MenACWY | Td/IPV (3-in-1 teenage booster)
Live vs Inactivated Vaccines
Live vaccines: MMR, rotavirus, BCG, live attenuated influenza vaccine (LAIV), oral polio (OPV — not used in UK routine schedule), varicella, yellow fever. Live vaccines are generally contraindicated in immunocompromised patients and in pregnancy. Two live vaccines should either be given on the same day or separated by at least 4 weeks.
Inactivated/component vaccines: DTaP, IPV, Hib, HepB, PCV, MenB, MenACWY, HPV. These are safe in immunocompromised patients but may be less effective.
Clinical Features
Symptoms
Fever within 48 hours of inactivated vaccines (common and self-limiting)
Local injection site reaction: redness, swelling, tenderness
Fever 6–11 days after MMR (mini-measles — occurs in ~10%)
Parotid swelling 2–3 weeks after MMR (rare, self-limiting)
Febrile seizure post-vaccination (rare but recognised)
Anaphylaxis
Signs
Injection site induration or nodule (may persist for weeks)
Mild non-specific rash after MMR
BCG site reaction: papule → ulcer → scar (normal evolution over 6–12 weeks)
Signs of anaphylaxis: urticaria, angioedema, wheeze, hypotension (within minutes)
Investigations
First-line
Clinical assessmentPre-vaccination screening: check for contraindications (immunosuppression, pregnancy for live vaccines, previous anaphylaxis to vaccine component)
Second-line
SerologyNot routinely checked. May be done in specific circumstances: post-exposure (HepB), in immunocompromised patients to confirm seroconversion
Specialist
Specialist immunology adviceFor immunocompromised children — individualised vaccination schedule needed. Green Book Chapter 6 and specialist input
1
Contraindications (TRUE)
- Confirmed anaphylaxis to a previous dose of the same vaccine or a vaccine component
- Live vaccines: contraindicated in immunocompromised patients (e.g. chemotherapy, high-dose steroids ≥2 mg/kg/day for ≥1 week or ≥1 mg/kg/day for ≥1 month, primary immunodeficiency, HIV with low CD4)
- Live vaccines in pregnancy — generally contraindicated
- Rotavirus: contraindicated if history of intussusception or SCID
2
NOT contraindications (common myths)
- Minor illness without fever — can vaccinate
- Family history of adverse reactions — not a contraindication
- Prematurity — vaccinate at chronological age (not corrected)
- Previous febrile seizure — not a contraindication (give prophylactic paracetamol with MenB)
- Breastfeeding — not a contraindication to any routine vaccine
- Antibiotics or stable neurological condition — can vaccinate
- Egg allergy: MMR is safe (grown on fibroblasts, not egg). LAIV and yellow fever contain egg protein — refer if severe egg allergy
3
Special situations
- Prophylactic paracetamol: recommended with MenB vaccine doses (at 8, 16 weeks, and 12-month booster) to reduce fever
- Missed vaccines: never restart the course — continue from where left off
- Preterm infants: vaccinate at chronological age (8 weeks from birth, regardless of gestation)
- Immunocompromised: inactivated vaccines safe but may be less effective. Live vaccines usually contraindicated — seek specialist advice
- Post-splenectomy/functional asplenia: additional pneumococcal, meningococcal (MenACWY + MenB), Hib, and annual influenza vaccines
4
Catch-up and travel vaccines
- Incomplete schedule: assess against the current schedule and fill gaps — never restart
- BCG: offered to at-risk neonates (parents/grandparents from high-incidence countries) — given at birth or shortly after
- Hepatitis B: given to at-risk neonates (mother HBsAg-positive) at birth + immunoglobulin
- Travel vaccines: discuss with travel health service — some require specialist advice
Complications
- Anaphylaxis: Rare (1–2 per million doses) but must be prepared — all vaccinators should have adrenaline available and be trained in its use
- Febrile seizures: Rare, self-limiting — more common after MMR (day 6–11) and pertussis-containing vaccines
- Vaccine-strain disease: Extremely rare with live vaccines — mainly in immunocompromised children (e.g. BCG dissemination in SCID)
- Intussusception: Very small increased risk with rotavirus vaccine (~1–6 per 100,000 infants) — benefits greatly outweigh risks
- Immune thrombocytopenia (ITP): Rare association with MMR (~1 in 25,000) — usually self-limiting
UKMLA Exam Tips
- 1First vaccinations at 8 WEEKS: 6-in-1 + Rotavirus + MenB. Know this age precisely
- 2MMR: 12–13 months (1st dose) and 3 years 4 months (2nd dose). MMR is NOT grown in egg — safe in egg allergy
- 3Live vaccines: MMR, Rotavirus, BCG, LAIV, Varicella. Mnemonic: "My Rabbits Bounce Lively, Very"
- 4Prophylactic paracetamol is given with MenB (not with other vaccines)
- 5Rotavirus is ORAL (not injected) and given at 8 and 12 weeks only (strict upper age limit — not after 24 weeks)
- 6Preterm babies: vaccinate at CHRONOLOGICAL age, not corrected age
- 7Egg allergy and vaccines: MMR = safe. LAIV = caution/avoid if severe. Yellow fever = refer
- 8Minor illness without fever is NOT a contraindication to vaccination
- 9HPV vaccine: now one dose (from 2023), given to ALL children at 12–13 years regardless of sex
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