Private Health Visitor | Health visiting | Find a health visitor
Immunisations - UK

 

Immunisations

 

Immunisation has caused dramatic improvements in health. Because of immunisation, diseases such as diphtheria, tetanus,

pertussis (whooping cough), measles and polio, which used to be major causes of ill health, are now rare in many countries.

Some immunisations are offered to all people through the childhood immunisation programme.

 

 



Immunisation - Legal implications/advice

The importance of consent cannot be underestimated.


Consent is valid so long as the individual giving consent has been offered as much information as they reasonably need in order to make an informed decision, in a form they can understand - e.g. which immunisation is being given, details of the disease(s) it protects against, side-effects of the immunisation(s) and their management, and the possible consequences if immunisations are declined.

 

Consent may be written, verbal or implied (e.g. bringing the child to the clinic rather than taking to school) but the details should be recorded on each occasion. Consent must be obtained before each injection.

 

When vaccinating children aged under 16, parents should feel involved in the decision, and their concerns should be fully answered. This may necessitate the advice of a community paediatrician or consultant in communicable disease control.

 

Adults aged over 18 can give their own consent provided they have capacity (see Mental Capacity Act). Children aged 16 or 17 are similarly presumed to be able to consent to their own treatment (Family Law Reform Act 1969) if they have capacity but, under some circumstances, their decisions can be overridden by a person with parental responsibility or by a court.7 In children under 16 years of age, consent should be obtained from an individual with 'parental responsibility'.

 

The natural father of a child, who was not married to the mother at the time of the child's birth, will not automatically have parental responsibility unless the child was born after 1st December 2003, and he is named as the father on the birth certificate. Parental responsibility can be acquired (see section 4 of the Children Act, 1989) either by (written) agreement with the mother, by court order, or by subsequently marrying the mother.

 

Parental responsibility can also be given to other individuals by court 'parental responsibility orders' or 'residence orders'. If the parent appoints another individual (e.g. a grandparent) to act in loco parentis, it is the parent's responsibility to inform the surgery about this, by letter or phone.

 

The surgery must record this information in the patient's medical record and should not give the injection without it. A child under 16 may consent or refuse, providing they are 'Fraser competent' (commonly known as 'Gillick competent', except that Mrs Gillick objected to the use of her name, so it is more properly known by the name of the judge who made the ruling). Fraser competent children should nevertheless be encouraged to involve the individual with parental responsibility in the decision.

 

When in doubt, always involve a specialist. The Children Act allows parental responsibility to be overridden in the best interests of a 'Fraser incompetent' child in an emergency, but this is unlikely to arise in the situation discussed here.

 

Individuals giving consent should also be informed about how the immunisation data will be stored on the practice's system and centrally (data protection and Caldicott guidance). Document references PL CMO (2006)

 

Important changes to the childhood immunisation programme, Dept of Health Introduction of Human Papillomavirus Vaccine into the national immunisation programme, Chief Medical Officer, PL CMO (2008)4 About vaccinations

 

NHS Choices Immunisation against infectious disease - 'The Green Book', Dept of Health (various dates) Consent, Immunisation against infectious disease

 

The Green Book, Dept of Health, 2006 Consent - Dept of Health Website; (detailed information regularly updated) Reference guide to consent for examination or treatment (second edition 2009)

 

Dept of Health Children Act 2004 Internet and further reading About vaccinations, NHS Choices Immunisation, Information for Professionals

 

Dept of Health Website Reference guide to consent for examination or treatment (second edition 2009)

 

Dept of Health Acknowledgements EMIS is grateful to Dr Huw Thomas for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2011

 

Document ID: 1572 Document Version: 30 Document Reference: bgp1534 Last Updated: 17 Jan 2011

How Does Immunisation Works?

 

How does immunisation work?

The body is given a vaccine which is a small dose of an inactive form of a bacterium or virus (germ) or a toxin (poison) made by the germ. As it is inactive it does not cause infection. However, the body makes antibodies and/or immune cells (white blood cells) against the germ or toxin.

 

 

 

Antibodies are proteins in the bloodstream that attack infecting germs.

 

Once we are immunised, the antibodies and/or immune cells are ready to attack the germ if it begins to invade our body. More antibody can quickly be made from cells which have previously made the particular antibody.



For some bacteria and viruses it has been difficult to produce a vaccine; however, technology is advancing and new vaccines will be available in the future.



A newborn baby has passive immunity to several diseases, such as measles, mumps and rubella, from antibodies passed from its mother via the placenta.

 

This passive immunity of babies usually only lasts for a few weeks or months but, for measles, mumps and rubella, it lasts up to one year. Immunisation with vaccines is called active immunity and provides long-term immunity.

