Catch-up and high-risk vaccination — Rapid

Synopsis

Construct a safe minimum-visit catch-up plan for an incomplete or uncertain history and add current risk-based vaccines for children with asplenia, complement disorders, immunosuppression or other vulnerable conditions.

Without a documented or reliable verbal history, assume the child is unimmunised and plan an age-appropriate full course while continuing to retrieve records.
Never restart a valid vaccine course solely because the interval is long; resume it and complete the missing doses.
Combine compatible vaccines into the minimum number of visits and shortest valid timescale, usually with 4 weeks between early catch-up visits.
A child entering the UK part-way through a course transfers to the UK schedule; assess each overseas dose by age, product, date and interval.
From 8 weeks to the first birthday, a basic three-visit course uses 6-in-1 each visit, MenB and rotavirus at visits 1 and 2 when age-eligible, and PCV13 at visit 3.
From the first to second birthday, visit 1 can include 6-in-1, PCV13, MenB and MMRV; repeat 6-in-1 and MenB at visit 2 and 6-in-1 at visit 3, then complete age-specific boosters.
From age 2 to under 10, use three age-appropriate DTaP/IPV/Hib/HepB-containing doses and two MMR or MMRV doses at least 4 weeks apart, then restore preschool boosters as specified.
From the 10th birthday, use three Td/IPV doses, two MMR doses and MenACWY, then add HPV and later boosters according to age and previous valid doses.
MMR or MMRV doses given before the first birthday do not count towards the routine two-dose course; leave at least 4 weeks between valid post-birthday doses.
Asplenia or splenic dysfunction requires additional meningococcal, pneumococcal and annual influenza protection, but vaccination never replaces fever action plans and antimicrobial prophylaxis where prescribed.
Complement deficiency or complement-inhibitor treatment requires MenACWY and MenB and risk-specific pneumococcal and influenza vaccination; invasive meningococcal risk persists after vaccination.
Severe immunosuppression usually contraindicates live vaccines, reduces responses to inactivated vaccines and requires specialist timing around chemotherapy, biologics or transplant.
Vaccinate household contacts fully to create indirect protection; most live vaccines are safe for healthy contacts, with specific precautions for very severely immunosuppressed people.
Use the current Green Book disease chapter for exact product, dose number, interval and revaccination plan because high-risk pneumococcal and immune schedules change.

Key red flags

Fever or systemic illness in a child without a functioning spleen, receiving complement inhibition or severely immunosuppressed requires urgent clinical assessment even when vaccinations are complete.

Never give a live vaccine to a severely immunosuppressed child without explicit specialist confirmation that immune status and timing permit it.

A significant measles or varicella exposure in an immunocompromised child is time critical and needs same-day specialist and health-protection advice.

Children starting complement-inhibitor therapy require MenACWY and MenB planning ideally at least 2 weeks beforehand, with antibiotic protection when the treatment cannot wait.

Planned splenectomy or immunosuppressive treatment should trigger vaccination review early; delaying review until after the procedure can reduce response or restrict live-vaccine options.

A child arriving with no reliable record must not be assumed protected because a country normally offers a vaccine or because a parent recognises a vaccine name.

Rotavirus has strict upper age limits; attempting to complete it outside the licensed programme window creates avoidable risk rather than useful catch-up.

Investigation priorities

First-line: record reconciliationFirst stepFirst line

Establish the number and validity of previous doses.

Management branches

Unknown historyAssume susceptible and compress safely

No documented or sufficiently reliable vaccine history can be obtained.

Classify the child by exact age, date of birth and clinical risk, and continue urgent record retrieval without postponing indicated protection.
Use the current UKHSA catch-up table to place all compatible visit-1 vaccines at separate sites, observing rotavirus, live-vaccine and immune restrictions.
Book visits 2 and 3 at the minimum valid intervals, record each product immediately and add age-specific boosters, HPV, influenza and selective vaccines.

Key medicines

Under-10 catch-up primary courseUse 3 visits usually 4 weeks apart. Under 1 year: 6-in-1 each visit, MenB and rotavirus at visits 1 and 2 when age-eligible, PCV13 at visit 3. Age 1 to under 2 adds PCV13, MenB and MMRV at visit 1. Age 2 to under 10 uses 6-in-1 and MMR or MMRV at visits 1 and 2, then 6-in-1 at visit 3.Use the current UKHSA table and product footnotes. Observe rotavirus upper ages, SCID and intussusception restrictions, live-vaccine contraindications, minimum intervals and the need for later boosters.

Catch-up from the 10th birthdayGive Td/IPV at 3 visits usually 4 weeks apart, MMR at visits 1 and 2 at least 4 weeks apart, and MenACWY at visit 1; add HPV, influenza and later Td/IPV boosters according to age, risk and valid previous doses.Do not use a paediatric pertussis combination by habit after the 10th birthday. Account for valid overseas doses and live-vaccine immune or pregnancy restrictions.

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