Executive summary
- The UK routine childhood schedule is one of the most effective public health interventions available. Falling MMR uptake has led to measles resurgence — every primary care contact is an opportunity to check and update immunisation status.
- Always check the red book and/or child's GP record at every contact for children under 5. Opportunistic vaccination is actively encouraged.
- No vaccine is ever "too late" to give if missed, unless it is age-specific (e.g., rotavirus). Use catch-up schedules for all other vaccines.
- Very few true contraindications exist. Most parental concerns do not constitute a contraindication. Anaphylaxis to a prior dose of the same vaccine or a confirmed allergy to a specific vaccine component are the main absolute contraindications.
Routine schedule overview
- 8 weeks: 6-in-1 (DTaP/IPV/Hib/HepB), MenB (Bexsero), rotavirus (Rotarix — oral).
- 12 weeks: 6-in-1 (2nd dose), PCV (pneumococcal), rotavirus (2nd oral dose).
- 16 weeks: 6-in-1 (3rd dose), MenB (2nd dose).
- 12–13 months (1st birthday review): Hib/MenC, MMR (1st dose), PCV (booster), MenB (booster).
- 2–3 years (annually, autumn): Children's flu vaccine (live attenuated intranasal — LAIV).
- 3 years 4 months: 4-in-1 pre-school booster (DTaP/IPV), MMR (2nd dose).
- 12–13 years (school Year 8): HPV (2 doses, Gardasil 9 — minimum 6-month interval), MenACWY (Nimenrix or Menveo).
- 13–15 years (school Year 9/10): 3-in-1 teenage booster (Td/IPV), MenACWY (if not given at Year 8).
MMR catch-up — the most common scenario
- Any child or adult who has not received 2 doses of MMR should be vaccinated regardless of age, unless there is a documented absolute contraindication.
- Minimum interval between MMR doses is 1 month. The second dose can be given from 4 weeks after the first.
- For infants 6–12 months at high risk of measles exposure (e.g., outbreak area, travel): a single MMR dose can be given from 6 months, but this does not count towards the primary schedule — two further doses are still required at 12–13 months and 3 years 4 months.
- MMR in immunocompromised patients: MMR is a live vaccine and is contraindicated in significantly immunocompromised individuals. Seek specialist advice. Household contacts should receive MMR to provide indirect protection.
- MMR in pregnancy: Contraindicated. Advise to avoid pregnancy for 1 month post-vaccination (theoretical teratogenicity — not documented in practice).
Missed and delayed doses
- Rotavirus: First dose must be given by 15 weeks 0 days; second dose by 24 weeks 0 days. If these windows have passed, the vaccine cannot be given (age limit due to rare intussusception risk).
- All other childhood vaccines: Can be given as catch-up if missed. Do not restart courses from the beginning — continue from where the course stopped.
- Catch-up resources: Refer to the UKHSA catch-up schedules (Green Book, Appendix 2) or the NHS England catch-up guidance for specific age-adjusted courses.
- Unimmunised or partially immunised older children/adults: Complete the 6-in-1 equivalent using age-appropriate single antigens (e.g., DTaP/IPV, Hib, HepB) — involve the local immunisation team or specialist if uncertain.
Contraindications and precautions
- Absolute contraindications for any vaccine: Anaphylaxis to a previous dose of the same vaccine, or confirmed anaphylaxis to a vaccine component (e.g., gelatin, neomycin for MMR; yeast for HepB).
- Live vaccines (MMR, LAIV, varicella, BCG): Contraindicated in significantly immunocompromised patients and in pregnancy. A 4-week interval should be maintained between different live vaccines if not given simultaneously.
- Common non-contraindications: Minor illness with low-grade fever, antibiotics, recent exposure to infection, previous mild adverse reaction (fever, soreness), stable neurological condition, and egg allergy (MMR and all seasonal flu vaccines can be given; see Green Book for anaphylaxis protocols).
- Egg allergy and flu vaccine: Children with egg allergy, including those with a history of anaphylaxis, can receive the LAIV in primary care following UKHSA guidance, provided standard allergy precautions are followed and a 15-minute post-vaccination observation period is observed.
Frequently asked questions
A parent wants to delay or split the MMR — what should I say?
The split MMR (M, M, R separately) is not available in the UK and there is no clinical evidence it is safer. Delaying vaccination increases the window of susceptibility. Discuss parental concerns respectfully, provide factual information about safety and effectiveness, and offer to revisit. Document the conversation. Do not refuse future vaccination if they later consent.
The child is on steroids — can I vaccinate?
It depends on dose and duration. Systemic steroids at immunosuppressive doses (prednisolone ≥2 mg/kg/day for ≥1 week, or ≥1 mg/kg/day for ≥1 month in children) are a contraindication to live vaccines. Topical, inhaled, or low-dose systemic steroids are not a contraindication. Seek specialist advice for uncertain cases.
When should I use the 2-in-1 versus 4-in-1 preschool booster?
The 4-in-1 (DTaP/IPV) is the correct preschool booster for children at 3 years 4 months and is different from the 3-in-1 teenage booster (Td/IPV, lower-dose diphtheria and no pertussis component). Ensure you are selecting the correct preparation from the prescribing system.
Does HPV vaccination still benefit those who are already sexually active?
Yes — catch-up HPV vaccination is recommended up to age 25 years (and up to age 45 in some circumstances for men who have sex with men). Even those already exposed to one HPV type benefit from protection against the others covered by Gardasil 9.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.