 

 

Further information

 

Information on immunisation from the NHS

 

Web: www.nhs.uk/Planners/vaccinations/Pages/Vaccinationchecklist.aspx
 

 

 

Seasonal Influenza Immunisation - The Flu Jab

 

Seasonal influenza is the strain of influenza virus that arrives in the UK each autumn. The actual strain varies from year to year and a new immunisation is developed each year to protect against the prevailing strain. This year, 2010-11, the influenza immunisation will provide protection also against the influenza A virus (H1N1v) strain.



The aim is to protect people who are more likely to develop complications from flu. You should be immunised against flu each autumn if you are aged 65 or over. Also, people of any age in any of the following at-risk groups.

 

If you:

 

 

  • Have any chronic (ongoing) lung diseases. Examples include: chronic bronchitis, emphysema, cystic fibrosis and
  •  
  •  

     

  •  

  •  

  •  

  •  
  • severe asthma (needing regular steroid inhalers or tablets). It is also recommended for any child who has previously
  •  
  •  
  •  

 

  •  
  • been admitted to hospital with a chest infection.

 

  • Have a chronic heart disease. Examples include: angina, heart failure or if you have ever had a heart attack.

 

 

  • Have a serious kidney disease. Examples include: nephrotic syndrome, kidney failure, a kidney transplant.

 

 

  • Have a serious liver disease such as cirrhosis.

 

 

  • Have diabetes.

 

 

 

 

 

  • Have a poor immune system. Examples include: if you are receiving chemotherapy or steroid treatment (for more
  •  
  •  

 

 

  • than a month), if you have HIV/AIDS or if you have had your spleen removed.

 

 

 

  • Have certain serious diseases of the nervous system, such as multiple sclerosis, or have had a stroke in the past.

 

  • Live in a nursing home or other long-stay residential care accommodation.

 

 

In addition to the main at-risk groups of people listed above:

 

 

 

  • You should be immunised if you are the main carer for an elderly or disabled person whose welfare may be at risk if
  •  
  •  
  •  

 

  •  
  • you fall ill with influenza.

 

  • Staff involved in direct patient care may be offered a flu jab from their employer.

 

 

 

  • Pregnant women. Even if you are otherwise healthy it is now recommended that all pregnant women receive the
  •  

 

  •  
  •  
  • influenza immunisation.

 

 

 

  • People who work in close contact with poultry.

 

Immunisation Against Tuberculosis -The BCG Vaccine

 

The BCG vaccine (BCG stands for bacillus Calmette-Guérin) is offered to the following people in the UK:

 

 

 

 

  • All infants (0-12 months old) living in areas of the UK where there is a high rate of tuberculosis (TB). That is, areas
  •  
  •  
  •  

 

  •  
  • where the incidence of TB is 40 cases per 100,000 people per year or greater.

 

 

  

 

  • Infants whose parents or grandparents were born in a country with a high rate of TB. That is, countries where the
  •  
  •  

 

  •  
  •  
  •  
  • incidence of TB is 40 cases per 100,000 people per year or greater.

 

 

        The following groups of people who have not previously been immunised:

 

 

    • Children (under 16 years) who have come to live in the UK from countries where TB is common (at least 40
    •  
    •  
    •  
    •  
    •  
    •  
    • cases per 100,000 people per year) and have not been immunised before.
    •  
    •  
  •  
  •  

 

 

 

  •  
  •  
    • Children between the ages of 6-16 years who have a parent or grandparent who was born in a country where
    •  
    •  
    •  
    •  
    • the incidence of TB is 40 cases per 100,000 people per year or greater.
    •  
    •  
  •  
  •  
  •  
  •  
    • Children under 16 years old who are close contacts of an individual who has active TB affecting their lungs.
    •  
    •  
  •  
  •  
  •  

 

  •  
  •  
    • Children under 16 years old who were born in, or have lived for more than three months in, a country where the
    •  
    •  
    •  
    •  
    •  
    • incidence of TB is 40 cases per 100,000 people per year or greater.
    •  
    •  
  •  
  •  
  •  
  •  
    • People at an increased risk due to their job. For example, health workers, prison staff, etc.

 

 

Note:

 

Until 2005, all schoolchildren in the UK were routinely given the BCG vaccine at about the age of 13.

 

The policy changed in autumn 2005 and those now immunised are in the groups listed above.

 

The policy change was due to the changing patterns of TB in the UK.

 

Rates of the disease are now very low in many parts of the country and children living in these areas have a very low risk of infection.

 

However, in other areas, rates of TB are increasing.

 

This is why the BCG vaccine is now mainly targeted at babies living in areas where there is an increasing rate of TB cases.

 

Your doctor or midwife will be able to tell you if you live in an area with a high rate of TB.



Children who would previously have been offered BCG through the schools' programme will now be screened for risk factors, tested and immunised as appropriate.

 

 

Who Should NOT Be Immunised?

 

 

 

There are very few reasons why people should not receive their full course of immunisations. Immunisations are

generally safe and effective.

