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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Routine UK childhood immunisation principles

Paediatrics and child health · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Anaphylaxis after vaccination

Rapid airway, breathing or circulation compromise, usually with skin or mucosal change but sometimes without it, should be treated as anaphylaxis. A vasovagal episode usually causes pallor and bradycardia with rapid improvement when supine; anaphylaxis may cause wheeze, stridor, swelling, urticaria and persistent hypotension.

Action: Call for emergency help, position appropriately, give age-appropriate intramuscular adrenaline into the anterolateral thigh according to the current Resuscitation Council UK algorithm, repeat after 5 minutes if required, provide oxygen and airway or fluid support, and arrange emergency transfer and later specialist assessment. Record vaccine, batch, route, timing and treatment and report through the Yellow Card scheme.

Synopsis

Apply the current UK childhood immunisation schedule safely, distinguish the 2026 date-of-birth cohorts, screen true contraindications, administer simultaneous vaccines correctly and turn every contact into an opportunity to protect the child.

  • Use the current national schedule and the child's exact date of birth; from 2026, MMRV and the new 18-month appointment create different pathways for adjacent cohorts.
  • At 8 weeks give 6-in-1, MenB and oral rotavirus; repeat 6-in-1, MenB and rotavirus at 12 weeks; at 16 weeks give 6-in-1 and PCV13.
  • At 1 year, on or after the first birthday, give PCV13, MenB and MMRV under the schedule from 1 July 2026.
  • Children born on or after 1 July 2024 attend at 18 months for a fourth 6-in-1 dose and MMRV; those born on or before 30 June 2024 have no routine 18-month appointment.
  • Children born on or after 1 January 2025 receive only dTaP/IPV at 3 years 4 months; those born on or before 31 December 2024 also receive MMRV at that visit.
  • Offer HPV at age 12 to 13 years and Td/IPV plus MenACWY at age 14 or school year 9, alongside annual influenza vaccination for the eligible paediatric cohort.
  • Check the record, not parental recall alone: child health record, GP record, Child Health Information Service and overseas documentation may each hold different doses.
  • Minor illness without systemic upset, antibiotics, prematurity, breastfeeding, family allergy history and local injection-site reactions are usually not contraindications.
  • Different inactivated vaccines can generally be given simultaneously or at any interval from one another and from live vaccines, unless a vaccine-specific rule says otherwise.
  • Administer all vaccines due at the same visit at separate documented sites. Delaying one to reduce the number of injections extends susceptibility and risks non-attendance.
  • Use a validated cold chain, correct product and diluent, expiry and batch check, correct route and anatomical site, and immediate electronic documentation.
  • Explain expected reactions, fever management, MenB paracetamol advice for infants, urgent symptoms and the next due date using clear language and interpreters when needed.

Key red flags

Suspected anaphylaxis after a vaccine is an ABC emergency; intramuscular adrenaline must not be delayed while awaiting rash, blood pressure or a senior review.

A previous anaphylactic reaction to the same vaccine or a confirmed component is a potential contraindication that requires specialist clarification before another dose.

Severe immunosuppression or pregnancy generally contraindicates live vaccines, but inactivated vaccines remain usable and may need additional schedules.

Rotavirus and BCG must not be given before the newborn severe-combined-immunodeficiency screening result has been checked where the programme requires this.

A child with a progressive or unexplained neurological disorder needs assessment before a pertussis-containing dose is deferred; a stable disorder is not itself a contraindication.

A serious unexpected adverse event, vaccine administration error or cold-chain failure requires immediate clinical assessment, documentation and programme-specific expert advice.

Investigation priorities

01
First-line: documented immunisation historyFirst stepFirst line

Establish which valid doses were received and when.

Management branches

Every vaccination visitCheck, consent, vaccinate and record

A child attends primary care, school vaccination or another immunisation service.

  1. Reconcile documented history against the current nation- and birth-cohort-specific schedule and identify all routine and selective doses due today.
  2. Explain benefits, expected reactions and alternatives, confirm valid consent, screen contraindications and check product, cold chain, route, site and emergency equipment.
  3. Give compatible vaccines at separate sites, document product, batch, expiry, dose, route, site, date and vaccinator, then book or recall for the next dose.
Infant scheduleProtect on time through 18 months

A child is in the routine infant or toddler programme.

  1. At 8 and 12 weeks give 6-in-1, MenB and rotavirus; at 16 weeks give 6-in-1 and PCV13, checking rotavirus age and SCID rules.
  2. At 1 year on or after the birthday give PCV13, MenB and MMRV according to the July 2026 schedule.
  3. At 18 months give 6-in-1 and MMRV only to children born on or after 1 July 2024, checking the MMR/MMRV history and exact cohort.

Key medicines

Routine infant vaccinesAt 8 weeks give 6-in-1, MenB and oral rotavirus; at 12 weeks repeat these; at 16 weeks give 6-in-1 and PCV13; at 1 year give PCV13, MenB and MMRV using the licensed age-appropriate product dose and route.Check SCID outcome before rotavirus, observe strict rotavirus upper ages, use separate injection sites and verify formulation and product-specific Green Book instructions.
Cohort-specific booster vaccinesFor children born on or after 1 July 2024, give 6-in-1 and MMRV at 18 months. At 3 years 4 months give dTaP/IPV to all; also give MMRV when born on or before 31 December 2024. Later give HPV and then Td/IPV plus MenACWY at programme ages.Use exact date of birth and documented previous MMR or MMRV because adjacent cohorts differ. Check live-vaccine contraindications and minimum intervals.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • UKHSA routine childhood immunisations from 1 July 2026Current age, birth-cohort, product, site and selective-programme schedule.
  • Green Book collectionAuthoritative UK principles and disease-specific immunisation guidance.
  • Green Book chapter 6 contraindicationsTrue contraindications, false contraindications and special considerations for live and inactivated vaccines.
  • UKHSA childhood schedule changes for practitionersImplementation details for the 18-month appointment, hexavalent fourth dose and MMRV transition cohorts.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draft
Clinical stateAwaiting review
JurisdictionUnited Kingdom