 

 

For some immunisations the three most common reasons why it might not be advisable are:

 

 

 

  • Pregnancy and / or breast-feeding.

 

 

 

  • If your immune system is not working properly. For example, people with HIV infection, people taking chemotherapy,
  •  
  •  

 

  •  
  •  
  • and people taking high-dose steroids.

 

 

 

  • If you have previously had a severe reaction to the same vaccine.

 

 

 

Hepatitis B Immunisation

 

Hepatitis B immunisation

 

This is advised for people who are at increased risk of contracting hepatitis B. For example:

 

 

 

  • Workers who are likely to come into contact with blood products, or are at increased risk of needlestick injuries,
  •  
  •  

 

  •  
  •  
  • assault, etc. For example: nurses, doctors, dentists, medical laboratory workers, prison wardens, etc. Also, staff at

 

  • residential centres where there is a risk of scratching or biting by residents.

 

  • People who inject street drugs, their sexual partners and children.

 

  • People who change sexual partners frequently.

 

 

 

 

  • People who live in close contact with someone infected with hepatitis B. (You cannot catch hepatitis B from touching
  •  
  •  

 

  •  
  • people or normal social contact. However, close regular contacts are best immunised.)

 

  • People who regularly receive blood transfusions (for example, haemophilia).

 

  • People with certain kidney or liver diseases.

 

 

  • People who live in residential accommodation for those with learning difficulties. People who attend day centres for
  •  

 

  •  
  • people with learning difficulties may also be offered immunisation.

 

 

 

  • Families adopting children from countries with a high or intermediate prevalence of hepatitis B when the hepatitis B
  •  
  •  

 

 

  • status of the child is unknown. (It is, however, advisable for the child to be tested for hepatitis B.)

 

 

 

 

  • Foster carers or if you live with foster children.

 

 

 

  • Prison inmates.

 

 

 

 

 

  • Travellers to countries where hepatitis B is common, who place themselves at risk when abroad.
  •  
  •  

 

 

  •  

 

 

 

  • The risks include includes sexual activity, injecting drug use, undertaking relief work and/or participating in contact
  •  
  •  

 

 

 

  •  
  • with an infected person or sports where blood is shed,
  •  
  •  
  •  
  •  
  •  
  •  

 

 

  • Also, if you may need a medical or dental procedure in some countries and the procedure may not have been done
  •  

 

 

 

  •  with sterile equipment. 
  •  
  •  
  •  
  •  

 

 

 

  • Babies who are born to infected mothers.

 

 

Routine Childhood Immunisation Schedule

 

 

All children starting the immunisation programme at 2 months of age will follow the
schedule below.
 
 
 
 
 

When to immunise

 What is given

 

 Vaccine and how it is given

 

 

Two months old

 

Diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP/IPV/Hib)  One injection (Pediacel)
 

 

Pneumococcal (PCV)

 

 One injection (Prevenar)

  

Three months old

 

Diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP/IPV/Hib)

 One injection (Pediacel)

 

 

Meningitis C (MenC)

 

One injection (Neisvac C or Meningitec or Menjugate)  

Four months old

 
Diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (DTaP/IPV/Hib)
 
 One injection (Pediacel)

 

 

  Pneumococcal (PCV)

 

One injection (Prevenar)

 

 

 Meningitis C (MenC)

 

 

One injection (Neisvac C or  Meningitec or Menjugate)

 

 

 Between 12 and 13 months old - within a month of the first birthday

 

 Haemophilus influenzae type b, Meningitis C (Hib/MenC)   One injection (Menitorix)

 

 

 

Measles, mumps and rubella (MMR)

 

One injection (Priorix or MMRvaxPro)

 

 

 

Pneumococcal (PCV)

 

  One injection (Prevenar)

 Three years four months to five years old

 

Diphtheria, tetanus, pertussis and polio (dTaP/IPV or DTaP/IPV)

 

One injection (Repevax or Infanrix-IPV)

 

 Measles, mumps and rubella (MMR)

 

One injection (Priorix or MMRvaxPro)

 

Girls aged 12-13 years

 

Human Papillomavirus Vaccine (HPV)

 

3 injections given at 0,1-2 month and 6 month intervals (Cervarix).

Thirteen to 18 years old

 

Tetanus, diphtheria and polio (Td/IPV)

 

One injection (Revaxis)
 
 
 
 
 
 
 
 

http://www.immunisation.nhs.uk/Immunisation_Schedule 

http://immunisation.dh.gov.uk/ 

 


Search Health Visitors by Name. Example: John

Ask an Expert

 Have a baby related question or worries which you would like answered?, 

 

 

The aims of our specialist service are:

• To provide 24-hour Internet access to a qualified health visitor to all parents and carers who require it.
 

Ask an expert here


Health Professionals Login